2018 Benefits Guide Final 2_23_18

2018 Employee Benefits Guide

MASTER YOUR BENEFITS

Table of Contents

In order to support the health, wealth and happiness of all employees
and their eligible dependents, CompSource Mutual Insurance
Company offers a competitive, comprehensive benefits program.

This Benefits Guide provides you with an overview of the
CompSource benefits program and the information you need
to make an informed decision about your benefits. Refer to plan
documents for specific coverage details.

General information:
How to enroll...................................................................................3
Benefit eligibility and coverage information....................4

Health care benefits:

LOYEES Medical................................................................................................7

Prescription drugs..........................................................................9
Dental................................................................................................ 11
Vision................................................................................................. 13

Tax advantaged accounts:
Flexible spending accounts................................................... 15
401(k) retirement plan.............................................................. 21

Work/life benefits:
Preventive care............................................................................. 17
Employee Assistance Program............................................. 17

Disability and life/accident insurance benefits:
Disability coverage..................................................................... 18
Life and accident insurance.................................................... 18
Supplemental insurance.......................................................... 19

2

EMPLOYEES

our most valuable asset

At CompSource, you are an integral component of our success and we
are committed to your health and wellness. We have taken great care
to research competitive benefit plans to assemble a comprehensive
program of benefits to retain and attract the best and brightest in our
industry.

HOW TO ENROLL

3 easy steps
1. Get ready. Review this guide to ensure you understand the benefit

elections. Open enrollment begins at 8 a.m. on Nov. 6.

2. Go to UltiPro. Complete your benefits enrollment through the UltiPro
system by 5:30 p.m. on Nov. 20. Locate the icon on your desktop, click to
open and navigate to the “Myself” tab to select “Open Enrollment.” The
system walks you through the benefits election process step by step.
Don’t forget to fill out the tobacco attestation form you received in your
packet and return it to Human Resources.

3. Enroll and Confirm. Once you have made your elections, click “Submit.”
You will receive a confirmation message that your elections have been
submitted. Elections can be made and modified until Nov. 20, at 5:30
p.m. during open enrollment or within seven days of your hire date

Be sure to print the confirmation for your records.

3

BENEFIT ELIGIBILITY AND COVERAGE
INFORMATION

Eligibility
You are eligible for benefits if you are a full-time employee who works 30 or more hours per week.
You may also enroll your eligible family members under certain plans you choose for yourself. Eligible
family members include:

• Your legal spouse (including common-law). Common-law marriage requires a completed
Common Law Affidavit or Affidavit of Domestic Partnership. Request form from HR.

• Your children who are your natural born children, stepchildren, adopted children, or children
for whom you have legal custody up to age 26, whether married or unmarried.

• A dependent, regardless of age, who is incapable of self-support due to a disability that was
diagnosed prior to age 26. Subject to medical review and approval by medical carrier. Request
certification form from HR.

Enrollment deadlines
• Employees enrolling during open enrollment, must enroll by 5:30 p.m. on the last day of open
enrollment
• New hires must enroll within seven days of hire date
• There are no exceptions to the deadlines. If you fail to enroll on time, you will not have benefits
coverage (except for basic life insurance and disability)

When coverage begins

• For employees enrolling through open enrollment, coverage is effective January 1
• For new hires, coverage is effective on the first day of the month following hire date

Coverage changes
Due to IRS regulations, you cannot change your elections until the next annual open enrollment
period, unless you have a qualifying life event during the plan year. When a change is made midyear,
coverage is generally effective the first of the month following the qualifying life event. Employees
are responsible for any additional out-of-pocket premium charges incurred due to the change in
coverage. Following are examples of the most common qualifying life events:

• Marriage or divorce
• Birth or adoption of a child
• Child reaching age 26
• Death of a dependent
• Loss of other coverage (i.e. through spouse’s employer’s plan)
• Gained other coverage (i.e. through spouse’s employer’s plan)
4 • Change in employment status of employee that affects eligibility

Coverage change deadlines
To change your benefit elections, you must contact Human Resources within 30 days of the
qualifying life event (including newborns). Be prepared to provide supporting documentation of
the event such as marriage license, hospital birth papers, or a divorce decree. If changes are not
submitted on time, you must wait until the next open enrollment period to make your coverage
changes.

Family and Medical Leave Act
Employees that meet the requirements and are approved to take FMLA will continue to be
responsible for the employee portion of premiums for elected benefits. CompSource will continue
to pay the employer portion of premiums for elected benefits.

Termination of coverage
Coverage will end the last day of the month, for most coverage options, in which a termination
event occurs. Flexible spending accounts terminate effective with your employment termination
date. Termination event examples include:

• Loss of employment
• Change in employment status of employee that affects eligibility
• Loss of dependent eligibility
• Non-FMLA leave without pay
• Non-payment of premiums
• Death

COBRA – Temporary continuation of coverage
The Consolidated Omnibus Reconciliation Act (COBRA) allows you and/or your covered
dependents to continue health, dental, and/or vision insurance coverage after your employment
terminates or after your dependent loses eligibility. The healthcare flexible spending account may
be continued through COBRA enrollment if employee has a positive balance upon termination.
Certain time limits apply to enrollment. Contact a benefits coordinator immediately upon
termination of your employment, or when changes to your family status occur. To find out more
about your COBRA rights, contact Human Resources. Be aware, voluntarily dropping dependent
coverage during open enrollment is not a COBRA qualifying event.

5

6

MEDICAL MEDICAL

Description Preferred (P) or Choice (C)

Lifetime maximum Unlimited

Individual calendar year deductible $500

Family calendar year deductible $1,000

Primary care physician/general practice visit copay $30

Specialist copay $50

Outpatient lab copay $30 P / $50 C

Outpatient X-ray copay $30 P / $50 C

Individual out-of-pocket maximum $4,000 P / $5,000 C

Family out-of-pocket maximum $8,000 P / $10,000 C

I O M Enmupatteapertragiente niient tynch ytohrsoopo siptma i tl /aslu/sr ugri gca icl al CCCCooooiiiinnnnssssuuuurrrraaaannnncccceeee + Deductible + 20% P or 30% C
+ Deductible + 20% P or 30% C
+ Deductible + 20% P or 30% C
+ Deductible + 20% P or 30% C

Urgent care center copay $50

A Wlelellr-gcyhitl rdeactamree n t and tes ting C10o0in%surance + Deductible + 20% P or 30% C

Immunizations 100%

Hearing screening (2 per year) 100%

Hearing aids Limited coverage for children

Physical, occupational or speech therapy * $30 copay subject to plan limits

Chiropractic and manipulative therapy * $30 copay subject to plan limits

S Dkuilrlaebdlen umresidnigcafla ecqiliutiiepsm ent C3C0ooiivnnisssuuitrrmaannaccxeeim++uDDmeedduuccttiibbllee + 20% P or 30% C
+ 20% P or 30% C

Temporomandibular joint dysfunction Not covered

Home he alth C30oivnissuitrmanacxeim+uDmeductible + 20% P or 30% C

Medical transportation 100% if medically necessary

H MTroaesnnpstiapclleah netasl th, alco h ol/d ru g ab u se ser v ices Coinsurance + Deductible + 20% P or 30% C
Coinsurance + Deductible + 20% P or 30% C

Outpatient Coinsurance + Deductible + 20% P or 30% C
or $30 / $50 copay (rare occasions)

PrevI ennptaitvieenct are 1C0o0in%surance + Deductible + 20% P or 30% C

* 25 visits combined 7

BLUE CROSS BLUE SHIELD

CompSource has partnered with Blue Cross and Blue Shield of Oklahoma (BCBSOK) to
offer a health care package to meet your family’s needs. BCBSOK has the largest provider
network in Oklahoma.
Employees have the option to select providers from either the BCBSOK Preferred Network
or Choice Network. Use of the Preferred Network offers a cost savings to employees in
terms of coinsurance rates and out-of-pocket maximums.

88

MEDICAL RATES

Description Prescription Drug Coverage

Generic $10

Formulary brand $45

Non-formulary $75 Mail order
provides better
Specialty $150 total savings.

Mail order 2.5x copay; 90 day supply

NON-TOBACCO RATES

Employee Employee cost CompSource cost
(semi-monthly) (semi-monthly)

$0.00 $291.19

Employee + spouse $67.92 $494.95
Employee + child(ren) $62.24 $477.91
Employee + family $136.13
$699.59

TOBACCO RATES

Employee Employee cost CompSource cost
Employee + spouse (semi-monthly) (semi-monthly)
Employee + child(ren)
Employee + family $58.24 $232.95
$436.71
$126.16 $419.68
$120.48
$641.35
$194.37

All rates are based on 24 pay periods. For the months that have 3 pay periods, no benefit deductions will
be taken in the third pay period, except for 401(k) and OPERS (for eligible employees).

99

DELTA DENTAL

CompSource has partnered with Delta Dental of Oklahoma to provide
employees access to the most extensive network of dentists in Oklahoma.

10

DENTAL Delta Dental PPO + Premier DENTAL + RATES

Description $2,500 per person
100%, with two cleanings per year
Annual maximum 80%
Diagnostic and preventive 80%
Basic restorative 80%
80%
Endodontic 80%
Periodontic 50%
Oral surgery 50% up to $2,000 lifetime maximum
Wisdom teeth extraction $50
Major restorative $50 per person, $150 max
Orthodontic (children up to age 26)
Individual deductible
Family deductible

RATES

Employee cost CompSource cost
(semi-monthly) (semi-monthly)

Employee $0.00 $18.16

Employee + spouse $5.45 $30.89
$11.24 $44.38
Employee + child(ren) $16.68 $57.09

Employee + family

All rates are based on 24 pay periods. For the months that have 3 pay periods, no benefit deductions will 11
be taken in the third pay period, except for 401(k) and OPERS (for eligible employees).

METLIFE

CompSource provides vision care options through MetLife, which utilizes the
VSP network. With a broad selection of physicians from which to choose, getting
all your vision care needs appropriately accessed has never been more clear.

12

VISION

Description MetLife

Vision exam $10
Frames (every 24 months) $150 allowance, 20% off balance over $150

Standard plastic lenses

single vision $25
bifocal $25

trifocal $25

lenticular $25

Contact lenses VISION + RATES

conventional $150 allowance, 15% off balance over $150
disposable $150 allowance

Additional pairs benefit 20% discount
15% off retail price or 5% off promotional price
Laser vision correction
LASIK or PRK at MetLife participating locations

RATES

Employee cost CompSource cost
(semi-monthly) (semi-monthly)

Employee $0.00 $2.70

Employee + spouse $0.81 $4.59

Employee + child(ren) $0.56 $4.01

Employee + family $1.45 $6.08

All rates are based on 24 pay periods. For the months that have 3 pay periods, no benefit deductions will 13
be taken in the third pay period, except for 401(k) and OPERS (for eligible employees).

BENEFIT RESOURCES, INC.

The Flexible Spending Account (FSA) gives you the opportunity to pay for out-of-
pocket medical, dental, vision and dependent care expenses with pretax dollars.
Money contributed to the FSA cannot be carried over or refunded and must be
used by March 15 of the following year or funds are forfeited.

14

FLEXIBLE SPENDING FSA
ACCOUNTS (FSA)

The annual maximum contribution for the FSA health (FSAH) plan is $2,650 and
$5,000 for the FSA dependent care (FSADC) plan.

When you enroll in an FSA, choose the contribution amount(s) to have
deducted from your paycheck before taxes are withheld. You use those pretax
contributions to pay your eligible out-of pocket expenses. This makes your
money go further.

An FSA debit card is available to pay for medical expenses and dependent
care expenses for children 12 and under.

With FSA Without FSA

$40,000 (gross annual pay) $40,000 (gross annual pay)

$4,980 FSADC contribution (pretax) $4,980 Dependent care (post-tax)

$1,140 FSAH contribution (pretax) $1,140 Medical expense (post-tax)

-$5,168 (estimated tax amount) -$6,765 (estimated tax amount)(post-tax)

$28,712 Your final net annual pay $27,115 Your final net annual pay

In this example, you
would take home $1,597
more with a Flexible
Spending Account.

15

PREVENTIVE CARE

CompSource strives to provide employees with the best work/life balance possible.

16

PREVENTIVE CARE PREVENTIVE

Included are routine health checkups, immunizations, routine diagnostic tests and mammograms in the
medical plan and teeth cleaning in the dental plan from in-network providers. See your benefit summaries
for more details.

Well onTarget
Earn Life Points from BCBSOK to spend on merchandise by creating a fitness plan, completing your Health
Risk Assessment or participating in online wellness programs. You can also access the Fitness Program to
view a network of more than 8,000 fitness centers for only $25 per month.

24/7 Nurseline
Call the BCBSOK Nurseline at (800) 581-0407 for trusted guidance on possible emergency care, urgent care,
family care and more. Plus, when you call, you can access an audio library of more than 1,000 health topics.

Condition Management
If you or a family member has a chronic health condition such as asthma, diabetes or heart problems, you
will have access to the best knowledge, tools and self-care techniques. To enroll, call the number on the
back of your member ID card.

1-800-QUIT-NOW
The Oklahoma Tobacco Helpline is a free service available by phone or online. It’s open to all Oklahomans
who desire to stop using tobacco products. Nicotine-replacement patches, gum or lozenges are also
available for free to registered participants.

Special Beginnings
Enroll in the BCBSOK Special Beginnings Program and receive the book,“The Simple Guide to Having a
Baby,”that covers many pregnancy and infant-care topics. It’s best to enroll during the first 12 weeks of your
pregnancy. Call (888) 421-7781 or go to bcbsok.com.

EMPLOYEE ASSISTANCE PROGRAM

CompSource provides employees and their household members a confidential service to assist with personal
and workplace issues.

The Employee Assistance Program (EAP), provided by ComPsych, is designed to help you and your family
members get assistance with behavioral and emotional health issues, family, wellness or financial matters.

Examples of EAP assistance

• Alcohol/substance abuse • Retirement planning • Work/school related issues
• Domestic violence • Family budgeting Performance
• Natural disasters • Insurance options Attendance Guidance counselors are available 24/7
• Fatal accidents • Investment options Peer relationships
• Serious illness • Money management Unprofessional behavior by toll-free number or email. Up to
Workplace violence
three sessions, per issue, per covered

• Credit issues • Loans and refinancing Corporate restructuring employee/covered family member per

• Debt and bankruptcy • Legal assistance year.
• Estate planning
ComPsych | (800) 311-4327
compsych.com
17

DISABILITY

CompSource provides employees with short and long-term disability coverage
through Prudential.

Short-term disability Long-term disability
Begins when you have been Begins when you have been totally
absent due to an illness or injury. disabled.

Benefit begins 8th day accident/15th day illness 91st day
Benefit duration 11 weeks Social Security retirement age
Benefit amount 60% of weekly earnings 60% of monthly earnings
Benefit maximum $2,200 weekly $15,000 monthly

LIFE AND AD&D

Basic life

CompSource provides employees with basic life insurance and AD&D (accidental
death and dismemberment insurance) in the amount of one and a half times your
annual salary. To update beneficiary information, go to UltiPro and navigate to “My
Company.” Locate the “Electronic Forms” and download the Beneficiary Form.

Basic dependent life

CompSource provides employees with basic dependent life Insurance in the amount
of $10,000 for a spouse and $5,000 for child(ren).

18

VOLUNTARY LIFE

You can purchase additional life insurance which includes AD&D for yourself,
your spouse and/or your child(ren), as listed below.

EMPLOYEE $10,000 Employee Step Rates
$10,000
Coverage in increments of $500,000 Semi-monthly cost*
Minimum coverage available $200,000 Age (per $1,000 coverage)
Maximum coverage available 35% at age 65, 50% at age 70
Guaranteed issue amount* 0-24 $0.0260
Age reduction schedule
25-29 $0.0300

30-34 $0.0380 LIFE INSURANCE

35-39 $0.0420

40-44 $0.0460

SPOUSE 45-49 $0.0660

Coverage in increments of 50-54 $0.0975
Minimum coverage available
Maximum coverage available $5,000 55-59 $0.1775
$5,000
Guaranteed issue amount* Lesser of $250,000 or 50% of employee 60-64 $0.2690
voluntary life
CHILD $20,000 65-69 $0.5120

70+ $0.8270

Spouse Step Rates

Coverage in increments of $5,000 Age Semi-monthly cost*
Minimum coverage available $5,000 0-24 (per $1,000 coverage)
Maximum coverage available $0.0300
Lesser of $10,000 or 50% of 25-29
Child minimum age employee voluntary life 30-34 $0.0340
Child age limit Live birth 35-39 $0.0420
19 or 26 if full-time student 40-44 $0.0460
45-49 $0.0500
50-54 $0.0700
55-59 $0.1015
60-64 $0.1815
65-69 $0.2730
70+ $0.5160
$0.8310

Child Rates

Semi-monthly cost formula **Costs based on 24 semi-monthly payments Age Semi-monthly cost**
0-19 or 26, (per $1,000 coverage)
_______________ / $1,000 x __________________ = ________________ if full-time $0.0485
Benefit amount Age Rate Semi-monthly cost** student

*Applies at initial eligibility only; any amounts greater than the guaranteed 19
issue amount are subject to underwriting review.

PRINCIPAL FINANCIAL GROUP

CompSource knows how important it is to plan for your future. With our employees
in mind, we offer a competitive 401(k) defined contribution plan through Principal
Financial Group, the leading provider of retirement solutions.

20

RETIREMENT

CompSource contributes 50% up to the first 6% employees contribute, per pay
period.
New employees are automatically enrolled at 6%.

If an employee wants to change their deferral Contribution example
amount or chooses not to participate, the
employee must log into their account via $40,000 Gross annual pay
Principal.com to change their deferral amount.
$2,400 6co%netrmibpultoioynee
CompSource has both pretax and post-tax
contribution options, for more information $1,200 CompSource contribution
contact Principal Financial Group.
(50% of employee’s 6% contribution)

Why should you start saving for retirement?

CATE VALUE AGE 65 JOSH

Start age 25 Start age 35

$1,000 contributed $117,753 $1,000 contributed
annually for 10 years $102,257 annually for 30 years
$10,000 contribution. $30,000 contribution. RETIREMENT

At retirement At retirement
$117,753 $102,257

Put time on your side

Cate contributed $20,000 less and has $15,000 more in her retirement account than Josh
because her money had more time to grow.*
So, you’re never too OLD, or too YOUNG, to start investing and take advantage of
compounding potential.
* Example based on 26 pay periods of equal contributions.

21

NOTES

22

NOTES 23

HERE TO HELP

CONTACTS

Primary Contacts CompSource Mutual Insurance Company
Human Resources Liaison
Carol Anderson – Insurica Consultant Contact information for your liaison is available
(918) 346-6977 | Office on “The Source.”
(918) 519-7229 | Fax
carol.anderson@insurica.com

Medical | BCBS Vision | MetLife
(800) 942-5837 | Customer service (855) MET-EYE1 | Customer service
(800) 672-2378 | Pre-certification (855) 638-3931 | Customer service
(877) 546-2779 | Prescription drug www.metlife.com/mybenefits
www.bcbsok.com Disability and Life | Prudential
Dental | Delta Dental (800) 524-0542 | Life customer service
(800) 522-0188 | Customer service (800) 842-1718 | Disability customer service
www.deltadentalok.org Retirement | Principal Financial Group
FSA | Benefit Resources, Inc. Bob Markle - Principal Securities, Southwest
(918) 481-6161 or (800) 339-7493 | Phone Branch Manager
(918) 481-6181 or (866) 364-7052 | Fax (405) 842-3093, ext. 110
www.britulsa.com markle.bob@principal.com
Employee Assistance Program | ComPsych www.principal.com
(800) 311-4327 | Phone FMLA | FMLASource
Company web ID: GEN311 (877) 462-3652| Phone
www.compsych.com www.fmlasource.com