IEC Dallas 2024 2025 benefit guide

2024

Employee Benefit Overview

WELCOME

Independent Electrical Contractors, Dallas Chapter offers you and your family members a comprehensive and valuable benefits program. Our employees are our most valuable asset. That is why we are committed to an employee benefit program that helps our employees stay healthy, feel secure, and maintain a work/life balance. We encourage you to take the time to educate yourself about your options and choose the best coverage for you and your family.

Benefits Available to you for 2024

Medical – SOTA Benefits; First Primary Care EFFECTIVE 02/01/2024

❖ We are now offering one plan. SOTA E301 with First Primary Care

Dental - Principal

❖ We offer one dental plan.

❖ The company will cover 100% of the Employee Only monthly premium.

Vision - Principal

❖ We offer one vision plan.

❖ The company will cover 100% of the Employee Only monthly premium.

Basic Life and AD&D - Principal

❖ The company will provide all full-time employees with $50,000 of Basic Life and AD&D coverage at no cost to you!

Long-Term Disability - Principal

❖ The company will provide all full-time employees with Long-Term Disability coverage at no cost to you!

Freshbenies

❖ The company will provide all full-time employees with this coverage at no cost to you!

This Employee Benefit Overview can be used as a reference throughout the year. If you have any questions, please contact your HR department or your Group Account Managers. Plan information and phone numbers are listed in the back of the overview.

MEDICAL OPEN ENROLLMENT

January 1, 2024 through January 31, 2024

IMPORTANT

New Hires – you will become eligible for benefits 1st of the month following 30 days from your date of hire.

Current Employees – Open Enrollment will occur annually during the month of January. The benefits you elect during open enrollment will be effective from January 1, 2024 through December 31, 2024.

Eligibility Guidelines

Who Can you Cover?

You and your dependents are eligible to enroll in benefits if:

You are a full-time eligible employee

Your dependents meet the following criteria:

• Dependent Child: dependent children can be covered under their parent’s coverage through the end of the month of their 26th birthday. This does not apply to legally disabled children.

• Spouse: Legal Spouses

When Can I Make Changes to My Benefits?

If you experience a qualifying life event that results in the gain or loss of insurance for yourself and/or your dependents, you must report it to HR within 30 days of the event.

• Marriage or Divorce

• Birth or Adoption

• Death of spouse or child

• Gain or loss of other coverage

• You or your eligible family members experience a change in employment status that affects benefits eligibility

• Dependent child reaches age 26

• Court judgement or decree

If you decide not to enroll in benefits for 2024, you will need to wait until the next open enrollment period to select benefits unless you experience a qualifying life event.

How to Enroll

Step 1:

Review your current benefit elections.

Step 2:

Make sure you understand your new options and ask any questions you may have.

Step 3:

Make your benefit elections by completing the election form linked below regardless if electing or declining coverage. Forms must be turned in within 30 days of employment to ensure your elections are processed and ID cards are sent out.

Independent Electrical Contractors, Dallas Chapter Enrollment Form

Please note that if electing an HMO plan you must select a Primary Care Physician (PCP) or one will be assigned to you

Medical Eligibility

FULL-TIME EMPLOYEES that work at least 30 hours per week are eligible for coverage on the 1st of the month following 30 days from date of Employment or Full Time Status

IMORTANT STEPS FOR YOUR ENROLLMENT PROCESS: You must complete your enrollment within your eligibility period or open enrollment period otherwise you will not be able to enroll in Independent Electrical Contractors, Dallas Chapter Benefit Plan until the next annual open enrollment unless you have a qualifying life event.

ELIGIBLE DEPENDENTS:

• Legal Spouse; Not Including Domestic Partners

• Any Child of an eligible employee up to age 26

• Any Child under legal guardianship of the eligible employee up to age 26

• Stepchildren of an eligible employee up to age 26

• Dependent Child(ren) required to be covered through Qualified Medical Support Order

• Any Child meeting the criteria above who is over the age of 26 and legally incapacitated

• All Employees must elect or Waive coverage

LIFE EVENTS:

• Birth or adoption of a child

• Marriage or divorce

• Death of spouse and/or dependents

• Dependent’s loss of eligibility

• Gain/loss of health care coverage of spouse due to employment changes

• Taking an unpaid leave of absence

• Your spouse becomes eligible or ineligible for Medicare Benefits

• Other such event Plan Administrator determines to be permitted under I.R.S Section 125 or other applicable guidelines issued by the I.R.S.

• Gain/loss of eligibility of Medicare/CHIP (60 days to enroll/cancel coverage)

The Change to your benefit election must be consistent with the change in family status (i.e. birth of child allows the Plan to add a newborn, but does not allow you to drop your current coverage). Newborn children of an eligible employee will not be covered from the moment of birth unless enrollment of the child as a dependent is completed within 31 days from the child’s date of birth.

Medical Premiums

Independent Electrical Contractors, Dallas Chapter will cover 100% of the Employee Only monthly cost Independent Electrical Contractors, Dallas Chapter provides certain benefits on a shared contribution basis and voluntary plIndependent Electrical Contractors, Dallas Chapter and does not necessarily reflect all benefits offered. Please refer to the employee handbook, employee benefit packet and/or contact Human Resources for more benefit information. In the event there is a contradiction between the information in this booklet and the information contained in the Master Contracts or Master Plan Documents with the insurance carriers, the Master Contracts and Plan Documents will govern.

Plan Type

HealthSmart Network Access

Plan Year Deductible (Individual/Family)

Deductible Type

Coinsurance (Plan Responsibility)

Maximum Out-of-Pocket

(Includes Deductible, Coinsurance & Copays)

Individual Family

Direct Primary Care

Telemedicine

In Office

In Office Testing / Surgery/ Routine Bloodwork

In Office Imaging (Excludes MRIs, CT & PET Scans)

Preventive Screening and Testing

MRIs, CT & PET Scans

Physician Office Visit Referal

Urgent Care Referal

Preventive Care

(Includes screenings, counseling, immunizations, birth control and other preventive care services)

Primary Care Office Visit

Specialist Office Visit

Urgent Care Clinic & Physician Services

Freestanding Facility or Urgent Care Center

Excludes In-office Surgery Laboratory and/or Radiology

Freestanding Facility Only

Excludes Emergency Room

Excludes MRIs, CT & PET Scans

MRI, CT & PET Scans

Emergency Room

Hospital Service - Inpatient/Outpatient

All Other Covered Services

100% After Deductible $500 Copay

100% After Deductible

Welcome to the Shield PBM Family!

We’re excited to introduce you to the Shield PBM Difference, a unique approach to prescription services that is designed to make your healthcare experience more convenient and cost-effective. Unlike other insurance carriers, we focus on the pharmaceutical realm, which means all plans (referred to as Tiers) benefit from our services. We know that everyone likes to save money, even when they have insurance, and that’s what we’re here to help you with.

Activating Your Account:

If you haven’t already, here’s how to activate your account:

Locate Your Company Benefits Card: Find your Company Benefits Card. Visit www.ShieldPBM.com: Go to our website.

Click Login With Member/Group ID: Select this option in the pop-up window.

Enter Your Member ID: Use the Member ID located on your Company Benefits Card.

Group ID: Enter the GROUP ID provided in your Welcome Email.

Add Essential Information: Verify the prefilled information, make any necessary changes, and save your profile. You’ll also have the option to create your password, add credit card information, specify your physician, choose your local preferred pharmacy, and add any dependents on your policy.

Start Using Your Account: After completing these steps, you can start processing orders for local pharmacy pick-ups and home delivery.

If you have any concerns or need assistance, don’t hesitate to call (877) 659-6101, and one of our Customer Care Specialists will guide you through the process. 1 2 3 4 5 6 7 8

Update Your Profile: Once you’re logged in, make sure to update your profile first. This step is crucial, as it ensures that your information is correctly saved.

Ordering Your Meds:

Here’s a quick overview of how to order your medications through Shield PBM:

Search: Find your prescribed medication, and select the form, strength, and quantity. You’ll receive the price, which could be your copay or less.

Select Delivery Method: Choose your method of delivery. You can pick up your prescription at your local pharmacy once, after which your plan will automatically switch to home delivery.

Online Payment: Handle your payment and processing online, eliminating the middle-man and saving 50% or more on most prescription medications.

Home Delivery: Home delivery can save you up to 80% on many medications. After your first purchase, it becomes automatic as long as you have a valid prescription on file. Allow 10 – 14 days for delivery.

Specialized Programs:

We offer specialized programs to cater to specific needs, such as diabetes management and an international pharmacy program. These programs are designed to provide you with the best solutions and savings for your unique healthcare requirements.

Prescription Assistance Program (PAP):

If you’re facing high-priced medications, our Prescription Assistance Program (PAP) is here to help. PAPs are available from pharmaceutical manufacturers, foundations, and government entities. Shield PBM offers a comprehensive PAP platform that can save you thousands of dollars. If you’re eligible, we may even waive your copay. Call us at (877) 659-6101 for assistance.

Pharmacy Advocacy:

Our Pharmacy Advocates act as an additional set of eyes and ears in the exam room. They can help you understand your medications, ask questions to your doctor on your behalf, maintain your medication list, assist with prescription assistance programs, and find alternative ways to save on your prescriptions. In case of emergencies, contact 911 for urgent medical assistance. Your local pharmacy and your family physician are also valuable resources for your healthcare needs.

RxValet

RxValet offers a range of convenient options to help you access your prescription medications affordably and with flexibility. Choose the option that best suits your needs:

Pre-Pay SELECT: Enjoy the guaranteed lowest price at a SPECIFIC PHARMACY. Be sure to visit the designated pharmacy as your purchase won’t be valid at any other location.

Pre-Pay CHOICE (Retail Pick-up): This option empowers you to select YOUR FAVORITE PHARMACY for the same guaranteed low price. It’s perfect for those who prefer a pharmacy closer to them.

RX Discount Card (Retail Pick-up): Pay only a fraction of retail prices. Search for your medication and choose the pharmacy based on your preferred savings distance. Unlike pre-paid options, the price you see cannot be guaranteed, and payment is required at the pharmacy.

1 2 3 4

Pre-Pay Home Delivery (Save up to 80%): Skip the pharmacy lines and access substantial savings with this home delivery option. In many cases, a 90-day supply through Home Delivery can cost less than a 30-day supply at a local pharmacy. Ideal for those with recurring medications.

International Pharmacy (Save up to 70% on name-brand medications): Enjoy the lowest pricing for name-brand medications, often up to two-thirds off the retail price. Rest assured, the quality of these medications matches US standards.

5 6

Prescription Assistance (IncomeBased Program): For those who qualify, this program offers assistance with specific medications. Determine your eligibility by completing a short online form. RxValet will expedite your qualification, guide you through the registration process, and make a challenging decision easier to manage.

RxValet is your trusted partner in ensuring accessible and cost-effective medication access. Choose the option that aligns with your needs and experience a better way to manage your prescriptions.

WHY FPC?

Unlimited Office Visits & Virtual Care

Same day/Next day Appointments

Annual Wellness Exams Including Labs

$0 Co-pays or Deductibles, and No Hidden Fees

Free Generic Prescriptions*

Free Mental Health Support

Well-Woman Exams and Birth Control

WHAT WE DO:

THE 4 STEP CHECKLIST

EDUCATE - Use online seminars and meet & greets with employees to raise awareness for what First Primary Care offers them through their plan design and care team

ONBOARD - Employees will enroll in real time with us to ensure technology is correctly set up to be utilized

ENGAGE - Our team continues to maintain a close relationship with each member we interact with. We work to treat short term illness, while establishing long term health goals and a plan to get there. Our team is available any time to assist with questions

ADVOCATE - Care coordination is offered at no cost to assist members in setting up surgeries, office visits, and treatments that First Primary Care does not provide.

At First Primary Care, a Direct Primary Care Provider, our goal is to ensure that your employees and their dependents have access to the highest quality Primary Care available. Direct Primary Care provides access to a specific Care Team 24 hours a day / 365 days a year. Access to the Care Team can be done in-person or virtual through a secure app that can be downloaded on their smartphone or tablet. By having a direct relationship established between patients and The Care Team, the focus is no longer on Sick Care but rather on Healthcare! We look forward to helping your team with their “Health” Care journey.

IN-OFFICE PROCEDURES INCLUDED:

EKG

Abscess Drainage

Breathing Treatments

IUD/Nexplanon Insertion

Pap Smears

Steroid Injections

PRESCRIPTIONS INCLUDED:

Minor Skin Procedures (Cyst/Skin Tag Removal) And other procedures

Prescription drugs are one of the high cost claims that affect companies the most. Whether you need a maintenance medication, urgent care medication or need to find a new pharmacy with better prices, you’re covered.

LAB TESTS 4X A YEAR AT NO COST:

Common diagnostic labs used for health maintenance and monitoring are included in First Primary Care at no cost up to 4x a year.

Welcome to the intersection of high-value care, transparency, and relationship-driven treatment.

Dr. Geetinder Goyal, MD

What medical services are included with a Primary365 Membership?

Family Medicine

On Time Routine O ce Visits

Same Day Illness and Injury Visit

Virtual Consults with Your Doctor

Annual Exams w/ Blood Work

Weight Loss Coaching / Consultation

Chronic Disease Management

Nebulized Breathing Treatments

Flu Test / Strep Test

Minor Procedures

Laceration Repair (Stitches)

Joint Injections

Electrocardiograms (EKG)

Venipuncture (Lab Draw)

Abscess Drainage

IV Hydration

Spirometry

Women’s Health

Annual Well-Woman Exams

Family Planning Counseling

Urine Pregnancy Testing

STD Testing

Hormone Replacement Testing/ Counseling/Replacement

Men’s Health

Testosterone Panel

Testosterone Replacement Injectable

Testosterone Replacement Cream Erectile Dysfunction Drugs

Skin Care

Wound Care

Removal of Minor Lesions

Biopsies of Skin Growths & Moles

Cryotherapy for growths

Wart Removal

Employee FAQs

How does First Primary Care work with my health plan?

What are the advantages of using Direct Primary Care?

Your FPC membership compliments your health plan and gives you unlimited access to a dedicated care-team that you can contact for any medical issue or concern for $0 out-of-pocket costs. Once you complete the onboarding process with First Primary Care (FPC), you are assigned a physician-led care team. This dedicated physician and care team are available to help you wherever and whenever you need care. Best of all, if you go through your FPC physician and care team first, generally your deductible can be waived meaning no out-of-pocket costs for you.

Since First Primary Care is integrated into your healthcare plan, most of the care you receive from your dedicated First Primary Care physician and care team will not cost you anything. This allows employees to focus more on getting healthier and spend less time worrying about how much something is going to cost or if they can afford it.

Another advantage is convenience and trust. If you can send a text message or make a phone call, you can connect with the same doctor every time. This one-to-one doctor-patient relationship is key to getting the best care for the least amount out-of-pocket. If you happen to need care outside what First Primary Care can provide, your dedicated physician will guide you and be your trusted medical advisor.

Do I have to stop seeing my doctors?

Not at all. But in many cases, First Primary Care is going to be more convenient and more costeffective. Since you’ll have direct access to a physician and care team, they can generally provide you with care and guidance sooner than other doctors. But if you don’t want to utilize First Primary Care, that’s fine as well. You just need to remember that you’ll be subject to co-pays, deductibles, and co-insurance based on your health plan.

Can I access this benefit after-hours?

Absolutely. That’s why it’s so important to complete the onboarding process with First Primary Care and be assigned to your dedicated primary care doctor and care team. This includes downloading and installing the Spruce Health app. If you need something after-hours, just send your physician a message. You’ll be asked if this is an urgent or not urgent issue. If urgent, your physician will be notified. If not, they usually get in touch with you the next business day.

Independent Electrical Contractors, Dallas Chapter offers a vision plan through Principal/VSP Vision Care. We will cover 100% of the Employee Only monthly cost You also have the option to add your dependents and the difference in premium will be taken on a pre-tax basis.

Glasses Lenses – 1 pair every 12 months Frames – Covered up to $130 every 24 months 20% off amount over allowance $25 Copay

Lens Enhancements

Elective Contacts

• Single lenses

• Lined bifocal lenses

• Lined trifocal lenses

• Lenticular lenses

• Polycarbonate lenses for dependent children under the age of 18

Standard progressive lenses covered once every 12 months with a $0 Copay

Most other popular lens enhancements are covered after a copay, saving you on average 30%

Covered up to $130 every 12 months. Contact lenses can be chosen instead of glasses.

Basic Life &Disability Insurance

BASIC LIFE AND AD&D - We provide all Full-Time employees with $50,000 of Basic Life and AD&D coverage at no cost to you through Principal. The Benefit Age Reduction schedule is as follows; 35% reduction at age 65 and an additional 15% reduction at age 70.

LONG TERM DISABILITY - We provide all Full-Time employees with Long-Term Disability through Principal in the amount of 60% your basic covered monthly earnings to a maximum benefit ($6,000) after a 90-day waiting period. Be sure to include salary information during enrollment

Long Term Disability Benefits

Benefit 60% of your earrings up to $6,000

Elimination Period 90 Days Pre-existing Waiting Period 12 months prior, 12 months insured Benefit Duration

Varies based on your age when you become disabled See chart below Earnings Definition Base Wage, including commissions and bonus

Freshbenies

This benefit will be paid for by Independent Electrical Contractors Dallas Chapter You will receive Telehealth, Behavioral Telehealth, Doctors Online, Advocacy Services, and Prescription Savings. Add-on options for additional savings are also available and will be deducted from your paycheck should you decide to add them.

Prescription Resources

Stop paying too much for your prescriptions…. Compare prices, find FREE coupons, and save up to 80%.

GoodRx is 100% FREE and is as easy as 1-2-3 to use:

1: Find free coupons

Coupons work at virtually every U.S. pharmacy. Prices may even beat your insurance!

2: Show coupon to pharmacy

Text, email or print your coupon. No approval or paperwork needed.

3: Save up to 80%

Save on all your family’ s prescriptions. Coupons work for refills too!

PLEASE NOTE: You have a choice to use your insurance OR the coupon, but you CANNOT use both. If you use the coupon, the cost of medication will not apply toward your deductible or max out of pocket.

How do I find discounts for my prescriptions?

It’s easy. Go to www.goodrx.com, type in the prescription name in the search field and click the “Find the Lowest Price” button. GoodRx will gather current prices and discounts to help you find the lowest cost pharmacy.

How do I get my coupon?

Select where you would like to fill your prescription and click on that pharmacy name and the coupon will generate on the next page

How do I use my coupon?

It’ s like using a coupon at a grocery store. Print, text, email, or just show it the coupon to the pharmacist when you pick up your prescription. They will enter the information into their system for the discount. REMEMBER this is not insurance!

Where to go for Care

Right Care. Right Place. Right Savings.

With many options for getting care, how do you choose? This chart can help you understand where to go for what and how you can save money. Where to go

Virtual Visit

Primary Care Physician

A virtual visit lets you see a doctor via smartphone, tablet, or computer.

▪ Allergies

▪ Cough/Colds ▪ Infections

Rashes

Go to a doctor’s office when you need preventive or routine care. Your primary doctor can access your medical records, manage your prescriptions, and refer you to a specialist if needed. ▪ Checkups ▪ Preventive Services

Children and Adolescents Well-Child Exam Immunizations

Screening Tests Preventive Treatments

Urgent Care

Seasonal Flu

Minor Conditions

Vaccinations

General Health Management

Preventive Care Includes:

Screening Tests Health Consulting

▪ Sprains

Urgent Care is ideal for when you need care quickly, but it is not an emergency or life threatening (and your doctor isn’t available).

▪ Strains

▪ Cuts that may need stitches

▪ Minor burns and infections

▪ Minor broken bones

*You can benefit significantly by using an urgent care facility versus an Emergency Room without sacrificing quality care.

Emergency Room

The ER is for life-threatening or very serious conditions that require immediate care. This is also when to call 911

▪ Heavy bleeding

▪ Large wounds

▪ Sudden change in vision

▪ Chest Pain

▪ Major burns, injuries or broken bones

Carrier Contact Information

Group #: IECDAL Network: HealthSmart

Website: https://providerlookup.healthsmart.com/ searchproviders.aspx

www.principal.com

Vision – Principal (through VSP)

Group #: 1021164

Network: Choice

Phone Number: 800-877-7195

Website: www.vsp.com Vision Summary of Benefits Basic Life and AD&D - Principal

Group #: 1021164

Phone Number: 800-247-4695

Website: www.principal.com

Life and AD&D Summary of Benefits Long-Term Disability - Principal Group #: 1021164 Phone Number: 800-247-4695 Website: www.principal.com Long-Term Disability Summary of Benefits

Group #: TBD

Member Services Number: 855-647-6762

Website: www.freshbenies.com/tanyaboydassociates

Key Terms

Preferred Provider Organization (PPO)

An insurance plan that provides both In and Out of Network benefits. You can choose a doctor you want to see from a large list of primary care and specialty doctors.

Health Maintenance Organization (HMO)

An insurance plan that provides In-Network benefits ONLY. You are also required to select a Primary Care Physician (PCP) who can refer you to a specialist when needed.

Exclusive Provider Organization (EPO)

An insurance plan that provides In-Network benefits ONLY. You do not need to select a Primary Care Physician (PCP) and no referral is needed to see a specialist.

Deductible

Primary Care Physician (PCP)

Is a healthcare professional who practices general medicine. Most PCP’s are doctors, but nurse practitioners and even physician assistants can sometimes be PCP’s.

The amount you pay for covered health care services before your insurance plan starts to pay.

Coinsurance

The percentage of costs of a covered health care service you pay after you’ve reached your deductible.

Out-of-Pocket Maximum (OPX)

The most you’ll pay each year towards your deductible, copay and coinsurance. Once you’ve met the maximum, your insurance company will pay for the remainder of your care, if it’s essential.

High Deductible Health Plan (HDHP)

These plans generally have higher deductibles and lower premiums and are typically paired with an HSA.

Health Savings Account (HSA)

Think of an HSA as a savings account that you can use for qualified medical expenses (doctor’s visits, copays, dental care, and prescriptions). The tax-free funds in an HSA can be saved from year to year.

Allowed Amount

Explanation of Benefits (EOB)

A statement from your health insurance plan describing what costs it will cover for medical care or products you’ve received The EOB generates when your provider submits a claim for the services you received

The discounted amount of a service that your doctor has negotiated with participating providers.

Billed Amount

The amount you are responsible for based on the providers set charges for various medications, items and services they provide.

Compliance Notices

❖ Women’s Health and Cancer Rights Act

❖ Patient Privacy and HIPAA

❖ Children’s Health Insurance Program Act (CHIP)

Newborns and Mothers Health Protection Act

HIPAA Special Enrollment Rights

Healthcare Reform Overview of Grandfathered Plans ❖ Uniformed Services Employment & Reemployment Rights

Patient Protection Act ❖ Medicare Part D Creditable Coverage

State Continuation – Texas 19 or less EE