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EMPLOYEE BENEFITS - TEXAS November 1, 2019 - October 31, 2020 2019 2020

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  • EMPLOYEE BENEFITS - TEXAS

    November 1, 2019 - October 31, 2020

    20192020

  • Team FX, LLC 2019 - 2020 Employee Benefits3

    CONTENTSINTRODUCTION

    About This Guide .................................................3

    Eligibility for Benefits ............................................4

    Making Changes to Your Benefits ........................4

    MEDICAL BENEFITS

    Overview .............................................................5

    CareFirst HealthyBlue Advantage HSA

    Option F-S ...........................................................6

    CareFirst Value Added Services ...........................7

    Blue Rewards ......................................................8

    Video Visit ............................................................9

    OTHER HEALTH BENEFITS

    Dental Plan ........................................................10

    Vision Plan .........................................................11

    LIFE INSURANCE AND DISABILITY

    Voluntary Short Term Disability ...........................12

    Voluntary Long Term Disability ...........................12

    Voluntary Life Insurance .....................................13

    NOTICES, COSTS AND CONTACTS

    Employee Costs 2019 - 2020 ............................15

    Benefits Contacts ..............................................16

    ABOUT THIS GUIDEWe understand that choosing your benefits is an important decision for you and your family. Everyone’s needs are unique. We offer a variety of benefits and options so you can choose what works best for you and your family. A number of these benefits are provided at no cost to you. We created this guide to help you make informed decisions. It is not a complete detailed description, nor is it a contract of employment or a guarantee of benefits. More detailed information for each benefit is contained in the relevant insurance policy’s Summary Plan Description (SPD).

    Great care has been taken to ensure that this guide is accurate. However, oversights can occur or condensed summaries can be misinterpreted. If there is a difference between this overview and the SPD or official plan documents governing the plan, the plan documents will be followed. The company reserves the right to amend or terminate the program in whole or in part at any time.

  • Team FX, LLC 2019 - 2020 Employee Benefits4

    Open Enrollment occurs once each year. You may change your benefit elections during the open enrollment period. Once you have made your selection, you may not change benefit elections until the next open enrollment unless you have a qualifying event in employment or family status. Qualifying Events include:

    • Marriage, divorce or legal separation (state specific)

    • Dependent child through birth, adoption or court-ordered custody

    • Death of a spouse or child

    • Your work schedule changes (i.e. reduction or increase in hours which affects eligibility)

    • Your dependent loses eligibility for coverage

    • You or your dependent become eligible for Medicare

    • Your spouse involuntarily loses health coverage through his/her employer

    • You and/or your spouse and dependents become eligible for COBRA

    • You and/or your spouse and dependents gain or lose Medicaid coverage

    • You received a Qualified Medical Child Support Order (QMCSO)

    If you experience one of these qualifying events, you have 30 days from the date of the event to notify the Human Resources Department and make any desired benefit changes. Otherwise, elections you make during open enrollment will remain in effect for the entire plan year. Also, if you or your eligible dependents are covered under Medicaid or a State Children’s Health Insurance Program (CHIP) and that coverage ends, you may be able to enroll yourself and any affected dependent in this Plan’s medical coverage. You must request enrollment within 60 days after the Medicaid or CHIP coverage ends. If you or your eligible dependent becomes eligible, under Medicaid or a State CHIP plan for financial assistance to pay for health coverage under this Plan, you may be able to enroll yourself and any affected dependent in this Plan. You must request enrollment within 60 days after the date a government agency determines that you are eligible for that financial assistance.

    ELIGIBILITY For BenefitsFull-time employees become eligible for benefits on the first of the month following date of employment. The following family members may be enrolled in the benefit programs:

    • Your legal spouse or qualified domestic partner

    • For medical, dental and vision benefits, children to age 26

    • For voluntary child life, newborn children to age 19 (to age 26 if full-time student)

    • Your dependent child who is incapable of self support because of a mental or physical disability

    For the purpose of our benefits plans, your children include:

    • Natural and adopted children

    • Children of your qualified domestic partner

    • Stepchildren who you support and who live with you in a parent-child relationship

    • Any other children you support for whom you are the legal guardian or for whom you are required to provide coverage as the result of a qualified medical child support order

    If you experience a family status change and want to change your benefits, you MUST contact Human Resources within 30 days of the change.

    MAKING CHANGES To Your BenefitsSpecial Enrollment Rights

  • Team FX, LLC 2019 - 2020 Employee Benefits5

    MEDICAL Overview

    We offer one medical plan through CareFirst BlueCross BlueShield. As you evaluate your options, it’s important to understand:

    • How the plan works

    • What services are covered

    • If your doctors are covered by the plan

    • Your total cost (the amount deducted from your paycheck each month + the amount you pay when you receive care)

    INSTRUCTIONS FOR FINDING A PARTICIPATING MEDICAL PROVIDER1. Go to www.carefirst.com

    2. Select Search Now under Find a Doctor

    3. Select Continue as Guest or Log in to your personal portal

    4. Select Medical, then modify search by entering your zip code/city state

    5. Select HealthyBlue then select your plan:

    • HealthyBlue Advantage

    6. Enter search criteria for doctor/facility

    7. For additional assistance, please call 888-567-9155

    Group Number: 1ZUTCustomer Service: 888-567-9155Website: www.carefirst.comMobile App: CareFirst Mobile

  • Team FX, LLC 2019 - 2020 Employee Benefits6

    HEALTHYBLUE ADVANTAGE HSA OPTION F-S

    GENERAL PLAN PROVISIONSIN-NETWORK OUT-OF-NETWORK1

    FREESTANDINGHOSPITAL CAMPUS/

    FACILITY*FREESTANDING

    HOSPITAL CAMPUS/FACILITY*

    Maximum Lifetime Benefit Unlimited

    Plan Year Deductible (Individual / Family)

    $2,500 / $5,000 $4,500 / $9,000

    Plan Year Out-of-Pocket Maximum (Individual / Family)

    $4,500 / $6,550 $6,000 / $12,000

    Coinsurance Limit 100% 100%

    Referral Required No No

    PCP Required No No

    PREVENTIVE SERVICESWell Child Care (ages 0-17) No Charge No Charge after Ded.

    Adult Physical (ages 17+)Including GYN and Cancer Screenings

    No Charge No Charge after Ded.

    OFFICE VISITS, LABS & TESTINGPrimary Care Visit No Charge after Ded. Ded., then $200 Copay Ded., then $50 Copay Ded., then $500 Copay

    Specialist Visit Ded., then $30 Copay Ded., then $200 Copay Ded., then $50 Copay Ded., then $500 Copay

    Complex Imaging Ded., then $100 Copay Ded., then $200 Copay Ded., then $200 Copay Ded., then $500 Copay

    X-ray Ded., then $50 Copay Ded., then $150 Copay Ded., then $50 Copay Ded., then $200 Copay

    Lab Tests No Charge after Ded. Ded., then $100 Copay Ded., then $50 Copay Ded., then $200 Copay

    URGENT CARE & EMERGENCY ROOMUrgent Care Center Ded., then $50 Copay Paid as In-Network

    Emergency Room (waived if admitted)

    Ded., then $200 Copay Paid as In-Network

    HOSPITALIZATIONInpatient Facility Ded., then $300 Copay / Day (5 day Copay max) Ded., then $500 Copay / Day (5 day Copay max)

    Outpatient Facility Ded., then $300 Copay Ded., then $500 Copay

    TELEMEDICINEVideo Visits Up to $49 Charge Not Covered

    VISIONRoutine Exam $10 Copay Total Charge minus $33 AB

    PRESCRIPTION DRUGSGeneric/Preferred/Non-Preferred/Specialty

    Retail Pharmacy Ded., then $0 / $25 / $45 / 50% to a $100 max

    Retail & Mail Order (90-day supply) Ded., the $0 / $50 / $90 / 50% to a $200 max

    Out-of-Pocket MaximumIndividual / Family)

    Combined with Medical

    1 AB = Allowed Benefit is the amount established for payment of covered In-Network services. The Allowed Benefit will generally be lower than the amount charged. You are responsible for copayments, coinsurance and all charges that exceed the Allowed Benefit for services received Out-of-Network. This is called balance billing.

    * FACILITY CHARGE—In addition to the physician copays/coinsurances listed, if a service is rendered on a hospital campus, ADD facility charge if applicable.

    Please note the carrier specific formulary list could potentially change during the plan year.

    MEDICAL Through CareFirst BlueCross BlueShieldTeam FX, LLC offers one medical option through CareFirst, BlueCross BlueShield. The following chart provides an overview of these benefits and the different options available for the plan year. Please note the preferred lab vendor is LabCorp.

  • Team FX, LLC 2019 - 2020 Employee Benefits7

    VALUE ADDED SERVICES Through CareFirst BlueCross BlueShield

    MY ACCOUNTMy Account provides you with information regarding your health insurance online at www.carefirst.com. This website gives you access to who is covered on your policy, what is covered, claims history and the current amount paid towards your deductible and out-of-pocket maximums. My Account also allows you access to health coaching, wellness information as well as an “ask a nurse” feature. You can also review pharmacy and hospital cost comparisons.

    TREATMENT COST ESTIMATOR THROUGH YOUR MY ACCOUNTQuickly estimate your total costs for procedures, office visits, lab tests and surgery.

    • Personalized estimates are based on your own health plan and factor in your current deductible, benefit maximums, copayments and coinsurance.

    • Avoid surprises and save money by comparing costs from different doctors, hospitals and medical facilities.

    • Plan ahead to keep health costs under control and make the best care decisions for you.

    PATIENT-CENTERED MEDICAL HOME (PCMH) PCMH from CareFirst encourages primary care physicians (PCP) to serve as the true coordinator of patient care. Physicians are given additional resources to create greater efficiencies in prescription management, patient care, hospitalizations, emergency room visits, and interaction between PCPs and specialty doctors.

    If your doctor participates in the PCMH program and you are in need of more comprehensive care, your PCP will ask that you agree to participate in the program. Participation is voluntary and consent can be revoked at any time.

    SPECIALIZED PROGRAMS THROUGH SHARECAREThe additional support provided by these focused programs can help you take charge of your wellness goals with confidence: Health coaching: If you are contacted to participate, we encourage you to take advantage of this voluntary and confidential program that can help you achieve your best possible health. Weight management program: Our program offers a personalized solution for long-term weight loss and helps participants maintain a healthier weight.

    Tobacco cessation program: Quitting tobacco can lower your risk for many serious health conditions. Expert guidance, support and wealth of tools make quitting easier than you might think. Financial well-being: Learn how to take small steps toward big improvements in your financial situation.

    FIRSTHELPIf you have a health concern, illness or urgent medical condition and are unable to reach your doctor, a registered FirstHelp nurse is available to answer your questions and assist you in determining your options. FirstHelp is available to you 24 hours a day, 7 days a week by calling 800-535-9700.

    DISCOUNTS ON HEALTH & WELLNESS The following offers and discounts are available to employees enrolled in the medical plan. As a partner in your health, Blue365 can help you achieve the lifestyle you desire through our extensive array of exclusive discounts, healthy tips, and inspirational stories from fellow Blue365 members on how the program has changed their lives. For additional details on any of the programs listed, visit www.carefirst.com/options and click on a service from the list provided. For more options, click on the Blue365 link.

    www.carefirst.comWrite your user information here:

    Username: __________________________________

    Password: __________________________________

  • Team FX, LLC 2019 - 2020 Employee Benefits8

    Earning your rewards just got easier! With CareFirst’s improved Blue Rewards incentive program, you can decide which healthy activities interest you and be rewarded for completing them.

    HERE’S HOW IT WORKS:

    Blue Rewards offers you incentives for taking steps to get and stay healthy. Both you and your spouse/domestic partner (if applicable) can earn rewards for completing one or all of the following activities:

    BLUE REWARDS

    Select a primary care provider (PCP) and complete a health screening. You can visit your PCP or visit a CVS MinuteClinic to complete your screening. Must complete within 120 days of your effective date.

    EARN $100

    EARN $50

    EARN $25

    Consent to receive wellness emails and take the RealAge test. The RealAge test is a simple questionnaire that will tell you what your RealAge is versus your actual age. Must complete within 120 days of your effective date.

    Retake the RealAge test. If you earned the reward for taking the test initially, you can earn an additional reward for retaking it after six months. Must complete before the end of your benefit period.

    LEARN MORE ABOUT THE ACTIVITIESChoosing a PCP

    Be sure to choose a PCP who participates in our Patient-Centered

    Medical Home (PCMH) program to earn your reward. The PCMH

    program is designed to provide your PCP with a more complete

    view of your health needs and the care you receive from other

    providers.

    RealAge

    Developed by our trusted partner, Sharecare, Inc., F RealAge test

    is a confidential online health assessment that helps determine

    the physical age of your body compared to your calendar age.

    RealAge identifies the habits impacting your body’s age so you

    can improve your well-being.

    Health Screening

    Health screenings help you understand your current health status,

    so you can take steps to improve it. You can complete a health

    screening with your PCP or at a CVS MinuteClinic.

    GETTING STARTED• Visit www.carefirst.com/sharecare

    • Enter your CareFirst account username and password

    • Complete the one-time registration with Sharecare

    YOUR CAREFIRST BLUE REWARDS VISAIncentive Card

    After you complete one or more of the activities, you’ll receive

    your incentive card in about 10-14 days. The incentive card

    can be used toward your annual deductible or other out-of-

    pocket costs like copays or coinsurance related to eligible

    expenses (medical, prescription drug, dental and vision)

    under your CareFirst BlueCross BlueShield plans. Make sure

    to always save your receipts as proof of your expense. You

    have until the end of your benefit period to use your reward,

    plus an additional 90 days to reimburse yourself for any eligible

    expense that occurred within that benefit period.

    If you have a Qualified High Deductible Health Plan

    (HealthyBlue Advantage HSA):

    IRS regulations allow members in a Qualified High Deductible

    Health Plan to receive an incentive card prior to meeting

    their deductible if they certify that they are going to use the

    expenses for CareFirst Dental and/or CareFirst Vision out-of-

    pocket expenses or that there is no contribution (employer or

    employee) being made to an HSA.

    Otherwise, members may need to wait until the minimum

    deductible ($1,300 for individual coverage / $2,700 for all

    other coverage levels) is met prior to using their incentive card.

    You will be prompted to answer a few questions online to

    determine whether you are eligible.

  • Team FX, LLC 2019 - 2020 Employee Benefits9

    VIDEO VISIT Included In Your CareFirst Coverage

    Video Visit is integrated into your medical plan. A Video Visit

    lets you see and talk to a doctor from your smartphone,

    tablet or computer without an appointment. Most visits take

    about 10-15 minutes and doctors can write a prescription if

    needed, that you can pick up at your local pharmacy.

    GET TREATMENT FOR COMMON HEALTH ISSUES:Doctors can diagnose and treat a wide range of non-

    emergency medical conditions, including:• Cold and flu symptoms• Bronchitis• Allergies• Poison Ivy• Pink eye

    SCHEDULE A VISIT FOR THESE NEW ADDITIONAL SERVICES:• Therapy/Psychiatry — Talk with a therapist or

    psychologist for help managing mental health issues.• Diet/Nutrition — Connect with a registered dietitian to

    get support with dietary and nutrition needs.• Breastfeeding Support — Speak with a lactation

    consultant who can advise you on breastfeeding topics.

    REGISTER TODAY SO YOU’LL BE READY WHEN YOU WANT TO VISIT. THERE ARE TWO EASY WAYS:

    1. Visit www.carefirstvideovisit.com and click on any of the Video Visit links.

    OR

    2. Download the CareFirst Video Visit app from your favorite app store.

    WHEN TO USE VIDEO VISIT:

    • Your doctor is not available.

    • You become ill while traveling.

    • You are considering visiting a hospital emergency room for a non-emergency health condition.

    VIDEO VISIT FAQHow do I start the process? Video Visit is available

    through www.carefirst.com/needcare and the mobile app.

    Members must have access to a camera on their computer

    or phone.

    What is the cost? The cost for Video Visit varies based

    on your benefits, but your specific cost information will be

    shown to you before your visit begins. Any amount paid will

    be applied towards the deductible (if applicable) and out-of-

    pocket maximum.

    What network does this utilize? AmericanWell.

    Can Video Visits doctors prescribe medicine? Yes.

    Do my family members on the plan need to have their

    own account? Yes, anyone over the age of 18 will need to

    register for their own account.

    Where is this service available?• Available in all states.To learn more, log in to www.carefirst.com!

    • Urinary tract infection• Sinus problems• Ear infection• and more!

  • Team FX, LLC 2019 - 2020 Employee Benefits10

    DENTAL Through CareFirst BlueCross BlueShield

    Team FX offers one dental plan option through CareFirst BlueCross BlueShield.

    With this plan, you can receive care from any provider. However, your out-of-pocket expenses will generally be higher if you visit a dentist out-of-network.

    Please see below for a brief description of the benefits.

    Group Number: 1ZUTCustomer Service: 888-567-9155Website: www.carefirst.comMobile App: CareFirst Mobile

    PLAN PROVISIONS PPO

    CALENDAR YEAR IN-NETWORK OUT-OF-NETWORK1

    Maximum Benefit $1,500

    Deductible - Individual $25 $50

    Deductible - Family $75 $150

    COVERED SERVICES YOU PAY AFTER DEDUCTIBLE YOU PAY AFTER DEDUCTIBLEPreventive No Charge 20% of AB1

    Basic Ded., then 20% of AB1 Ded., then 40% of AB1

    Major Care (Surgical) Ded., then 20% of AB1 Ded., then 40% of AB1

    Major Care (Restorative) Ded., then 50% of AB1 Ded., then 65% of AB1

    1Allowed Benefit is the amount established for payment of covered In-Network services. The Allowed Benefit will generally be lower than the amount charged. You are responsible for copayments, coinsurance and all charges that exceed the Allowed Benefit for services received Out-of-Network. This is called balance billing.

    INSTRUCTIONS FOR FINDING A PARTICIPATING DENTAL PROVIDER

    1. Go to www.carefirst.com

    2. Select Search Now under Find a Doctor

    3. Select Continue as Guest or Log in to your personal portal

    4. Select Dental, then modify search by entering your zip code/city state

    5. Select Preferred PPO

    6. Enter search criteria for doctor/facility

    7. For additional assistance, please call member services at 866-891-2802

  • Team FX, LLC 2019 - 2020 Employee Benefits11

    VISION Through CareFirst BlueCross BlueShieldTeam FX offers a vision plan option through CareFirst BlueCross BlueShield. BlueVision Plus has a national network of optometrists, ophthalmologists and opticians. There is a 12-month benefit period for all benefits listed below.

    PLAN PROVISIONS BLUE VISION PLUS OPTION 3

    CALENDAR YEAR IN-NETWORK OUT-OF-NETWORKEye Exam $10 Copay Plan pays $45

    Frames Allowance1 Plan pays $45 Plan pays $45

    Single Vision Lenses No Copay Plan pays $52

    Bifocal Lenses No Copay Plan pays $82

    Trifocal Lenses No Copay Plan pays $101

    Medically Necessary Contact Lenses

    No Copay with prior approval

    Plan pays $285

    Elective Single Vision Contact Lenses

    Plan pays $97 Plan pays $97

    Group Number: 1ZUT

    Customer Service: 800-783-5602Website: www.carefirst.comMobile App: CareFirst Mobile

    INSTRUCTIONS FOR FINDING A PARTICIPATING VISION PROVIDER1. Go to www.carefirst.com

    2. Select Search Now under Find a Doctor

    3. Select Continue as Guest or Log in to your personal portal

    4. Select Vision, then enter zip-code

    5. Select BlueVision Plus

    6. Enter search criteria for doctor/facility

    7. For additional assistance, please call member services at 800-783-5602

    1 No copayment for approximately 400 frames in the Davis Vision Frame Collection. Non-Davis Vision Collection frames, the plan pays $45 toward

    the wholesale price (or equivalent allowance at a retailer), and you pay the balance.

    The benefit period begins on the actual date of service, not the plan year.

  • Team FX, LLC 2019 - 2020 Employee Benefits12

    VOLUNTARY DISABILITY Through Unum Disability insurance replaces a percentage of your income during extended periods of illness or injury that prevent you from performing your regular work. These benefits will coordinate with any state disability programs in which you are automatically enrolled.

    PLAN PROVISIONS SHORT TERM DISABILITYYour Benefit 60% of your weekly pre-disability earnings, up to a maximum of $750 per week.

    Benefit Period You will receive benefits as long as you qualify as disabled, for up to 24 weeks.

    When Benefits Begin Benefits begin after the 14th day of disability or illness.

    Definition of DisabilityYou are qualified if you are unable to work due to illness or injury as determined by a physician in writing.

    PLAN PROVISIONS LONG TERM DISABILITYYour Benefit 60% of your monthly pre-disability earnings, up to a maximum of $2,000 per month.

    Benefit Period

    You will receive benefits as long as you qualify as disabled. If you become disabled prior to age 60, benefits will continue until you reach your normal Social Security Retirement Age. If you are still working and become disabled after the age of 60 years, the duration of benefit payments are subject to the schedule found in the policy.

    When Benefits Begin Benefits begin after 180 days of disability.

    Definition of DisabilityFor the first 24 months, you are disabled if you are not working full-time, or are residually disabled due to illness or injury and cannot perform your normal occupation. Thereafter, you will be considered disabled if you cannot perform any occupation.

    Pre-Existing ConditionsIf you are treated for a condition 3 months prior to your effective date, and become disabled as a result of such condition within the first 12 months of your coverage, you will not be eligible for disability payments for such condition.

    Group Number: 879697Customer Service: 866-679-3054Website: www.unum.comMobile App: Unum Customer

  • Team FX, LLC 2019 - 2020 Employee Benefits13

    While the basic life insurance benefit is designed to provide a foundation for you and your dependents, we recognize the potential need to increase your family’s protection. Through our benefit program, you have access to Voluntary Life and AD&D Insurance.

    This program allows you to purchase additional amounts of insurance at favorable group rates with certain amounts of coverage guaranteed. These benefits are insured by Unum.

    PLAN PROVISIONS VOLUNTARY LIFE AND AD&D INSURANCE

    Life Benefit

    Coverage is available in increments of $10,000 up to the lesser of five times annual earnings or $500,000.

    If you apply when initially eligible, you are guaranteed issue up to $100,000. Evidence of Insurability (EOI) is required for amounts over $100,000 or for any amount if you do not apply when you are initially eligible.

    AD&D BenefitCoverage is available in increments of $10,000 up to the lesser of five times annual earnings or $500,000.

    If you apply when initially eligible, you are guaranteed issue up to $100,000.

    Spouse / Domestic Partner Benefit

    Spouse coverage is available in increments of $5,000 up to the lesser of $500,000 or 100% of the employee’s elected benefit amount.

    EOI is required for amounts over $25,000 or for any amount, if you do not apply when initially eligible.

    Child benefitNewborn children to six months are covered at a flat benefit of $1,000. Children 4 months to age 19 (age 26 if a full-time student) can be covered in increments of $2,000 up to $10,000.

    Reductions to the Benefits

    At age 65: coverage is reduced to 65%.At age 70: coverage is reduced to 50%.

    Accelerated BenefitIf you are terminally ill, you can receive a portion of your lifetime benefit in a lump sum, Your life benefit will be reduced by this accelerated payment.

    ConversionYou may convert this policy to an individual policy upon termination of your employer provided coverage. Contact Human Resources for details and rates.

    VOLUNTARY LIFE & AD&D INSURANCEThrough Unum

    Group Number: 879697Customer Service: 866-679-3054Website: www.unum.comMobile App: Unum Customer

  • Team FX, LLC 2019 - 2020 Employee Benefits14

    EMPLOYEE COSTS 2019 - 2020PLAN

    SEMI-MONTHLY EMPLOYEE CONTRIBUTIONS

    MEDICALCareFirst BlueCross BlueShield HealthyBlue Advantage HSA Option F-S

    Employee Only $196.38

    Employee + Spouse/DP $451.65

    Employee + Child(ren) $363.28

    Family $596.95

    DENTALCareFirst Dental

    Employee Only $18.45

    Employee + Spouse/DP $42.43

    Employee + Child(ren) $34.13

    Family $56.08

    VISIONBlueVision Plus

    Employee Only $2.98

    Employee + Spouse/DP $6.85

    Employee + Child(ren) $5.51

    Family $9.05

    ABOUT YOUR CONTRIBUTIONSAny contributions you make for yourself, your spouse or your children’s medical, dental or vision plan coverage are automatically deducted from your paycheck on a pre-tax basis per IRS guidelines under Section 125. This decreases your taxable earnings and can increase your take-home pay. You are enrolled in this program when you become eligible for benefits and do not need to take any action if no changes are needed. You must notify Human Resources in writing if you would like your contributions to be taken post-tax.

    The health plan reserves the right to change employee contributions at any time during the year.

    PREMIUMS FOR DOMESTIC PARTNERS AND THEIR CHILDRENBecause the IRS does not recognize domestic partners or their children (unless they qualify as dependents under Section 152) for tax filing purposes, we are required to “impute” the value of these benefits and report that value, less any post-tax deductions, as taxable income to you. The applicable amount will be added back into your paycheck as taxable income and you will pay taxes on that amount. In addition, deductions for your Domestic Partner and their children will be taken post-tax.

    If you enroll a domestic partner in these plans, you may be able to deduct your portion of the premium costs on your state tax return. Each state’s requirements vary; please consult your tax advisor for details.

    Some states do not permit pre-tax or tax-free coverage for adult children. As a result, we may impute the value of this coverage and report it as taxable income.

    To determine the applicable imputed income for the plan you have chosen, please contact Human Resources. 

  • Team FX, LLC 2019 - 2020 Employee Benefits15

  • CONTACTS For Benefits

    PLAN GROUP NUMBERMEMBER SERVICES

    WEBSITE

    MEDICALCareFirst Member Services 1ZUT 888-567-9155 www.carefirst.com

    OTHER HEALTH BENEFITSCareFirst Dental 1ZUT 800-783-5602 www.carefirst.com

    CareFirst BlueVision Plus 1ZUT 800-783-5602 www.carefirst.com

    LIFE INSURANCE AND DISABILITYUnum Voluntary Short Term Disability 879697 866-679-3054 www.unum.com

    Unum Voluntary Long Term Disability 879697 866-679-3054 www.unum.com

    Unum Voluntary Life and AD&D Insurance 879697 866-679-3054 www.unum.com

    ADDITIONAL BENEFITS QUESTIONSSIGCorinne FinneyTasha Connelly

    [email protected]@silbs.com

    410-823-8066 www.silbs.com

    CareFirst Video VisitSee a doctor anytime on your phone, tablet or computer. CareFirst BlueCross BlueShield Video Visit allows you and your family members to connect with doctors whenever and wherever you want.

    Unum CustomerEasily manage your claim or leave 24/7 on all your mobile devices.

    Please Note: This booklet provides a summary of the benefits available, but this is not your Summary Plan Description (SPD). The Company reserves the right to modify, amend, suspend, or terminate any plan at any time, and for any reason without prior notification. The plans described in this book are governed by insurance contracts and plan documents, which are available for examination upon request. We have attempted to make the explanations of the plans in this booklet as accurate as possible. However, should there be a discrepancy between this booklet and the provisions of the insurance contracts or plan documents, the provisions of the insurance contracts or plan documents will govern. In addition, you should not rely on any oral descriptions of these plans, since the written descriptions in the insurance contracts or plan documents will always govern.

    CareFirst Mobile App by CareFirst

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