Benefits Guide

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B E N E F I T S

P L A N

ENROLLMENT GUIDE

CHAPARRAL IS COMMITTED TO PROVIDING COMPREHENSIVE HEALTH AND WELLNESS BENEFITS FOR OUR EMPLOYEES AND THEIR FAMILIES. Our annual benefits open enrollment is your opportunity to review and make changes to your health and wellness elections for the upcoming year. From medical plans to flexible spending accounts, we are here to help you understand and select the best options for you and your family.

Chaparral will be holding benefits meetings at each of our office locations. Please take the time to read through this guide with your family before your meeting. We encourage you and your spouse to both attend the open enrollment meeting at your location. Our Human Resources team will be on hand to discuss options and talk personally with you about any questions you may have.

Open enrollment will be held from October 22 to November 16. Remember, the elections you make during this time will be effective from January 1 to December 31, 2019 and cannot be changed during the calendar year without a qualifying life event. If you have any questions, please visit the Benefits section of The Wire or email benefits@chaparralenergy.com.

TABLE OF CONTENTS

E N R O L L M E N T C H E C K L I S T ..................................................... 4 E L I G I B I L I T Y A N D Q U A L I F Y I N G E V E N T C H A N G E S ..................... 4 M E D I C A L , P R E S C R I P T I O N A N D V I S I O N O P T I O N S .................... 5 H S A P L A N D E TA I L S .............................................................. 6 F L E X I B L E S P E N D I N G A C C O U N T S ........................................... 8 P L A N O P T I O N C O M PA R I S O N S .............................................. 10 W E L L N E S S ......................................................................... 13 M D L I V E ........................................................................... 13 D E N TA L P L A N O P T I O N S ...................................................... 14 L I F E A S S I S TA N C E P R O G R A M ................................................ 15

O P E N E N RO L L M E N T I S YO U R C H A N C E TO: •

Update dependent coverage and beneficiary information

•

Update your medical, dental, prescription and/or vision coverage

•

Elect contributions to a medical or dependent care Flexible Spending Account (FSA) and a limited-purpose FSA if you enroll in the High Deductible Health Plan

•

Elect or increase supplemental life insurance for you and/or your dependents (requires evidence of insurability)

VISIT THE HRM TOOL AT H T T P S :// H R M .

C H A PA R R A L E N E R G Y. COM/BENEFITS TO MAKE Y O U R 2019 E L E C T I O N S .

O N C E LO G G E D I N, YO U CAN BEGIN TO MAKE SELECTION AND MONITOR YO U R P RO G R ES S.

B A S I C T E R M L I F E A N D A D & D ............................................... 16 D I S A B I L I T Y ....................................................................... 17 401( K ).............................................................................. 18 PA I D T I M E O F F ................................................................. 18 C O N TA C T I N F O R M AT I O N..................................................... 19

OPEN ENROLLMENT CHECKLIST

MEDICAL, PRESCRIPTION AND VISION OPTIONS

U S E T H I S ST E P-BY-ST E P L I ST TO H E L P YO U M A K E Y O U R 2019 B E N E F I T S S E L E C T I O N S .

Chaparral will continue to offer a traditional Preferred Provider Organization (PPO) plan and a High Deductible Health Plan (HDHP) combined with a Health Saving Account (HSA) in 2019.

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Review your current benefits and coverage levels in ADP. Read this guide and attend a benefits meeting to fully understand your benefits options.

Collect necessary documentation, such as Social Security numbers for eligible dependents you want to cover.

Gather a summary of 2018 health and childcare expenses to help you estimate next year’s flexible spending account or health saving account elections if you enroll in the High Deductible Health Plan.

Log in to the HRM tool to make your elections.

Update your beneficiary information for your life insurance.

ELIGIBILITY If you are a full-time employee regularly working 30 hours or more per week, you and your eligible dependents can enroll in Chaparral’s benefits program on the first day of your employment. Eligible dependents include: • • •

Please note, dependent coverage automatically terminates at the end of the month in which a child turns 26. Dependents may be verified through a formal audit process.

Q UA L I F Y I N G E V E N T C H A N G E S Changes to your elections can only be made within 30 days of your hire date, during Chaparral’s annual open enrollment period or within 30 days of a qualifying life event, which include: • • • • • •

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Spouse Children under the age of 26, including adopted and stepchildren, as well as children who do not reside in your home Unmarried, dependent children 26 years or older who are medically certified as disabled

Marriage, divorce or legal separation Birth or adoption of a child Change in a child’s dependent status Death of a qualified dependent Change in residence due to an employee transfer Loss or gain of other coverage

TRADITIONAL PPO A traditional PPO is what you most likely associate with health insurance. Through a traditional PPO you, the patient, are responsible for a co-pay each time you receive care. After meeting your deductible, you and the insurance company share the cost of the health care services you receive until you reach your out-of-pocket maximum. Under Chaparral’s PPO plan, prescription drugs have a separate out-of-pocket maximum and co-pay.

If you select the traditional PPO plan, the cost of your coverage will be pre-tax deducted from your paycheck twice a month throughout the calendar year.

H I G H D E D U C T I B L E H E A LT H P L A N W I T H H E A LT H S AV I N G S A C C O U N T High Deductible Health Plan (HDHP) with a Health Savings Account (HSA) is Chaparral’s alternative approach to how you pay for health care and save for the future. Our HDHP offers you medical coverage at a lower monthly premium because you are responsible for the Blue Cross Blue Shield (BCBS) negotiated rate for any care or prescriptions received prior to reaching a deductible. After the deductible has been reached, you and the insurance will share the cost of services or prescriptions received until the out-of-pocket maximum is reached.

Chaparral’s HDHP meets the federal requirements that allow a participant to also qualify for a tax-advantaged HSA. HSAs allow you to make pre-tax contributions for qualified medical expenses, such as routine care, imaging, prescription drugs and more. HSAs behave much like a personal bank account and are owned by you, regardless of your employment. In addition, account balances can be invested and carried over each year.

There are a few key features to consider when contemplating a HDHP, such as: •

The HDHP provides you the flexibility to receive care from the same network of providers as our PPO plan.

•

In-network preventive care services, as defined by BCBS, are still 100 percent covered. Preventive medication is also 100 percent covered.

•

Chaparral will contribute $1,000 for individual coverage or $2,000 for employee+spouse, employee+child(ren) or employee+family to your HSA account.

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HSA DETAILS

According to the IRS, participants eligible for a Health Savings Account (HSA) plan may not: • • • •

Be covered by any other non-HSA compatible health plan Be receiving Medicare, TRICARE or Veterans Administration benefits Be claimed as a dependent on another person’s tax return (unless it is your spouse) Use a traditional Flexible Spending Account (FSA) with a HSA

C H A PA R R A L’ S H D H P W I T H A H S A As part of your HDHP, you can make pre-tax payroll deductions or after-tax contributions to your HSA. This money can then be used to pay for any necessary IRSeligible health care expenses for you and your family, including: • • • • • • •

Office visits Dental work and orthodontics Vision exams and eyeglasses Prescription medications Chiropractic treatment Surgeries Nursing home expenses

In addition, your HSA can act as a savings account earning tax-deferred interest or invested into mutual funds. This allows you to grow your money and save more for future medical expenses. Most importantly, the account is yours and stays with you even if you change jobs, health care coverage or move to another state.

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For a complete list of eligible HSA expenses, visit hsabank.com/IRSQualifiedExpenses or irs.gov.

HSA DETAILS

CONTRIBUTIONS AND IRS LIMITS Chaparral will contribute an initial $1,000 for employee only coverage and $2,000 for family coverage to your HSA. You may then elect your own desired semi-monthly contributions, which will be payroll deducted in the same manner as our traditional PPO option. You do, however, have the ability to adjust your semi-monthly contribution throughout the year. In addition, you can also add funds to your HSA at any time on a post-tax basis through an electronic transfer from your bank account or by mailing a check to HSA Bank.

The 2019 IRS contribution limits are $3,500 for employee only coverage and $7,000 for family coverage. If you are 55 years or older, you can make up an extra $1,000 annual catch-up contribution.

2019 H S A C O N T R I B U T I O N S L I M I T S

IRS Maximum Chaparral Contribution Employee Maximum Contribution 55+

EMPLOYEE ONLY

EMPLOYEE & FAMILY

$3,500

$7,000

$1,000

$2,000

$2,500

$5,000

$1,000

$1,000

Please note, any money taken out of your HSA to pay for qualified medical expenses is tax-free, however, non-qualified expense withdrawals are taxable, carry a 20 percent penalty and must be added back into your gross income for tax filings. Although you are not required to maintain receipts, it is highly recommended you keep them on file.

CLAIM SUBMISSIONS HDHP claim submissions work the same as with a traditional PPO plan. They too must be submitted through BCBS to ensure you receive the in-network discounts.

DOCTOR SUBMITS CLAIM TO BCBS

BCBS APPLIES NETWORK DISCOUNT

BCBS SENDS E X P L A N AT I O N OF BENEFITS TO E M P LOY E E

EMPLOYEE PAY S PROVIDER

Participating HSA members will receive a packet from HSABank with information to help you make the most of your account. A visa debit card will also be sent separately.

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FLEXIBLE SPENDING ACCOUNTS

FSA LIMITS

If you enroll in the PPO medical plan, you may also establish a Flexible Spending Account (FSA) for health care expenses and/or dependent care expenses. When you elect a FSA, you authorize pre-tax deductions from your paycheck to be put into an account you can access later for reimbursement of out-of-pocket costs associated with qualified medical and dependent care. As these deductions are pre-tax, your yearly income reported to the IRS and subsequent income taxes are reduced, which results in an annual tax savings.

FSA elections and modifications can only be made during open enrollment or as a result of a qualifying life event.

Health Care FSA

HOW MUCH YOU CAN CONTRIBUTE

ELIGIBLE EXPENSE EXAMPLES

COMPLETE LIST OF ELIGIBLE EXPENSES

$100 to $2,650

Health care expenses not covered by your medical, vision, prescription or dental plans, such as:

irs.gov

Please note, if you have contributed to a FSA in 2018 and elect to enroll in the HDHP/HSA plan for 2019, your deadline to incur expenses for your current FSA plan is December 31, 2018. You, however, have until March 30, 2019 to file a reimbursement claim.

• • •

H E A LT H C A R E F S A Expenses must be for services already received and cannot be reimbursed by insurance or another source. The IRS 2018 maximum annual contribution for a health care flexible spending account is $2,650*.

Dependent Care FSA

$100 to $5,000 (or $2,500 if you and your spouse file separate income tax returns)

DEPENDENT CARE FSA A Dependent Care FSA option is available to everyone regardless of medical plan coverage. Eligible reimbursements are for child or elder care expenses that are incurred if both spouses are employed outside of the home. Generally, eligible expenses are only for the care of qualified dependents under 13 years of age or those who are physically or mentally incapable of caring for themselves. The maximum contribution allowed by the IRS is $5,000 per year if you are married and file a joint income tax return, $2,500 per year if you are single and file as a single head of household or if you are married and file separate income tax returns.

All FSA accounts are administered through HSABank. You must submit receipts for anything that is not a standard co-pay. For a complete list of eligible FSA expenses, visit hsabank.com/IRSQualifiedExpenses or irs.gov. *Please note, this is the 2018 IRS limit. The 2019 limit has yet to be issued. Once released, however, you can check irs.gov to verify the 2019 limit.

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deductibles co-pays co-insurance

Dependent care while you are at work, including: • • •

day care after-school programs care in your home

irs.gov

H D H P/ H S A L P F S A

Health Care LPFSA

HOW MUCH YOU CAN CONTRIBUTE

ELIGIBLE EXPENSE EXAMPLES

COMPLETE LIST OF ELIGIBLE EXPENSES

$100 to $2,650

Health care expenses not covered by your vision or dental plans, such as:

irs.gov

• •

deductibles co-insurance

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COMPARING MEDICAL, PRESCRIPTION AND VISION PLAN OPTIONS

BCBS

H D H P/ H S A

PPO PLAN

IN-NETWORK

OUT-OF-NETWORK

IN-NETWORK

OUT-OF-NETWORK

20% after deductible

40% after deductible

20% after deductible

40% after deductible

COVERAGE DETAILS Maternity Inpatient Care Outpatient Care/Hospital Service

BCBS

H D H P/ H S A IN-NETWORK

Outpatient Therapy Service Chiropractic Care

PPO PLAN

OUT-OF-NETWORK

IN-NETWORK

OUT-OF-NETWORK

DEDUCTIBLE Individual

$1,750

$750

Family

$2,700/$3,500

$1,500

(muscle manipulations limited to 25 visits per benefit period) Emergency Care (waived if admitted)

NET DEDUCTIBLE Individual

$750

$750

Family

$1,500**

$1,500

20% after deductible (generic/formulary) Retail Prescription Drugs***

OUT-OF-POCKET MAXIMUM Individual

$4,000

$8,000

$3,000

$5,000

Family

$8,000

$16,000

$6,000

$10,000

EMPLOYER HSA CONTRIBUTION Individual

$1,000

N/A

Family

$2,000

N/A

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30% after deductible (non-formulary brand)

Mail-order Prescription Drugs***

20%

40%

20%

40%

Primary Care Physician (PCP) Office Visit

20% after deductible

40% after deductible

$25 co-pay, 100%

40% after deductible

Specialist Office Visit

20% after deductible

40% after deductible

$50 co-pay, 100%

40% after deductible

Prescription Out-of-Pocket Maximum (OOP) (individual/family)

Lab/X-ray

20% after deductible

40% after deductible

20% after deductible

40% after deductible

VISION COVERAGE

30% after deductible (non-formulary brand)

$250 co-pay, then 20% Generic: $10

40% after deductible

Formulary: 20% $40 min/$125 max

N/A

Non-formulary: 30% $60 min/$185 max

Generic: $20

20% after deductible (generic/formulary)

COVERAGE DETAILS Member Co-insurance

20% after deductible

40% after deductible

Included in medical (OOP)

Formulary: 20% $80 min/$250 max

N/A

Non-formulary: 30% $120 min/$370 max $2,500/$5,000

N/A

Preventive

No cost to employee

No cost to employee

Routine Vision Exam

No cost to employee

No cost to employee

Immunizations

No cost to employee

No cost to employee

Mammography (one annual screening every five years for women 35 - 39; one annual screening for women 40 and older)

Vision Products (lens, frames, contacts, etc.)

$350 annual maximum

$350 annual maximum

No cost to employee

No cost to employee

*Family coverage includes employee+spouse, employee+child(ren) and employee+family. **For each person in a family unit (other than single coverage), the individual deductible is $2,700 with a family maximum of $3,500. The entire family is allotted $2,000 into their HSA to offset the deductible. ***If a generic drug is available and the individual opts for the preferred brand drug, he or she will be responsible for the preferred brand co-pay PLUS the difference in cost between the generic and preferred brand drug.

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SEMI-MONTHLY PLAN

H D H P/ H S A P L A N NON-WELLNESS

WELLNESS

Employee Only

$37.12

$12.12

Employee + Spouse

$133.94

$108.94

Employee + Child(ren)

$107.15

$82.15

Family

$148.61

$123.61

WELLNESS

As part of our commitment to encourage consistent, long-term healthy behavior, Chaparral encourages employees to lead a healthy lifestyle and as such offer a discounted insurance premium for those who earn 200 wellness points during the year. You will still be required to complete a member health assessment and three preventive care items, which are worth 100 points.

You can also earn points for completing a variety of challenges and online videos throughout the year. Points must be recorded through your SimplyWell account (formerly known as MyViverae) to receive credit. Those who earn 250 or 300 points will receive their insurance wellness discount, as well as a wellness prize(s) at the end of the year.

PPO PLAN

ITEM

POINTS

NON-WELLNESS

WELLNESS

Member health assessment (required)

50

Employee Only

$76.05

$51.05

Preventive care compliance (required)

50

Employee + Spouse

$192.65

$167.65

Self-reported tobacco free

25

Employee + Child(ren)

$154.12

$129.12

Targeted tobacco cessation program passed

25

Family

$214.46

$189.46

PROGRAM ACTIVITIES Online videos

5 each/50 max

Online articles

5 each/50 max

Employee challenge goals

25 each/100 max

Peer seven-day challenges

1 each/50 max

FinFit (financial wellness)

10 each/50 max

PRIZE TIER LEVELS

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Tier 1 Goal (wellness discount)

200

Tier 2 Goal (wellness discount + prize)

250

Tier 3 Goal (wellness discount + prize + prize)

300

Skip the trip to the doctor’s office or after-hours visits to urgent care clinics for non-emergency aliments. MDLIVE allows you to consult a physician over the telephone, online or through its mobile app around the clock. In fact, the average wait time for those using MDLIVE is less than 10 minutes.

Doctors and pediatricians contracted through MDLIVE are state-licensed and board-certified, and have an average of at least 15 years of experience. They can recommend treatment and write prescriptions, if appropriate, for many non-emergency medical conditions, such as: • • • • • • •

Acne Allergies Cold & flu Constipation Cough Earache Fever

• • • • • • •

Headache Insect bites Nausea, vomiting or diarrhea Pink eye Rash Sore throat Urinary problems

If enrolled in the HDHP/HSA plan, there is a $40 per visit cost, which is treated like any other medical expense. If enrolled in the PPO plan, there is a $25 copay.

For additional information or to activate your personal account, visit members.mdlive.com/bcbsok or call 800-400-6354.

Note, MDLIVE is not appropriate for every medical condition and is not intended to replace your primary care doctor for common or chronic conditions.

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DENTAL

CHAPARRAL OFFERS A BASE AND HIGH DENTAL PLAN OPTION FOR EMPLOYEES THROUGH DELTA DENTAL. Maximum Benefit Deductible (individual/family)

BASE PLAN

HIGH PLAN

$1,000

$2,000

$100/$300

$50/$150

No cost to employee

No cost to employee

LIFE ASSISTANCE PROGRAM

Class I Services ▸ Routine Exam ▸ Full Mouth X-ray ▸ Space Maintainer ▸ Sealant ▸ Fluoride Class II Services ▸ Amalgam and Composite Filling

20% (after deductible)

20% (after deductible)

50% (after deductible)

40% (after deductible)

▸ Stainless Steel Crown (eligible children only) Class III Services ▸ Endodontics ▸ Oral Surgery ▸ Periodontics ▸ Implants Class IV Services ▸ Orthodontic

N/A

40% (no deductible)

N/A

$1,000

(children under the age of 19) Maximum Ortho Benefit

Cigna’s Life Assistance Program (LAP) provides resources to help you deal with potentially stressful or emotional situations. The LAP can serve as your personal research center to help you find potential resources to assist with a variety of issues, including: • • • • • • • • •

Child and elder care providers Daily living services Financial services Health and wellness concerns Legal services Marriage, relationship and family counselors Personality changes Professional issues Stress and anxiety

You and your family are eligible for up to three consultations with a licensed professional per incident, per individual, per calendar year. These services include a choice between telephonic or webvideo consultations.

Consultations are free and completely confidential and available 24 hours a day, 365 days a year. The LAP also provides access to helpful articles, interactive assessments, financial calculators, service locators, online newsletters, podcasts and more. Contact Cigna LAP for more information at cignabehavioral.com/cgi or 800-538-3543.

D E N TA L P R E M I U M S ( S E M I - M O N T H LY PAY M E N T S )

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BASE PLAN

HIGH PLAN

Employee Only

$0.00

$2.55

Employee + Spouse

$12.24

$17.76

Employee + Child(ren)

$23.63

$30.94

Employee + Family

$34.94

$44.54 15

DISABILITY

BASIC TERM LIFE AND AD&D

SHORT-TERM DISABILITY P L A N F E AT U R E S Basic term life insurance provides a benefit in the event of a covered participant’s death.

Accidental Death and Dismemberment (AD&D) is an additional benefit that pays in the event a covered participant dies or is dismembered in a covered accident.

Eligibility

Life Benefit

2x annual compensation rounded up or down to the nearest $1,000 not to exceed $750,000

Child (under 20)

$0.083

50 to 54

$0.1835

Minimum Benefit

<20 to 24

$0.0605

55 to 59

$0.421

Employees also have an option to purchase additional term life and AD&D insurance.

25 to 29

$0.062

60 to 64

$0.6175

V O L U N TA R Y T E R M LIFE INSURANCE & AD&D

30 to 34

$0.063

65 to 69

$0.918

35 to 39

$0.068

70 to 74

$1.053

40 to 44

$0.0935

75+

$7.6925

45 to 49

$0.147

Employee

AVA I L A B L E C O V E R A G E

Benefit Amount: $5,000 increments up to the lesser of 5x your annual salary rounded up or down to the nearest $5,000 or $500,000 Employee guaranteed issue amount of $200,000 or less; amounts between $200,000 to $500,000 will require completion of evidence of insurability

Spouse

Benefit Amount: $5,000 increments up to $100,000

(eligible only if an Spouse guaranteed issue amount of $30,000 or less; employee is eligible to amounts between $30,000 to $100,000 will require participate) completion of evidence of insurability Benefit Amount (Age 14 days to six months): $100 Infant/Child Life 16

V O L U N TA R Y L I F E & A D & D R AT E S ( P E R $1,000) ( B E N E F I T A M O U N T/$1,000 X A G E R AT E = S E M I - M O N T H LY C O N T R I B U T I O N )

Guaranteed Issue Amount The lesser of 2x annual compensation rounded up or down to the nearest $1,000 or $500,000 $10,000

Benefit Amount (Age six months to 26 years): $1,000, $2,000, $4,000, $5,000 or $10,000

Active, full-time employees regularly working a minimum of 30 hours per week

Coverage Amount (may be reduced by additional sources of income and disability earnings)

Chaparral provides all active, full-time employees who regularly work a minimum of 30 hours per week the following at no charge:

Satisfactory evidence of insurability will not go into effect until approved by Cigna and is required when: •

Requesting more than the guaranteed issue amount

•

Requesting increases in current coverage amounts

•

Applying after your initial eligibility period (more than 30 days after first eligible)

All basic term life, AD&D and short- and long-term policies are administered through Cigna. Visit cigna.com or call 888-84-CIGNA (888-842-4462) for more information.

ELIGIBLE EMPLOYEES

Maximum Payment Period Elimination Period

70% of your weekly earnings up to a maximum of $3,000 per week Up to 12 weeks after elimination period is satisfied Seven days

LONG-TERM DISABILITY P L A N F E AT U R E S Eligibility

Coverage Amount (may be reduced by additional sources of income and disability earnings) Elimination Period Pre-existing Conditions

ELIGIBLE EMPLOYEES Class 1: Active, full-time employees classified as a senior executive regularly working a minimum of 30 hours per week Class 2: Active, full-time employees regularly working a minimum of 30 hours per week excluding employees classified as senior executives Class 1: 60% up to $12,000 Class 2: 60% up to $8,000 90 days 3 months prior/12 months insured

Pre-existing condition means during the three months prior to the employee’s effective date of insurance the employee received medical treatment, consultation, care or services, including diagnostic measures or took prescribed drugs or medicines for the disabling condition.

Pre-existing condition for increases in amounts of insurance means during the three months prior to the employee’s effective date of any increase in an employee’s amount of insurance the employee received medical treatment, consultation, care or services, including diagnostic measures or took prescribed drugs or medicines for the disabling condition.

Survivor Benefit

Three-month lump sum

You can learn more about short- and long-term disability coverage at cigna.com or by calling 888-84-CIGNA (888-842-4462). 17

401(K)

CONTACT INFORMATION

PAID TIME OFF

Chaparral’s paid time off (PTO) model combines traditional vacation and sick time into a single account, which allows you to determine the best use of your time off. PTO accruals are based on years of relevant work experience and are earned incrementally every pay period.

YEARS OF EXPERIENCE 0 to <5

120 hours

5 to <10

160 hours

10 to <15

200 hours

Elected contribution amounts are effective the first day of each month. Chaparral’s plan features:

15+

240 hours

• • • • • • •

Automatic enrollment at three percent of earnings 100 percent matching contribution from Chaparral, up to the first seven percent of your eligible contributions 100 percent vest after three years of service Ability to contribute the IRS maximum allowable amount of $18,500* per calendar year $6,000 catch-up contribution for those over the age of 50 Ability to take loans and hardship withdrawals A wide variety of investment options, including target date funds selection for those who do not wish to pick individual funds 24/7 account access at 401k.com Comprehensive communications and planning tools, including an annual retirement quick check to help you stay on track and remain focused on what is most important to you

If you have questions or need help getting started, please visit 401k.com or call Fidelity at 800-835-5097. *Please note, this is the 2018 IRS limit. The 2019 limit has yet to be issued. Once released, however, you can check irs.gov to verify the 2019 limit.

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PTO

Your 401(k) plan is a powerful tool to help you achieve your retirement goals. Chaparral offers fulltime employees the opportunity to participate in our 401(k) plan through Fidelity Investments.

• •

For more information about Chaparral benefits, please visit the Benefits section of The Wire or email benefits@chaparralenergy.com.

MEDICAL/VISION

HSA, LPFSA OR FSA ACCOUNT

BCBS of Oklahoma 800-942-5837 bcbsok.com

HSABank 800-357-6246 hsabank.com

PHARMACY RX

B A S I C & V O L U N TA R Y T E R M L I F E & A D & D

Prime Therapeutics 877-357-7463 myprime.com

Cigna 888-842-4462 cigna.com

MDLIVE

SHORT- & LONG-TERM DISABILITY & FML

MDLIVE 800-400-6354 mdlive.com

Cigna 888-842-4462 cigna.com

WELLNESS PROGRAM

L I F E A S S I S TA N C E P R O G R A M

SimplyWell (Formerly MyViverae) 888-848-3723 MyViverae.com

Cigna 800-538-3543 cignabehavioral.com/cgi

D E N TA L

401( K )

Delta Dental 800-522-0188 deltadentalok.org

Fidelity 800-835-5097 401k.com

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