2020 benefits guide - mammoth energy services, inc. · january 1, 2020 through december 31, 2020...

2020 BENEFITS GUIDE

Mammoth Energy Services, Inc. January 1, 2020 through December 31, 2020

Welcome Information ......................................... 1

Contacts ............................................................. 2

Blue Cross Medical Plans ............................... 3-5

Guardian Dental Plan ......................................... 6

Guardian Vision Plan .......................................... 7

Guardian Life & Disability Plans ......................... 8

Guardian EAP Plan ............................................ 9

Discovery Benefits FSA Information................. 10

Payroll Deductions ........................................... 11

Paycom Online Instructions ........................ 12-16

Notices ........................................................ 17-24

Eligibility

You and your dependents are eligible for the benefits package

if you satisfy the definition of an eligible employee. Full-time is

defined as working 30 hours or more per week and satisfying

the required waiting period. Eligible dependents are your legal

spouse, children under age 26, and disabled dependents of

any age that satisfy the plan requirements. Domestic Partners

may be covered as long as the individual meets the eligibility

requirements under each plan and they are not already

covered on Mammoth’s policy as an employee. If you have any

questions about either your, or your family’s eligibility, please

speak with your onsite Human Resources representative.

It’s important for you to remember that any elections and/or

changes made now will remain in effect until the next open

enrollment period unless you or your family experience a

special enrollment event. If you experience such an event,

contact your Human Resources Department within 30 days of

the event. For more information about what constitutes a

special enrollment event (e.g., birth, marriage, etc.) and the

required timeframes involved, please see the notice section

within this guide.

Let’s Get Started!

It’s mandatory for all eligible employees, even those that are

currently enrolled, to login to the Paycom website at

www.paycomonline.com and complete the required online

enrollment. The process must be completed during the open

enrollment dates of November 4th through November 15th. If

you don’t go online and complete the required process within

the allowed timeframe, you and your family will not have

benefits. Detailed instructions on how to enroll can be found

starting on page 12 of this guide.

As you begin your review of this packet, please review the

choices provided including the cost information that has been

provided by your employer. More information about your

benefits and a link to the Paycom system can be found at

www.mammothenergy.com/benefits.

If you have questions, please reach out to any of the resources

listed on page 2.

Table of Contents

NOTE: If you (and your dependents) have Medicare or will become

eligible for Medicare in the next 12 months, a Federal Law gives you more

choices about your prescription drug coverage. Please see the notices

present at the back of this guide for more details.

1

Welcome to your Employee Benefits

Mammoth Energy Services has been diligent in

searching for a comprehensive benefits package

that helps you achieve the best fit for your family’s

insurance needs. The coverage lines included are

shown below:

Medical

Dental

Vision

Basic Life/AD&D

Voluntary Life

Short Term Disability

Long Term Disability

Employee Assistance Program

Flexible Spending Account

Dependent Care Flexible Spending Account

This is your open enrollment period. During this

time, you can review your current coverage lines

and eligibility selections to determine if changes

are necessary. For example, you can elect

coverage lines if you previously declined, or

change your current elections. This is the time of

year that you can change your dependent

elections as well.


Did you know?

2

As an employee of Mammoth Energy Services, Inc., you now

have access to a dedicated customer service line that has been

set up especially for Mammoth Energy Services, Inc.

When you have questions about your insurance, your employer

wants you to have access to a top-notch service department

that can address questions on all coverage lines. To achieve

this, your employer has chosen to utilize the Benefit Advocate

Center (BAC).

They can assist you with several day-to-day services such as:

Helping you understand the benefits

Providing assistance with claim problems

Helping you understand your EOB’s (Explanation of Benefits)

Providing assistance with ordering ID cards

Helping you locate in-network providers

The BAC is available Monday through Friday from 8:00 AM to 6:00 PM CST to assist you.

Please take advantage of this valuable resource.

BENEFIT ADVOCATE CENTER

BAC Service Line BAC Service Associates 1-866-898-7089 [email protected]

Although the Benefit Advocate Center (BAC) is available to help with any insurance related question(s), it is important to

have more than one resource to turn to when you need assistance. Therefore, if a question or circumstance arises that

the Benefit Advocate Center may not be able to assist you with, we have provided a comprehensive carrier listing

below .

Benefit Carrier Phone Website/Email

Medical BCBS of Oklahoma 1-800-942-5837 www.bcbsok.com

Dental Guardian 1-800-541-7846 www.guardiananytime.com

Vision Guardian 1-800-541-7846 www.guardiananytime.com

Basic Life/ADD Guardian 1-800-525-4542 www.guardiananytime.com

Voluntary Life Guardian 1-800-525-4542 www.guardiananytime.com

Short Term Disability Guardian 1-800-268-2525 www.guardiananytime.com

Long Term Disability Guardian 1-800-268-2525 www.guardiananytime.com

EAP Program Guardian 1-800-386-7055 www.ibhworklife.com

Flexible Spending Account Discovery Benefits 1-866-451-3399 www.DiscoveryBenefits.com


MEDICAL Blue Cross and Blue Shield of Oklahoma

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Mammoth Energy Services will continue to offer a BASE and BUY-UP plan through Blue Cross and Blue Shield of

Oklahoma. The provider network will be changing to BLUE PREFERRED. Since there is a network change, we

encourage you to go to the website at www.bcbsok.com, click on Find a Doctor or Hospital and verify that your provider

participates in the network. It is your responsibility to check providers, so please protect yourself and do so prior to your

medical appointments.

Both medical plans are experiencing slight changes. Below is a synopsis of the in-network benefits under each plan

design. Please keep in mind that this is a general overview, and you must refer to your plan documents for full details.

BCBS of Oklahoma Blue Preferred Network

BASE PLAN BUY-UP PLAN

In-Network In-Network

Annual Deductible Individual / Family

$2,000 / $6,000 $1,000 / $3,000

Annual Out-of-Pocket Individual / Family

$5,000 / $15,000 $4,000 / $12,000

Coinsurance 20% 20%

Primary Care Office Visit $25 Copay $25 Copay

Specialist Office Visit $40 Copay $40 Copay

Urgent Care $75 Copay $75 Copay

Emergency Room $400 Copay / Visit $400 Copay / Visit

Hospital—Inpatient Deductible, 20% Deductible, 20%

Hospital—Out Patient Deductible, 20% Deductible, 20%

PRESCRIPTIONS *

Generic Retail: $10 Copay

Mail Order: $25 Copay Retail: $10 Copay

Mail Order: $25 Copay

Preferred Brand Retail: $35 Copay

Mail Order: $87.50 Copay Retail: $35 Copay

Mail Order: $87.50 Copay

Non-Preferred Brand Retail: $75 Copay

Mail Order: $187.50 Copay Retail: $60 Copay

Mail Order: $150 Copay

Specialty $250 Copay** $150 Copay**

*Retail: 30 Day Supply / Mail Order: 90 Day Supply **Specialty Drugs must be obtained from network specialty pharmacy


Remember: No program listed is a substitute for a doctor ’s

care. You must talk to your doctor about any health questions or

concerns. For medical emergencies, call 911.

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Your employer chose Blue Cross and Blue Shield of Oklahoma as your medical carrier, you will

receive much more than medical. Please see below for some of the additional cost saving tools

and perks you get just by being a Blue Cross member.

Virtual Visits powered by MDLIVE

It never fails. We get sick after hours or on the

weekends. This used to mean a lengthy wait in an

urgent care or emergency room, followed by an

extremely costly bill. But with the Virtual Visits

powered by MDLIVE, you can see a doctor

24/7/365 in the comfort of your own home! And it is

at NO COST!

With virtual visits, you get:

24/7 access to an independently contracted, board-certified doctor.

Access via online video, mobile app or telephone.

If necessary, e-prescriptions sent to your local pharmacy.

To activate your account or schedule a virtual visit:

Go to Blue Access for MembersSM

or MDLIVE.com/bcbsok.

Download the MDLIVE app from Apple’s App Store

SM or Google Play™

.

Call MDLIVE at (888) 970.4081.

Text BCBSOK to 635-483. (MDLIVE’s online assistant Sophie will help you activate your account.)

Nurses when you need them.

Because health happens—good or bad, 24 hours a

day, seven days a week. Blue Cross has

registered nurses waiting to talk whenever you call.

They can answer questions about asthma,

dizziness, high fevers, sore throats and so much

more.

Please take advantage of this amazing benefit

simply by calling the Nurseline phone number on

the back of your ID card. Anytime.

Blue Access for Members (BAM)

The Blue Access for Members website (i.e., BAM),

offers members the ability to review plan

information, and access many additional resources

and tools.

Just some of the information and services you can

access are shown below:

Review benefits and claim status

Order ID cards, or print temporary ID cards

View and print your Explanation of Benefits

Search for and compare in-network doctors

and hospitals using Provider Finder®

Use the cost esimator tool to research and

compare costs between different doctors /

hospitals

You can also obtain Blue Access MobileSM

. The

mobile application makes it even easier for you to

access your information on the go. You can

perform the services above, plus get tips like the

following:

Exercise and Fitness

Heart Healthy Diet

Diabetes Diet

To register for BAM and all that it offers, just go to

the website at www.bcbsok.com and sign up.

MEDICAL and……. Blue Cross and Blue Shield of Oklahoma


The Member Rewards program is provided by Sapphire Digital, an independent company. Incentives available for select procedures only.

Amounts you receive through Member Rewards may be taxable. BCBSOK does not provide tax advice, so please contact your HR or tax advisor

for more information. Rewards may be delivered by check or an alternative form of payment. Members with coverage under Medicaid or Medicare

are not eligible to receive incentive rewards under the Member Rewards Program.

Blue Cross and Blue Shield of Oklahoma makes no endorsement, representation or warranty regarding Sapphire Digital’s administration of the

Member Rewards program. Information received through the Member Rewards program is not meant to replace advice of a health care

professional, and decisions regarding course and place of treatment remain with the member and his or her health care provider. Eligibility

for rewards is subject to terms and conditions of the Member Rewards program. 5

Blue Cross has gone a step further to help you not only become a more cost conscience

consumer, but to reap the rewards for doing so through their new program called Benefit Value

Advisor and Member Rewards powered by Sapphire Digital.

Benefit Value Advisor and Member Rewards

At no additional cost, the Benefit Value Advisor and Member Rewards is being offered. Did you know that the same

procedure at two different facilities can have a cost variance from hundreds to thousands of dollars? This new

program offers you cash rewards when a lower-cost, quality provider is selected from several options.

What is this Program?

Benefit Value Advisor and Member Rewards with Provider Finder, the Blue Cross and Blue Shield nationwide

database of independently contracted health care providers, can help you:

Compare costs and quality for procedures

Estimate out of pocket costs

Earn cash while shopping for care

Save money and use your benefits efficiently

Consider treatment options with your doctor

How does the Program work?

1. When a doctor recommends treatment, log into Blue Access for MembersSM

at www.bcbsok.com

2. Click Doctors and Hospitals tab—then on Find a Doctor or Hospital—and Shop for Procedures

3. Choose a Member Rewards eligible location, and you may earn a cash reward

4. Complete your procedure and, once verified, you will receive a check within 4-6 weeks.

MEDICAL and……. Blue Cross and Blue Shield of Oklahoma

NEW!

Most all of us look for value when we’re shopping—now you can apply this practice to shopping for health care

services. Take more control over your health care financial decisions with Member Rewards administered by

Sapphire Digital.

If you have questions about this great new program, call the number on the back of your member ID card.


DENTAL Guardian

Are you on the go?

If you’re on the go, why not take Guardian with you? Remember to download the Guardian Anytime Mobile Application

which can be found at www.guardiananytime.com. This application gives you quick and easy access to in-network

providers, benefit information and much more. Please keep this in mind when you’re on the go!

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We all know that our teeth are important and regular dental check-ups keep our smiles fresh and bright. But, did you

know that regular dental check-ups can also help detect more serious health issues? The benefits of regular dental

exams are extremely important, and this is why your employer has chosen to renew their dental plan with the Guardian.

Please keep in mind that this is an overview, and you must refer to your plan documents for full details. If you need to

locate an in-network provider, remember to utilize the website at www.guardiananytime.com. If you have any other

questions, please reach out to the BAC, or to the other valuable resources listed on page 2.

Guardian In-Network Out-of-Network *

Calendar Year Deductible Individual / Family

$50 / $150 $50 / $150

Calendar Year Maximum Per Person

$1,000 $1,000

Preventive & Diagnostic 100% 100%

(cleanings, x-ray, exam)

Preventive Yes Yes

Is deductible waived?

Basic Deductible, 80% Deductible, 80% of U&C

(fillings, root canals, extractions)

Major Deductible, 50% Deductible, 50% of U&C

(crowns, bridges, dentures)

Orthodontia 50% 50% of U&C

(under age 19)

Orthodontia Yes Yes

Is deductible waived?

Orthodontia $1,000 $1,000

Lifetime Maximum

*IMPORTANT: “U&C” stands for “Usual and Customary”. Out-of-Network providers don’t accept in-network contract

discounts. This means that out of network, this carrier will only pay according to their “Usual & Customary” pricing, and

you will be responsible for any costs over “U&C”. Please check with the Guardian before each appointment to ensure

you’re inside the network to control your costs.

COST SAVING MEASURE: When the expected cost of a proposed course of treatment is $300 or more, ask

your dentist to submit a Pre-Treatment Estimate. By doing so, you can know what your cost will be prior to the treatment

starting. This can also make sure you know what’s covered and what’s not covered before any services begin. Take

advantage of this valuable tool to help you save money.


VISION Guardian

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Regular eye exams can help detect problems at their earliest stages, and when they are at the most treatable. Make

sure you take advantage of the vision benefits available through the Guardian to help detect diseases such as

glaucoma, diabetes and even blindness.

Please review the short benefit description below to view general benefits available through the Guardian vision

program. Please keep in mind that this is an overview, and you must refer to your plan documents for full details. If you

need to locate an in-network provider, remember to utilize the website at www.guardiananytime.com and search the

VSP Choice Full Feature Network. If you have any other questions, please reach out to the BAC, or to the other

valuable resources listed on page 2.

Guardian

In-Network Out-of-Network *

Annual Eye Exam $10 Copay Up to $45 Once every 12 months

Frames $150 Allowance Up to $70 Once every 24 months

Lenses

Once every 12 months

Single

$25 Copay Up to $65 depending on lens

type Lined Bifocal

Lined Trifocal

Lenticular

Contacts (in lieu of glasses) Once every 12 months

Elective $130 Allowance Up to $105

Medically Necessary $25 Copay Up to $130

Are you on the go?

If you’re on the go, why not take Guardian with you? Remember to download the Guardian Anytime Mobile Application

which can be found at www.guardiananytime.com. This application gives you quick and easy access to in-network

providers, benefit information and much more. Please keep this in mind when you’re on the go!


LIFE and DISABILITY Guardian

UPDATE YOUR BENEFICIARY DATA: As you review your elections, please remember to verify your listed

beneficiary and make any changes that may be necessary. 8

Have you thought about what would happen to your family if something unfortunate happened to

you? These are things we don’t want to think about, but when they happen, you want the

protection that Life and Disability policies can provide.

Your employer understands this, and this is why they will continue to provide Basic Life/AD&D, Short Term Disability

and Long Term Disability at no cost to you. In addition, they provide you with the opportunity to elect and pay for

additional Life coverage. Please see the below information for a short description of the Life and Disability benefits

available through Mammoth Energy Services.

Basic Life/AD&D

Mammoth Energy Services will provide each full-

time eligible employee with a Basic Life/AD&D

insurance benefit of two times their annual salary

up to a maximum of $500,000. Eligible employees

are defined as employees working 30 hours or

more per week and that have satisfied the waiting

period applicable to the coverage line per the

policy requirements. Please keep in mind that

amounts are subject to applicable age reductions

and evidence of insurability requirements. You

must review your full policy documents for

complete plan details.

Voluntary Life

If you would like the opportunity to elect more life

coverage for yourself, and your dependents, you

have the opportunity to purchase additional life

coverage through the Guardian Voluntary Life

policy.

Employees can elect in increments of $25,000 up

to a $100,000 maximum. Spouses can elect up to

50% of the employee’s volume, and children can

elect up to 10% of employee’s volume.

As with the Basic Life coverage, the Voluntary Life

is subject to all appropriate age reductions and

evidence of insurability requirements according to

the plan guidelines.

You must review your full policy documents to

obtain complete plan details.

Short Term Disability

If you meet the plan requirements, Mammoth

Energy Services pays for your Short Term

Disability plan. The plan provides a benefit of 60%

of your weekly earnings to a maximum of $1,500

per week. Benefits begin on the 15th day from an

absence at work due to an accident or illness.

The duration of benefits can be up to a maximum

of 24 weeks. Limitations and exclusions do apply.

The policy is also subject to pre-existing condition

limitations. To find out if you meet the plan

requirements for this benefit, please speak with

your Human Resources Department. As with all

coverage lines, you must read the full policy

documents to obtain complete plan details.

Long Term Disability

This coverage provides a 60% benefit based on

your pre-disability earnings to a maximum of

$10,000 per month. The benefit coincides with the

STD policy and begins on the 181st day of your

disability period and continues until you reach

SSNRA (Social Security Normal Retirement Age).

Limitations and exclusions do apply. The policy is

also subject to pre-existing condition limitations.

The duration of payment for LTD is limited for

certain conditions such as mental, emotional,

alcohol and drug abuse. When applicable, this

coverage will be integrated with both Social

Security and Workers Compensation.


WORKLIFE MATTERS EMPLOYEE ASSISTANCE PROGRAM (EAP) Guardian and Integrated Behavioral Health

There are times in life when we all need support and guidance. The WorkLife Matters Employee

Assistance Program provided by Guardian and Integrated Behavioral Health can provide you with

services that help promote your well-being and enhance the overall quality of life for both you and

your family.

The program exists to help you obtain helpful guidance and support in many various circumstances. Below are just a

few examples of what the EAP can assist you with:

Health

Healthy Living

Stress Management

Mental Health

Diet and Fitness

Financial

Legal Issues

Will Preparation

Taxes and Debt

ID Theft Services

Just remember that the WorkLife Matters Employee Assistance Program is there for you when you need guidance and

support. To take advantage of this valuable service, you can either email [email protected], go to the website

at www.ibhworklife.com and enter the user name of “Matters”, and the password of “wlm70101, or simply place a phone

call to 1-800-386-7055 for assistance.

Office hours: Monday-Friday 6am-5pm PST, Live answer exchange available after hours, WorkLife Matters Program services are provided by

Integrated Behavioral Health, Inc., and its contractors. Guardian does not provide any part of WorkLife Matters program services. Guardian is not

responsible or liable for care or advice given by any provider or resource under the program. This information is for illustrative purposes only. It is not

a contract. Only the Administration Agreement can provide the actual terms, services, limitations and exclusions. Guardian and IBH reserve the right

to discontinue the WorkLife Maters program at any time without notice. Legal services provided through WorkLife Matters will not be provided in

connection with or preparation for any action against Guardian, IBH or your employer. WorkLife Matters program services is not an insurance benefit

and may not be available in all states. Integrated Behavioral Health Laguna Niguel, CA File # 2018-56600 Exp. 3/20 Pub 3525 GUARDIAN® and the

GUARDIAN G® logo are registered service marks of The Guardian Life Insurance Company of America.®

9

Family

Parenting Support

Child and Elder Care

Learning Programs

Special Needs Help


FLEXIBLE SPENDING ACCOUNT Discovery Benefits

10

Effective January 1, 2020, your Flexible Spending Account, and Dependent Care Accounts will

be administered by Discovery Benefits.

Save money with a Health Care FSA

A Flexible Spending Account (FSA) allows you to budget and save for qualified medical expenses incurred over the

course of your plan year. Dollars invested in an FSA are tax-free. That makes an FSA a great tool for saving money,

especially when big expenses are anticipated. Upon enrollment in the plan, you must decide how much you will set

aside in the account. You may select up to $2,700 annually. The deductions for your FSA election will be split by the

number of pay periods remaining in the calendar year. However, you may use your full election amount at any time after

your coverage begins.

When you determine how much to set aside, you also need to understand how to use the money within your FSA. In

order to have an expense covered by your FSA dollars, that expense has to be considered eligible by the IRS.

Discovery Benefits makes it easy for you to find a list of eligible expenses. Simply go to their website at

www.DiscoveryBenefits.com/eligibleexpenses to view a full listing of qualified expenses.

When your enrollment is complete, you’ll receive a debit card that can be used to pay deductibles, copayments and

coinsurance amounts for medical, dental and vision out of pocket costs. You may also spend FSA funds on prescription

medications as well as some over the counter medicines with a doctor’s prescription. If you have FSA funds that you

don’t use during the plan year, you may roll over up to $500 to the next plan year. However, any balance over $500 will

be forfeited.

Stretch your dollars with a Dependent Care FSA

We all know that the cost of taking care of a dependent can be an expense. Setting up a Dependent Care Flexible

Spending Account (DCFSA) is one way to help with the staggering price. A Dependent Care FSA allows you to pay for

the cost of day care on a pre-tax basis. You may contribute up to $5,000 per year. It works much like a Health Care FSA

in that you must use all of your Dependent Care FSA funds by the end of the plan year. However, unlike a health care

FSA, you may only receive reimbursement equal to the amount you have actually deposited. If you elect to participate in

the Health and Dependent Care FSA plans, you may not comingle funds. You also may not use the Health FSA debit

card to pay for day care expenses. Daycare expenses must be filed manually for reimbursement from your DCFSA

plan and there is no Dependent Care rollover.

If you have any questions, please reach out to the BAC or the other resources listed on page 2.


PAYROLL DEDUCTIONS

All employee costs are based on bi-weekly pay periods. Payroll deductions for your elected plans will begin the

first payroll cycle after January 1, 2020. Any elections you make during open enrollment will be in effect until

December 31, 2020 unless you have a qualifying event such as a birth, death, marriage or divorce. You will have

30 days from the date of your qualifying event to make changes to your plan elections. 11

Below are the payroll deductions created by your employer. They are based on twenty-six pay

periods.

If you have any questions regarding the costs below, you must speak directly with your Human

Resources Department.

Per Pay Period Cost (26 Pay Periods)

Employee

Employee & Spouse

Employee & Child(ren)

Family

MEDICAL—BASE $10.50 $89.25 $73.50 $115.50

MEDICAL—BUY UP $35.70 $144.90 $121.80 $194.25

MEDICAL Spousal Surcharge

Add $75.00 per pay period to the Employee & Spouse or Family medical cost if your spouse has access to coverage through his or her employer.

DENTAL $0.53 $4.15 $5.03 $7.02

VISION $0.12 $0.91 $0.97 $1.56

BASIC LIFE/AD&D Employer Paid

VOLUNTARY LIFE See Rate Chart Below

SHORT TERM DISABILITY Employer Paid

LONG TERM DISABILITY Employer Paid

Per Pay Period Cost (26 Pay Periods) *


PAYCOM ONLINE INSTRUCTIONS Navigating the enrollment system...

Now that you’ve read through your benefits for the 2020 plan year, it’s time for you to go online

and complete your enrollment process.

Before beginning, make sure you have your Paycom login information. If you don’t have this data,

please speak with your onsite HR representative and this data will be provided to you. Once you have the information,

it’s time to begin.

You will first be asked to verify your contact information. Once you have reviewed and made any necessary updates,

click “Next”.

Let’s get started!

Go to www.paycomonline.com. Click the Login button and select Employee from the dropdown menu.

Enter your username and password and the last four digits of your social security number. Click Log In.

If this is your first time logging into the Paycom system, you’ll be prompted to enter a unique password to replace the temporary one provided. You’ll also be required to register answers to five security questions.

Once login is complete, locate the Benefits option on the second row of tiles. Click on “2020 Benefit Enrollment”.

After reading through the provided tips, click on “Start Enrollment”.

The following screen requests that you enter/review your dependents and beneficiaries. Please ensure all data is entered correctly. If additional dependents or beneficiaries should be added, click “Add” and enter the date. When all family members have been added and verified, click “Next”.

If you add someone as a beneficiary and don’t select “Dependent and Beneficiary” you won’t be able to change after entry.

12



13

MEDICAL

Medical benefit enrollment will populate on the screen with five plan options: Medical Base Spousal Surcharge, Medical Base, Medical Buy Up Spousal Charge, Medical Buy Up, and Decline Coverage. Choose the option that best fits your needs by checking the box in the upper left-hand corner of that plan. Unless you are declining coverage, select the appropriate level of coverage below.

Continuing in 2020 any employee choosing to elect spousal coverage will be required to enroll in one of the spousal surcharge titled plans if the spouse has coverage available through their own place of employment.

Please be sure to include all dependents that you wish to have covered by checking the corresponding box next to each family member or using the select all feature. Once complete, click “enroll” (or “decline” if rejecting coverage).

DENTAL

Repeat the above steps for Dental enrollment. There is only one plan for dental coverage, so you may choose to either enroll or decline. If enrolling, please remember to choose your coverage level. After making your selection, verify that the boxes representing all family members who should have coverage have been checked.

VISION

Follow the above steps to enroll in or opt out of vision coverage. If selecting coverage only for yourself, you will only need to check the box in the upper left-hand corner and then click “Enroll”. Otherwise, follow the same steps as before to ensure appropriate dependents have been included.



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BASIC LIFE

You will be automatically enrolled in the Basic Life. Since the cost of this coverage is employer paid, you’ll only need to be sure the box electing the coverage is checked and then add and verify beneficiary information including which should be primary and which should be secondary. Once complete, click “Enroll”. If you fail to elect a primary beneficiary, you’ll receive an error and will be required to redo this step. Evidence of Insurability is required if 2x your annual W-2 earnings will be above $350,000.

VOLUNTARY LIFE

You may request additional life coverage on the next screen. Once the desired amount has been selected from the dropdown, the employee per pay period cost will populate automatically. Update / verify beneficiary information and click “Enroll” (or “decline” if rejecting coverage). If you fail to elect a primary beneficiary, you’ll receive an error and will be required to redo this enrollment step. Evidence of Insurability is required if voluntary life has previously been declined and is now being elected.

VOLUNTARY DEPENDENT LIFE

If you choose to elect voluntary life coverage for yourself, you will also have the option to purchase additional life coverage for your spouse and/or children. Coverage for your spouse will be available at 50% of the coverage amount elected for the employee. Coverage for children will be available at 10% of the coverage amount elected for the employee. Choose the appropriate levels on the following two screens. You may elect coverage for your spouse and decline coverage for children or elect coverage for children and decline coverage for spouse. Once elections have been made, click “Enroll” (or “decline” if rejecting coverage).


BASIC AD&D

You will be automatically enrolled in the Basic AD&D. Since the cost of this coverage is employer paid, you’ll only need to be sure the box electing the coverage is checked and then add and verify beneficiary information including which should be primary and which should be secondary. Once complete, click “Enroll”. If you fail to elect a primary beneficiary, you’ll receive an error and will be required to redo this step. Evidence of Insurability is required if 2x your annual W-2 earnings will be above $350,000.


15

LONG TERM and SHORT TERM DISABILITY

You will automatically be enrolled in Short Term and Long Term Disability. No beneficiary information is required for these coverage lines, so no action will need to be taken.

FLEXIBLE SPENDING ACCOUNT MEDICAL and DEPENDENT CARE FSA

If you choose to elect a Medical and/or Dependent Care Flexible Spending Account you will need to check the box and enter the maximum amount you want to have available to you within the FSA. The system will automatically calculate the cost per pay period based on the total you enter. You will need either to enroll or decline the Medical FSA, and the Dependent Care FSA.


FINALIZING YOUR ENROLLMENT

On the following screen, you will be able to review your elections. There will be multiple view options available. You will first see a list of the requested benefits followed by declined / denied benefits.


16

Changes or corrections

can be made through

the Edit option in the

upper right corner of

each benefit.

Dependent enrollment will be summarized below the list of benefits.

After reviewing all details, click “Finalize” at the bottom of the receipt

view on the right side of the screen. You will then be asked to click

“Sign and Submit” to complete your enrollment.


THIS PAGE IS INTENTIONALLY BLANK.


DISCLAIMERS

The intent of this benefit guide is to provide you with general information regarding the status of, and/or potential concerns related to, your current employee benefits environment. It should not be construed as, nor is it intended to provide, legal advice. Laws may be complex and subject to change. This information is based on current interpretation of the law and is not guaranteed. Questions regarding specific issues should be addressed by legal counsel who specializes in this practice area.

This benefit guide gives you an overview of the main features of your benefit plans. The plans are administered according to legal plan documents and insurance contracts. Although we have tried to summarize the provisions of these legal documents clearly and accurately, if any information contained herein conflicts with the legal documents, the legal documents will govern. For more detailed information on the plans and your legal rights under the plans, be sure to read the summary plan descriptions or request a copy of the plan documents. All benefits are subject to change from time to time and Mammoth Energy Services, Inc. reserves the right to amend or cancel any benefits described in this booklet, with or without notice. This benefit guide is an outline of the coverages proposed by the carrier(s) based upon the information provided by your company. It does not include all the terms, coverages, exclusions, limitations, and conditions of the actual contract language. See the policies and contracts for actual language. This benefit guide is not a contract and offers no contractual obligation on behalf of GBS. Policy forms for your reference will be made available upon request.

If your plan has out-of-network benefits, the amount the plan pays for covered services provided by non-network providers is based ono a maximum allowable amount for the specific service rendered. Although your plan stipulates an out-of-pocket maximum for out-of-network services, please note the maximum allowed amount for an eligible procedure may not be equal to the amount charged by your out-of-network provider. Your out-of-network provider may bill you for the difference between the amount charged and the maximum allowed amount. This is called balance billing and the amount billed to you can be substantial. The out-of-pocket maximum outlined in your policy will not include amounts in excess of the allowable charge and other non-covered expenses as defined by your plan. The maximum reimbursable amount for non-network providers can be based on a number of schedules such as a percentage of reasonable and customary or a percentage of Medicare. The plan document or carrier’s master policy is the controlling document, and this Benefit Highlight does not include all of the terms, coverage, exclusions, limitations, and conditions of the actual plan language. Contact your claims payer or insurer for more information.

2020 benefits guide - mammoth energy services, inc. · january 1, 2020 through december 31, 2020...

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