Flex Force
YOU ROCK NOW LET’S ENROLL YOUR 2024 BENEFITS CHOOSER GUIDE
ANNUAL ENROLLMENT IS OCT. 3-20, 2023
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SET LIST
ELIGIBILITY, VERIFICATION AND ENROLLMENT
2
WHAT IS THE RIGHT PLAN FOR YOU
4
MEDICAL PLAN PERKS
8
THE HEALTH SAVINGS ACCOUNT (HSA)
8
FLEXIBLE SPENDING ACCOUNT (FSA)
9
DENTAL
10
VISION
11
FINDING YOUR GROOVE
12
VOLUNTARY BENEFITS
14
ANNUAL NOTICES
15
If you (and/or 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 legal notices in the back of this guide for more details.
WHAT IS YOUR BIGGEST MOTIVATOR — THE SOUNDTRACK TO YOUR LIFE?
Is it committing to a healthy lifestyle? Putting your family’s health first? Maybe financial stability or prioritizing your mental health?
Finding your motivation for maintaining your health can help you stay on track toward your wellness goals.
But not everyone’s motivation is the same, and at Averitt, our motivation is supporting our associates. Like a great Spotify playlist, our benefits program is designed to appeal to a wide audience: easy favorites like medical, dental and vision, plus some deep cuts like our voluntary options. Think of this Benefit Chooser Guide as the liner notes to a friend’s favorite album. In it, you’ll find all the extra information that will help you find your groove and sing along in 2024!
ELIGIBILITY, VERIFICATION AND ENROLLMENT
FlexForce associates are eligible to participate in our health benefits.
ELIGIBLE DEPENDENTS AND THE DOCUMENTS YOU NEED DEPENDENT
DOCUMENTS FOR VERIFICATION
Page 1 of most current year’s federal income tax return (1040 or 1040SR), with financial data blacked out OR Certified marriage certificate AND a joint checking account statement or mortgage statement from within the past 90 days Page 1 of current year’s federal income tax return (1040 or 1040SR), with financial data blacked out OR Birth certificate showing associate as parent OR Court document (Medical Support Notice)
SPOUSE — PERSON TO WHOM YOU ARE LEGALLY MARRIED
YOUR NATURAL BORN CHILD(REN)
YOUR ADOPTED CHILD(REN)
Adoption certificate or court documents
YOUR STEPCHILD(REN)
Birth certificate AND completed dependent verification of eligible spouse
CHILD(REN) FOR WHOM YOU MUST LEGALLY PROVIDE HEALTH CARE COVERAGE
Relevant sections detailing coverage requirements of completed, signed and dated court documents
Children will age out of benefits at age 26 and will be automatically removed at the end of the month in which they turn 26.
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ANNUAL ENROLLMENT: OCT. 3-20, 2023 Annual Enrollment for 2024 benefits is Oct. 3-20, 2023. Remember that you must participate in annual enrollment in order to receive the lowest weekly premiums. Also note that you must elect contributions for your flexible spending account (FSA), as these accounts always default to $0 each new plan year. Your changes will be effective Jan. 1, 2024.
After annual enrollment, you can only make changes to your benefits if you experience a qualifying life event, such as getting married or having a child.
If you think you are eligible to make changes because of a qualifying life event, you must send documentation to our Benefits Team within 31 days of the event. Fax or email verification documents to Averitt Benefits Administration at 931-520-5101 or averittbenefits@averitt.com .
ENROLL ONLINE: OCT. 3-20, 2023.
• Call 866-606-9553 to talk to a Colonial Life Benefits Counselor to enroll in medical, dental, vision, FSA, HSA, voluntary life, voluntary long-term disability, accident, cancer, hospital confinement, critical illness or whole life insurance benefits. • Call 833-644-2392 to enroll in long-term care from Trustmark. • If you’re adding a new dependent to medical, dental, or vision benefits, submit required documents to annualenrollment@averitt.com or fax them to Averitt Benefits Administration at 931- 520-5101 with a cover sheet that lists your name, phone number and the last four digits of your Social Security number. Check your email for the confirmation form you will receive after enrollment to ensure your benefits are correct. ENROLL BY PHONE: OCT. 3-20 FROM 7 A.M. TO 7 P.M. CT, MONDAY-FRIDAY
Visit InsideAveritt.com/ChooseWell . Log in using your email address and your MyPortal password . • To enroll in medical, dental, vision, FSA, HSA, voluntary life and voluntary long-term disability, click the “Annual Enrollment” widget on your dashboard, then double click on “Annual Enrollment” to begin the enrollment process. Follow the prompts to review your tobacco use status, current benefits (if applicable) and choose. Submit your selections. • If you choose to enroll in Colonial Life coverage, such as accident, cancer, hospital confinement, critical illness or whole life insurance : ■ Click on the “Colonial Voluntary Benefits” widget in MyPortal. This will take you to a separate website called Harmony Enroll . ■ Log in using your email and Avrt!MMDDYYYY (fill in with your date of birth ) as your password. • If you choose to enroll in long-term care offered by Trustmark :
■ Click on the “Trustmark Long-Term Care Benefits” widget in MyPortal. This will take you to a separate website. ■ Log in using your Associate ID as your Username and the last four digits of your Associate ID plus your full birth year as your password .
HIT PLAY ON THIS ONE! The earlier you enroll using MyPortal, the more you could earn. • Oct. 3-9: Drawing for four winners of 125,000 Red Thinkin’ Rewards points • Oct. 9-15: Drawing for four winners of 62,500 Red Thinkin’ Rewards points • Oct. 15-20: Drawing for four winners of 25,000 Red Thinkin’ Rewards points
• If you’re adding a new dependent, submit required documents to annualenrollment@averitt.com or fax them to Averitt Benefits Team at 931-520-5101 with a cover sheet that lists your name, phone number and the last four digits of your Social Security number. For help with InsideAveritt username or password, contact Averitt Tech Support at 800-296-9907 . For help logging in to MyPortal, contact the MyPortal Help Team at 844-805-6189 .
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WHICH IS THE RIGHT PLAN FOR YOU? As you’re considering Averitt’s two medical plan options through BlueCross BlueShield, think through how you and your dependents use the medical plan. On the Traditional Health Plan, you’ll pay more out of your paycheck but less when you use the plan. On the High Deductible Health Plan, you have extra money from the HSA and you’ll pay less out of your paycheck, but you may pay more at the doctor or pharmacy. Don’t overpay to have more coverage than you need! Some key features below can help you compare.
HIGH DEDUCTIBLE HEALTH PLAN (HDHP)
TRADITIONAL HEALTH PLAN (THP)
PAYCHECK PREMIUMS How do the plans compare on the amount I pay out of my paycheck?
Higher
Lower
Yes! You’re ready for a rainy day with $10 per week for individual coverage or $20 per week if you’re covering family Yes, up to IRS limits ($4,150 individual, $8,300 family in 2024) — and you won’t be taxed on contributions, growth or when you buy eligible expenses
HSA FUNDING Does Averitt offer any funding to my HSA?
None, this plan is not eligible for an HSA
TAX-ADVANTAGED SAVINGS Can I contribute my own pre-tax dollars to an HSA? PREDICTABLE COSTS Does the plan have copays, so I can budget and anticipate what I’ll pay a little more easily? DEDUCTIBLE How do the plans compare on the amount I’ll pay out-of-pocket before the plan starts paying a percentage? OUT-OF-POCKET MAXIMUM How do the plans compare in a worst-case scenario — the most I’ll pay before the health plan covers all eligible costs?
No
Yes
No
Lower
Higher
Lower
Higher
PHARMACY How does my plan work when I fill prescriptions?
You pay copays, which count toward the out-of-pocket max but not the deductible
You pay the full cost of prescriptions until you meet the deductible, then you pay 20% of the cost
• Preventive care visits are covered at 100% • One ID card for both medical and prescription coverage • Averitt pays the majority of your medical premium cost • You pay less when you use in-network providers through BlueCard PPO, but you can also go out-of-network • Access to Teladoc virtual medical care • Ability to fill both 30- and 90-day prescriptions
HOW ARE THEY THE SAME?
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REPEAT AND SHUFFLE • If you don’t anticipate a lot of medical expenses this year, paying more for the Traditional Health Plan is like buying the whole record when you really like just one song. Choosing your plan based on your expected health expenses in 2024 could save you money. • Be sure that your doctor and other services, such as lab work or anesthesiology, are in-network before your visit. • If you and your covered spouse are tobacco-free (or participating in a cessation program at least 31 days prior to enrollment), you will qualify for lower 2024 medical plan premiums during annual enrollment.* • Pay less by filling a 90-day supply of certain prescriptions and save time by having them delivered to your home from Express Scripts.
TRADITIONAL HEALTH PLAN (THP)
HIGH DEDUCTIBLE HEALTH PLAN (HDHP)
WEEKLY PREMIUM
ONE TOBACCO- FREE CREDIT*
TWO TOBACCO FREE CREDITS*
WEEKLY PREMIUM
ONE TOBACCO- FREE CREDIT*
TWO TOBACCO FREE CREDITS*
ASSOCIATE ONLY
$53.00
$41.00
N/A
$43.25
$31.25
N/A
ASSOCIATE + SPOUSE
$107.05
$95.05
$83.05
$87.60
$75.60
$63.60
ASSOCIATE + CHILD(REN)
$73.55
$61.55
N/A
$58.40
$46.40
N/A
FAMILY
$130.85
$118.85
$106.85
$104.90
$92.90
$80.90
* Our health plan is committed to helping you achieve your best health. Rewards for participating in the tobacco cessation wellness program are available to all associates and covered spouses. If you think you might be unable to meet a standard for a reward under this wellness program, you might qualify for an opportunity to earn the same reward through a reasonable alternative. Reach out to our Benefits team for more information about alternative methods to earn.
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TRADITIONAL HEALTH PLAN (THP)
IN-NETWORK BENEFITS
ANNUAL DEDUCTIBLE
$2,000 individual / $4,000 family
ANNUAL OUT-OF-POCKET MAXIMUM
$5,500 individual / $11,000 family
IN-NETWORK COPAYS
TELADOC
$0
PRIMARY CARE OFFICE VISIT SPECIALIST OFFICE VISIT
$45
$60
URGENT CARE (CLINIC)
$70
OFFICE VISIT DIAGNOSTIC X-RAY & LABS
$0 after copay
HEARING AIDS (ONE PER YEAR, PER EAR, EVERY 3 YEARS)
$0 ($5,000 maximum for 18+)
IN-NETWORK PHYSICIAN SERVICES
OFFICE SERVICES (X-RAYS, LABS, SURGERIES)
included in copay
ALLERGY INJECTIONS
$0
ROUTINE/PREVENTIVE CARE
$0
ROUTINE GYNECOLOGICAL CARE AND/OR MAMMOGRAMS
$0
CARDIAC STRESS TEST
$0
IN-NETWORK HOSPITAL SERVICES
EMERGENCY ROOM CARE
$500
INPATIENT HOSPITAL SERVICES
20% after deductible
OUTPATIENT DIAGNOSTIC HIGH-TECH RADIOLOGY
OUT-OF-NETWORK BENEFITS
ANNUAL DEDUCTIBLE
$4,000 individual / $8,000 family
ANNUAL OUT-OF-POCKET MAXIMUM COST TO USE PROVIDERS/FACILITIES
$11,000 individual / $22,000 family
40% after deductible
PRESCRIPTION BENEFITS
RETAIL PRESCRIPTION (30-DAY SUPPLY) CERTAIN PREVENTIVE GENERICS SEE INSIDEAVERITT.COM FOR THE FULL LIST
$0 copay
GENERIC
$20 copay
PREFERRED BRAND, INCLUDING SPECIALTY NONPREFERRED BRAND, INCLUDING SPECIALTY
$40 copay
$80 copay
RETAIL OR MAIL ORDER PRESCRIPTION (90-DAY SUPPLY) CERTAIN PREVENTIVE GENERICS SEE INSIDEAVERITT.COM FOR THE FULL LIST
$0 copay
GENERIC
$40 copay
PREFERRED BRAND
$80 copay
NONPREFERRED BRAND $160 copay This is a summary of your coverage only. In-network services are based on negotiated charges; out-of-network services are based on reasonable and customary (R&C) charges.
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HIGH-DEDUCTIBLE HEALTH PLAN (HDHP)
IN-NETWORK BENEFITS
ANNUAL DEDUCTIBLE
$3,200 individual / $6,400 family
ANNUAL OUT-OF-POCKET MAXIMUM
$6,550 individual / $13,100 family
IN-NETWORK COPAYS
TELADOC
$55 until deductible is met, then 20%
PRIMARY CARE OFFICE VISIT
SPECIALIST OFFICE VISIT URGENT CARE (CLINIC) OFFICE VISIT DIAGNOSTIC X-RAY & LABS
20% after deductible
IN-NETWORK PHYSICIAN SERVICES
OFFICE SERVICES (X-RAYS, LABS, SURGERIES)
20% after deductible
ALLERGY INJECTIONS ROUTINE/PREVENTIVE CARE ROUTINE GYNECOLOGICAL CARE MAMMOGRAMS
$0
$0 for preventive
CARDIAC STRESS TEST
$0 after deductible
IN-NETWORK HOSPITAL SERVICES
EMERGENCY ROOM CARE
INPATIENT HOSPITAL SERVICES OUTPATIENT DIAGNOSTIC HIGH-TECH RADIOLOGY
20% after deductible
OUT-OF-NETWORK BENEFITS
ANNUAL DEDUCTIBLE
$6,400 individual / $12,800 family
ANNUAL OUT-OF-POCKET MAXIMUM COST TO USE PROVIDERS/FACILITIES
$13,100 individual / $26,200 family
40% after deductible
PRESCRIPTION BENEFITS
RETAIL PRESCRIPTION (30-DAY SUPPLY) CERTAIN PREVENTIVE GENERICS SEE INSIDEAVERITT.COM FOR THE FULL LIST
$0 copay
GENERIC
PREFERRED BRAND, INCLUDING SPECIALTY NONPREFERRED BRAND, INCLUDING SPECIALTY SPECIALTY RETAIL OR MAIL ORDER PRESCRIPTION (90-DAY SUPPLY) CERTAIN PREVENTIVE GENERICS SEE INSIDEAVERITT.COM FOR THE FULL LIST
20% after deductible
$0 copay
GENERIC
20% after deductible PREFERRED BRAND NONPREFERRED BRAND This is a summary of your coverage only. In-network services are based on negotiated charges; out-of-network services are based on reasonable and customary (R&C) charges.
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MEDICAL PLAN PERKS
These extra features and programs are available to medical plan members.
RECEIVE CARE ANYWHERE THROUGH TELADOC
NICOTINE CESSATION PROGRAM If you or your spouse are ready to quit tobacco – including chewing tobacco or e-cigarettes – our free tobacco cessation program can help. Begin your journey to nicotine-free life with HealthCheck360.
If you have a minor illness, going to the emergency room can be expensive, urgent care may be unnecessary, and you may not be able to see your primary care physician right away. Teladoc saves you time and money! Teladoc allows you and your enrolled dependents to speak with a doctor anytime. Teladoc is great for: • Minor conditions such as fever, sore throat, congestion, nausea or vomiting, rash and more. Plus, Teladoc physicians can prescribe medications when appropriate. • Behavioral health concerns including stress, anxiety, depression, addiction, abuse and grief counseling.
This program includes: • Step-by-step Guidance • Health Coaching • Access to a Mobile App
There is no right way to quit nicotine; there is only your way. Enroll now by calling HealthCheck360 at 866-511-0360 (ext. 5099) or sending an email to healthcoach@healthcheck360.com .
Activate your account at bcbst.com/Teladoc or by calling BlueCross BlueShield at 833-377-9371 .
HEALTH SAVINGS ACCOUNT (HSA)
IT’S LIKE A 401(K) FOR YOUR HEALTH EXPENSES: THE HEALTH SAVINGS ACCOUNT (HSA) FOR HDHP MEMBERS If you enroll in the HDHP, you will have access to a health savings account (HSA) – with free money from Averitt – to help you save for health care expenses. Contributions, earnings and withdrawals for qualifying expenses are tax-free. Here’s how the account works: • Make contributions. WEX will automatically set up your bank account, and Averitt will deposit $10 per week for individual coverage or $20 per week if you cover dependents. You can also contribute additional funds up to the 2024 IRS limits of $4,150 for individuals/$8,300 for families, plus an annual $1,000 catch-up contribution for those over age 55. • Use your funds. WEX will send you a debit card to access your funds, and you can use the bank account to pay for eligible medical, dental and vision costs now or in the future. View a full list of eligible expenses at wexinc.com/insights/benefits- toolkit/eligible-expenses/ . • Save your funds. The bank account also works like a savings or retirement account. It’s yours, even if you leave the company, and your balance rolls over each year accruing interest tax-free. When your account balance reaches $1,000, you can invest your funds.
To be eligible for the HSA, you must meet certain qualifications during enrollment, like enrolling in the HDHP and not being enrolled in a health care FSA. A full list of eligibility requirements is available in MyPortal.
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FLEXIBLE SPENDING ACCOUNT (FSA) Flexible spending accounts (FSAs) let you set aside some of your pay, pre-tax, into an account to pay for certain predictable expenses. THERE ARE TWO TYPES OF FSA: • The health care FSA can pay for copays, deductibles, coinsurance, prescriptions, dental care, glasses, and other eligible health-related expenses for you and your tax dependents. Available to THP members or associates who waive coverage
HERE’S HOW EACH FSA WORKS: • Make contributions. You set aside pre-tax money through payroll deductions up to IRS limits. You can’t change your contribution during the year unless you experience a qualifying life event. You must re-enroll every year. ■ HCFSA limit: $5 weekly minimum, $3,050 annual maximum ■ DCFSA limit: $5 per week minimum, $5,000 annual maximum per household • Use your funds. View a full list of eligible expenses at wexinc.com/insights/benefits-toolkit/eligible- expenses/ . When you have an expense, you can pay for it with your FSA debit card or reimburse yourself. The full contribution you elect is available for access or reimbursement on your first day of enrollment on your health care FSA and as you contribute them (like a bank account) on your dependent care FSA. • Budget carefully. The health care FSA can roll over up to $610 each year, but all other funds and all excess dependent care funds are lost at the end of the plan year. To keep your rolled over funds, you must re-enroll in the health care FSA plan year.
• The dependent care FSA covers childcare expenses while you are at work for children under age 13 or older dependents who are incapable of self-care. That includes costs for things like babysitters, summer day camps, and elder care. Available to all associates
RUN THAT BACK THIS SOUNDS LIKE THE HSA. HOW IS IT DIFFERENT? Both are tax-advantaged accounts. The HSA is the tax-advantaged account offered to associates who elect the HDHP medical plan. It has advantages over the FSA — you keep the account for life, it accrues interest and funds can be invested. But if you don’t think the HDHP is the right plan for you, a health care FSA is a great way to budget for medical expenses in the coming year and pay for them with tax-free dollars.
Keep your receipts, as the IRS may ask you to submit them for verification.
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DENTAL
You have two dental plans to choose from, both administered by Delta Dental. You’ll save the most money and time — you won’t have to file claims yourself – if you see a Delta Dental provider.
DENTAL BENEFITS
STANDARD PLAN
MAXIMUM PLAN
DIAGNOSTIC AND PREVENTIVE SERVICES Oral exams and routine cleaning (two per year), x-rays (one bitewing per year, one full mouth every three years), and fluoride treatments (two per year, to age 19) BASIC SERVICES Oral surgery, anesthesia, fillings, extractions, endodontia and periodontia MAJOR SERVICES AND ORTHODONTIA* Crowns, cast restorations, fixed bridgework, dentures and orthodontia (to age 19)
Plan pays 100%*
Plan pays 100%*
Plan pays 50%
Plan pays 80%
Plan pays 50%
Plan pays 50%
ANNUAL BENEFIT MAXIMUM
$1,500
$2,000
ORTHODONTIA LIFETIME MAXIMUM
$1,500
$2,000
YOUR WEEKLY PAYROLL DEDUCTION
STANDARD PLAN
MAXIMUM PLAN
ASSOCIATE ONLY
$3.55
$5.65
ASSOCIATE + SPOUSE ASSOCIATE + CHILD(REN)
$7.90
$12.55
$8.70
$13.60
FAMILY
$11.95
$16.65
*New enrollees will be subject to a 12-month waiting period for major services and orthodontia.
NEW FOR 2024 Effective 2024, members who complete at least one preventive service during each plan year will have their annual maximum increased by an additional $200. But keep up the good work — you can have an additional $200 added for up to 5 years to an additional $1,000 in annual maximum benefit. If you don’t complete preventive services in a given year, the annual max reverts to the original benefit and the rollover is lost. ENHANCED BENEFIT FOR SPECIAL NEEDS DEPENDENTS With this enhanced benefit, your dependents with special needs have access to: • Additional visits to the dentist’s office and/or consultations that can be helpful prior to the first treatment to help patients learn what to expect and what is needed for a successful dental appointment. • Up to four total dental cleanings in a benefit year. • The use of silver diamine fluoride that can be applied to cavities for patients who can’t tolerate the use of dental instruments. • Treatment delivery modifications necessary for dental staff to provide oral health care for patients with sensory sensitivities, behavioral challenges, severe anxiety or other barriers to treatment.
See Summary Plan Description (SPD) for further details.
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VISION We offer two vision plans administered by VSP. Both vision plans pay 100% for an annual eye exam. Both plans include allowances for contact lenses and coverage for retinal imaging. As with dental coverage, you’ll save the most money and time if you see an in-network VSP provider.
VISION BENEFITS
STANDARD PLAN
MAXIMUM PLAN
EYE EXAM One exam per calendar year
Plan pays 100%*
Plan pays 100%*
EYEGLASS LENSES**
$0 copay — NEW enhancement!
$25 copay
Polycarbonate lenses (children only)
Polycarbonate lenses (adults and children)
Single vision, lined bifocal and lined trifocal lenses
Anti-reflective coating
Standard progressive lenses
All progressive lenses
One pair each calendar year
One pair each calendar year; $210 annual allowance — NEW enhancement! *
FRAMES*
No coverage
CONTACT LENSES*
Allowance for contact lenses and contact lens exam (fitting and evaluation) 15% savings on exam fees (up to $60 copay) Each calendar year RETINAL IMAGING ESSENTIAL MEDICAL EYE CARE Additional exams and services beyond routine care to treat immediate issues from pink eye to sudden changes in vision or to monitor ongoing conditions, such as dry eye, diabetic eye disease, glaucoma and more
$210 annual allowance — NEW enhancement! *
$150 annual allowance*
$0 copay — NEW enhancement!
$10 copay
$20 copay**
$20 copay**
YOUR WEEKLY PAYROLL DEDUCTION
STANDARD PLAN
MAXIMUM PLAN
ASSOCIATE ONLY
$2.55
$5.25
ASSOCIATE + SPOUSE ASSOCIATE + CHILD(REN)
$2.85
$6.20
$3.00
$6.40
FAMILY
$4.70
$9.75
* You may obtain contacts or eyeglasses every year (but not both in the same year). **See Summary Plan Description (SPD) for further details.
VISION ENHANCEMENTS TO THE MAXIMUM PLAN ONLY: • $0 materials copay • Increased frames and lens allowance to $210 • $0 retinal imaging copay
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FINDING YOUR GROOVE GET INTO THE SWING OF LIFE WITH THE EAP From caring for elderly parents to dealing with divorce or facing financial problems, we understand life can get complicated, and you could use help to enjoy the music of life.
AREAS WHERE THE EAP CAN HELP The EAP and its free counseling are available to all associates, their family members and their household members, even if they are not enrolled in our benefits. EAP counselors can help you manage stress, depression, anxiety, relationship issues, work-related pressures, and substance abuse. • Marriage, divorce and parenting problems • Daycare, nutrition and development concerns • Suggestions for local child care and elder-care resources, including referrals to nursing homes • Diet and health concerns • Stress, anxiety and depression • Substance abuse • Debt, taxes, retirement and estate planning issues • Answers to legal questions • Moving and relocation, college planning, home repair, vacation and event planning
New for 2024: Averitt has partnered with ComPsych through Voya to provide an updated Employee Assistance Program (EAP). These services focus on building and broadening your strengths and wellbeing. This benefit is provided at no cost to you, and you are automatically enrolled. COUNSELING RESOURCES With ComPsych provided by Voya, you can receive up to three no-cost, confidential, behavioral health counseling sessions, available either in-person or virtually with a licensed counselor. You also have access to unlimited guidance from a counselor or work/life support specialist. Your counselor will provide short-term support and advice. When more extensive or specialized resources are needed, the EAP can also provide you with information and referrals.
SPEAK WITH A GUIDANCECONSULTANT NOW: Phone: 877-533-2363 or TTY 800-697-0353 Web: www.guidanceresources.com
App: GuidanceNow ID: My5848i
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LIFE INSURANCE
No-cost financial protection for you and your family in the event of the unexpected. We provide basic life insurance for part- time FlexForce associates through Voya.
AVERITT-PROVIDED BASIC LIFE INSURANCE
ASSOCIATE BASIC LIFE INSURANCE
$10,000
See Summary Plan Description (SPD) for further details.
REPLAY Take a moment during annual enrollment to check that your beneficiaries are correct.
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VOLUNTARY BENEFIT OPTIONS Voluntary benefits are the deep cut tracks that still have you singing along. These can provide you with covered benefits on top of the coverage you have on your health, disability or life insurance. Unless otherwise specified, you can enroll yourself, your spouse or your children in these benefits.
COLONIAL LIFE VOLUNTARY BENEFITS
• Accident Insurance — Provides benefits for injuries resulting from covered accidents, such as fractures, burns and lacerations, as well as for doctor’s office or emergency room visits, ambulance charges, X-rays, and physical therapy. • Cancer Insurance — Helps offset the covered out-of-pocket medical and indirect, non-medical expenses related to cancer, including benefits for diagnosis and treatment. This coverage also provides a benefit for specified cancer screening tests. • Critical Illness Insurance — Supplements 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, such as heart attack (myocardial infarction), end-stage renal failure, coronary artery bypass surgery, stroke or major organ transplant. Provides an annual health screening benefit for covered tests. Cancer benefit is optional at an additional cost. • Hospital Confinement Indemnity Insurance — Provides a lump-sum benefit for a covered hospital confinement to help cover copayments and deductibles that are not covered by most major medical plans. • Whole Life Insurance — Provides death benefit coverage that you can increase or decrease as your needs change. The policy builds cash value on a tax-deferred basis at current interest rates, and premium payments are flexible.
NOTE: Policies have limitations and exclusions that may affect benefits payable. Ask your Colonial Life Benefits Counselor for complete details. In New York Colonial Voluntary Benefits are underwritten by the Paul Revere Life Insurance Company.
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ANNUAL NOTICES
Important Notice About Your Prescription Drug Coverage and Medicare Please read this notice carefully and keep it where you can find it. This notice has information about your current prescription drug coverage and about your options under Medicare’s prescription drug coverage. This information can help you decide whether or not you want to join a Medicare drug plan. If you are considering joining, you should compare your current coverage, including which drugs are covered at what cost, with the coverage and costs of the plans offering Medicare prescription drug coverage in your area. Information about where you can get help to make decisions about your prescription drug coverage is at the end of this notice. There are two important things you need to know about your current coverage and Medicare’s prescription drug coverage: Medicare prescription drug coverage became available in 2006 to everyone with Medicare. You can get this coverage if you join a Medicare Prescription Drug Plan or join a Medicare Advantage Plan (like an HMO or PPO) that offers prescription drug coverage. All Medicare drug plans provide at least a standard level of coverage set by Medicare. Some plans may also offer more coverage for a higher monthly premium. Averitt Express, Inc. has determined that the prescription drug coverage offered by the Express Care Plan is, on average for all plan participants, expected to pay out as much as standard Medicare prescription drug coverage pays and is therefore considered Creditable Coverage. Because your existing coverage is Creditable Coverage, you can keep this coverage and not pay a higher premium (a penalty) if you later decide to join a Medicare drug plan. WHEN CAN YOU JOIN A MEDICARE DRUG PLAN? FOR MORE INFORMATION ABOUT THIS NOTICE OR YOUR CURRENT PRESCRIPTION DRUG COVERAGE:
You can join a Medicare drug plan when you first become eligible for Medicare and each year from October 15 to December 7. However, if you lose your current creditable prescription drug coverage, through no fault of your own, you will also be eligible for a two (2) month Special Enrollment Period (SEP) to join a Medicare drug plan. WHAT HAPPENS TO YOUR CURRENT COVERAGE IF YOU DECIDE TO JOIN A MEDICARE DRUG PLAN? If you decide to join a Medicare drug plan, your Averitt Express, Inc. coverage will not be affected. See below for more information about what happens to your current coverage if you join a Medicare drug plan. RETAIL PRESCRIPTION DRUG BENEFITS (30-DAY SUPPLY) 30 DAYS THP HDHP Generic $20 copay
Contact Marsha Brock, Benefits Administrator, 931-525-5323 for further information. NOTE: You’ll get this notice each year. You will also get it before the next period you can join a Medicare drug plan, and if this coverage through Averitt Express, Inc. changes. You also may request a copy of this notice at any time. FOR MORE INFORMATION ABOUT YOUR OPTIONS UNDER MEDICARE PRESCRIPTION DRUG COVERAGE: More detailed information about Medicare plans that offer prescription drug coverage is in the “Medicare & You” handbook. You’ll get a copy of the handbook in the mail every year from Medicare. You may also be contacted directly by Medicare drug plans. FOR MORE INFORMATION ABOUT MEDICARE PRESCRIPTION DRUG COVERAGE: • Visit www.medicare.gov • Call your State Health Insurance Assistance Program (see the inside back cover of your copy of the “Medicare & You” handbook for their telephone number) for personalized help • Call 1-800-MEDICARE ( 1-800-633-4227 ). TTY users should call 1-877-486-2048 . If you have limited income and resources, extra help paying for Medicare prescription drug coverage is available. For information about this extra help, visit Social Security on the web at www.socialsecurity.gov , or call them at 1-800-772-1213 (TTY 1-800-325-0778 ). Remember: Keep this Creditable Coverage notice. If you decide to join one of the Medicare drug plans, you may be required to provide a copy of this notice when you join to show whether or not you have maintained creditable coverage and, therefore, whether or not you are required to pay a higher premium (a penalty).
Preferred Brand
$40 copay
20% after deductible
Non-Preferred Brand
$80 copay
Specialty
$40 or $80 copay
Since the existing prescription drug coverage under the Express Care Plan is creditable (e.g., as good as Medicare coverage), you can retain your existing prescription drug coverage and choose not to enroll in a Part D plan; or you can enroll in a Part D plan as a supplement to, or in lieu of, your existing prescription drug coverage. If you do decide to join a Medicare drug plan and drop your Averitt Express, Inc. prescription drug coverage, be aware that you and your dependents can only get this coverage back at open enrollment or if you experience an event that gives rise to a HIPAA Special Enrollment Right. WHEN WILL YOU PAY A HIGHER PREMIUM (PENALTY) TO JOIN A MEDICARE DRUG PLAN? You should also know that if you drop or lose your current coverage with Averitt Express, Inc. and don’t join a Medicare drug plan within 63 continuous days after your current coverage ends, you may pay a higher premium (a penalty) to join a Medicare drug plan later. If you go 63 continuous days or longer without creditable prescription drug coverage, your monthly premium may go up by at least one percent of the Medicare base beneficiary premium per month for every month that you did not have that coverage. For example, if you go 19 months without creditable coverage, your premium may consistently be at least 19 percent higher than the Medicare base beneficiary premium. You may have to pay this higher premium (a penalty) as long as you have Medicare prescription drug coverage. In addition, you may have to wait until the following October to join.
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Women’s Health and Cancer Rights Act If you have had or are going to have a mastectomy, you may be entitled to certain benefits under the Women’s Health and Cancer Rights Act of 1998 (WHCRA). For individuals receiving mastectomy-related benefits, coverage will be provided in a manner determined in consultation with the attending physician and the patient, for: • All stages of reconstruction of the breast on which the mastectomy was performed; • Surgery and reconstruction of the other breast to produce a symmetrical appearance; • Prostheses; and treatment of physical complications of the mastectomy, including lymphedema. These benefits will be provided subject to the same deductibles and coinsurance applicable to other medical and surgical benefits provided under this Plan. For further details on WHCRA benefits, please refer to the Plan’s Summary Plan Description. Newborns’ and Mothers’ Health Protection Act Group health plans and health insurance issuers generally may not, under Federal law, restrict benefits for any hospital length of stay in connection with childbirth for the mother or newborn child to less than 48 hours following a vaginal delivery, or less than 96 hours following a cesarean section. However, Federal law generally does not prohibit the mother’s or newborn’s attending provider, after consulting with the mother, from discharging the mother or her newborn earlier than 48 hours (or 96 hours as applicable). In any case, plans and issuers may not, under Federal law, require that a provider obtain authorization from the plan or the insurance issuer for prescribing a length of stay not in excess of 48 hours (or 96 hours). If you would like more information on maternity benefits, call your plan administrator.
HIPAA Notice of Special Enrollment Rights If you decline enrollment in your employer’s health plan for you or your dependents (including your spouse) because of other health insurance or group health plan coverage, you or your dependents may be able to enroll in your employer’s health plan without waiting for the next open enrollment period if you: • Lose other health insurance or group health plan coverage. You must request enrollment within 30 days after the loss of other coverage. • Gain a new dependent as a result of marriage, birth, adoption, or placement for adoption. You must request health plan enrollment within 30 days after the marriage, birth, adoption, or placement for adoption. • Lose Medicaid or Children’s Health Insurance Program (CHIP) coverage because you are no longer eligible. You must request medical plan enrollment within 60 days after the loss of such coverage. If you request a change due to a special enrollment event within the 30-day timeframe, coverage will be effective the date of birth, adoption or placement for adoption. For all other events, coverage will be effective the first of the month following your request for enrollment. In addition, you may enroll in your employer’s health plan if you become eligible for a state premium assistance program under Medicaid or CHIP. You must request enrollment within 60 days after you gain eligibility for medical plan coverage. If you request this change, coverage will be effective the first of the month following your request for enrollment. Specific restrictions may apply, depending on federal and state law. Note: If your dependent becomes eligible for a special enrollment rights, you may add the dependent to your current coverage or change to another health plan. Availability of Privacy Practices Notice We maintain the HIPAA Notice of Privacy Practices for Averitt Express, Inc. describing how health information about you may be used and disclosed. You may obtain a copy of the Notice of Privacy Practices by contacting the Averitt Express Benefits Department at 931-525-5323 .
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Premium Assistance Under Medicaid and the Children’s Health Insurance Program (CHIP) If you or your children are eligible for Medicaid or CHIP and you’re eligible for health coverage from your employer, your state may have a premium assistance program that can help pay for coverage, using funds from their Medicaid or CHIP programs. If you or your children aren’t eligible for Medicaid or CHIP, you won’t be eligible for these premium assistance programs but you may be able to buy individual insurance coverage through the Health Insurance Marketplace. For more information, visit www.healthcare.gov . If you or your dependents are already enrolled in Medicaid or CHIP and you live in a State listed below, contact your State Medicaid or CHIP office to find out if premium assistance is available. If you or your dependents are NOT currently enrolled in Medicaid or CHIP, and you think you or any of your dependents might be eligible for either of these programs, contact your State Medicaid or CHIP office or dial 1-877-KIDS NOW or www.insurekidsnow.gov to find out how to apply. If you qualify, ask your state if it has a program that might help you pay the premiums for an employer-sponsored plan. If you or your dependents are eligible for premium assistance under Medicaid or CHIP, as well as eligible under your employer plan, your employer must allow you to enroll in your employer plan if you aren’t already enrolled. This is called a “special enrollment” opportunity, and you must request coverage within 60 days of being determined eligible for premium assistance. If you have questions about enrolling in your employer plan, contact the Department of Labor at www.askebsa.dol.gov or call 1-866-444-EBSA (3272) .
If you live in one of the following states, you may be eligible for assistance paying your employer health plan premiums. The following list of states is current as of July 31, 2023. Contact your State for more information on eligibility.
ALABAMA: Medicaid myalhipp.com 855-692-5447 ALASKA: Medicaid The AK Health Insurance Premium Payment Program: myakhipp.com 866-251-4861 CustomerService@MyAKHIPP.com Medicaid Eligibility: https://health.alaska.gov/dpa/ ARKANSAS: Medicaid myarhipp.com 855-MyARHIPP (855-692-7447) CALIFORNIA: Medicaid
INDIANA: Medicaid Healthy Indiana Plan for low-income adults 19-64: in.gov/fssa/hip 877-438-4479 All other Medicaid: https://www.in.gov/medicaid 800-457-4584 IOWA: Medicaid and CHIP (Hawki) Medicaid: https://dhs.iowa.gov/ ime/members 800-338-8366 Hawki: dhs.iowa.gov/Hawki 800-257-8563 HIPP: https://dhs.iowa.gov/ime/ members/medicaid-a-to-z/hipp 888-346-9562 KANSAS: Medicaid https://www.kancare.ks.gov Kentucky Integrated Health Insurance Premium Payment Program (KI-HIPP): https://chfs. ky.gov/agencies/dms/member/ Pages/kihipp.aspx 855-459-6328 KIHIPP.PROGRAM@ky.gov KCHIP: https://kidshealth.ky.gov 877-524-4718 Kentucky Medicaid: https://chfs. ky.gov LOUISIANA: Medicaid Medicaid: medicaid.la.gov 888-342-6207 LaHIPP: ldh.la.gov/lahipp 855-618-5488 MAINE: Medicaid https://www. mymaineconnection.gov/ benefits/s 800-442-6003 (TTY: Maine relay 711) Private Health Insurance Premium Webpage: https:// www.maine.gov/dhhs/ofi/ applications-forms 800-977-6740 (TTY: Maine relay 711) 800-792-4884 800-967-4660 KENTUCKY: Medicaid
MASSACHUSETTS: Medicaid and CHIP https://www.mass.gov/ masshealth/pa 800-862-4840 (TTY: 617-886-8102) masspremiumassistance@ accenture.com MINNESOTA: Medicaid https://mn.gov/dhs/people-we- serve/children-and-families/ health-care/health-care- programs/programs-and- services/other-insurance.jsp 800-657-3739 MISSOURI: Medicaid dss.mo.gov/mhd/participants/ pages/hipp.htm 573-751-2005 MONTANA: Medicaid dphhs.mt.gov/Montana HealthcarePrograms/HIPP 800-694-3084 HHSHIPPProgram@mt.gov NEBRASKA: Medicaid ACCESSNebraska.ne.gov 855-632-7633
NORTH CAROLINA: Medicaid https://medicaid.ncdhhs.gov 919-855-4100 NORTH DAKOTA: Medicaid https://www.hhs.nd.gov/ healthcare 844-854-4825 OKLAHOMA: Medicaid and CHIP insureoklahoma.org 888-365-3742 OREGON: Medicaid healthcare.oregon.gov 800-699-9075 PENNSYLVANIA: Medicaid Medicaid: https://www.dhs. pa.gov/Services/Assistance/ Pages/HIPP-Program.aspx 800-692-7462 CHIP: https://www.dhs.pa.gov/ CHIP/Pages/CHIP.aspx 800-986-KIDS (5437) RHODE ISLAND: Medicaid and CHIP eohhs.ri.gov 855-697-4347, or 401-462-0311 (Direct RIte Share Line)
VIRGINIA: Medicaid and CHIP https://coverva.dmas.virginia. gov/learn/premium-assistance/ famis-select https://coverva.dmas.virginia. gov/learn/premium-assistance/ health-insurance-premium- payment-hipp-programs Medicaid: 800-432-5924 CHIP: 800-432-5924 WASHINGTON: Medicaid https://www.hca.wa.gov 800-562-3022 WEST VIRGINIA: Medicaid and CHIP https://dhhr.wv.gov/bms mywvhipp.com Medicaid: 304-558-1700 CHIP: 855-MyWVHIPP (855-699-8447) WISCONSIN: Medicaid and CHIP https://www.dhs.wisconsin.gov/ badgercareplus/p-10095.htm 800-362-3002 WYOMING: Medicaid
Health Insurance Premium Payment (HIPP) Program: dhcs.ca.gov/hipp 916-445-8322
Fax: 916-440-5676 hipp@dhcs.ca.gov
COLORADO: Health First Colorado (Colorado’s Medicaid Program) & Child Health Plan Plus (CHP+) Health First Colorado: https://www.healthfirstcolorado.com 800-221-3943/ State Relay 711 CHP+: https://hcpf.colorado. gov/child-health-plan-plus 800-359-1991, State Relay 711 Health Insurance Buy-In Program (HIBI): https://www.mycohibi.com 855-692-6442 FLORIDA: Medicaid https://www. flmedicaidtplrecovery.com/ flmedicaidtplrecovery.com/hipp 877-357-3268 GEORGIA: Medicaid GA HIPP: https://medicaid. georgia.gov/health-insurance- premium-payment-program-hipp 678-564-1162, Press 1 GA CHIPRA: https://medicaid. georgia.gov/programs/third- party-liability/childrens- health-insurance-program- reauthorization-act-2009-chipra 678-564-1162, Press 2
https://health.wyo.gov/ healthcarefin/medicaid/ programs-and-eligibility 800-251-1269
Lincoln: 402-473-7000 Omaha: 402-595-1178 NEVADA: Medicaid
SOUTH CAROLINA: Medicaid https://www.scdhhs.gov 888-549-0820 SOUTH DAKOTA: Medicaid dss.sd.gov 888-828-0059 TEXAS: Medicaid
To see if any other states have added a premium assistance program since July 31, 2023, or for more information on special enrollment rights, contact: U.S. Department of Labor Employee Benefits Security Administration dol.gov/agencies/ebsa 866-444-EBSA (3272)
dhcfp.nv.gov 800-992-0900
NEW HAMPSHIRE: Medicaid https://www.dhhs.nh.gov/
programs-services/medicaid/ health-insurance-premium- program 603-271-5218 Toll free number for HIPP: 800-852-3345, ext 5218 NEW JERSEY: Medicaid and CHIP Medicaid: state.nj.us/ humanservices/dmahs/clients/ medicaid 609-631-2392 CHIP: njfamilycare.org/index.html 800-701-0710 NEW YORK: Medicaid https://www.health.ny.gov/ health_care/medicaid 800-541-2831
https://www.hhs.texas.gov/ services/financial/health- insurance-premium-payment- hipp-program 800-440-0493 UTAH: Medicaid and CHIP Medicaid: https://medicaid. utah.gov CHIP: health.utah.gov/chip 877-543-7669 VERMONT: Medicaid https://dvha.vermont.gov/ members/medicaid/hipp- program 800-250-8427
OR
U.S. Department of Health and Human Services Centers for Medicare & Medicaid Services cms.hhs.gov 877-267-2323, Menu Option 4, Ext. 61565
OMB Control Number 1210-0137 (expires 1/31/2026)
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INSIDEAVERITT.COM/CHOOSEWELL 1415 NEAL STREET, P.O. BOX 3166, COOKEVILLE, TN 38502-3166
This brochure is intended only to be an overview of the Averitt Express benefits plans. The complete details about the plans and how they work are included in the Summary Plan Descriptions (SPDs) and plan documents, which are available upon request. SPDs are also available online at InsideAveritt.com . If there are any inconsistencies between this brochure and the plan documents, the plan documents will govern. Averitt Express is committed to providing competitive benefits programs to its associates. At the same time, we must manage our business carefully and be in a position to change the way we operate, including our benefits plans, when we determine necessary. Therefore, Averitt retains the right to amend, change or end one or more of the benefits plans at any time.
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