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2013 – 2014 Employee Benefits Booklet GBS Benefits, Inc. UnitedHealthcare

Medical

GBS Benefits, Inc.

Tim King Account Executive

GBS Benefits, Inc. GBS Benefits, Inc.

Colette Kremin Benefit Specialist

Monica Wells Account Manager

(866) 633-2446 www.uhc.com www.myuhc.com

(435) 789-9151 tim.king@gbsbenefits.com

(435) 789-9151 colette.kremin@gbsbenefits.com

(800) 427-6586 x1111 (801) 364-7233 x1111 monica.wells@gbsbenefits.com

In an effort to make your benefits more understandable, this brief summary of your benefits has been prepared. The benefit booklet is provided as a summary of your employee benefits only. While the benefits listed are considered accurate, they are not a guarantee of service, or payment by the insurance company. For complete details regarding any of your employee benefits, please see plan summaries. This summary of benefits is a cursory description of your employee benefits and should be considered such.


Table of Contents Important Information .......................................................................................................................................... 7 Enrollment Guidelines .................................................................................................................................... 8 Health Care Reform & Changes to Your Benefits ................................................................................. 8 Medicare Part D................................................................................................................................................. 9 Medicaid & CHIP ............................................................................................................................................... 10 Medical – UnitedHealthcare ................................................................................................................................... 12 Medical Plan Options ...................................................................................................................................... 13 Preventive Health Services ........................................................................................................................... 14 Health4Me ........................................................................................................................................................... 16 What can I do at myuhc.com? ...................................................................................................................... 17


IMPORTANT INFORMATION

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Important Information Enrollment Guidelines Welcome to the 2013-2014 Benefit Booklet for Gold Spur Trucking. This booklet provides a quick overview of our benefits program and helps to remove confusion that sometimes surround employee benefits. This booklet helps to clarify plan concepts and prepares you to make informed choices about your benefit options.

Eligibility

You are eligible to enroll for benefits if you are a full-time employee working at least 32 hours per week. New employees are eligible for benefits on the first of the month following 90 days of eligible employment. Your dependents are eligible if less than 26 years of age.

Open Enrollment

Open Enrollment for benefit programs is once a year and all elections will be effective August 1, 2013. After the enrollment deadline, you may not change your benefit elections until the next open enrollment. The elections you make now stay in effect through July 2014, unless a qualified event occurs. Qualified life events are: • Marriage • Divorce • Birth • Adoption • Change in Custody • Death • Loss of Coverage

When you have a qualifying life event, you have 30 days to complete and return a new enrollment/change form.

Important Information Regarding Health Care Reform and Changes to Your Benefits Notice Lifetime Limit No Longer Applies and Enrollment Opportunity The lifetime limit on the dollar value of benefits under this group health plan no longer applies. Individuals whose coverage ended by reason of reaching a lifetime limit under the plan are eligible to enroll in the plan. For more information contact Human Resources.

Notice of Opportunity to Enroll in connection with Extension of Dependent Coverage to Age 26 Individuals whose coverage ended, or who were denied coverage (or were not eligible for coverage), because of

the availability of dependent coverage of children ended before attainment of age 26 are eligible to enroll in this group health plan coverage. Enrollment will be effective August 1, 2013. For more information, contact Human Resources. 8


Medicare Part D IF…

− You or your spouse are age 65 or older; − You or your spouse are eligible for Medicare due to having end stage renal disease, or − You or your spouse are eligible for Medicare due to disability –

Then this information is for you

Gold Spur Trucking has determined that the prescription drug coverage offered by UnitedHealthcare is expected to pay out as much as the standard Medicare prescription drug coverage will pay and is considered Creditable Coverage.

Because your existing coverage is at least as good as standard Medicare prescription drug coverage, you can keep this coverage and not pay extra if you later decide to enroll in Medicare prescription drug coverage. Individuals can enroll in a Medicare prescription drug plan when they first become eligible for Medicare and each year from October 15th – December 7th.

You should also know that if you drop or lose your coverage through Gold Spur Trucking and don’t enroll in Medicare prescription drug coverage after your current coverage ends, you may pay more to enroll in Medicare prescription drug coverage later. If you go 63 days or longer without prescription drug coverage that’s at least as good as Medicare’s prescription drug coverage, your monthly premium will go up at least 1% per month for every month that you did not have coverage. For example, if you go nineteen months without coverage, your premium will always be at least 19% higher than what many other people pay. You’ll have to pay this higher premium as long as you have Medicare prescription drug coverage. In addition, you may have to wait until the following October to enroll.

For more information about this notice or your current prescription drug coverage…

If you have questions about this notice, check with your medical carrier at an Open Enrollment meeting or contact Human Resources. You will receive this notice annually and at other times in the future, such as before the next period you can enroll in Medicare prescription drug coverage, and if this coverage changes. You also may request a Certificate of Creditable Coverage.

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 prescription drug plans. For more information about Medicare prescription drug plans: − Visit www.medicare.gov −

Call your State Health Insurance Assistance Program (see 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.

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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 are eligible for health coverage from your employer, your State may have a premium assistance program that can help pay for coverage. These States use funds from their Medicaid or CHIP programs to help people who are eligible for these programs, but also have access to health insurance through their employer. If you or your children are not eligible for Medicaid or CHIP, you will not be eligible for these premium assistance programs. If you or your dependents are already enrolled in Medicaid or CHIP and you live in a State listed below, you can 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, you can 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, you can ask the State if it has a program that might help you pay the premiums for an employer-sponsored plan. Once it is determined that you or your dependents are eligible for premium assistance under Medicaid or CHIP, as well as eligible under your employer plan, your employer must permit you to enroll in your employer plan if you are not 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, you can contact the Department of Labor electronically at www.askebsa.dol.gov or by calling toll-free 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 January 31, 2013. You should contact your State for further information on eligibility –

ALABAMA – Medicaid

COLORADO – Medicaid

Medicaid Website: http://www.colorado.gov/ Medicaid Phone (In state): 1-800-866-3513 Medicaid Phone (Out of state): 1-800-221-3943

Website: http://www.medicaid.alabama.gov Phone: 1-855-692-5447

ALASKA – Medicaid

FLORIDA – Medicaid

Website: http://health.hss.state.ak.us/dpa/programs/medicaid/ Phone (Outside of Anchorage): 1-888-318-8890 Phone (Anchorage): 907-269-6529

Website: https://www.flmedicaidtplrecovery.com/ Phone: 1-877-357-3268

Website: http://www.azahcccs.gov/applicants Phone (Outside of Maricopa County): 1-877-764-5437 Phone (Maricopa County): 602-417-5437

Website: http://dch.georgia.gov/ Click on Programs, then Medicaid, then Health Insurance Premium Payment (HIPP) Phone: 1-800-869-1150

ARIZONA – CHIP

GEORGIA – Medicaid

IDAHO – Medicaid and CHIP

MONTANA – Medicaid

Medicaid Website: www.accesstohealthinsurance.idaho.gov Medicaid Phone: 1-800-926-2588 CHIP Website: www.medicaid.idaho.gov CHIP Phone: 1-800-926-2588

Website: http://medicaidprovider.hhs.mt.gov/clientpages/ clientindex.shtml Phone: 1-800-694-3084

Website: http://www.in.gov/fssa Phone: 1-800-889-9949

Website: www.ACCESSNebraska.ne.gov Phone: 1-800-383-4278

Website: www.dhs.state.ia.us/hipp/ Phone: 1-888-346-9562

Medicaid Website: http://dwss.nv.gov/ Medicaid Phone: 1-800-992-0900

Website: http://www.kdheks.gov/hcf/ Phone: 1-800-792-4884

Website: http://www.dhhs.nh.gov/oii/documents/hippapp.pdf Phone: 603-271-5218

INDIANA – Medicaid

NEBRASKA – Medicaid

IOWA – Medicaid

NEVADA – Medicaid

KANSAS – Medicaid

NEW HAMPSHIRE – Medicaid

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KENTUCKY – Medicaid

NEW JERSEY – Medicaid and CHIP

Website: http://chfs.ky.gov/dms/default.htm Phone: 1-800-635-2570

Medicaid Website: http://www.state.nj.us/humanservices/ dmahs/clients/medicaid/ Medicaid Phone: 609-631-2392 CHIP Website: http://www.njfamilycare.org/index.html CHIP Phone: 1-800-701-0710

LOUISIANA – Medicaid

Website: http://www.lahipp.dhh.louisiana.gov Phone: 1-888-695-2447

MAINE – Medicaid

NEW YORK – Medicaid

Website: http://www.maine.gov/dhhs/ofi/publicassistance/index.html Phone: 1-800-977-6740 TTY 1-800-977-6741

Website: http://www.nyhealth.gov/health_care/medicaid/ Phone: 1-800-541-2831

Website: http://www.mass.gov/MassHealth Phone: 1-800-462-1120

Website: http://www.ncdhhs.gov/dma Phone: 919-855-4100

Website: http://www.dhs.state.mn.us/ Click on Health Care, then Medical Assistance Phone: 1-800-657-3629

Website: http://www.nd.gov/dhs/services/medicalserv/medicaid/ Phone: 1-800-755-2604

Website: http://www.dss.mo.gov/mhd/participants/pages/hipp.htm Phone: 573-751-2005

Website: http://health.utah.gov/upp Phone: 1-866-435-7414

Website: http://www.insureoklahoma.org Phone: 1-888-365-3742

Website: http://www.greenmountaincare.org/ Phone: 1-800-250-8427

MASSACHUSETTS – Medicaid and CHIP

NORTH CAROLINA – Medicaid

MINNESOTA – Medicaid

NORTH DAKOTA – Medicaid

MISSOURI – Medicaid

UTAH – Medicaid and CHIP

OKLAHOMA – Medicaid and CHIP

VERMONT– Medicaid

OREGON – Medicaid and CHIP

VIRGINIA – Medicaid and CHIP

Website: http://www.oregonhealthykids.gov http://www.hijossaludablesoregon.gov Phone: 1-877-314-5678

Medicaid Website: http://www.dmas.virginia.gov/rcpHIPP.htm Medicaid Phone: 1-800-432-5924 CHIP Website: http://www.famis.org/ CHIP Phone: 1-866-873-2647

PENNSYLVANIA – Medicaid

Website: http://www.dpw.state.pa.us/hipp Phone: 1-800-692-7462

RHODE ISLAND – Medicaid

WASHINGTON – Medicaid

Website: www.ohhs.ri.gov Phone: 401-462-5300

Website: http://hrsa.dshs.wa.gov/premiumpymt/Apply.shtm Phone: 1-800-562-3022 ext. 15473

SOUTH CAROLINA – Medicaid

WEST VIRGINIA – Medicaid

Website: http://www.scdhhs.gov Phone: 1-888-549-0820

Website: www.dhhr.wv.gov/bms/ Phone: 1-877-598-5820, HMS Third Party Liability

SOUTH DAKOTA - Medicaid

WISCONSIN – Medicaid

Website: http://dss.sd.gov Phone: 1-888-828-0059

Website: http://www.badgercareplus.org/pubs/p-10095.htm Phone: 1-800-362-3002

Website: https://www.gethipptexas.com/ Phone: 1-800-440-0493

Website: http://health.wyo.gov/healthcarefin/equalitycare Phone: 307-777-7531

TEXAS – Medicaid

WYOMING – Medicaid

To see if any more States have added a premium assistance program since January 31, 2013, or for more information on special enrollment rights, you can contact either: U.S. Department of Labor Employee Benefits Security Administration www.dol.gov/ebsa 1-866-444-EBSA (3272)

U.S. Department of Health and Human Services Centers for Medicare & Medicaid Services www.cms.hhs.gov 1-877-267-2323, Menu Option 4, Ext. 61565

OMB Control Number 1210-0137 (expires 09/30/2013) 11


MEDICAL UnitedHealthcare

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UnitedHealthcare Medical Plan Options

Benefit

Deductible (single / family)

*Out-of-Pocket Maximum (single / family)

Lifetime Maximum Benefit Preventive Care Office Visit Primary Care Physician Specialist

Urgent Care

Hospital Services

$1,000 / $3,000 Deductible Base Plan Choice Plus Network Provider

Out-of-Network

Choice Plus Network Provider

Out-of-Network

$1,000 / $3,000

$2,000 / $6,000

$500 / $1,500

$1,000 / $3,000

$3,500 / $7,000

$7,000 / $14,000

$2,000 / $4,000

100% Coverage

45% AD

100% Coverage

45% AD

$25

45% AD

$20

45% AD

$75

45% AD

$50

45% AD

Unlimited

45% AD

$50

$3,000 / $6,000

Unlimited

45% AD

$30

Outpatient Services

20% AD

45% AD

20% AD

45% AD

Emergency Room Services

$250

$250

$150

$150

Inpatient Services

Mental Health / Substance Abuse Outpatient Services Inpatient Services

Prescriptions Tier 1

20% AD

45% AD

45% AD

$50

20% AD

45% AD

Retail / 30-Day Supply $15

Tier 2

20% AD

Premiums Per Pay Period Employee Only

Employee & Spouse

Employee & Child(ren) Employee & Family

Includes Deductible & Coinsurance Only AD = After Deductible

45% AD

20% AD

45% AD

Retail / 30-Day Supply $15 $45

$75

Tier 4

45% AD

$30

$45

Tier 3

*

$500 / $1,500 Deductible Buy-Up Plan

$75

$150

$150

Hourly Employees

Salaried Employees

Hourly Employees

Salaried Employees

$84.81

$91.88

$105.34

$114.12

$190.82

$206.72

$182.34

$197.53

$262.90

$284.81

$237.01

$226.47

$326.55

This spreadsheet was designed for illustration and comparison purposes only. Please refer to the carrier plan documents for specific plan details.

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$256.76

$245.35

$353.76


Preventive Care Services UnitedHealthcare is dedicated to helping people live healthier lives, and we encourage our members to receive age and gender appropriate preventive health services.

We encourage you to obtain preventive care services and health screenings, as appropriate for your age, to help maintain or improve your health and achieve your health and wellness goals. Regular preventive care visits and health screenings may help to identify potential health risks for early diagnosis and treatment, helping you live a healthier life. UnitedHealthcare plans typically cover preventive services, as specified in the health care reform law,1 at 100% without charging a copayment, coinsurance or deductible, as long as they are received in the health plan’s network. UnitedHealthcare also covers other routine services, which may require a copayment, coinsurance or deductible. Always refer to your plan documents for your specific coverage.

All members at an appropriate age and/or risk status Screening for: }} Obesity

}} Cholesterol level and lipids

}} Colorectal cancer2 for ages 50+

}} Certain sexually transmitted diseases including HIV

}} Cardiovascular Disease aspirin use counseling for ages 45+ }} High blood pressure

}} Diabetes for certain populations }} Tobacco use

}} Diet and nutrition

Talk to your doctor

}} Alcohol abuse

Consult your doctor for your specific preventive health recommendations, as he or she is your most important source of information about your health.

Women’s health services effective as of 9-23-2010:

Summary of preventive care services benefit

}} Depression

}} Screening mammography (film and digital) for all adult women2

}} Cervical cancer screening including Pap smears

UnitedHealthcare is committed to advancing prevention and early detection of disease. The following is a high-level summary of the services covered under the preventive care services benefit shown by age/gender groups:

All members }} Preventive medicine for adults ; all standard immunizations recommended by the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention (CDC). 2

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}} Genetic counseling for the BRCA breast cancer gene

}} Counseling for cancer prevention strategies for women at high risk for breast cancer

}} Screening for certain sexually transmitted diseases including HIV for certain populations }} Osteoporosis for certain populations2


Women’s health continued

Children:

}} Pregnant women for:

Services at each of these preventive visits will vary based on age, but will include some of the following: }} Measurement of your child’s head size

• • • • •

Iron-deficiency anemia Bacteria in urine Hepatitis B virus Rh incompatibility Counseling to promote and aid with breast feeding

}} Measurement of length/height and weight }} Screening blood tests, if appropriate

}} Providing age appropriate immunizations

The follow guidelines reflect the expanded Women’s preventive health care services provided under the health reform law as of August 1, 2012.

}} Vision screening

}} Hearing screening

}} Counseling on oral health

Please note the expanded women’s preventive care services become effective the first plan year beginning on or after Aug. 1, 2012. So it is important to note that your specific coverage for these services will depend on your first plan renewal date on or after Aug. 1, 2012. Please speak to your Health Benefits Administrator to confirm your specific plan coverage for:

}} Psychological and behavioral development assessment

}} Counseling on the harmful effects of smoking and illicit use of drugs (for older children and adolescents) }} Counseling for children and their parents on nutrition and exercise

}} Screening certain children at high risk for high cholesterol, sexually transmitted diseases, lead poisoning, tuberculosis and more.

}} Yearly well-women visits

}} Sexually transmitted infections counseling

As outlined above, many women’s preventive health care services, including mammograms, screenings for cervical cancer, and immunizations, are covered with no cost sharing by UnitedHealthcare for certain health plans. And many of the new women’s preventive health care services in the new guidelines for 2012 are covered today for UnitedHealthcare members; however, cost sharing usually applies.

}} Contraception methods and counseling }} Domestic violence screening

}} Gestational diabetes screening

}} HIV screening and counseling

}} Human papillomavirus testing (beginning at age 30, and for every 3 years thereafter)

It is our hope that during this transition period, women will not unnecessarily put off important and timely personally appropriate health services until the new guidelines become effective for their plan. Please talk with your doctor and make the health care decisions that may be right for you in managing your own health today.

}} Breast-feeding support, supplies, including renting or purchase of specified breast feeding equipment from an approved vendor and counseling

Men’s health Screening: }} Human Papillomavirus for males age 9-26 years

To learn more about the preventive care services that may be right for you visit www.uhcpreventivecare.com.

}} Abdominal aortic aneurysm for men 65 – 75 years old who have ever smoked

Note that the above screenings are provided with no cost sharing. Medications prescribed to treat a condition are not covered without cost-share under the preventive services benefit.1

1 Preventive services that are covered with no cost share are those services described in the United States Preventive Services Task Force A and B recommendations, the Advisory Committee on Immunization Practices (ACIP) of the CDC, and HRSA Guidelines for women, as well as children, including the American Academy of Pediatrics Bright Futures periodicity guidelines. 2 Certain preventive care services are not currently required to be covered by the health reform law; however, various additional services are covered under UnitedHealthcare’s preventive care services benefit. The content provided is for informational purposes only, and does not constitute medical advice. Always consult your doctor before making any decisions about medical care. Certain procedures may not be fully covered under some benefit plans. Always refer to your plan documents for specific benefit coverage and limitations or call the toll-free member phone number on the back of your health plan ID card. Insurance coverage provided by or through UnitedHealthcare Insurance Company or its affiliates. Administrative services provided by United HealthCare Services, Inc. or their affiliates. 100-10938 7/12 © 2012 United HealthCare Services, Inc.

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Your award-winning road map to health. UnitedHealthcare’s Health4Me mobile app was selected as the Appy Award winner for 2013 in the Healthcare and Fitness category.

Key features include* „„Search for physicians or facilities by location or specialty „„Store favorite physicians and facilities „„View claims „„Have an Easy Connect representative contact you to answer any questions „„View and share health plan ID card information „„Access and update your Personal Health Record „„Check status of deductible and out-of-pocket spending „„Locate nearby convenience clinics, urgent care facilities and emergency rooms „„Complete confidentiality „„Personalize with notes and reminders

The UnitedHealthcare Health4MeTM mobile app makes it easier for members to take greater control of their health by providing millions of UnitedHealthcare members with 24/7 access to a registered nurse and their personal health benefits information, as well as the ability to locate a nearby physician, hospital or other medical facility that participates in the UnitedHealthcare care provider network. Within the app, members can access myHealthcare Cost Estimator to comparison shop for the most common treatments and procedures based on both quality and cost. The estimates are based on the actual contracted rates with physicians, hospitals, clinics and other health care providers to provide estimated pricing.

Android available in

Produced by MediaPost Communications, a media, advertising and marketing news and events publishing company based in New York, the annual Appy Awards’ aim is to acknowledge extraordinary Applications, whether they be mobile, social, or Web-based. The Appys don’t discriminate by format, platform or device; instead, they focus on simply honoring the best Apps in all imaginable categories: http://appyawards.net/. *Some features may not be available for all employer plans. All UnitedHealthcare members can access a cost estimator online tool at myuhc.com.® Depending on your specific benefit plan and the ZIP code that is entered, either the myHealthcare Cost Estimator or the Treatment Cost Estimator will be available. A mobile version of myHealthcare Cost Estimator is available in the Health4Me mobile app, and additional ZIP codes and procedures will be added soon. This tool is not intended to be a guarantee of your costs or benefits. Your actual costs and/or benefits may vary. When accessing the tool, please refer to the Terms and Conditions of Use and Why Your Costs May Vary sections for further information regarding cost estimates. Refer to your health plan coverage document for information regarding your specific benefits. App Store is a service mark of Apple, Inc. Android is a registered trademark of Google, Inc. Insurance coverage provided by or through UnitedHealthcare Insurance Company or its affiliates. Administrative services provided by United HealthCare Services, Inc. or their affiliates. Health plan coverage provided by or through a UnitedHealthcare company. 16 4/13 ©2013 United HealthCare Services, Inc. UHCEW637084-000


What can I do at myuhc.com ? ®

Find a doctor. Track my blood pressure. Find a great hospital. Track my weight. Look up my claims. Improve my health. Order my prescriptions online – and save. Chat with a nurse. Simplify my life. Learn about diabetes. Save money on services. Stay healthy. Replace my health plan ID card. Record my health history. Keep track of my family’s medical history. Estimate costs ahead of time. Embrace wellness. See my benefits. Keep track of my shots. And much, much more.

It all adds up to peace of mind.

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Organize my claims

Find a doctor

• See the status of my current claims • Check my past claims history • View my monthly statements • See my whole family in one view • Print copies for my records

•S  earch for a doctor or hospital in my area • See which doctors meet stringent quality standards • Evaluate hospitals on cost, quality and patient safety • Find a mental health professional • Get driving directions and print a map • Find a doctor who treats a lot of people like me

Get more from your health benefits with myuhc.com Get the facts

Improve my health

• Learn more about my coverage • Check my current eligibility • Look up my deductible or out-of-pocket limit

•T  ake a complimentary online Health Assessment, with recommendations for change • Read the most up-to-date, trustworthy healthy lifestyle advice • Use tools, quizzes, and calculators on everything from aging well to world travel

UnitedHealthcare Health4MeSM mobile app •A  ccess your family’s health information anytime, anywhere. • Features include easy access to registered nurses, personal health benefits information, and the ability to locate nearby physicians and hospitals (Currently available for iPhone® and AndroidTM operating systems.)

Get help with decisions • Learn more about health conditions or procedures • Connect with a nurse through live, one-to-one online Nurse Chats • Check the facts on medications and estimate my costs • Read up on common symptoms and what they might mean • Explore various treatment options

It’s easy to register. 1. Visit www.myuhc.com 2. Select REGISTER NOW 3. Type in the requested information 4. Get started

©2012 United HealthCare Services, Inc. Insurance coverage provided by or through UnitedHealthcare Insurance Company or its affiliates. Administrative services provided by United HealthCare Services, Inc. or their affiliates. 18 100-7586 7/12 UHCEW477992-004


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GBS

B E N E F I T S, I N C. 1256 West 400 South, #2 Vernal, UT 84078 Phone: (435) 789-9151

Gold spur trucking 2013 bb  

2013 BB

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