MVT GROUP BENEFITS GUIDE

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2021 MVT GROUP BENEFITS GUIDE

Transcript of MVT GROUP BENEFITS GUIDE

2021

MVT GROUP BENEFITS GUIDE

GENERAL INFORMATIONWelcome to your 2021 Benefits Guide, a comprehensive resource containing information about this benefit package offered by your company. This benefits package is an important part of your total compensation package, adding value and giving you peace of mind.

HUMAN RESOURCES BENEFITS DEPARTMENT 7131 Copper QueenEl Paso, TX 79915

(915) 791-4000, Option 51 (866) 477-0200

8:00 a.m. – 5:00 p.m. Monday – FridayCOLONIAL BENEFIT COUNSELORS

Enrollment Line: 1-(888) 419-3669 or 1-(800) 793-1510-Se habla Español-

BENEFITS SELF-ENROLLMENT You can enroll on-line via this link: https://harmony.benselect.com/mvt.

ENROLL IN YOUR BENEFITS FOR 2021FROM OCTOBER 12–NOVEMBER 13, 2020

During Open Enrollment, employees will have the ability to elect or change the benefit options available through MVT's Comprehensive Health and Welfare Plan (the Plan). Benefits will become effective January 1, 2021. Each employee will have the option to call and connect with a Benefits Counselor, or complete an on-line self-enrollment that contains all current benefit elections.

All benefit elections must be electronically signed with the changes noted by November 13, 2020

Review this 2021 Benefits Enrollment Outline to compare your options and to see 2021 premiums for the benefits the Plan offers.

Complete the on-line Self-Enrollment or schedule to connect with a Benefit Counselor if you want to make any changes to your current benefit elections. To meet with a Benefit Counselor you can schedule a direct call from them at a time of your choosing.

Be sure to review the additional Medical benefits for 2021. Both voluntary benefit plans and medical plans remain the same as you currently have in 2020 we accomplished keeping cost the same. Visit your Benefits Counselor for more details.

If you need assistance, please contact the Benefits team. You may email [email protected] or call 1-866-477-0200 between 7:00 AM and 5:00 PM MST and someone in the Benefits Department will be available.

ENROLLMENT CHECKLIST

OPEN ENROLLMENT

AUTOMATIC ROLLOVER OF BENEFIT ELECTIONSIf an employee fails to re-enroll, the benefits currently in effect for 2020 will automatically rollover into the equivalent benefit options available in 2021. However, if you want to contribute to a Health Savings Account (HSA), you must make a new election during Open Enrollment

This workbook will help you prepare for open enrollment by providing a brief description of the benefits offered to you. Detailed benefit information is provided in the Summary Plan Description (SPD) which can be provided by calling the Benefits Department at 1-866-477-0200 or by emailing [email protected]. If there is a conflict of information,the SPD supersedes information provided in this workbook.

Initial Enrollment Period (New Hires) The Initial Enrollment Period is the first period of time when you can enroll yourself and your dependents. Coverage begins the first of the month following 60 days of your employment date. Your on-line enrollment forms will be made available for you to complete. You will have 30 days to complete. Open Enrollment Period (Existing Employees) During our Open Enrollment period, you can enroll or make changes to your current elections for yourself and your dependents. Coverage changes will begin on January 1, 2021.Pre-Tax Eligible Plans Your contributions towards the qualifying Health & Welfare Benefits (Medical, Dental and Vision) are before-tax deductions in accordance with Section 125 of the Internal Revenue Code. This will reduce your taxable income. These elections are binding and cannot be modified until the next enrollment period, unless you have a Family Status Change or Qualifying Event.You must notify Human Resources of your qualifying event within 30 days of the event. Depending on the type of event, you may need to provide proof of the event such as a marriage license. If you do not submit within 30 days of the qualifying event, you will have to wait until the next annual enrollment period to make changes. When Coverage Ends Coverage ends on the date of separation or loss of full-time status.

How to EnrollBeginning October 12, 2020 Benefit Counselors will be available to answer any questions and help you enroll in your benefits for the 2021 Plan Year. You can call 888.419.3669 or call 800.793.1510 (Toll Free), or you can enroll on-line via this link:

https://harmony.benselect.com/mvt Your username is your Social Security Number, and your password is the last 4 digits of your SSN, and the last 2 digits of your birth year.Example: SSN 123-45-6789; Birthday 10/15/1966 = Password 678966

BENEFIT BASICS FOR 2021

MVT will continue to offer Base, Buy-up and HDHP plans without a rate increase for 2021 with the same benefit design. With one of these three plan elections you will have option to add the Mexico PPO plan free of charge.MVT is a self-funded health plan that relies on the administrative services and negotiated savings from its providers. Our goal is to provide you with the strongest network and the highest network savings. Managing your health is one of the greatest investments you can make.

HEALTH AND WELFARE BENEFITSMEDICAL BENEFITS

Base Plan

Benefits Outline

Deductibles:

$2,500 $5,000

Visit Any Provider: Individual Family

Services Referred by Care Connex: $1,250 Individual

Family $2,500

$50 $80 40%

Copays: Primary Care: Specialist:

Coinsurance:Out of Pocket Maximums

$7,150 Individual: Family: $14,300

Prescription Drugs

If the Prescription Drug Costs: You Pay: More information about prescription drug coverage is available at www.simplesaverx.com

Tier 1 $0 to $20.00 $5.00 Copay Tier 2 $20.01 to $50.00 $12.50 Copay Tier 3 $50.01 to $100.00 $25.00 Copay Tier 4 $100.01 to $250.00 $37.50 Copay Tier 5 $250.01 to $1,000.00 $150.00 Copay Tier 6 $1,000.01 to $2,500.00 $250.00 Copay Tier 7 $2,500.01 to $5,000.00 $500.00 Copay Tier 8 $5,000.01 plus $750.00 Copay

Options & Cost

Coverage Option: Weekly Bi-Weekly Bi-Monthly Monthly Annual

Employee Only: $ 62.69 $125.37 $135.82 $ 271.64 $ 3,259.68 Employee and Child(ren): $132.33 $264.65 $286.71 $ 573.41 $ 6,880.92

Employee and Spouse: $173.04 $346.08 $374.92 $ 749.84 $ 8,998.08 Employee & Family: $203.58 $407.15 $441.08 $ 882.16 $10,585.92

Waive Coverage: N/A N/A N/A N/A N/A

High Deductible Health Plan (HDHP)

Benefits Outline

Deductibles: Visit Any Provider:

Individual Plan pays 100% after deductible is met Family Plan pays 100% after deductible is met

Services Referred by Care Connex: Individual Up to $2000 added to HSA the following year Family for each individual utilizing Care Connex

Copays: Primary Care: Plan pays 100% after deductible is met Specialist: Plan pays 100% after deductible is met

Coinsurance: 0% Out of Pocket Maximums

Individual: $6,550 Family: $13,100

Prescription Drugs Plan pays 100% after deductible is met

Options & Cost

Coverage Option: Weekly Bi-Weekly Bi-Monthly Monthly Annual

Employee Only: $ 20.77 $ 41.54 $ 45.00 $ 90.00 $ 1,080.00 Employee and Child(ren): $ 38.25 $ 76.50 $ 82.88 $ 165.75 $ 1,989.00

Employee and Spouse: $ 50.02 $100.04 $108.38 $ 216.75 $ 2,601.00 Employee & Family: $ 58.85 $117.69 $127.50 $ 255.00 $ 3,060.00

Waive Coverage: N/A N/A N/A N/A N/A

Heath Savings Account (HSA)

• You are eligible to contribute to the HSA if you elect HDHP plan.• Your HSA account will be with Health Equity – log-in:https://my.healthequity.com or call at (866) 346-5800• You can also elect to contribute additional monies to your Health Savings Account via pre-tax payroll

deductions.• The total contribution amounts allowed for 2021 is $3,600 for employee only, and $7,200 for family

coverage. If you are over 55, you may contribute an additional $1,000.• You can use funds in an HSA to help pay for qualified expenses or save for the future. The dollars in your

HSA account is your money. You can take your account with you if you retire or leave your employment.Remember, it is always your money.

• Qualified medical expenses (QMEs) are designated by the IRS and include medical, dental, vision andprescription expenses. QMEs are subject to change by the IRS at any time. It is the member’sresponsibility to verify that expenses incurred are designated by the IRS as a QME. Please visit the IRSwebsite for more information.

HEALTH AND WELFARE BENEFITSMEDICAL BENEFITS

Buy-Up Plan

Benefits Outline

Deductibles: Visit Any Provider:

Individual $900 Family $1,800

Services Referred by Care Connex: Individual No Deductible Family No Deductible

Copays: Primary Care: $45.00 Specialist: $45.00

Coinsurance: 20% Out of Pocket Maximums

Individual: $5,000 Family: $10,000

Prescription Drugs

If the Prescription Drug Costs: You Pay:

More information about prescription drug coverage is available at

www.simplesaverx.com

Tier 1 $0 to $20.00 $5.00 Copay

Tier 2 $20.01 to $50.00 $12.50 Copay

Tier 3 $50.01 to $100.00 $25.00 Copay

Tier 4 $100.01 to $250.00 $37.50 Copay

Tier 5 $250.01 to $1,000.00 $150.00 Copay

Tier 6 $1,000.01 to $2,500.00 $250.00 Copay

Tier 7 $2,500.01 to $5,000.00 $500.00 Copay

Tier 8 $5,000.01 plus $750.00 Copay

Options & Cost

Coverage Option: Weekly Bi-Weekly Bi-Monthly Monthly Annual

Employee Only: $164.75 $ 329.51 $ 356.97 $ 713.93 $ 8,567.16 Employee and Child(ren): $212.04 $ 424.08 $ 459.42 $ 918.83 $11,025.96

Employee and Spouse: $277.28 $ 554.56 $ 600.77 $1,201.54 $14,418.48 Employee & Family: $309.45 $ 618.90 $ 670.48 $1,340.95 $16,091.40

Waive Coverage: N/A N/A N/A N/A N/A

HEALTH AND WELFARE BENEFITSMEDICAL BENEFITS

Please Note: A Summary of Benefits and Coverage (SBC) for each plan listed above is available upon request, or can be found at harmony.benselect.com/mvt. For more information about limitations and exceptions, see your Benefits Office for a copy of the plan or policy document.

Mexico PPO PlanMexico PPO Plan is provided by International Medical Solutions (IMS) and is a comprehensive health care service plan that is designed to provide quality healthcare for MVT employees and their families whose preference is to receive healthcare coverage in Mexico. You will receive a separate membership card for the Mexico PPO once enrolled.This Mexico PPO Plan option is provided to allow coverage for only specified services received in Mexico. Any services not listed on the Schedule of Benefits are not covered under this Plan option. In order for benefits to be payable under this provision of the Plan, covered services must be received by INTERNATIONAL MEDICAL SOLUTIONS PROVIDERS (IMS). For more information or to obtain a Schedule of Benefits, you may email IMS at [email protected] or call IMS at (928) 446-6179

Benefits Outline

Deductibles: In-Network Provider:

Individual Family

Copays: In-Network Primary Care: In-Network Specialist (referral required): In-Network Outpatient/Surgical Facility Out-of-Network

Coinsurance:

Inpatient Hospital Emergency Room Services Urgent Care

Out of Pocket Maximums Individual: Family:

Prescription Drugs

$50 $100 (Aggregate)

100% After $5 co-pay 100% After $5 co-pay 100% After $35 co-pay 0% Benefit - Services Not Covered 0% of In-Network Benefits 100% After $100 co-pay 100% After $50 co-pay 100% After $50 co-pay

$0 $0

Point of Purchase Benefit Limitations

IMS Network 100% Plan payment after $10 co-pay

90 Day Supply

Preferred Drugs Only

Generics not covered

HEALTH AND WELFARE BENEFITSMEDICAL BENEFITSS

Important Notice:

• If you are enrolled in A US medical plan (Base, HDHP or Buy-Up) you havethe option to add Mexico PPO at no cost to you or your family.

ging
Highlight

MVT will continue to offer Dental Insurance through MetLife without a premium increase for 2021.The Preferred Dentist Program was designed to help you get the dental care you need and help lower your costs. You get benefits for a wide range of covered services — both in and out of the network. The goal is to deliver affordable protection for a healthier smile and a healthier you. You can access a list of participating dentists with directions and mapping capabilities online at www.metlife.com/dental or call 1-800-ASK-4-MET (800-275-4638) to have a list faxed or mailed to you based upon the requested ZIP code. Please Note: Be sure to verify provider participation when you make your appointment.

DENTAL BENEFITS – MetLife

VISION BENEFITS – VSP

Coverage Type In-Network: Out-of-Network:

% of Negotiated Fee % of R&C Fee1

Type A 100% 100%

Type B 80% 80%

Type C 50% 50%

Orthodontia 50% 50% Deductible: Individual/Family* $50 (Type B & C) $50 (Type B & C)

Annual Maximum Benefit: Per Individual $1750 $1750

Orthodontia Lifetime Maximum: Per Individual

$1500 $1500

Ortho applies to Adult and Child (Up to dependent age limit)

Options & Cost

Coverage Option: Weekly Bi-Weekly Bi-Monthly Monthly Annual

6.19$ $ 12.38 $ 13.41 26.82$ 321.84$ $ 12.46 $ 24.91 $ 26.99 53.98$ 647.76$ $ 21.32 $ 42.66 $ 46.21 92.42$ 1,109.04$

Employee Only:Employee + 1 Dependent

Employee + Family Waive Coverage: N/A N/A N/A N/A N/A

MVT will continue to offer Vision Insurance through VSP without a premium increase for 2021. VSP offers two levels of coverage, Standard and Premium, within the VSP Provider Network Please see your Benefits Counselor for a complete schedule of benefits

− Value and Savings. You'll enjoy more value and low out-of-pocket costs.− High Quality Vision Care. You'll get great care from a VSP network doctor, including a WellVision Exam®-a

comprehensive exam designed to detect eye and health conditions.− Choice of Providers. The decision is yours to make-with the largest national network of private-practice doctors,

plus participating retail chains, it's easy to find the in-network doctor who's right for you.− Great Eyewear. It's easy to find the perfect frame at a price that fits your budget.

Coverage Option: Weekly Bi-Weekly Bi-Monthly Monthly Annual

1.30$ 2.60$ 2.82$ 5.63$ 67.56$ 3.33$ 6.66$ 7.22$ 14.43$ 173.16$

Standard

Employee OnlyEmployee + Family

Premium

2.21$ 4.41$ 4.78$ 9.56$ 114.72$ Employee OnlyEmployee + Family 4.41$ 8.82$ 9.55$ 19.10$ 229.20$

Options & Cost

401(k) RETIREMENT

401(k) RETIREMENT SAVINGS PLAN –

• You can enroll, opt-out, or make changes at any time by contacting John Hancock.• The Plan matches $1 for every $1 you save up to a maximum of 4% of your contribution.• You must contribute 4% to maximize the Company match at 4%.• The new company matching contributions are 100% vested when you join the plan.• You can save for your retirement with pre-tax contributions.• You can withdraw after age 59 1/2, per IRS regulations.• The plan offers a loan provision and hardship withdrawals are permitted.

In 2021, the maximum allowable contribution is $19,500 for a person less than age 50 and $26,000 for a person age 50 or older.

Don’t delay – join now! It’s never too early (or too late) to start saving for your future.To Register:

Online: https://myplan.johnhancock.com/login Contract number: 107713Access Number: 079596

Need help with enrollment? Call us. 1-855-JHENROLL (543-6765)

It all starts with enrollment!

COMPANY PAID BENEFITS

Remember to review and update your Beneficiary . You can add or remove beneficiaries at any time.

BASIC TERM LIFE AND ACCIDENTAL DEATH AND DISMEMBERMENT(AD&D) INSURANCE-COLONIAL LIFEMVT provides basic term life insurance coverage at no cost to you and gives you the opportunity to add additional coverage, helping you tailor a life insurance portfolio that meets your particular needs.The Basic Term Life coverage provides your beneficiaries with a benefit of $25,000.In addition, you automatically receive Accidental Death and Dismemberment (AD&D) coverage, which pays an amount equal to the basic term life insurance benefit at no cost to you.

24/7 *365 DOCTOR ACCESS -MD LIVEMVT provides access to MDLive at no cost to you, helping you avoid the Doctor's office. With MDLive, you can visit a doctor or counselor 24/7 from your home

U.S. board-certified doctors and licensed counselors with an average of 15 years of experience.

Consultations are convenient, private and secure.

Prescriptions can be sent to your nearestpharmacy, if medically necessary.

Per visit

Your COPAY is just

$0, Family Coverage

Activate your coverage first by visiting www.247mdaccess.com or by calling (888) 674-2490 Group ID: 247DOCTOR

Enter your Last Name and Phone Number to activate your account.

EMPLOYEE ASSITANCE PROGRAMHealth Advocate 's Employee Assistance Program and Work/Life Balance program ( EAP Work/Life) provides Counseling and resources via phone, in-person or Online chat for a variety of personal and work issues:

• Stress, anxiety anddepression

• Substancedependency/addiction

• Child Care, camps andafter-school care

• Grief and loss• Special needs services• Identity theft resources• Retirement Planning• Staying Healthy

To access, Call or go Online: 1-888-645-1772

ColonialLife.com/EAP

ADDITIONAL COMPANY BENEFITSACCIDENTAL DEATH AND DISMEMBERMENT(AD&D) INSURANCE-COLONIAL LIFEThis Open enrollment period all employees can register for $10,000 AD&D insurance free of charge just for meeting with one of our Colonial Benefit Counselors. To enroll in the complimentary plan you can call 1-888-419-3669 or 1-800-793-1510.

WELLNESS-COLONIAL LIFEMVT will be providing Wellness Card savings through Colonial to save on doctor office visits, pet care, prescription drugs, vision services, and other cash rewards and entertainment benefits. Cards will be distributed at your designated work sites These are just some of them services available to you to learn more about discounts visit WellCardSavings.com

VOLUNTARY BENEFITSMVT provides additional voluntary benefits to cover you and your family. Talk with your Benefits Counselor, or log on to your on-line enrollment site at: harmony.benselect.com/mvt to learn about the costs and details of these exciting benefits.

Accident Insurance – Colonial LifeYou never know when you or someone you love could get hurt in an accident. And accidents come with costs, such as emergency room fees, doctor's bills and lost income from missing work. Even if you have good health insurance, deductibles and co-pays can really add up. With accident insurance from Colonial Life, you can receive benefits to help with the expenses of a covered accident. This financial protection can help you focus on what really matters: healing.

Critical Illness Insurance – Colonial Life No matter where you are in life,you never know when you or a loved one could experience a critical illness, such as a heart attack or stroke. Medical advancements and early detection are helping many people survive critical illnesses. However, preventive tests and treatment can lead to increased medical expenses, and your health insurance may not cover these costs. Critical illness insurance from Colonial Life helps supplement your major medical coverage by providing a lump-sum benefit that you can use to pay the direct and indirect costs related to a covered critical illness.

Disability Insurance – Colonial LifeLosing just one paycheck would be difficult, but a disability could have you out of work for weeks or even months. And while your paychecks might stop, your bills would continue coming. Without your income, how would you pay for housing, utilities and other everyday living expenses? Disability insurance from Colonial Life helps protect your income, so you can have help paying the bills while you recover from a covered accident or sickness.

Hospital Confinement Indemnity Insurance – Colonial LifeIf you're admitted to the hospital because of an accident or sickness, it's important to focus on your recovery- not your finances. That's easier said than done if you have costly co-payments, deductibles and other expenses coming your way. Hospital confinement indemnity insurance from Colonial Life can help you pay for medical expenses that your health insurance may not cover.

Term Life Insurance – Colonial LifeLife insurance needs change as life circumstances change. You may need different coverage if you're getting married, buying a home or having a child.

Whole Life Insurance – Colonial LifeWhole life insurance provides guaranteed features -cash value accumulation, premium rates and a death benefit (minus any loans and loan interest)-that help ensure those benefits will be there to help protect your family's way of life.

Legal Coverage – U.S. Legal ServicesUS Legal's Nationwide Attorney Network provides coverage for you and your spouse while on the job or in your personal vehicle. USL pays 100% of your attorneys’ fees for all covered services.

Please Note:

All elections you make will remain in effect unless changed according to the provisions of the MVT Summary Plan Descriptions (SPD). By making your elections, you are authorizing the Plan to deduct from your pay the amounts indicated for the benefits selected. This workbook does not guarantee any benefits.

Falsification of information including dependent eligibility could result in claims repayment and disciplinary action, up to and including termination of employment. Falsification may be considered a serious violation and will be handled by disciplinary action policy. MVT may audit dependent eligibility at any time.

This workbook is intended to summarize the benefits that we offer to our employees. The actual determination of your benefits is based solely on the plan documents provided by the carrier of each plan. This summary is not legally binding, is not a contract, and does not alter any original plan document. The Plan posts all relevant documents on your enrollment website at: https://harmony.benselect.com/mvt If you require a paper copy, please contact the Benefits Department at 1-866-477-0200.

Copyright © 2020 MVT Services, LLC (MVT).