Buffalo Exchange 2018 Benefits Guide

EMPLOYEE BENEFITS GUIDE MARCH 2018-FEBRUARY 2019

Benefits at Buffalo Whether you are a new employee enrolling in benefits for the first time or considering your benefit options during Open Enrollment, this guide is designed to help you through the process.

As a Buffalo Exchange employee, you have access to a wide variety of benefits including employee discount, paid time off and 401k. We offer medical, dental and vision insurance to all employees who work an average of 20+ hours a week. The coverage is great and the cost is affordable!

Buffalo Exchange believes that our growth as a company is dependent upon the people that work with us, including their health and well-being.

To that end, the company contributes significantly toward the cost of premiums for medical insurance, 80% for employee-only coverage, and 70% for employees who have dependents on their plans.

Additionally, Buffalo Exchange offers HRA (Health Reimbursement Account) funding to employees with our medical insurance. The HRA is FREE MONEY from the company for you to use for your medical and prescription costs before you ever have to pay out of pocket.

NEW EMPLOYEES All enrollment is completed online on the Ultipro Web Portal. You must enroll within 30 days of your date of hire. The benefits you select will become effective on the first of the month following when you meet the eligibility requirements. So, for example if you are hired on May 5th and work more than 20 hours per week on average your benefits will begin on August 1st.

If you don’t enroll when you initially become eligible, you will be required to wait until Annual Open Enrollment or until a Qualifying Life event (such as a marriage, divorce or birth of a child) takes place.

OPEN ENROLLMENT Open Enrollment happens annually in January. This is your one time per year to make changes to your benefits. All enrollment is completed online on the Ultipro Web Portal.

Enrollment How to elect or decline benefits in Ultipro For Open Enrollment: From the Ultipro homepage: Menu >Myself > Open Enrollment > 2018 Open Enrollment

For New Employee Enrollment: From the Ultipro home page: Menu >Myself >Life Events > I’m a New Employee!

For a Qualifying Event: From the Ultipro home page: Menu > Myself > Life Events > I’ve experienced a Qualifying Event

Adding Dependents to your Benefits Eligible dependents include a legal spouse or qualified domestic partner and/or dependent children under the age of 26. If you have any questions about who might qualify to be added to your coverage, please call the Human Resources Department.

Domestic Partner Coverage Buffalo Exchange recognizes “domestic partner” status (available to same sex and opposite sex partners) and offers spousal benefit coverage to them whenever possible. Certain criteria must be met and tax implications may apply. Contact the Human Resources Department for more information.

Terms to know Premium The amount per paycheck you pay to have insurance.

Like a Netflix subscription - this amount is due regardless of if you use the insurance that month or not.

Health Reimbursement Account- HRA

*Out-of-Pocket Maximum The most you’ll pay out of pocket for medical and prescription costs in a plan year. Once you reach this amount ($3500 for an individual) Cigna will pay 100% of the bills for the rest of the plan year.

I n-Network Provider

FREE MONEY ($750 for an individual) that you can use towards medical and prescription expenses. If you have funds, HRA pays first and helps chip away at your deductible. Once your HRA funds are used up, you’re responsible for paying the rest of the deductible.

Doctors, hospitals, etc... that are contracted with Cigna to provide services at specific pre-negotiated rates. Staying in-network can save you money!

Deductible

Pre-Tax Deductions

The dollar amount you pay for your care before Cigna starts paying.

Once you reach your deductible, Cigna starts sharing the bill; this is called coinsurance.

The amount of money that comes out of your paycheck for insurance is taken prior to your check being adjusted for taxes. This helps lessen your tax liability.

*Coinsurance 80/20 Once you reach your deductible, you’ll have to pay only part of the bill (20%) and Cigna covers the rest (80%) until you hit the Out-of-Pocket Maximum.

* In-Network Benefits Reflected

HEALTH REIMBURSEMENT ACCOUNT (HRA) The HRA is FREE MONEY provided to you by Buffalo Exchange to help you pay for your medical expenses. The money will be applied automatically to any medical or pharmacy claims first until the fund is depleted. Any unused funds you have at the end of the plan year can rollover into the next plan year (up to the amount of your deductible). *The HRA fund amount is pro-rated if you enroll at anytime that is not the Annual Open Enrollment period. Please see the chart “Pro-rated HRA Amounts” on Ultipro for the amount your HRA will be funded if you enroll outside of Open Enrollment.

FUNDING REQUIREMENT Buffalo Exchange requires that employees and their spouses/domestic partners who enroll in medical insurance during the annual Open Enrollment complete a biometric screening or physical exam with a doctor and fax a verification form to Human Resources in order to receive Health Reimbursement Account (HRA) funding. Participation is voluntary. You will be required to take some simple body measurements and have blood work done. Federal regulations prevent Buffalo Exchange from knowing what your personal results are. The purpose of the screening is to give you useful information that you might need to make important decisions about your health and for you to establish a relationship with a physician.

If you are enrolling at any time other than Open Enrollment, you do not need to complete this requirement until the following Open enrollment.

Prescriptions Prescription drugs are covered at different percentages based on whether they are preventive, generic, or brand name. Many preventive generic drugs are covered at 100% (including generic oral contraceptives), which means they are provided at not cost to you.

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Preventive Generic Prescription Drugs: - Available at no cost

Generic

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You pay 30%*

Generic oral contraceptives : - Available at no cost

Preferred Brand

You pay 40%*

Non-Preferred Brand

You pay 50%*

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Preventive Brand Prescription Drugs:

- HRA pays first, then subject to coinsurance only, no deductible

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All other prescription drugs

- HRA pays first, then subject to deductible and coinsurance

Medical Plan Information Buffalo Exchange offers one medical plan which is a Consumer Driven Health Plan (CDHP) through Cigna. If you choose to enroll, Buffalo Exchange provides you with a Health Reimbursement Account (HRA) to help pay for eligible medical expenses.

Plan Basics Preventive Care - Covered at 100% Annual physicals, vaccinations and age recommended preventive screenings are covered at 100% by Cigna.

HRA– Funded by Buffalo Exchange Any claims, medical or pharmacy, that aren't covered as preventive, will automatically be paid from this account until all funds have been used.

Your Share– The deductible Once all funds from your HRA are used, you are responsible for the full amount of any claim until you meet the plan deductible.

Cigna’s Share– Coinsurance After you meet the deductible, you are responsible for only 20% of remaining claim costs until you meet the Out-of-Pocket Maximum.

Your EEOC notice regarding Biometric Screening can be found in Ultipro web portal.

2018 Medical Rates CIGNA Medical Insurance Employee

Emp. + 1

Employee + Family

Employee

Company

Employee

Company

Employee

Company

$38.46

$153.84

$123.06

$280.74

$207.66

$407.64

All rates are on a per pay period basis. *Deductible and Out-of-Pocket

HRA

Deductible

Out-of-Pocket Max

$750

$1,750

$3,500

$1,125

$3,500

$7,000

$1,500

$3,500

$7,000

Maximum Amounts Employee Only Employee + 1 (Spouse or Child)

Employee + Family

* In-Network Benefits Reflected

Telehealth Connection Your Cigna medical plan gives you access to Cigna Telehealth Connection. The visit, whether over the phone or via video chat, will only cost you $42 and can be paid for with HRA funds.

Connect with a doctor about: Acne

Sore throats

Asthma

Stomachaches

Allergies

Headaches

Cold and flu

Insect bites

Ear infections

Pink eye

Fever

Rashes

Sinus infections

and more!

When: 24/7, 365 Where: Home, work or on the go!

How: Phone or video chat.

Who: Amwell or MDLIVE doctors.

Life and AD&D Buffalo Exchange offers a $20,000 Life and Accidental Death and Dismemberment policy to any employee who enrolls in medical insurance.

This coverage is FREE and you simply need to designate a beneficiary in order to enroll.

Vision Plan Information Cigna Vision covers an annual eye exam at no cost to you (once per year) and allows up to $150 allowance on frames and contact lenses. You must visit an in-network provider to receive maximum coverage.

In-Network

Out-of-Network

Benefit

Benefit

$0

Up to $45

Single Vision

Covered 100%

Up to $32

Bifocal

Covered 100%

Up to $55

Trifocal

Covered 100%

Up to $65

Lenticular

Covered 100%

Up to $80

Contact Lens allowance

Up to $150

Up to $120

Retail allowance for frames

Up to $150

Up to $83

Coverage

Exam Co-pay Eyeglass Lens allowance

Cigna Vision Rates Employee Employee + 1 Employee +Child(ren) Employee + Family

$5.85 $11.06 $12.05 $15.51

Cigna Dental Rates Buffalo Exchange offers you a choice between two dental options. Both options are provided by Cigna (except in New Mexico) and include coverage for preventive services and routine office visits.

Cigna Dental Insurance Dental HMO*

PPO

Employee

$6.12

Employee

$22.95

Employee +1

$9.91

Employee +1

$43.72

Employee + Family

$15.18

Employee + Family

$65.82

*Dental HMO in New Mexico is not offered through Cigna and the rates are different. See the web portal for details.

Cigna Dental HMO Highlights: -No deductible or benefit plan maximums.

-You will know the exact dollar amount you’ll pay for each procedure up front.

-You must select an in-network provider from Cigna’s Dental HMO network. *Does not apply in New Mexico, see coverage specifics on the web portal.

Cigna Dental PPO Highlights: -Freedom to choose any dentist you wish.

-No referrals needed to visit a specialist.

-Unlike the DHMO Plan, Cigna covers procedures based on the rate the provider has agreed to with Cigna, and the Class that the procedure falls into (Class I, II, or III).

-There is a deductible and a benefit plan maximum. The deductible doesn't apply to Class I Services.

Dental Plan Information Cigna Dental HMO Basics*: Routine Office Visit

$5.00

Oral Exam (Periodic)

No Charge

Complete Series X-rays

No Charge

Routine Cleaning

No Charge (limit 2 per year)

Amalgam (filling) 2 surfaces

$22.00

Porcelain Crown

$515.00

Molar Root canal

$530.00

*Benefits as of 12/18/17. The fee schedule is subject to change. Updated fees can be found on myCigna.com.

Cigna Dental PPO Basics: Class I

Plan pays 100%

Oral Exams Routine Cleanings X-rays Sealants Space Maintainers Class II

Plan pays 80%

Fillings Simple Extractions Class III

Plan pays 50%

Crowns Oral Surgery Root Canals Surgical Extractions Check out the Ultipro Benefits Information Center for more specific plan information and plan documents.

Coming March 1, 2018..

Cigna One Guide® Cigna One Guide service can help you make informed choices and get the most from your Cigna insurance plan. This high level support will help you understand your coverage and get answers to your plan questions.

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Connect to health coaches, pharmacists and more

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Stay on track with appointments and preventive care

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Take advantage of dedicated one-on-one support for complex health situations

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Get cost estimates and service comparisons to avoid surprises

Stay tuned for more info to come!

Pre-Enrollment Phone Number: 1-888-806-5042

Employee Assistance Program Buffalo Exchange offers an Employee Assistance Program, or EAP as a resource to help employees and members of their households with difficult situations in their personal lives that might affect their health or job performance.

This benefit is offered at no charge to employees and is completely confidential

The Employee Assistance & Work/Life Support Program is available to help you and your family find a solution to restore your peace of mind.

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Achieve Work/Life Balance

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Child Care

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Financial Services & Referral

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Identity Theft

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Parenting

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Pet Care

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Senior Care

You don’t have to have insurance through Buffalo Exchange in order to use the EAP. It is free, confidential and available to all Buffalo Exchange employees now!

Disability Insurance Disability Insurance is designed to assist you in the event that an illness or injury prevents you from working. Buffalo Exchange offers disability insurance through Colonial.

These policies are individualized so cost is based on your personal situation and what kind of coverage you are interested in. Contact a Colonial representative at 520-349-9341 to enroll.

401(k) A 401(k) is an employer-sponsored plan to help you save for retirement.

Retirement may seem like a long way off to you, but there are so many advantages to begin saving early. You decide how much (as a percentage) of your pay you would like to invest, Buffalo Exchange makes those contributions on your behalf and matches a portion of what you choose to contribute. For every dollar you put into your 401k, Buffalo Exchange will match $0.25 cents. Buffalo Exchange will match up to the first 10% you contribute. Eligibility for Buffalo Exchange’s 401(k) plan is different from eligibility for our other insurance offerings. You must work for the company for 1 year (at least 1000 hours) and be 21 or older. HR will notify you when you become eligible.

Making Changes to Benefits The elections that you make during your initial benefits eligibility period or during Open Enrollment will remain in effect for the duration of the plan year (March-Feb). However, if you have a Qualifying Life Event you will be able to make changes to your coverage.

Any changes in benefits must be completed within 30 days of the event and must be done by contacting Human Resources.

Qualifying Live Events Examples* Marital Status Changes

Covered Dependent Changes

• Marriage

• Birth or adoption of a child

• Divorce

• Dependent becomes ineligible for coverage (i.e. turning 26 and losing parental coverage)

• Spouse gains or loses coverage • Spouse’s Open Enrollment

I mportant Phone Numbers Cigna Medical, Dental & Vision 1-800-244-6224 for Medical & Dental 1-877-478-7557 for Vision www.MyCigna.com Plan/Policy number 3334454 Cigna Telehealth Connection AMwellforCigna.com 1-855-667-9722 or MDLIVEforCigna.com 1-888-726-3171 Fidelity 401(k) 1-800-835-097 401k.com Colonial Disability 520-349-9341 Cigna EAP 1-877-622-4327 Buffalo Exchange Human Resources 520-622-2711 520-838-3765 fax GA-HumanResources@bufex.com