uaw local 551 benefits quick reference · accident and sickness benefits to ... 2011entry level...

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5166 Employee Medical FMLA Leave Form NESC / ACS 1-800-248-4444 TESPHE 1-800-248-4444 www.myfordbenefits. com Pay stub online www.at.ford.com A-PLAN 1-800-348-7709 www.axz.ford.com UAW/FORD Legal Services 1-708-868-7520 Unicare Life Insurance 1-800-843-8184 www.Unicare.com/ford Company Paid Optional Life Insurance Unicare Disability Pay 1-877-475-9652 Unicare must be notified within 20 days of your disability for accident and sickness benefits to be paid. To Change your Insurance Provider 1-800-248-4444 0r MyFordbenefits.com To change your HMO Primary care Doctor contact your Insurance Provider New Insurance will take effect on the first day of the second month Following the day in which you make the change of insurance. If you have Blue Cross Blue Shield PPO Insurance Member Inquiries BCBS PPO 1-800-482-5146 Other Important #'s Going to be out of town? Don't caught out of network (for non-emergency) Find an In network doctor http://provider.bcbs.com Need to check the status of your bills or get a new E.O.B.? (Explanation of Benefits) www.bcbs.com DME 1-800-810-2583.. (Durable Medical Equipment) or to find a provider provider.bcbs.com Merck Medco 1-800-778-0735 www.express - scripts.com (Mail order Pharmacy) SVS Vision 1-800-225-3095 www.svsvision.com Blue Cross Blue Shield HMO – Illinois Member inquiries 1-800-892-2803 www.bcbsil.com Questions Regarding prescription benefits 1-800-423-1973 Questions Regarding a placed prescription 1-800-275-7204 Vision Provider Finder w ww.davisvision.com use open enrollment code (4513) or blue advantage vision.com Davis Vision phone 1-877-393-8844 Dental Dental Network of America 1-888-736-7794 www.bcbsm.com/bluedental/ UAW LOCAL 551 Benefits Quick Reference 2011 Health Care Changes for Dependant s Surviving Spouses: Who to call when an employee passes 5166E Employee FMLA Leave Form for Family Member Going on a medical or FMLA leave? There are new reporting procedures that have taken effect. Click below to learn more New Medical Leave Reporting requirements.pdf UAW FORD Legal Services Page 1 of 1 3/23/2014

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Page 1: UAW LOCAL 551 Benefits Quick Reference · accident and sickness benefits to ... 2011Entry Level Contract ... The information in this document is a summary. Always refer to the UAW

5166 Employee

Medical FMLA

Leave Form

NESC / ACS 1-800-248-4444

TESPHE 1-800-248-4444 www.myfordbenefits.

com

Pay stub online www.at.ford.com

A-PLAN 1-800-348-7709 www.axz.ford.com

UAW/FORD Legal Services 1-708-868-7520

Unicare Life Insurance 1-800-843-8184 www.Unicare.com/ford

� Company Paid

� Optional Life Insurance

Unicare Disability Pay 1-877-475-9652

� Unicare must be notified within 20 days of your disability for

accident and sickness benefits to be paid.

To Change your Insurance Provider 1-800-248-4444 0r MyFordbenefits.com

� To change your HMO Primary care Doctor contact your Insurance Provider

� New Insurance will take effect on the first day of the second month Following the day in which you make the change of insurance.

If you have Blue Cross Blue Shield PPO Insurance

Member Inquiries BCBS PPO 1-800-482-5146 Other Important #'s

Going to be out of town? Don't caught out of network (for non-emergency)

Find an In network doctor

http://provider.bcbs.com

Need to check the status of your bills or get a new E.O.B.? (Explanation of Benefits)

www.bcbs.com

DME 1-800-810-2583.. (Durable Medical Equipment) or

to find a provider provider.bcbs.com

Merck Medco 1-800-778-0735 www.express-scripts.com

(Mail order Pharmacy)

SVS Vision 1-800-225-3095 www.svsvision.com

Blue Cross Blue Shield HMO – Illinois � Member inquiries 1-800-892-2803 www.bcbsil.com

� Questions Regarding prescription benefits 1-800-423-1973

� Questions Regarding a placed prescription 1-800-275-7204

Vision Provider Finder www.davisvision.com use open enrollment code (4513) or

blue advantage vision.com

Davis Vision phone 1-877-393-8844

Dental

Dental Network of America 1-888-736-7794 www.bcbsm.com/bluedental/

UAW LOCAL 551

Benefits Quick Reference

2011 Health Care Changes

for Dependants

Surviving Spouses: Who to call

when an employee passes

5166E

Employee

FMLA Leave

Form for

Family Member

Going on a medical or FMLA

leave? There are new

reporting procedures that

have taken effect. Click

below to learn more

New Medical Leave

Reporting

requirements.pdf

UAW FORD Legal Services

Page 1 of 1

3/23/2014

Page 2: UAW LOCAL 551 Benefits Quick Reference · accident and sickness benefits to ... 2011Entry Level Contract ... The information in this document is a summary. Always refer to the UAW

� Insurance Eligibility begins in the 1st day of your 8th

month

call to enroll yourself and dependants By your 6th month

� Tax efficient saving plan (TESPHE) 90 days

www.myfordbenefits.com

National Employee Service Center (NESC) 1-800-248-4444

Member Inquiries BCBS PPO 1-800-482-5146

Find an In network doctor

http://doctor_hospital_finder.bcbs.com USE prefix "FGP" for member search Need to check the status of your bills or get a new E.O.B.? (Explanation of Benefits)

www.bcbs.com

DME 1-800-831-0999 (Durable Medical Equipment) or

www.dmensions.net to find a provider

ESI 1-800-778-0735 www.express-scripts.com (Formerly Medco)

(Mail order Pharmacy) *** Mandatory Mail Order Prescriptions for long term medications after 3 fills at pharmacy, (original script and 2 refills)***

***Please Read*** Helpful Guide for Understanding your Blue Cross Blue

Shield Traditional PPO Insu.

Outpatient Physical therapy Theramatrix. is provided by

Veiw the slide show presentation

View Your BCBS

PPO Coverage

ESI Prescription Mail Order Form ESI Prescription Reimbursement Form

Diabetic supplies Meters, lancets and Test strips Order form

Emergency Benefits Guideline

National Employee service center (NESC)

Tax efficient Savings Plan hourly Employees 1-800-248-4444

www.myfordbenefits.com

Unicare Company paid life insurance 1-800-843-8184

A - Plan Discount vehicle purchase 1-800-348-7709

www.axz.ford.com

Check pay stub on line www.at.ford.com

BCBS Frequently asked Questions

2011Entry Level Contract language changes

To save a copy to your computer for offline

use: right click on Icon then select "save

target as"

View Your Dental Coverage Search for a

dentist Dental_Coverage_SPD_Update

SVS Vision 1-800-225-3095

www.svsvision.com

Page 1 of 1

3/23/2014

Page 3: UAW LOCAL 551 Benefits Quick Reference · accident and sickness benefits to ... 2011Entry Level Contract ... The information in this document is a summary. Always refer to the UAW

Blue Cross Blue Shield Traditional PPO Valid as of 1/01/2014

Blue Cross Blue Shield Traditional PPO has many Carve out programs that must

be used in order for benefits to be paid. Those carve out programs or providers

must be used for certain benefits to be paid. The following is a list of such

programs. Additionally, "PPO" Network means Participating Provider

Organization. Your Doctor and Hospital both need to be a Participating or limited

or no benefit will be paid in some instances.

Durable Medical Equipment (Wheel Chairs, crutches, Oxygen, Therapeutic

equipment, in home hospital beds, insulin pumps, etc.)

Effective 1/1/2014 Dmension will no longer be used call Blue Cross Blue

Shield.

Prescriptions requiring more than three fills (first fill and two refills) must use the

mail order prescription program from Medco. (Includes Insulin, needles &

syringes) ESI Express Scripts (formerly Medco) 1-800-778-0735

www.express-scripts.com

Diabetic supplies: Lancets, test strips & test meter

Call Blue Cross Blue Shield for DME supplier.

Diabetic Insulin Pump supplies: call Dmensions, the support program above

** VISION: SVS Vision 1-800-225-3095

www.singlevisionsolution.com For Expanded Network search

Out Patient Physical Therapy only: www.theramatrix.com 1-888-638-8786

Important "must get Approval First"

### No benefit will be paid if you are out of network###

Mental health/Substance Abuse: Pre Authorization Value Options 1-800-626-1423

**Dental Network: Dental Network of America (DNoA) If you use a Dentist in

the (DNoA) Network, you may have less out of pocket expenses

1-888-736-7794 or www.bcbsm.com/bluedental/

Need to find a Network Hospital, Doctor and additional Plan Information check

our local website @ WWW.UAWLOCAL551.COM Or call 1-800-482-5146

** Entry Level EE's or EE's hired after 9/14/2007 1st of month after 3 years

seniority for dental and eye exams and 5 years for glasses.

Page 4: UAW LOCAL 551 Benefits Quick Reference · accident and sickness benefits to ... 2011Entry Level Contract ... The information in this document is a summary. Always refer to the UAW

Benefit Overview for UAW-Ford “Entry Level” Employees

Page 1 of 9 02/20/14

The information in this document is a summary. Always refer to the UAW-Ford Collective Bargaining Agreement (CBA) and your employee benefits

handbook for details regarding the plans.

Benefit Summary for Entry Level Employees Eligibility

Effective Date Enrollment

TESPHE (401k Plan): Company Contributions Consist of both Retirement Contributions and Supplemental Contributions

Ford will make an automatic Retirement Contribution to your Tax-Efficient Savings Plan for Hourly Employees (TESPHE) account, based on your Ford Service Date (FSD) as described below:

FSD between November 19, 2007, and October 23, 2011: 6.4%

FSD on or after October 24, 2011: 4.0% The specific contribution rate will be applied to the straight-time portion of base hourly wages received, not to exceed 40* hours per pay period.

Date of hire Enrollment materials will be sent to you by the National Employee Services Center (NESC); you may also view your account on myfordbenefits.com If this is your first time logging in to myfordbenefits.com, please note:

Your User ID has been set to your Social Security Number

Your PIN has been set to your date of birth in MMDDYY format (e.g., if your date of birth is March 1, 1967, your PIN is ‘030167’)

You will be prompted to change your User ID after you have logged in

You will be prompted to enter security questions/answers and an email address to make it easier to reset your PIN or receive a User ID reminder if you ever forget it

The Company also will contribute Supplemental Contributions ($1 per compensated hour), capped at 40* hours per pay period, to your TESPHE account in lieu of post-employment healthcare.

*Company Contributions: Employees on a “qualified” Alternative Work Schedule (AWS) and who work less than 40 hours will be treated as having worked 40 hours if they work the minimum number of required straight-time hours for the respective AWS. Otherwise, Company Contributions are calculated on actual straight-time hours worked, up to a maximum of 40 hours per pay period.

90 days from date of hire

You also may contribute up to 50% of your pay either pre-tax, Roth and/or post-tax.

Be sure to read the “Your Guide to the Tax-Efficient Savings Plan for Hourly

Employees (TESPHE)” and the TESPHE Summary Plan Document available online

at myfordbenefits.com. These booklets also are included in the enrollment kit

mailed to your address of record.

90 days from date of hire

Vesting means you own the assets in your TESPHE account. You are always vested in the contributions deducted from your pay check and any related earnings. You are vested in Company contributions (Retirement and Supplemental Contributions) and any related earnings three years from your original hire date with Ford Motor Company.

100% vested in employee contributions; vested in Company Contributions 3 years from original hire date

NOTE: Entry Level employees hired or rehired between November 19, 2007, and October 23, 2011, received a benefit under the Personal Retirement Plan (PRP). The PRP was terminated effective June 30, 2012, and assets were distributed.

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Benefit Overview for UAW-Ford “Entry Level” Employees

Page 2 of 9 02/20/14

Benefit Summary for Entry Level Employees Eligibility

Effective Date Enrollment

Life Insurance

Basic Life Insurance (BLI) is payable in the event of your death or if you become terminally ill. Accidental Death & Dismemberment (AD&D) is payable if you die as a result of an accident. A benefit is also available to you, if you suffer a covered dismemberment. Benefit available includes:

Active Employees: o BLI = $45,000 o AD&D = $22,500

Post-Employment (if you are at least age 55 with 10 years of service at termination): o BLI = $15,000 o AD&D = $7,500

Not eligible for Survivor Income Benefit or Safety Belt User Benefit.

This a summary only, all other benefit plan provisions described in the Group Life and Disability Insurance section of the Collective Bargaining Agreement (CBA) apply.

Date of hire or rehire Automatic UniCare Life Insurance Company is the insurer of the benefits. To designate a beneficiary, please call UniCare at 1-800-843-8184

Optional Life Insurance – Voluntary

You may elect to supplement your Company-provided life insurance benefits by enrolling in an optional (voluntary) life insurance program. UniCare Life Insurance Company is the insurer of the benefits. Benefits available are:

Optional Life – up to $500,000* in coverage is available for you

Dependent Life – up to $150,000/$60,000 in coverage is available for your Spouse/Same Sex Domestic Partner and child(ren)

Optional Accident – up to $500,000: If family coverage is elected: o Spouse/SSDP covered at 50% of coverage amount elected o Children covered at 10% of coverage amount elected

*A Statement of Health is not required, up to $200,000, if you enroll within 31 days of the eligibility effective date.

First of the month following date of hire or rehire

Enroll within 31 days of eligibility effective date*. An annual enrollment period occurs each year and you will be notified via a mailing from UniCare. For more information, to enroll or to designate a beneficiary, please call UniCare at: 1-800-843-8184 or Contact your local UAW Benefit Representative

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Page 6: UAW LOCAL 551 Benefits Quick Reference · accident and sickness benefits to ... 2011Entry Level Contract ... The information in this document is a summary. Always refer to the UAW

Benefit Overview for UAW-Ford “Entry Level” Employees

Page 3 of 9 02/20/14

Benefit Summary for Entry Level Employees Eligibility

Effective Date Enrollment

Ford Hourly Profit Sharing Plan

Profit Sharing is calculated through a formula based upon Ford's North American pre-tax profits. Individual payments are based upon the number of compensated hours worked. Employees are subject to the eligibility and payment provisions of the Ford hourly Profit Sharing Plan Agreement.

Employees who have compensated hours in the plan year

Automatic

Vehicle Plans

Employee Vehicle Voucher Program – A one-time $500 discount toward the purchase of a new Ford or Lincoln vehicle. It is good for a new vehicle purchase for one full year from the date hired as Entry Level.

A Plan – This vehicle discount purchase program covers purchases and leases on most new company vehicles. Employees are allowed a maximum of four A Plan discounts per calendar year.

X Plan – This vehicle discount purchase program is designed to introduce company products to potential customers who are considering the purchase of competitive products. Ford employees may sponsor up to four X Plan purchases per calendar year.

Automatically eligible on date of hire (takes approximately 30 days to be recognized in AXZ system)

Voucher Program: Letter mailed to you explaining how to use it.

Go to www.axz.ford.com and register to use the website. You may also generate a PIN or ask plan questions by calling the AXZ Headquarters at 1-800-348-7709, 8 a.m. to 8 p.m. EST, Monday through Friday

Sterling Auto & Homeowners Insurance Program – Voluntary Program

This voluntary program provides a wide selection of individual insurance coverage options. With one call, you have access to multiple carriers (MetLife, Travelers, Hanover/Citizens, Progressive, Auto Owners and many more) for exclusive group savings on a voluntary auto and home program that provides you with access to insurance coverage for your personal insurance needs.

Date of hire To ask questions, receive quotes, and/or apply for policies, call the Sterling Auto & Home Insurance program at 1-888-525-7575 8 a.m. to 5 p.m. EST, Monday through Friday

Tuition Assistance Program

Eligible for an annual allotment of $5,000 in education benefits. Of the $5,000, all may be used toward a degree from approved schools, and up to $2,200 of the $5,000 may be used for eligible Personal Development Assistance (PDA) classes.

90 days as a full-time Entry Level employee

To find out more about UAW-Ford education benefits, visit www.myuawford.com or call: 1-800-367-3829

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LTS not eligible unless mutual agreement per the letter of understanding.
Page 7: UAW LOCAL 551 Benefits Quick Reference · accident and sickness benefits to ... 2011Entry Level Contract ... The information in this document is a summary. Always refer to the UAW

Benefit Overview for UAW-Ford “Entry Level” Employees

Page 4 of 9 02/20/14

Benefit Summary for Entry Level Employees Eligibility

Effective Date Enrollment

Legal Services (ends December 31, 2013)

Provides personal legal services to participants, through the UAW-Ford Legal Services Plan. Any application received by December 31, 2013, shall be processed to the conclusion of the matter.

90 days of seniority (Legal Services Plan ended 12/31/13)

UAW-Ford Legal Services Plan at 1-800-482-7700

Medical/Prescription Drug Coverage

The National Preferred Provider Organization (National PPO) medical plan is provided at no monthly premium. You will be automatically enrolled when you become eligible and will receive a Summary of Benefits Coverage from the National Employee Services Center (NESC) at that time. You will also receive an ID card from Blue Cross Blue Shield of Michigan. Summary:

Office visit co-pay: $20 for in-network

Emergency Room visits: No co-pay, annual deductible and co-insurance may apply

Urgent Care billed by hospital-based center as a medical emergency: No co-pay, annual deductible and co-insurance may apply

Urgent Care billed by freestanding Urgent Care center: $20 office visit, and co-pay may apply

Urgent Care billed by hospital-based center, not a medical emergency: Not covered

Express Scripts/Medco will send a Welcome Kit and letter outlining pharmacy drug benefits. Express Script/Medco’s name and information is on the BCBSM ID card

Retail and Mail Order Drug co-pays: Generic: $7.50/prescription, Brand Name: $15/prescription

Eligible for Durable Medical Equipment, Prosthetics and Orthotics

Eligible for Outpatient Physical Therapy through TheraMatrix NOTE: Not eligible for retirement/survivorship health care COBRA (Consolidated Omnibus Budget Reconciliation Act) may be available at termination.

Beginning January 1, 2014, eligibility begins on the 90th day following your date of hire

Upon reaching eligibility requirements, enrollment is automatic. You will receive information from the National Employee Services Center (NESC) at that time

Page 8: UAW LOCAL 551 Benefits Quick Reference · accident and sickness benefits to ... 2011Entry Level Contract ... The information in this document is a summary. Always refer to the UAW

Benefit Overview for UAW-Ford “Entry Level” Employees

Page 5 of 9 02/20/14

Benefit Summary for Entry Level Employees Eligibility

Effective Date Enrollment

Health Reimbursement Arrangement (HRA)

Employees enrolled in the National PPO are also eligible for annual Company-provided credits to a Health Reimbursement Arrangement (HRA) in the amount of:

$300 for an employee with individual health care coverage

$600 for an employee with one or more dependents The HRA is used for reimbursement of eligible health care expenses (including deductibles and co-pays). An employee can either use the HRA debit card to pay up front for eligible expenses, or submit a claim form for eligible expenses already incurred. The full amount is deposited regardless of the initial effective date. Unused HRA amounts at the end of each calendar year will be forfeited, and a new $300 or $600 will be available at the beginning of the following year (as long as the employee remains enrolled in Company health care). The debit card can be used for all eligible expenses. The IRS establishes what is considered an eligible expense. Once you become eligible for the HRA, you can access information about the HRA and eligible expenses at myfordbenefits.com. Click on “Drive Health” and then select “DCAP/HRA” to access the list. The Welcome Kit from WageWorks will contain information about how to submit claims for services. Participants have until March 31 of the following year to submit expenses for services rendered during the prior plan year. Claims that are submitted after that time for a prior year cannot be reimbursed.

Beginning January 1, 2014, eligibility begins on the 90th day following your date of hire You become eligible for the HRA at the time you first become eligible for medical coverage

Once an employee is eligible, the NESC will establish the HRA for the employee automatically with WageWorks and the account will be funded fully

DCAP (Dependent Care Assistance Plan)

You can designate a specified amount, up to $5,000 ($2,500 for a married person filing separately) of your annual pay, on a pre-tax basis, to go into a DCAP account for reimbursement of eligible child care or elder care expenses. Eligible expenses are as defined under IRS code Section 129. There is an annual enrollment period each November, with your DCAP elections being effective as of the following January 1. DCAP elections you make will automatically be taken through payroll deduction and sent to WageWorks, the DCAP Plan Administrator.

Beginning January 1, 2014, eligibility begins on the 90th day following your date of hire

There is an annual enrollment period each November with DCAP effective as of the following January 1 Contact the NESC in November of each year to enroll, at

1-800-248-4444

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Page 9: UAW LOCAL 551 Benefits Quick Reference · accident and sickness benefits to ... 2011Entry Level Contract ... The information in this document is a summary. Always refer to the UAW

Benefit Overview for UAW-Ford “Entry Level” Employees

Page 6 of 9 02/20/14

Benefit Summary for Entry Level Employees Eligibility

Effective Date Enrollment

Disability Benefits: If you are disabled and otherwise eligible, you may qualify for disability benefits. Disability benefits are provided at no cost to you by the Company. You are not eligible for these benefits until the day after one* year of seniority as an Entry Level Employee (see further clarification and example below). Even if you are not eligible, you are required to initiate a medical leave of absence with UniCare if you are absent for more than three days for a medical reason. You must report your medical leave of absence within five days of your last day worked.

Accident & Sickness (A&S) duration:

0 – 1 year* = 0 weeks

1 year of seniority, but less than 3 years = 26 weeks of benefits

3 years or more of seniority = 52 weeks of benefits Extended Disability Benefits (EDB) duration:

0 – 1 year = 0 weeks

1 year of seniority but less than 3 years = 13 weeks of benefits

3 years of seniority but less than 5 years = 26 weeks of benefits

5 years of seniority but less than 10 years = benefits duration equal to seniority

10 years or more years seniority = maximum 10 years or to age 65, whichever comes first

All other benefit plan provisions described in the Group Life and Disability Insurance section of the CBA apply.

*Please review the following scenarios to ensure your understanding of the Disability Insurance Program eligibility.

Scenario 1: An employee has reached one year of seniority on 8/14, works on 8/15, and becomes disabled on 8/16. The employee will be eligible for Disability Benefits due to working the day after he/she acquired 1 year of seniority.

Scenario 2: An employee has reached one year of seniority as of 8/14, becomes disabled on 8/15, and does not work on 8/15. The employee’s claim will be denied and he/she will not receive any Disability Benefits because he/she was not available to work the day after their one year of seniority.

The day after one year of seniority as an Entry Level Employee NOTE: If accident or sickness prevents you from working the day coverage would take effective, coverage will not be available until you return to work

UniCare Life Insurance Company is the administrator for these benefits. To file a disability claim, you must call UniCare within five (5) days of the last day worked at 1-877-HRLY-MLA For claim questions, call 1-800-572-1581

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Page 10: UAW LOCAL 551 Benefits Quick Reference · accident and sickness benefits to ... 2011Entry Level Contract ... The information in this document is a summary. Always refer to the UAW

Benefit Overview for UAW-Ford “Entry Level” Employees

Page 7 of 9 02/20/14

Benefit Summary for Entry Level Employees Eligibility

Effective Date Enrollment

Disability Benefits (Continued)

Scenario 3: An employee has reached one year of seniority as of 8/14, their Regularly Scheduled Days Off (RDO’s) are 8/15 to 8/17, and the employee becomes disabled on 8/16. The employee will be eligible for Disability Benefits because he/she was available to work.

Scenario 4: An employee has reached one year of seniority as of 8/14. Their RDO’s are 8/15 to 8/17, and the employee becomes disabled on 8/15. The employee will be denied for Disability Benefits because he/she was not available to work.

If you have further questions, contact your UAW Benefits Representative (UBR).

Supplemental Unemployment Benefit (SUB)

If you are on a qualifying layoff from the Company and otherwise eligible, you may be eligible for SUB in addition to unemployment benefits. SUB is provided at no cost to you by the Company. Duration of SUB benefits:

1 year of seniority, but less than 3 years = 13 weeks SUB

3 or more years of seniority = 26 weeks SUB

NOTE: Not eligible for Transition Assistance Program (TAP). All other provisions described in the Supplemental Unemployment Benefit Agreement and Plan section of the CBA apply.

One year of seniority as of your last day of work prior to a qualifying layoff

Automatic Please see your Hourly Personnel Administrator for more information

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Page 11: UAW LOCAL 551 Benefits Quick Reference · accident and sickness benefits to ... 2011Entry Level Contract ... The information in this document is a summary. Always refer to the UAW

Benefit Overview for UAW-Ford “Entry Level” Employees

Page 8 of 9 02/20/14

Benefit Summary for Entry Level Employees Eligibility

Effective Date Enrollment

Vision

Part 1: Eligible for annual eye exams (once every twelve (12) months) through SVS Vision Optical Services. In addition to the annual vision test examination, when services are provided by a Network Provider, you and your eligible dependents will receive the group discount rate for lenses and frames. -------------------------------------------------------------------------------------------------------------- Part 2: Eligible for full Vision benefits through SVS. In addition to the annual vision testing examination (once every twelve (12) months), when services are provided by a Network Provider, you and your eligible dependents will receive full coverage for:

Regular lenses, certain tints and scratch resistant coating for those age 13 and under once every twenty-four (24) months

Photochromic/transition lenses

Standard frames ($40 for designer frames) once every twenty-four (24) months

A benefit is available for contact lenses (instead of eyeglasses):once every twenty-four (24) months as follows: o Non-medically necessary contact lenses: $75 plus a $40 professional

fitting and follow-up fees o Medically necessary contact lenses up to $350

On the 1st day of the month following the month in which the employee acquires three (3) years of seniority ------------------------------ On the 1st day of the month following the month in which the employee acquires five (5) years of seniority

Enrollment is automatic for both parts/levels of benefits. Once eligible, you may contact SVS Vision at 1-800-225-3095

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From date of conversion from LTS Entry Level.
Page 12: UAW LOCAL 551 Benefits Quick Reference · accident and sickness benefits to ... 2011Entry Level Contract ... The information in this document is a summary. Always refer to the UAW

Benefit Overview for UAW-Ford “Entry Level” Employees

Page 9 of 9 02/20/14

Benefit Summary for Entry Level Employees Eligibility

Effective Date Enrollment

Dental – BCBS Enhanced Traditional Dental Plan

The Traditional Dental Plan is offered through Blue Cross Blue Shield and is provided at no monthly premium. If you are enrolled in medical at the time of eligibility, you will be enrolled at the same level (e.g., you + one). If you are not enrolled in medical at the time of eligibility, you will be enrolled in dental plan at the employee-only level. The Enhanced Traditional Dental Plan offers a nationwide dental provider network through an agreement between Blue Cross Blue Shield and Dental Network of America (DNoA). When you receive services from a DNoA provider, your out-of pocket expenses will be lower than those incurred if services were received from a non-DNoA provider. Traditional Dental benefits cover most dental services. Benefits are paid at 100%, 90% or 50% of the covered expense depending on the service you receive. The annual maximum dental benefit payable in a calendar year is $1,850 for each individual. There is a lifetime maximum of $2,200 for orthodontia for each covered person under age 19. Most orthodontic services are covered at 50%.

On the 1st day of the month following the month in which the employee acquires 3 years of seniority

Enrollment is automatic. You will receive an ID card at your address of record, once eligible

This overview contains an explanation of your employee benefits based on the documents, policies and negotiated Agreements by which these benefits are provided. If there is any difference between the Plan texts, negotiated

Agreements and this overview , the Plan texts and negotiated Agreements always will govern. The Company reserves the right to end, suspend or amend these plans, subject to the applicable Collective Bargaining Agreement.

Amendments also will be made to comply with applicable statutes and regulations. If changes are made, you will be notified. In certain cases, employees may be eligible for some – but not all – benefits in this summary. If someone

receives this overview in error, it does not make them eligible for benefits.

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Page 13: UAW LOCAL 551 Benefits Quick Reference · accident and sickness benefits to ... 2011Entry Level Contract ... The information in this document is a summary. Always refer to the UAW

Looking for information about your Ford benefits?

Visit myfordbenefits.com!

Here’s what you can do at myfordbenefits.com.

*Available if you are eligible for annual enrollment or life event changes

Using myfordbenefits.com for the first time?

You’ll have access to myfordbenefits.com approximately two weeks after your hire date. Log in from home or your smart

phone (but NOT from a plant kiosk) using one of the following options.

View all of your current benefits

Enroll in or change your health plan coverage*

Use handy calculators and tools

View and print Summary Plan Descriptions

View and update your profile and personal information

Ask benefit questions using the real-time “chat” feature

View documents, forms and helpful links while researching your benefits information

Select, change or review your retirement savings plan contribution rates, beneficiaries, investment options, and investment performance

Manage your communication preferences

By logging in directly

Visit myfordbenefits.com

Enter your initial User ID: your Social Security Number

Enter your initial PIN: your date of birth in MMDDYY format (if your date of birth is March 1, 1967, your PIN would be 030167)

You will be asked to change both your User ID and PIN the first time you log in

Via Paystub Online

Visit hronline.ford.com and enter your Ford CDSID and Ford password

In the Compensation section, select Paystub Online

Click on the myfordbenefits.com banner message in the top right corner of the page

Forget your User ID or PIN? You can request a reminder via email or regular mail

by visiting myfordbenefits.com and clicking on “Forgot Your User ID?” or “Forgot your PIN?”

If you forgot both, click “Forgot your User ID” first

Forget your Ford CDSID or password? If you have forgotten your CDSID or password, or need to have your

password reset, contact the Ford Help Desk at 1-888-317-4957

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