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Employee Benefits Guide for Plan Year: January 1, 2018 - December 31, 2018
X-FAB takes great pride in offering an excellent selection of benefits to
all full-time employees. This guide provides quick access to information
about your employee benefit program, which is an important part
of your total compensation package. Please take a few moments to
familiarize yourself with the benefit programs available to you as part
of the X-FAB family.
Eligibility & Enrollment Guidelines 3
Payroll & Deduction Options 3
www.myXFABbenefits.com 3
Medical Plans 4
X-FAB + 5
Connect your Care Flexible Spending Account 6
Teladoc 7
Dental Plans 8
Vision Plans 9
Basic Term Life and AD&D 10
Voluntary Term Life and AD&D 10
Short & Long Term Disability 11
Cancer & Rare Disease Insurance 11
Legal Shield 12
401(k) 13
X-FAB Wellness | NEST 13
Common Terms 14
Contacts 15
Carrier Contacts 15
What’s Inside
DISCLAIMER: The information in this Enrollment Guide is intended for illustrative and informational purposes only. The information contained herein
was taken from various summary plan descriptions, certificates of coverage and benefit information. Every effort was taken to accurately report
your benefits however discrepancies and errors are always possible. It is not intended to alter or expand rights or liabilities set forth in the official
plan documents or contracts. It is not an offer to contract nor are there any express or implied guarantees. In case of a discrepancy between this
information and the actual plan documents, the actual plan documents will prevail. If you have any questions about this summary, please contact
Human Resources. © 2018 iaCONSULTING, a Marsh& McLennan Agency. All Rights Reserved.
3
Eligibility & Enrollment Guidelines
Employees are eligible on the first date of hire. If you choose not to enroll during initial eligibility, the employee must wait to enroll during the next Open Enrollment, unless there is a qualifying event.
Open enrollment takes place in November and it is the one opportunity during the year to make changes to benefit elections. Qualifying events allow an employee to make coverage election changes within 30 days of the event. These include:
◗ Marriage
◗ Divorce
◗ Court Order
◗ Birth or adoption of a child
◗ Loss of a dependent
◗ Loss of other coverage
◗ Significant change in employee’s or spouse’s employment status
The benefit elections you make during open enrollment will be effective January 1, 2018 - December 31, 2018.
Payroll & Deduction Options
Access employee self-service, review your benefits, check your latest pay stub and more with Paycom’s mobile application or online at paycomonline.com.
X-FAB has a Section 125 Cafeteria Plan. Participation allows you to pay for health, dental and vision premiums on a pre-tax basis. Employees enrolled in these benefit plans are automatically enrolled in the Cafeteria plan. Employees can opt out in writing to Human Resources prior to the start of coverage each plan year.
www.myXFABbenefits.com
Visit your Employee Benefit Center (EBC) to access your benefit information and relevant documents such as:
◗ Benefit Summaries
◗ Plan Documents
◗ Claim Forms
◗ Contact Information
Password: Lubbock1
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Medical Plans
Your medical plans are administered by BlueCross BlueShield of Texas.
IN-NETWORK BENEFITS
CopaysPrimary Care Physician 20% coinsurance, after deductible
Specialist 20% coinsurance, after deductible
Urgent Care 20% coinsurance, after deductible
Prescription Drugs
Tier 15% coinsurance, for generics filled at WalMart or
Sam’s Club 25% coinsurance, if filled elsewhere
Tier 2 40% coinsurance
Tier 3 50% coinsurance
Calendar Year DeductibleIndividual $500
Family $1,000
Out of Pocket Limit (Includes Deductible)Individual $3,000
Family $6,000
Member CoinsurancePreventive Care Covered at 100%
Lab and X-ray 20% coinsurance, after deductible
Diagnostic Imaging (MRI, Pet Scans, CT Scans, etc.) 20% coinsurance, after deductible
Hospital Services 20% coinsurance, after deductible
Emergency Services 20% coinsurance, after deductible
Per Pay Period Employee Contributions Effective 1/1/2018Wellness Status No Wellness With Wellness*Employee Only $21.88 $12.50
Employee + Children $85.63 $48.93Employee + Spouse $123.78 $70.73Employee + Family $187.53 $107.16
Covered Member Tobacco Use Fee $15.00 per user covered by the medical plan
*Requires Completion of HRA
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X-FAB +
X-FAB has partnered with Physician Network Services (PNS) to give you access to a special discount on medical services provided at UMC PNS clinics. X-FAB employees and dependents that are covered on the medical plan will have a $5 copay per visit at the following locations:
Amigos United Express Clinic | N. University 112 N University | 9 am - 6 pm
United Express Clinic | 130th & Indiana 12815 Indiana | 9 am - 6 pm
United Express Clinic | 50th & Q 1701 50th | 9 am - 7 pm
United Express Clinic | 82nd & Boston 2703 82nd | 9 am - 7 pm
Express Care Clinic | South Plains Mall 6002 Slide Road | 9 am - 8 pm
Services available at PNS Express Care Clinics ◗ Ordinary and routine office visits
◗ Chronic illness evaluation
◗ Diagnosis of diabetes and referral to PCP for treatment
◗ High cholesterol
◗ Asthma
◗ Acute conditions – sore throats, ear, headache, fever, body aches
◗ Allergies, cough, sinus
◗ Rashes
◗ Stomach aches
◗ Strains, sprains, musculoskeletal problems
Laboratory services including:
◗ Urine pregnancy tests – included in visit fee
◗ Glucose Test (finger stick) – included in visit fee
◗ Urine Analysis – included in visit fee
◗ Bloodwork (South Plains Mall location only) – charged separately at standard rates
Services NOT available at PNS Express Care Clinics ◗ Preventive Care
◗ Well Checks
◗ Radiology
◗ Wellness Screenings
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Connect your Care Flexible Spending Account
What is a Flexible Spending Account?
A Flexible Spending Account (FSA) allows you to use pre-tax dollars to pay for qualified health or dependent day care expenses.
There are hundreds of eligible expenses for your FSA funds, including prescriptions, doctor office copays, health insurance deductibles and coinsurance for you, your spouse or eligible dependents, and much more.
1. Health FSA
You may contribute up to $2,600 a year to your Health FSA.
2. Dependent Care FSA
You may contribute up to $5,000 a year, or up to $2,550 a year if married and filing separately, to the Dependent Care FSA.
24/7 Online/Mobile Access & Support
CYC Mobile, our secure mobile app, saves you time by delivering important account information on the go. Download it today!
◗ View account balances & payments
◗ Request a payment
◗ View FAQs or tap to call Customer Service
◗ Receive important account alerts
◗ Cut the time needed to submit a receipt - take a photo of your receipt and upload it directly to the system
◗ Available for Android, iOS & Windows devices
ConnectYourCare.com | 877-292-4040
Enjoy savings that really add up.
You can also access your account details online at ConnectYourCare.com.
Save time with CYC Mobile.
Because FSA contributions are set aside before taxes are taken from your paycheck, the amount of income you pay taxes on is reduced and you save money.
A typical FSA participant can save $490* a year!
How it works: Assume “Samantha” earns $35,000 a year and has $1,500 in eligible expenses.
With FSA
No FSA
Annual pay $35,000 $35,000
Pre-tax FSA contribution –$1,500 –$0
Taxable income =$33,500 =$35,000
Federal income and Social Security taxes
–$7,362 –$7,852
After-tax dollars spent on eligible expenses
–$0 –$1,500
Spendable income =$26,138 =$25,648
Samantha’s Tax Savings with FSA
$490 $0
CYC Mobile, our secure mobile app, saves you time by delivering important account information on the go. Download it today!
• View account balances & payments
• Request a payment
• View FAQs or tap to call Customer Service
• Receive important account alerts
• Cut the time needed to submit a receipt - take a photo of your receipt and upload it directly to the system
• Available for Android, iOS & Windows devices
“I absolutely LOVE the mobile app!
Being able to take a picture of my
receipt from my smartphone & upload
it with my claim is very efficient!”
- Jennifer, FSA Participant *Sample tax savings for a single taxpayer with no dependents; actual savings will vary based on your individual tax situation. Consult a tax professional for more information.
The average FSA participant saves
hundreds annually!
Learn more about FSA tax savings with a short video. Use the QR code or visit ConnectYourCare.com/FSAsavings
...because you don’t have money to throw away.
FSAs are the smart choice...
Flexible Spending Accounts
Enroll in an FSA Save on health and dependent day care!
0914
With your consent, Teladoc is happy to provide information about your Teladoc consult to your primary care physician.
STEP 1 SET UP YOUR
ACCOUNT
We've made it quick and easy to set up your account online. Simply visit the website and
click "Set up account".
STEP 2UPDATE YOUR
MEDICAL HISTORY
Make sure the "My Medical History" tab is updated so the
doctor has the information needed to provide an accurate diagnosis.
STEP 3 REQUEST A CONSULT
10E-141A
Facebook.com/Teladoc Teladoc.com/mobile
© 2016 Teladoc, Inc. All rights reserved. Teladoc and the Teladoc logo are trademarks of Teladoc, Inc. and may not be used without written permission. Teladoc does not replace the primary care physician. Teladoc does not guarantee that a prescription will be written. Teladoc operates subject to state regulation and may not be available in certain states. Teladoc does not prescribe DEA controlled substances, non-therapeutic drugs and certain other drugs which may be harmful because of their potential for abuse. Teladoc physicians reserve the right to deny care for potential misuse of services. © 2016 Teladoc, Inc. Todos los derechos reservados. Teladoc y el logotipo de Teladoc son marcas de Teladoc, Inc. y no pueden ser utilizados sin permiso por escrito. Teladoc no sustituye al médico de atención primaria. Teladoc no garantiza que una receta se escribe. Teladoc opera sujeta a la regulación estatal y pueden no estar disponibles en ciertos estados. Teladoc no prescribir sustancias controladas DEA, las drogas no terapéuticas y algunos otros medicamentos que pueden ser perjudiciales debido a su potencial de abuso. Médicos Teladoc reservamos el derecho de negar la atención por el mal uso potencial de los servicios.
Teladoc doctors are available when you need
care now. Request a consult anytime online or by phone.
Teladoc® gives you 24/7/365 access to U.S. board-certif ed doctors throughi phone or video consults. It does not replace your primary care physician but is an affordable option for quality care.
Teladoc
X-FAB offers Teladoc services to all employees enrolled in the medical plan. Teladoc gives you access to a doctor through the convenience of phone 24 hours a day, 7 days a week, 365 days a year, at no cost to you!
Use company code: xft1101
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Dental Plans
Your dental plans are administered by BlueCross BlueShield of Texas.
Dental Plan Highlights
Receive two routine cleanings/year at no cost when visiting network providers.
You may choose any dentist. However, if you elect to see an out-of-network provider, you may be balance billed for anything over the usual and customary amount allowed by BlueCross. Find in-network dentists at www.bcbstx.com.
BCBSTX DENTAL PLANCalendar Year Deductible Individual $50 | Family $150
Preventive Care (i.e. cleanings)
100%, Deductible waived
Basic Care (e.g. fillings)
80%, After deductible
Major Care (e.g. crowns, inlays/onlays)
50%, After deductible
Orthodontia (children only)
50%, Deductible Waived
Annual Maximum Benefit $3,000 per covered person
Orthodontia Lifetime Maximum Benefits $3,000 per child under 19 years old
Per Pay Period Employee Contributions
Employee Only $13.00
Employee + Children $43.55
Employee + Spouse $41.55
Employee + Family $45.64
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SUPERIOR VISION IN-NETWORK OUT-OF-NETWORKAnnual deductibles
Eye Exam $10 $10
Materials $25 $25
LensesSingle Vision Covered at 100% Up to $25 retail
Bifocal Covered at 100% Up to $40 retail
Trifocal Covered at 100% Up to $45 retail
Lenticular Covered at 100% Up to $80 retail
FramesFrames Up to $150 Up to $70 retail
Contact Lenses (in lieu of Glasses)Exam and fitting Included in allowance Up to $80 retail
Medically Necessary Covered at 100% Up to $150 retail
Elective Up to $150
FrequenciesExams Once every 12 months
Once every 12 months
Once every 12 months
Lenses
Frames
Per Pay Period Employee Contributions
Employee Only $7.41$18.52Employee + Family
Vision Plans
Your vision plan is administered by Superior Vision.
Vision Plan Highlights
Locate an in-network vision provider at www.superiorvision.com or call 800-507-3800. If you use an out-of-network provider the benefits will be reduced and you will be required to submit a reimbursement to Superior Vision along with the receipt for your related expenses.
10
Basic Term Life and AD&D
Your Basic Term Life and Accidental Death & Dismemberment coverage is through Unum. All Active Full-Time Employees are Eligible for the following benefits, at no cost:
Voluntary Term Life and AD&D
Your Term Life Insurance coverage is through Unum. All active Full-Time Employees are Eligible for the following benefits
Please be sure you have a current beneficiary form on file!
UNUM AMOUNTLife Benefit $30,000
AD&D Benefit $30,000
Accelerated Death Benefit 50% of benefit amount
Age Reduction Schedule: 65 Benefits reduce to 65%
70 Benefits reduce to 50%
UNUM EMPLOYEE SPOUSE* CHILD/REN
Benefit Amount 5x Annual Earning, Maximum of $500,000
50% of EE Amount, Maximum of $250,000
50% of EE Amount, Maximum of $10,000
Increments $10,000 $5,000 $2,000
Guarantee Issue $150,000** $25,000** $10,000**
Accelerated 50% of benefit amount up applicable maximums n/a
*Spouse benefit not to exceed 50% of employee’s coverage
Age Reduction Schedule: 70 Benefits reduce to 65% n/a
75 Benefits reduce to 50% n/a
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Short & Long Term Disability
Your short and long term disability coverage is provided through Unum, and is paid for by X-FAB. All Active Full-Time Employees are Eligible for the following benefits, at no cost:
UNUM SHORT TERM DISABILITY LONG TERM DISABILITY
Benefit Amount 60% of Weekly Earnings 60% of Monthly Earnings
Maximum Benefit $1,200/week $6,000/month
Elimination Period 14 Days Injury or Illness 90 Days Injury or Illness
Benefit Duration 11 weeks To age 65
Please see carrier plan documents for additional details, limitations, and exclusions.
Cancer & Rare Disease Insurance
Your cancer & rare disease insurance is provided through Allstate. Group Cancer Insurance supplements existing coverage and can help provide cash to cover medical and living expenses.
Group Voluntary Cancer coverage from Allstate Benefits pays cash benefits for cancer and 29 specified diseases to help with the costs of treatments and expenses as they happen.
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Legal Shield
HAVE YOU EVER?
This is a general overview and is for illustrative purposes only. Plans
and services vary from state to state. See a plan contract for your state of
residence for complete terms, coverage, amounts, conditions and exclusions.
WHAT IS LEGALSHIELD? LegalShield was founded in 1972, with the mission to make equal justice under law a reality for all North Americans. The 3.5 million individuals enrolled as LegalShield members throughout the United States and Canada can talk to a lawyer on any personal legal matter, no matter how trivial or traumatic, all without worrying about high hourly costs. LegalShield has provided identity theft protection since 2003 with Kroll Advisory Solutions, the world’s leading company in ID Theft consulting and restoration. We have safeguarded over 1 million members, provided more than 200,000 identity consultations, and helped restore nearly 10,000 individual identities.
¨ Needed your Will prepared or updated
¨ Been overcharged for a repair or paid an unfair bill
¨ Had trouble with a warranty or defective product
¨ Signed a contract
¨ Received a moving traffic violation
¨ Had concerns regarding child support
¨ Worried about being a victim of Identity theft
¨ Been concerned about your child’s identity
¨ Lost your wallet
¨ Worried about entering personal information on-line
¨ Feared the security of your medical information
¨ Been pursued by a collection agency
LegalShield
IDShield
Combined
Payroll Deduction Monthly
For more information, please call your independent associate:
$18.95
$18.95
$33.90
$16.95
$8.95
$25.90
Individual Family
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401(k)
The X-FAB 401(k) Plan allows you to save for retirement with either pre-tax or post-tax dollars. You may choose between a traditional 401(k) or a Roth 401(k). (Roth 401(k) deferrals are made post-tax.)
Eligibility
You are eligible to enroll in the 401(k) if you are at least 18 years old and have completed 3 months of continuous service.
Enrollment
As a new hire, you will be automatically enrolled in the 401(k) plan at the beginning of the quarter following 3 months of continuous employment. This contribution will be 5% of your compensation per pay period, unless you opt out of participation in the plan, and this amount will increase by 1% each year up to 10%.
You will have the opportunity to make changes to your contribution amounts, or opt out of participation at the beginning of any quarter as follows:
◗ January 1
◗ April 1
◗ July 1
◗ October 1
Employer Contributions
X-FAB will match 100% of the first 3% and 50% of the next 2% of your contributions. X-FAB’s matching contributions are NOT subject to the vesting schedule and are 100% vested.
For complete plan details, visit your EBC or refer to your plan documents.
X-FAB Wellness | NEST
We are excited to continue to partner with iaWellness to bring you a best in class wellness program! Some of the features include:
◗ Interactive points system to achieve your insurance premium incentive
◗ Team & individual challenges
◗ Education opportunities
◗ Free health coaching with Registered Nurses, Registered Dietitians, and Certified Personal Trainers
800-343-3548 | netbenefits.com
Visit the NEST website for more information! xfabwellness.com | password: XFABNEST
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Common Terms
Allowed Amount: Maximum amount on which payment is based for covered health care services. This may be called “eligible expense,” “payment allowance” or “negotiated rate.” If your provider charges more than the allowed amount, you may have to pay the difference. (See Balance Billing)
Annual Maximum Benefit: A cap on the benefits your insurance company will pay in a year while you’re enrolled in a particular health insurance plan. These caps are sometimes placed on particular services such as prescriptions or hospitalizations. After an annual limit is reached, you must pay all associated health care costs for the rest of the year.
Balance Billing: When a provider bills you for the difference between the provider’s charge and the allowed amount. For example, if the provider’s charge is $100 and the allowed amount is $70, the provider may bill you for the remaining $30. A preferred provider may not balance bill you for covered services.
Coinsurance: The percentage of costs of a covered health care service you pay (20%, for example) after you’ve paid your deductible.
Copayment (copay): A fixed amount ($20, for example) you pay for a covered health care service after you’ve paid your deductible. Copays can vary for different services within the same plan, like drugs, lab tests, and visits to specialists.
Deductible: The amount you pay for covered health care services before your insurance plan starts to pay. With a $2,000 deductible, for example, you pay the first $2,000 of covered services yourself. After you pay your deductible, you usually pay only a copayment or coinsurance for covered services. Your insurance company pays the rest.
Guarantee Issue: A requirement that health plans must permit you to enroll regardless of health status, age, gender, or other factors that might predict the use of health services. Except in some states, guaranteed issue doesn’t limit how much you can be charged if you enroll.
In-Network: Health care providers who contract with your health insurance or plan. In-network coinsurance and copayments usually cost you less than out-of-network providers
Out-of-Network: Health care providers who don’t contract with your health insurance or plan. Out-of-network coinsurance and copayments usually costs you more than in-network coinsurance.
Out of Pocket Max: The most you have to pay for covered services in a plan year. After you spend this amount on deductibles, copayments, and coinsurance, your health plan pays 100% of the costs of covered benefits. The out-of-pocket limit doesn’t include your monthly premiums. It also doesn’t include anything you may spend for services your plan doesn’t cover. Out-of-pocket costs include deductibles, coinsurance, and copayments for covered services plus all costs for services that aren’t covered.
Prescription Drug Formulary: A list of prescription drugs covered by a prescription drug plan or another insurance plan offering prescription drug benefits. Also called a drug list.
Prior Authorization: Approval from a health plan that may be required before you get a service or fill a prescription in order for the service or prescription to be covered by your plan.
Preventive Care: Routine health care that includes screenings, check-ups, and patient counseling to prevent illnesses, disease, or other health problems.
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Contacts
X-FABAmy Hymel,
Benefits & Wellness [email protected]
806-747-4400 ext. 2849
iaCONSULTINGJulie Lawson,
Senior Account [email protected]
806-765-7264
866-765-7264 (toll free)
Carrier Contacts
MEDICAL/DENTAL BENEFITSBlueCross BlueShield of Texas800-521-2227 | bcbstx.com
FLEXIBLE SPENDING ACCOUNTConnect Your Care877-292-4040 | connectyourcare.com
TELEMEDICINETeladoc800-Teladoc | teladoc.com
VISION BENEFITSSuperior Vision800-507-3800 | superiorvision.com
LIFE & DISABILITY BENEFITSUnum866-679-3054 | unum.com
CANCER & RARE DISEASE POLICYAllstate877-810-2920 | allstate.com
401(k)Fidelity800-343-3548 | netbenefits.com
X-FAB Mixed Signal Foundry Experts 2301 N. University Avenue | Lubbock, TX 79415 | 806-747-4400
