2015-2016 benefit enrollment guide - wisenbaker builder ... · 2015-2016 benefit enrollment guide ....

2015-2016 Benefit Enrollment Guide

Contents

Contact Information 3

Introduction 4

Eligibility and Enrollment Guidelines 5

Medical Information 6

Medical Benefit Options 7

Health Savings Account 8

Medical Assistance Program 9

Dental Plans 10-12

Vision Plans 12-13

Life and AD&D, STD, LTD and Voluntary Products 14-16

Plan Election Rates 17-22

401(k), Paid Time Off, 2015 Holiday Schedule 21 & 23

Welcome to your Benefits Program

Carrier Benefit Contact Information

Blue Cross Blue Shield of Texas

Medical - PPO 1-800-521-2227 www.bcbstx.com

Blue Cross Blue Shield of Texas

Medical - HSA 1-800-521-2227 www.bcbstx.com

HSA Bank H.S.A. Banking Resources www.hsabank.com

Assurant 5457586

Dental

1-800-733-7879 www.assurantemployeebenefits.com

Consult A Doc 24/7 access to telemedicine,

medical advise and guidance. 1-800-362-2667

www.consultadr.com

EyeMed 9814583

Vision 1-866-723-0514

www.eyemedvisioncare.com

Dearborn National Life & Disability 877-348-0487

www.dearbornnational.com

Aflac Worksite www.aflac.com

John Hancock 401k 1-800-395-1113

www.johnhancock.com

Benefit Resource Center (BRC) Personal Benefit Advocates 855-874-0110

HUMAN RESOURCES

Tiffany Truett 281-233-4051 [email protected]

Tracy Rodriguez 281-233-4058 [email protected]

Judi Van Meter 214-270-1063 [email protected]

INSURANCE BROKERAGE FIRM

Adam Shivers - USI Southwest 713-490-4610 [email protected]

Annie Ortiz - USI Southwest 713-490-4592 [email protected]

Lori Walton—USI Southwest 713-490-4623 [email protected]

Contact Information

Refer to this list when you need to contact one of the carriers or benefit providers. For general infor-mation contact Human Resources.

4

Getting the most value from your benefits depends on how well you understand your plans and how to use them. Benefits are important; they provide support to you when you need it most. They’re also personal: your life circumstances change from year to year and your financial and protection needs may change too. Open Enrollment is a good time to review your family’s changing needs, evaluate your existing plans and decide whether to continue with your current choices or make a change. Use the many resources available to make well-informed open enrollment decisions about your benefits for the coming year. Being proactive now will help you and your family to make Your Health Count! throughout the year ahead. Open Enrollment allows you to:

Change/enroll in a medical plan

Change/enroll in a dental plan

Change/enroll in a vision plan

Change your current coverage level (Employee, Employee / Spouse, Employee + Child, Employ-ee + Family )

Add or remove dependents Why this guide is important: This Guide provides information about your benefits to help you make well informed decisions during Open Enrollment. Take this opportunity to review your current benefit elections and decide if they’ll meet your needs for the next year or whether you want to make changes in your coverage. In order to make informed choices, you should:

Read the material in this enrollment guide

Share the material with your family members

Review your current enrollments

Review and compare the benefit plans that are available to you through your spouse’s employer

YourHealthC1o2 u3 n4 t5s6

Introduction

It is time to enroll in your employee benefits for eligible employees. Eligible Employees are Full-Time Employees who work 40 hours or more per week. This booklet has been provided to inform you of all the benefit options available to you. Please take the time to review the various plan designs and coverage's, and decide which option's best fit your needs for the 2015-2016 plan year.

Eligibility and Enrollment Guidelines

Employees You are eligible for benefits if you are a Full-Time Employee working 40 hours or more per week. Benefit elections take effect first of the month following 60 days of employment. Dependents Dependents eligible for benefits include your legal spouse and your dependent child(ren). Dependent child(ren) include:

Natural born children Legally adopted children or children placed for adoption Stepchildren who reside in your home Grandchildren who are entitled to be claimed as your dependents for federal income tax purpos-

es Children are eligible for coverage from birth up to age 26. If a child becomes mentally or physically handi-capped while covered under the benefit plan(s), the child’s coverage may be continued as long as the child remains handicapped and depends on you for support. If you and your spouse are both employees of the company, dependent children can only be covered under either your coverage or your spouse’s coverage, but not under both.

In most cases, your benefit elections remain in effect until the next open enrollment period. The 2015-2016 plan year is April 1 to March 31, 2016. The annual open enrollment period is a set period defined by the company and will be widely broadcast by Human Resources to allow you ample opportunity to make any plan or enrollment changes. To make changes outside of the open enrollment period you must incur an IRS approved family status change. Approved family status change events include:

Birth, Adoption Marriage, Divorce Death Loss of eligibility under another health plan

If you think you may have a family status change that would allow you to make changes to your coverage, you MUST notify Human Resources within 31 days of the event. Failure to make timely notice means you would have to wait until the next open enrollment period to be eligible for coverage.

What you need to do for Open Enrollment: Evaluate your needs and expected expenses MUST ENROLL OR DECLINE COVERAGE FOR ALL BENEFITS Update your Beneficary Information Complete the Evidence of Insurabilty form if required

Making Enrollment Changes During the Year

To Do List

Who is Eligible for Coverage?

6

Medical Information

Our medical benefits will continue to be administered through Blue Cross Blue Shield of Texas. We encourage all members to register as a Blue Access member by logging onto www.bcbstx.com/member. This online resource offers you tools and resources to help you manage your health benefits; such as finding a doctor, hospital and pharmacy in the BlueChoice network, view claim status, down load an explanation of benefits, request id cards and much more. IMPORTANT: You have the freedom to select any provider of your choice; however, you will experience less out of pocket expense if you use an in-network provider. To access a directory online, visit www.bcbstx.com and select the BlueChoice Network. In an effort to offset an increase in our premium, Wisenbaker Builder Services has elected to change the benefit plan deductibles and out-of-pocket maximums. We are offering two different medical PPO plans, Base HDHP HSA plan with a $3,000 In-Network Deductible and a PPO Buy-Up plan with a $1,500 In-Network Deductible. You can review the benefit highlights on page 7 of this enrollment guide and refer to a detailed benefit summary located in the enrollment packet. Additional Services offered through Blue Cross Blue Shield: 24/7 Nurseline - 866-412-8795 Life is full of ups and downs. You will have access to registered nurses to answer your health questions, 24 hours a day, seven days a week. Get trusted guidance on possible emergency care, urgent care, family care and more. Well on Target - a New Way to Experience Wellness Wellness is more than healthy eating and working out. It involves making healthy choices that enrich your mind, body and spirit. This program offers personalized tools and resources to help - no matter where you may be on the path to health and wellness. We encourage all members to access the Live on Member Wellness Portal which is at the heart of this program. You will have access to the Health Assessment , Life Points Program and the Fitness Program. Special Beginnings / Maternity Program This program will help you better understand and manage your pregnancy. Available at no additional cost, this maternity program supports you from early pregnancy until six weeks after delivery. Enrollment is easy and confidential. Just call 888-421-7781. Fitness Program Fitness can be easy, fun and affordable. The Fitness Program is a flexible membership program that gives you unlimited access to a nationwide network of fitness centers. With more than 8,000 participating gyms on hand, you can work out at any place or at any time. Choose one gym close to home and another near your office. Other program perks are:

No Long Term Contract Required, Membership is month to month.

Automatic withdrawal of monthly fee.

Monthly fees are $25 per month per member, with a one-time enrollment fee of $25.

Sign up for the Fitness Program today! Call toll-free at 888-762-2583, Monday through Friday, 8 a.m. – 9 p.m. in any continental U.S. time zone.

BlueEdge HSA ($3,000) Base Plan

BlueChoice PPO ($1,500) Buy-Up Plan

In-Network Out-of-Network In-Network Out-of-Network

Calendar Year Deductible Individual Family

$3,000 $6,000

$6,000 $12,000

$1,500 $3,000

$3,000 $6,000

Out-of-Pocket Maximum Individual Family

$5,000 $10,000

$10,000 $20,000

$3,000 $6,000

RX Drug Limit $1KIndv/$2K Family

$6,000 $12,000

RX Drug Limit $1KIndv/$2K Family

Deductibles are included in the Out-of-Pocket Maxi-mum. Network Deductible & Out-of-Pocket maximum does not accumulate to the out of network benefits. Out-of-Network Deductible & Out-of-Pocket maximum does not accumulate to the network benefits.

Deductibles are included in the Out-of-Pocket Maxi-mum. Network Deductible & Out-of-Pocket maximum does not accumulate to the out of network benefits. Out-of-Network Deductible & Out-of-Pocket maximum does not accumulate to the network benefits.

Lifetime Maximum Unlimited Unlimited

Plan Coinsurance (Coins) percentage is payable after Calendar Year Deductible has been satisfied

Physician Office Visit Plan pays 80% Coins Plan pays 60% Coins $30 Copay Plan pays 60% Coins

Specialist Office Visit Plan pays 80% Coins Plan pays 60% Coins $40 Copay Plan pays 60% Coins

Preventive Care Plan pays 100% Plan pays 60% Coins Plan pays 100% Plan pays 60% Coins

Diagnostic Lab & X-ray Basic Lab & X-ray in Office/Free Standing Facility (basic) Major Lab & X-ray (CT, MRI, PET, etc.)

Plan pays 80% Coins

Plan pays 80% Coins

Plan pays 60% Coins

Plan pays 60% Coins

100% of Allowable

Amount

Plan pays 80% Coins

Plan pays 60% Coins

Plan pays 60% Coins

Hospital Services (pre-authorization required)

Plan pays 80% Coins

Plan pays 60% Coins

Plan pays 80% Coins

Plan pays 60% Coins

Emergency Room Physician Charges

Plan pays 80% Coins

Plan pays 80% Coins

Plan pays 60% Coins

Plan pays 60% Coins

$250 Copay

Waived if admitted

Plan pays 80% Coins

$250 Copay

Waived if admitted

Plan pays 60% Coins

Urgent Care Visit Urgent Care

Plan pays 80% Coins

Plan pays 80% Coins

Plan pays 60% Coins

Plan pays 60% Coins

$75 Copay

Plan pays 80% Coins

Plan pays 60% Coins

Plan pays 60% Coins

Physical Medicine Services Includes Physical, Occupational, and Manipulative Services

Plan pays 80% Coins

Limited to 35 visits combined

Plan pays 60% Coins Limited to 35 visits

combined


combined


combined

Members electing to purchase Preferred/Non-Preferred Brand Name Drugs will pay additional cost unless indicated “brand medically necessary”.

Prescription Drugs Generic Preferred Brand Non-Preferred Brand

Plan pays 80% Coins after calendar year

deductible

Plan pays 80% Coins after calendar year

deductible

$10 Copay $25 Copay $50 Copay

80% of submitted cost after the applicable

preferred copay; after deductible

Mail Order Drugs - 90 Day Generic Preferred Brand Non-Preferred Brand

Plan pays 80% Coins

after calendar year deductible

N/A

$30 Copay $75 Copay $150 Copay

N/A

Medical Benefit Options

8

Health Savings Account About Health Savings Account (HSA) and High Deductible Plans (HDHP) - If you enroll in the HDHP, you are eligible to open a Health Savings Account (HSA). Wisenbaker will match your amount elected for payroll deduction up to $50 per month if you elect to enroll in the HDHP/

The Blue Cross Blue Shield HDHP with a tax preferred Health Savings Account (HSA). Use the funds in your HSA to help meet the plan’s high deductible and to pay for other qualified expenses.

What happens when I have medical claims? When you visit an in-network physician or facility, you do not need to make a payment at the time of service. Keep in mind preventive care is always covered at 100%. After your visit, the physician’s office bills BCBS. BCBS calculates your cost and your benefit from BCBS’s discounted rates. BCBS sends you an explanation of benefits (EOB) statement and you pay your doctor using your HSA funds, if desired. What happens when I have pharmacy (Rx) claims? Your pharmacist will calculate your cost. Generally, if you have not met your annual deductible, you pay the full negotiated cost for your prescription. Prescription costs count towards your deductible. If you have met your deductible you pay the prescription copay. Once you reach the out-of-pocket maximum for the year, your prescriptions will be covered at 100%.

Who can have an HSA? An HSA account is for individuals that elect a high deductible health plan (HDHP). Wisenbaker Builder Services’ eligible plan is the BCBS HDHP. To be eligible to set up an HSA and make contributions, you may not be covered by any other health plan and cannot be claimed as a dependent on another person’s tax return, and cannot be enrolled in Medicare (although anyone who meets the regular eligibility requirements (see page 1) may elect to participate in the HDHP). What can I spend my HSA money on? Use your HSA money for qualified expenses including medical, dental, vision, and prescription costs. However, only covered medical and prescription expenses will reduce your annual medical plan deductible. How much can I contribute to my HSA? How do I make a contribution? You may contribute up to the IRS maximum each year including the employer contribution. For 2015 the maximum is $3,350 for single and $6,650 for family coverage, plus an additional $1,000 catch-up if you are over age 55. How do I access my HSA money? You will automatically receive a HSA debit card. Use this card at doctors’ offices and pharmacies, or at the ATM. You may also request a checkbook ( checking fee applies.) You do not need to file claims to access your money, but are encouraged to save your receipts in the event you are audited by the IRS. What happens to unused HSA money? Your money rolls over year after year and earns interest. At age 65, you will have the freedom to use your HSA funds for any purpose without penalty (although amounts are included in income when not used for qualified medical expenses), so the HSA also lets you save for retirement, tax-free. If you change jobs or retire, your HSA funds are yours to keep. You will become a free agent, and can continue to use your funds for qualified expenses, but cannot resume contributions unless you meet the eligibility requirements described in the third Q&A above. How do I enroll in an HSA? Please complete the HSA Beneficiary Designation and HSA Enrollment Form found in your HDHP envelope. Your employer will set up an account and deposit money based on you enrollment in the medical plan. You will receive a welcome kit with instructions on how to log in to your personal account.

Two Piec-es, Work-

ing To-gether

If you elected medical coverage, you will have the opportunity to use Teladoc, formerly known as Consult A Doctor! Teladoc Doctor provides easy, convenient and immediate access to physicians for phone and online secure email/video medical consultations. Physicians provide specific answers to medical questions, advice regarding non-emergency, preventative, maintenance and/or routine medical conditions. They discuss symptoms, recommend treatment options, diagnose many common, minor and/or brief illnesses, and prescribe medication when appropriate.

Medical Assistance

10

Dental Plans F

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Pre

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IGH

Wisenbaker Builder Services, Inc. offers a choice of three dental plan options. The Freedom Preferred Plan is a traditional PPO dental plan. The Freedom Preferred is a Mac PPO. The third plan offering is a DHMO. The DHMO provides an unlimited calendar year maximum and has a schedule of benefits to ensure member’s know exactly what their responsibility will be. In order to receive a benefit under the DHMO a member MUST use an As-surant DHMO provider and select an Assurant dental office location. When looking for a DHMO dentist, make sure to list TX as the state and select the Heritage Series.

Calendar Year Deductible Individual Family Office Visit Copay

In-Network $50 $150 None

Out-of-Network $50

$150 None

Annual Maximum Dental Benefit Maximum (per participant)

$1,200

Preventive Care Cleanings (once in a 6 month period) Oral Exams (once in a 6 month period) Sealants (per tooth, molar teeth only) Bitewing X-rays (once in a 12 month period)

100% 100% 100% 100%

100% 100% 100% 100%

Basic Care X-Rays Fillings (one surface) Replacement Fillings (once in a 24 month period) Simple Extractions

80% 80% 80% 80%

80% U&C 80% U&C 80% U&C 80% U&C

Major Services Bridges and Dentures Repair and Maintenance Crowns, Bridges & Dentures Complex Extractions Perio Surgery Root Canal Scaling Root Planning (per quadrant in a 24 month period) Single Crowns

50% 50% 50% 50% 50% 50% 50%

50% U&C 50% U&C 50% U&C 50% U&C 50% U&C 50% U&C 50% U&C

Orthodontics (children under the age of 19 only) 50% 50% U&C

Orthodontia Maximum Lifetime Benefit

$1,000

This dental program offers a PPO through Dental Health Alliance that provides a variety of cost saving features. Although you may visit any dentist you choose, you will receive maximum savings if you visit a DHA provider. The allowable amount for non-participating dentists is based on the usual and customary. Patients are responsible for fees in excess of usual and customary.

U&C = Usual & Customary

To locate providers logon to: www.assurantemployeebenefits.com

Select “For Member” - Find a dentist by selecting the Dental Health Alliance network.

Refer to the plan dental summary for waiting periods, late entrant rules, exclusions and limita-

tions on certain dental procedures.

The dental MAC plan allows employees to have access to the Dental Health Alliance PPO provides and take advantage of their fee discounts. Dentists participating in the DHA networks have agreed to dis-count their usual fees. Treatment is available from dentists who do not participate in the DHA, but their fees are subject to Maximum Allowable Charge (MAC). The allowable amount for non-participating dentists is based on 45% off the 80th percentile of usual and customary. Patients are responsible for fees in excess of the MAC. There can be significant out-of-pocket expenses if a non-participating dentist is chosen.

To locate providers logon to: www.assurantemployeebenefits.com

Select “For Member” - Find a dentist by selecting the Dental Health Alliance network.

Refer to the plan dental summary for waiting periods, late entrant rules, exclusions and limita-

tions on certain dental procedures.

Fre

edo

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MA

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Dental Plans Continued

Calendar Year Deductible Individual Family Office Visit Copay

In-Network $50

$150 None

Out-of-Network $50

$150 None

Annual Maximum Dental Benefit Maximum (per participant)

$1,200

Preventive Care Cleanings (once in a 6 month period) Oral Exams (once in a 6 month period) Sealants (per tooth, molar teeth only) Bitewing X-rays (once in a 12 month period)

100% 100% 100% 100%

Fee Based

Basic Care X-Rays Fillings (one surface) Replacement Fillings (once in a 24 month period) Simple Extractions

100% 100% 100% 100%

Fee Based

Major Services Bridges and Dentures Repair and Maintenance Crowns, Bridges & Dentures Complex Extractions Perio Surgery Root Canal Scaling Root Planning (per quadrant in a 24 month period) Single Crowns

60% 60% 60% 60% 60% 60% 60%

Fee Based

Orthodontics (children under the age of 19 only) 50% Fee Based

Orthodontia Maximum Lifetime Benefit

$1,000

12

Dental Plans Continued Calendar Year Deductible Individual Family Office Visit Copay

None None None

Preventive Care Cleanings Oral Exams Sealants (per tooth) X-rays

Refer to copay schedule

Basic Care Complex Extractions Scaling & Root Planning (per quadrant) Fillings (one surface) Repair and Maintenance of Crowns, Bridges & Dentures Simple Extractions


Major Services Bridges and Dentures Inlays, Onlays, Veneers Perio Surgery Root Canal Single Crowns


Orthodontics Discount

Plan has no annual deductible, no waiting periods, no deductible for orthodontia (includes child and adult), and no annual maximums. All services are covered at a scheduled copay and you must select a DHMO Provider use in network providers and facilities to have coverage. Refer to the plan dental summary for waiting periods, late entrant rules, exclusions and limitations

on certain dental procedures. Pre

pai

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Vision Benefit In-Network Out-of-Network

Copay

Exams

Materials

$10 - Routine Eye Exam: 1 every 12 months

$25 - Lenses: 1 every 12 months, Frames: 1 every 24 months

Eye Exam $10 $30 Allowance

Single Vision Lenses $25 $25 Allowance

Bifocal Lenses $25 $40 Allowance

Trifocal Lenses $25 $60 Allowance

Frames $120 Allowance, then 20% discount off balance $60 Allowance

Contact Lenses (elective) $120 Allowance $96 Allowance

Contact Lenses (medically necessary) Paid in Full $200 Allowance

Laser Vision Correction 15% off Retail Price, or 5% off promotional price No discount

Vis

ion P

lan

Vision Plan - Select Network

Vision Value Adds

14

Basic Life

Wisenbaker Builder Services provides an Employer paid Basic Life/AD&D benefit to all employees enrolled in the Medical

Plan.

Basic Life & AD&D

Life Amount AD&D Benefit

$50,000 Flat Benefit An amount equal to your basic life

Short Term Disability and Long Term Disability Short -Term/ Long Term coverage is paid for by your employer through Dearborn National. Disability covers a

portion of your salary when you are unable to work due to an accident or illness. You are eligible to participate if

you are a full-time employee, with 5 years of continuous active employment as defined by your employer and ac-

tively at work and working in the United States. Other policyholder-defined eligibility requirements may apply.

Temporary or seasonal workers are not eligible.

Short -Term Disability

Benefit Amount 60% of your weekly earnings

Benefit Maximum $1,000

Benefits Begin

(Accident/Illness) 8th day

Benefit Period 25 weeks

Pre-existing Limitation 3/3/12

Class 1

Corp. Acct., Corp. Purchasing, Corp. Admin.,

Corp Est.,H.R. & Managers

Benefit Amount 60% of your monthly earnings


Elimination Period 180 days

Definition of Disability

Own Occupation /

Earnings Test

Unlimited partial disability

To age 65; 80%; indexed at the lesser of

10% or the CPI-W


Class 2

All Other Eligible Employees




Definition of Disability

Own Occupation /

Earnings Test

Unlimited partial disability

24 months; then Social Security Qualified 80%

own occupation period, then 60%; indexed at the

lesser of 10% or the CPI-W


Long - Term Disability

Voluntary Life and AD&D

Coverage Benefit Amount

Employee Life Benefit $10,000 increments to a maximum of $500,000 not to exceed 5X your basic annual

earnings

Spouse Life Benefit

$5,000 increments to a maximum of $250,000 not to exceed 50% of the employees

elected amount

Child(ren) Life Benefit

(children age birth to 26 years)

Age 15 days to 6 months: $100

Age 6 months to 26 years: $5000, or $10,000.

Guarantee Issue Amount

Employee: $150,000

Spouse: $50,000

Child(ren): $5,000 or $10,000

AD&D Equal to the Voluntary Life

You must elect AD&D for yourself in order to elect AD&D for your dependents. AD&D provides 24-hour coverage and a

benefit in the event of your loss of a life, limb or eyesight as a direct result of an accident, provided the loss occurs within 365

days of the accident. AD&D cannot be purchased separate of the Voluntary Life.

Benefit Reductions 33% at age 65 of the original amount, and further reduced by 55% at age 70.

Rates are Age-Banded and increase in 5 year increments

Premiums will increase on plan year anniversary after you have entered the next 5 year age band

Spouse age is based on employee’s age and terminates at age 70 for both Voluntary Life and Voluntary AD&D

Voluntary Short Term Disability


Benefit Amount 60% of your weekly earnings

Benefit Maximum $1,000 per week

Elimination Period

Illness

Injury

8 days

8 days

Benefit Duration

Pre-Existing Conditions Limitation

Exclusions

25 weeks or until LTD begins, whichever is earlier

12/6/12 — A pre-existing condition means a sickness or injury for which the

insured has received treatment within 12 months prior to the insured’s effective date.

The policy will not cover any disability which is caused or contributed to by, or re-

sults from a pre-existing condition; and which begins in the first 12 months after the

insured’s effective date, unless no treatment has been received for 6 consecutive

months after the insured’s effective date.

Loss of professional license, occupational license or certification; commission of,

participation in or attempt to commit an assault or felony; intentionally self-inflicted

injuries; attempted suicide, cosmetic surgery, occupational sickness or injury; partici-

pation in a war, declared or undeclared, or any act of war.

Total Disability Total Disability means that due to injury or Sickness the employee is unable to per-

form all of the material and substantial duties of the employee’s regular occupation,

and the employee’s disability earnings, if any, are less than the percentage (20%) of

the employee’s pre-disability weekly earnings.

16

Voluntary Long Term Disability



Benefit Maximum $7,000 per month

(not to exceed 100% of your monthly earnings)


Benefit Duration Social Security Normal Retirement Age (SSNRA)

Own Occupation Period

Partial Disability:

Earnings Test—During Own Occ

Earnings Test—After Own Occ

Survivor Benefit

24 months

80%

60%

If the employee passes away after being disabled and receiving long-term

disability benefits for six consecutive months, we will pay the employee’s

beneficiary a lump sum benefit equal to three months of disability benefits.

Pre-existing Condition Exclusion 3/3/12—Benefits will not be paid for disabilities resulting from conditions

for which received treatment within 3 months prior to your effective date.

This exclusion does not apply to a disability that begins more than 12

months after your effective date. Your plan may also contain a provision in

which this exclusion does not apply if you have been treatment free for the

first 3 months after your effective date.

Voluntary Worksite Benefits

Wisenbaker Builder Services, Inc. offers a complete menu of Voluntary Worksite Benefits. Choosing the right ben-

efits at the right time of your life can be critical. The Voluntary Worksite products offer choices for individuals to

better protect themselves and their family members from life’s unexpected turns. These products are completely

portable and can be taken with you should you leave Wisenbaker. For a complete list of product offerings, pricing,

and enrollment options contact your HR department for an enrollment kit.

Plan Election Rates MEDICAL - Blue Cross Blue Shield of Texas

(HSA Base Plan 3,000) (PPO Buy-Up Plan 1,500)

Weekly Bi-Weekly Weekly Bi-Weekly

Employee Only $0.00 $0.00 $70.00 $140.00

Employee + Spouse $75.00 $150.00 $190.00 $380.00

Employee + Child(ren) $65.00 $130.00 $176.00 $352.00

Employee + Family $130.00 $260.00 $290.00 $580.00

DENTAL - Assurant

Plan DHMO Freedom Preferred/ Freedom

Preferred MAC Plan

Weekly Bi-Weekly Weekly Bi-Weekly

Employee Only $2.37 $4.74 $6.56 $13.12

Employee + Spouse $4.01 $8.02 $13.13 $26.27

Employee + Child(ren) $5.56 $11.12 $17.31 $34.61

Employee + Family $6.56 $13.13 $26.22 $52.45

VISION - EyeMed

Weekly Bi-Weekly

Employee Only $1.32 $2.64

Employee + Spouse $2.51 $5.02

Employee + Child(ren) $2.64 $5.28

Employee + Family $3.88 $7.77

EMPLOYEE & SPOUSE VOLUNTARY LIFE and AD&D (rate per $1,000 in benefit) - Dearborn

Age Band Monthly Rate Per $1,000 of Benefit Employee and/or Spouse

* Spouse rate is based on

employees age.

** For a complete list of

estimated premium

calculations please review the

Dearborn Rate Sheet on follow-

ing page.

Under Age 30 $0.050

30-34 $0.070

35-39 $0.100

40-44 $0.170

45-49 $0.260

50-54 $0.410

55-59 $0.730

60-64 $1.330

65-69 $2.190

70-74 $2.190

75-79 $2.190

80-84 $2.190

85-89 $2.190

90-94 $2.190

95-99 $2.190

18

Voluntary Life & AD&D


Monthly Rate per $10 of Weekly Benefit

Age Rate

20-24 0.621

25-29 0.652

30-34 0.592

35-39 0.551

40-44 0.542

45-49 0.569

50-54 0.691

55-59 0.902

60-64 1.121

65-69 1.146

70+ 1.296

STD Rates are based on five-year increments. Rates increase as you age.

Step 1 Enter your basic weekly pay (divide your annual pay by 52) rounded to the nearest dollar. 1._____________

Step 2 Multiply the amount in Step 1 by 60% and enter the result (rounded to the next higher dollar).

This is your weekly benefit. Do not enter more that $1,000. 2._____________

Step 3 Divide the amount in Step 2 by 10 and enter the amount. 3._____________

Step 4 Enter the rate for your age from the chart below. The rate is determined by your age and will be

reevaluated on each subsequent coverage policy anniversary. 4._____________

Step 5 Multiply the amount in Step 3 by the amount in Step 4 and then enter it here. This is your

approximate monthly premium. 5._____________

Example: The following is a calculation for an employee earning $27,250 annually who is 26 years of age:

Step 1 $27,250 divided by 52 = $524.04, which rounds to $524.

Step 2 $524 times .60 = $314.40. When rounded to the next higher dollar, the amount is $315.

Step 3 $315 divided by 10 = $31.50

Step 4 0.652 = The rate from the table above for an employee age 26.

Step 5 $31.50 times 0.652 = $20.53, which is your approximate monthly premium.

Under Age 20 0.619


20



Monthly Rate per $100 of Covered Salary

Age Rate Age Rate

Under Age 20 $0.060 45-49 $0.717

20-24 $0.082 50-54 $0.778

25-29 $0.148 55-59 $1.185

30-34 $0.224 60-64 $0.852

35-39 $0.323 65-69 $1.244

40-44 $0.491 70-74 $0.843

LTD Rates are based on five-year increments. Rates increase as you age.

Step 1 Enter your basic monthly premium pay (divide your annual pay by 12) rounded to the nearest dollar. 1._____________

Step 2 Divide the amount in Step 1 by 100 and enter the amount. 2._____________

Step 3 Enter the rate for your age from the chart below. The rate is determined by your age and will be

reevaluated on each subsequent coverage policy anniversary. 3._____________

Step 4 Multiply the amount in Step 3 by the amount in Step 4 and then enter it here. This is your

approximate monthly premium. 4._____________

401(k) Plan - John Hancock

Wisenbaker Builder Services, Inc. offers a 401(k) plan administered through John Hancock. Employees are eligible to partici-

pate after meeting one year of service. There are four enrollment periods throughout the year, falling on the first day of each

quarter. Initial enrollment information should be submitted to the HR Department. Once initial enrollment is complete, all

fund updates and deferral changes should be initiated through the John Hancock website. For a complete list of funds, and

fund details, please review the John Hancock 401(k) enrollment kit.

Paid Time Off (PTO)

PTO days are a bank of days that are used at the employee’s discretion, be it sick, vacation, personal, etc. PTO days accrue on

your anniversary date and must be used before the next anniversary date, as no carryover of days is allowed.

Accrual Rate 1st Year of Employment 0 Days

1st Anniversary 10 Days

2nd Anniversary 15 Days

5th Anniversary 18 Days

10th Anniversary 21 Days

** After an employee has been with Wisenbaker Builder Services, Inc. for 90 days, they will be allowed to borrow up to five

of the ten days that will accrue on their 1st anniversary, at a borrow rate of 1 day for every 2.5 months allowed. This is the on-

ly year an employee will be allowed to borrow PTO from the next year.

Example: The following is a calculation for an employee earning $30,000 annually who is 26 years of age:

Step 1 $30,000 divided by 12 = $2,500.

Step 2 $2,500 divided by 100 = $25.00.

Step 3 0.224 - the rate from the table above for an employee age 30.

Step 4 $25.00 times 0.224 = $5.60, which is your approximate monthly premium.


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Holiday Schedule

2015 January 1—New Year’s Day September 7—Labor Day

January 2—Day After New Year’s November 26—Thanksgiving Day

May 25—Memorial Day November 27—Day after Thanksgiving

July 3—Day before Independence Day December 25—Christmas Day

This brochure summarizes the benefit plans that are available to Wisenbaker Builder Services Inc.’s eligible employ-ees and their dependents. Official plan documents, policies and certificates of insurance contain the details, condi-tions, maximum benefit levels and restrictions on benefits. These documents govern your benefits program. If there is any conflict, the official Summary Plan Documents and Certificates of Coverage prevail. These documents are available upon request through the Human Resources Department. Information provided in this brochure is not a guarantee of benefits.

1703 Westfield Loop Houston, TX 77073

This booklet has been prepared by USI.