2020-2021 BENEFIT GUIDE - Team Member & Shift - Border Foods Benefits

2020-2021 BENEFIT GUIDE - Team Member & Shift - Border Foods Benefits
         Team Member & Shift
2020-2021 BENEFIT GUIDE - Team Member & Shift - Border Foods Benefits
Welcome to Border Foods! We at Border Foods know that our employees are our biggest asset
so it is our goal to offer a complete benefits package that can properly meet your needs. The
following pages will introduce you to Border Foods employee benefits, eligibility requirements,
costs of coverage and how to enroll. We encourage you to read this guide in its entirety so you can
make the choices that are right for you and your family.

ELIGIBILITY/ENROLLMENT .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  . 1

MEDICAL COVERAGE.  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  . 2

MEDICAL BENEFITS AT-A-GLANCE.  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  . 3

HEALTH SAVINGS ACCOUNT (HSA) .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  . 5

FLEXIBLE SPENDING ACCOUNTS (FSA).  .  .  .  .  .  .  .  .  .  .  .  .  .  .  . 6

DENTAL COVERAGE.  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  . 8

VISION COVERAGE.  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  . 9

ACCIDENT COVERAGE.  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  . 10

LIFE AND DISABILITY INSURANCE.  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  . 11

CRITICAL ILLNESS INSURANCE. .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  . 12

ADDITIONAL BENEFITS. .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  . 13

DEFINITIONS.  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  . 15

GETTING STARTED .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  . 17

CONTACT INFORMATION.  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  . 19

IMPORTANT NOTICES.  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  . 20
2020-2021 BENEFIT GUIDE - Team Member & Shift - Border Foods Benefits

As a Border Foods Team Member/Shift employee, you are eligible for benefits on the first of the month following 12
months of employment if during your first 11 months your average hours worked per week is 30+.
You continued eligibility will be determined annually based on the same criteria.

When you enroll in the Benefits Program, you may also cover your eligible dependents for medical, accident, dental,
vision and life insurance.
Eligible dependents include your:
n Legal spouse (unmarried individuals and/or domestic partners are not eligible)

n   Dependent Child(ren)
    n   Medical, Dental and Vision coverage up to age 26 regardless of student status
    n   Other benefits up to age 19 or 26 (if a full-time student)

Changing Your Benefits During the Year
Your benefit elections remain in effect for the entire plan year (April 1 – March 31), unless you have an IRS qualified life
event (proof will be required). All changes as a result of a qualified life event must be made within 30 days of the event.
Eligible qualified life events include the following:
n   Legal marital status – any event that changes your legal marital status, including marriage, death of spouse,
    divorce, legal separation, or annulment.
n   Number of dependents – any event that changes the number of your dependents, including birth, adoption,
    placement for adoption, divorce or death of a dependent, or assuming primary support of the child of an unmarried
    dependent child.
n   Employment status – any event in which an eligible dependent gains or loses access to employer-sponsored
n   Dependent status* – any event, due to age or similar circumstances, which causes your dependent to satisfy or
    cease to satisfy eligibility requirements under the plan which you receive coverage.
n   Medicare or Medicaid eligible status – you or your spouse become Medicare or Medicaid eligible.
*If at any time during the year your enrolled dependents no longer meet eligibility requirements, you must notify the Human
    Resources Department to remove the individual from coverage.

    Accessing the benefits portal is simple!
    Simply go to: www.borderfoods.bswift.com
        Username: first initial of first name + full last name + month and day of birth
                  (i.e. John Brown, born on January 26th,1984 would be “JBrown0126”)
        Password: last four digits of your SSN
        Please Note: On your initial log in you will be required to change your password for security purposes

You must:
n   Register prior to your effective date upon notification of eligibility.
    n   www.borderfoods.bswift.com
n   Enroll during the enrollment period or you will not have coverage until the next Open Enrollment time period,
    unless you have a Qualifying Life Event.

2020-2021 BENEFIT GUIDE - Team Member & Shift - Border Foods Benefits

           High quality, affordable health care is a high priority for most people. That is why Border Foods
           is pleased to continue to offer you and your family two PPO plans – the Basic Plan and the
           Premium Plan through Medica.

           Basic Plan – Health Savings Account (HSA) Eligible
           The Basic plan has the lowest cost to you per pay period and the highest deductible. You must
           pay all expenses for services except as noted in the Medical Benefits At-A-Glance Chart (see
           page 4) until you meet the deductible. Once the deductible is met you will pay coinsurance for
           services in the amounts noted on the chart. If you choose the Basic Plan, you can open an HSA
           account, fund it with pre-tax contributions throughout the year and use that money to pay for
           qualified healthcare expenses. See page 5 for more details on the Health Savings Account.

           Premium Plan – Flexible Spending Account (FSA) Eligible
           The Premium plan offers a lower deductible but has a higher per pay period cost. If you choose
           this plan you are not eligible to open an HSA but you can open a Health Care Flexible Spending
           Account (FSA) to help you with meeting your deductible. You can make pre-tax contributions
           to this account to be set aside to pay for medical expenses including deductible, coinsurance,
           co-pays and IRS 213(d) expenses. See page 8 for more details on the Health Care FSA.

           Bi-Weekly Medical Plan Cost Comparison
                  Coverage                   Basic Plan - HSA Eligible                  Premium Plan - FSA Eligible

                                         Non-Tobacco              Tobacco             Non-Tobacco              Tobacco

            Employee Only (MN)               $61.11                $113.35               $113.36                $163.09

            Employee Only (IA, IL,
                                             $46.85                 $97.31               $113.36                $163.09
            MI, SD, WI & WY)

            Employee + 1
                                             $113.36               $215.93               $221.31                $327.65

            Family                           $140.35               $269.90               $278.53                $415.64

           *You will be subject to a $45.00 per pay period surcharge if your spouse has coverage available through another
           employer and you choose to enroll him/her in the Border Foods Plan. Documentation may be required if your spouse is
           not eligible for coverage elsewhere.

           Please note: Employee Only rates differ by state due to state specific regulations that Border
           Foods adheres to.

           Network of Providers
           Both plans offer considerable advantages when you use network providers. Besides the financial
           benefit of pre-negotiated rates, the network also provides reassurance about the level of care
           available. In addition, using the services of network providers eliminates the hassle of filing claim
           forms, since the providers take care of this. To find out if a certain doctor or hospital is a network
           provider, visit www.medica.com and click “Find Physician or Facility” then select “Medica
           Choice Passport with UnitedHealthcare Choice Plus” or call 1-800-952-3455.

2020-2021 BENEFIT GUIDE - Team Member & Shift - Border Foods Benefits

      Coverage                            Basic Plan – HSA Eligible                                  Premium Plan – FSA Eligible

                                     Network                    Out-of-Network                    Network             Out-of-Network

n Employee Only                        $3,500                        $7,000                         $1,250                  $2,500
n Family                               $7,000                        $9,000                         $2,500                  $5,000

Out-of-Pocket Limit
n Employee Only                       $6,350                         $12,700                        $6,350                 $12,700
n Family                              $12,700                        $25,700                       $12,700                 $25,700

Routine Care
n Preventive Care
                                     No charge               50% after deductible                 No charge         40% after deductible
n Screening
n Immunization
Primary Care/
Specialist Visit
n Illness or injury
                              20% after deductible           50% after deductible                $30 co-pay         40% after deductible
n Physical, speech,
  occupational therapy
n Chiropractic Care**

Convenience Care
n Retail Health Clinics       20% after deductible           50% after deductible                $10 co-pay         40% after deductible
n Virtual Care

Emergency Care
n Urgent Care                 20% after deductible           20% after deductible              $50 co-pay               $50 co-pay
n Emergency Room              20% after deductible           20% after deductible          20% after deductible     20% after deductible

Hospital and
Outpatient Care
                              20% after deductible           50% after deductible          20% after deductible     40% after deductible
n Facility Fee
n Physician/Service Fees

Maternity Care
n Prenatal                        No Charge                  50% after deductible              No Charge            40% after deductible
n Postnatal                   20% after deductible           50% after deductible              No Charge            40% after deductible
n Delivery/Inpatient          20% after deductible           50% after deductible          20% after deductible     40% after deductible

Health Care
n Outpatient                  20% after deductible           50% after deductible              $30 co-pay           40% after deductible
n Inpatient                   20% after deductible           50% after deductible          20% after deductible     40% after deductible

Substance Abuse Care
n Outpatient                  20% after deductible           50% after deductible              $30 co-pay           40% after deductible
n Inpatient                   20% after deductible           50% after deductible          20% after deductible     40% after deductible

n Tier 1                     $15 co-pay after deductible*      50% or $50 co-pay                $15 co-pay             Greater of 40%
n Tier 2                     $25 co-pay after deductible*       after deductible                $25 co-pay           coinsurance or $50
n Tier 3                     $50 co-pay after deductible                                        $50 co-pay         co-pay after deductible
n Specialty Tier 1&2            20% coinsurance                   Not covered                 20% coinsurance           Not covered
                                 after deductible
  *No charge for preventive drugs listed on the approved list. Access the HSA Preventive Drug List at medica.com by typing “HSA Preventive Drug
  List” into the Search bar then select “Member: HSA Preferred Drug List for Exchange Members”. Preventive drugs are covered at 100% until you
  reach the deductible, then standard co-pay amounts will apply.
  **Chiropractic visits are limited to a 15 visit annual max per member for out-of-network chiropractic care.                                 3
2020-2021 BENEFIT GUIDE - Team Member & Shift - Border Foods Benefits

           Prescription Drug Benefits
           If you choose to elect medical coverage, you will receive prescription drug coverage through
           Medica’s pharmacy program. You can get prescription drugs filled through a network of retail
           pharmacies. Find out more about your pharmacy and prescription options. Go to mymedica.com,
           click on pharmacy information and select Medica Choice Passport. From there you can estimate
           drug costs and view preferred drug lists.
           In an effort to help keep health care costs as low as possible, while still providing continued
           access to safe, affordable and effective prescription medication, effective January 1, 2020, Medica
           utilizes Express Scripts, Inc. as its pharmacy benefit manager.
           Medications considered “specialty” drugs must be filled through an approved specialty
           pharmacy or there will be no coverage. Medica partners with Accredo to provide specialty
           pharmacy services. The Accredo clinical team offers one-on-one counseling and assistance as
           well as opportunities to engage through web, mobile, text, chat and email to make refilling
           medications as easy as possible. Specialty medications are conveniently delivered to members
           via FedEx or UPS. You can contact Accredo by phone at 1-877-ACCREDO (222-7336) or access
           their website: www.accredo.com.

           Manage Your Health Online:
           Once you are enrolled in the medical plan, you can create an account at mymedica.com which
           will provide you access to:
           n   Look up your benefits information
           n   See your claims and explanations of benefits (EOBs)
           n   Search for doctors in your network
           n   Sign up to get your health plan documents delivered online

           This virtual clinic can diagnose and treat over 40 common conditions, such as pink eye, ear infection
           and sinus infections, 24 hours a day, 7 days a week. Each visit is $49 or less*, depending on which
           medical plan you have. If they can’t treat you, you don’t pay! Prescriptions, if needed, can be sent
           to the pharmacy of your choice. Visit virtuwell.com or amwell.com whenever you need care.
           * Virtual care providers must be in your plan’s network. Search for providers in your plan’s network at medica.com/members
           or call the number on the back of your Medica ID card. Amwell is available in every state. Not available in SD, WY, or IL.

           My Health RewardsSM by Medica
           Earn rewards for your healthy behaviors. My Health Rewards by Medica offers you the
           opportunity to earn up to $100 in gift cards to your favorite stores, restaurants and entertainment
           venues just by completing their web activities. Every 100 points earns a $20 gift card. The new
           Invest program is now available to employees enrolled in HSA. This innovative platform allows
           employees who meet monthly wellness goals related to sleep, nutrition, and activity to earn up to
           $75 per month (up to $900 per calendar year). Log in to mymedica.com and select the “Health
           and Wellness” tab to get started.

           Fit ChoicesSM - Medica
           Employees enrolled in the Medica Medical Plan are eligible to receive savings at participating
           fitness facilities. Employees who work out 12 days or more in a calendar month will receive a $20
           credit towards that month’s membership dues.
           Visit www.medica.com/fitchoices for more information on the Fit Choices program and to find
           out if your health club is a participating facility.
2020-2021 BENEFIT GUIDE - Team Member & Shift - Border Foods Benefits

       How the HSA works
       You can open an HSA account and fund it with pre-tax contributions through bi-weekly
       payroll deductions throughout the year. You can then withdraw the funds tax-free to reimburse
       yourself for eligible expenses including deductibles, coinsurance and co-pays. After incurring a
       qualified expense and submitting any required documentation, you will receive reimbursement
       for this expense.
       You must enroll in the High Deductible Health Plan (Basic Plan) to be eligible to participate in
       the HSA. In addition, in order to be eligible to participate in an HSA, you can not:
       n   Be claimed as a dependent on someone else’s tax return
       n   Have a spouse with a Health FSA that could reimburse your medical expenses
       n   Be enrolled in a government health plan, such as Medicare or Medicaid
       You do not need to use all of the money you contribute to the account in any given year.
       Unused HSA funds will rollover from year to year so you can used it when you need it most.
       If you change jobs you can take the money with you.

       HSA Annual Contribution Limits:
       Employee only coverage: $3,550
       All other coverage levels: $7,100
       Age 55+ catch up: $1,000

       Employer Contributions NEW!
       Effective April 1, 2020, Border will begin contributing to HSAs for those employees that choose
       to actively participate and contribute to their HSA.
       The annual employer contribution amounts are as follows:
       Employee          $340
       Employee + 1 $560
       Family            $720
       These amounts will be posted to employees accounts on a quarterly basis (1st of the months
       of April, July, October and January). Please note: You will only be eligible for the quarterly
       contribution if you are an active employee at the start of each quarter.

             n   Employee contributions are tax-free
                 reducing your taxable income.
             n   Distributions of HSA funds are tax-free
                 when used to cover qualified health
                 care expenses.
             n   HSA balances grow tax free.

             Learn more and manage your account
             at tasconline.com

2020-2021 BENEFIT GUIDE - Team Member & Shift - Border Foods Benefits

           A Flexible Spending Account (FSA) is a voluntary account that allows you to use pre-tax
           funds to pay for certain health care and dependent day care expenses as determined by IRS
           regulations. You can set up two separate accounts- one for qualified health care expenses and
           one for qualified dependent care expenses. The monies in one account cannot be used to
           satisfy expenses in the other account. TASC is the claims administrator for both FSA programs.
           You can not contribute to both a Health Care FSA and a HSA.

           Your FSA Contributions
           When you establish a Health Care and/or a Dependent Care FSA, you choose the annual
           amount you wish to contribute, up to certain plan limits. This amount is deducted from your
           paycheck in equal installments before Federal and Social Security taxes are withheld. If you
           experience a qualified life event, you are eligible to change your FSA election during the year.

           Health Care Flexible Spending Account
           You may make a pre-tax contribution of up to $2,750 per year to your Health Care FSA. If you set
           up a Health Care FSA, you can be reimbursed for eligible expenses that you or your dependents
           incur after your effective date and during the plan year in which you participate. Examples of
           eligible health care expenses*, to the extent not covered by another plan (through June 15th,
           2021), include:
           n   Copayments and deductibles not covered by medical or dental insurance
           n   Uninsured expenses, such as hearing aids, eyeglass, contact lenses and certain eye surgeries
           n   Orthodontia
           n   Diabetic supplies
           n   Smoking cessation programs
           n   Fertility services

           *For a complete list of eligible and ineligible Health and Dependent Care FSA expenses visit www.IRS.gov and review
           Publications 213(d), 502, and 503. A list can be obtained from your local IRS office.

                 IMPORTANT REMINDER
                 Be sure to calculate your FSA election carefully, as any unused funds in your account
                 will be forfeited at the end of the plan year.
                 Please note: you may still submit eligible claims for reimbursement through the 2 1/2
                 month grace period (through June 15th, 2021) after the plan year ends.


       Dependent Care Flexible Spending Account
       In the Dependent Care FSA, you may contribute up to $5,000 per year, per family household,
       on a pre-tax basis. This annual maximum applies to all contributions made by you and your
       spouse to a dependent care account. Therefore, if you are married and filing separately for
       federal income tax purposes, you may elect to contribute up to $2,500 per year.

       Eligible dependents
       You can be reimbursed for dependent care expenses if they are necessary to allow you or your
       spouse to work. These services may be provided inside or outside your home by babysitters,
       companions, or eligible day care centers. Services may not, however, be provided by someone
       you claim as a dependent on your tax return.
       Your day care expenses must be for:
       n   Your dependent under age 13 who lives with you for more than half the year and
           for whom you can claim an exemption
       n   Your dependent under age 13 for whom you have custody if you are divorced or
           legally separated
       n   Your spouse who is physically or mentally incapable of self-care
       n   Your dependent of any age, such as an elderly parent or other adult dependent,
           who meets all of the following criteria:
            n   Is physically or mentally incapable of caring for himself or herself,
            n   Receives over half of his or her support from you,
            n   Lives with you for more than half the year, and
            n   Is your sibling, step-sibling or any of their descendants; a parent or step-parent
                or any of their ancestors; an aunt, uncle, niece or nephew; children or parents-in-law;
                or an unrelated individual who shares your residence as a member of the household.

           TEXT     – DELTA DENTAL

    Dental Coverage is an often overlooked but important health benefit. Routine dental care can improve your oral health
    and your overall health and well-being. Delta Dental of Minnesota offers two great networks, Delta Dental PPO and
    Delta Dental Premier, that work together to provide the greatest access to providers and help control your costs.
    Four out of five dentists nationally are Delta Dental Network dentists. You can choose to see a dentist outside of
    the network but your expenses may be higher and you may be responsible for submitting your own claim. To find a
    participating dentist, simply visit www.deltadentalmn.org and use the interactive Find a Dentist tool or call Customer
    Service toll free at 800-448-3815.

    Summary of Dental Coverage
                                                               Delta Dental PPO              Delta Dental Premier              Non-Participating

     Per person/per family (calendar year)
                                                                     $50/$150                        $50/$150                       $75/$225
     No deductible for diagnostic and
     preventive services or orthodontics

     Calendar Year Plan Per person                                     $1,500                         $1,500                          $1,000

     Lifetime Ortho Maximum Per covered person                         $1,500                         $1,500                          $1,200

    What the Plan Pays*
                 Service & Description                         Delta Dental PPO              Delta Dental Premier              Non-Participating

     Diagnostic & Preventive Services
                                                                                                                                90% of maximum
     n Exams & cleanings n Routine x-rays                              100%                            100%
                                                                                                                                 allowable fee**
     n Fluoride treatments n Sealants

     Basic Services
                                                                                                                                70% of maximum
     n Fillings n Oral Surgery, Extractions                             80%                             80%
                                                                                                                                 allowable fee**
     n Periodontics

                                                                                                                                70% of maximum
     n Pulpotomies on primary teeth                                     80%                             80%
                                                                                                                                 allowable fee**
     n Root canal therapy on permanent teeth

     Major Restorative
                                                                                                                                40% of maximum
     n Crowns and crown repair                                          50%                             50%
                                                                                                                                 allowable fee**
     n Bridges n Dentures

                                                                                                                                40% of maximum
     Coverage available for dependent children                          50%                             50%
                                                                                                                                 allowable fee**
     only, age 8 - 18
    *This is a summary of benefits only and does not guarantee coverage. For a complete list of covered services, limitations, exclusions, and benefit
    frequencies, please refer to the Dental Benefit Plan Summary.

    **Dentists who have signed a participating network agreement with Delta Dental have agreed to accept the maximum allowable amount as payment
    in full. Non-participating dentists have not signed an agreement and are not obligated to limit the amount they charge; the member is responsible
    for paying any difference to the non-participating dentists.

                  Coverage                            Bi-Weekly Cost
     Employee Only                                         $14.89
     Employee + One Dependent                              $28.72
     Family                                                $45.60


Your eyesight is an integral part of your overall health and key component of safety. Your vision benefits are
provided through EyeMed and covers eye exams, eyeglasses, and contact lenses. Services are provided through
the extensive EyeMed Vision Care network of optometrists, ophthalmologists, and other eye care professionals.

Receiving benefits from a network provider is as easy as making an appointment with the provider of your choice
from the list of EyeMed Vision Care providers. The provider will coordinate all necessary authorizations from
EyeMed Vision Care once you supply your membership information. To find a list of Advantage network providers,
contact EyeMed Vision Care at 1-888-203-7437 or www.eyemed.com.
You may also choose to use providers outside the network, but you’ll pay more for rendered services. You will
be responsible for paying the entire service fee and then requesting reimbursement of the scheduled allowance
(shown in the chart below) from EyeMed Vision Care.

What the Plan Pays
           Coverage                               In-Network                          Out-of-Network

Well Vision Exam
                                                   $10 Co-pay                        Plan pays up to $35
(once every 12 months)

Frames                                         $140 allowance:
                                                                                     Plan pays up to $56
(once every 24 months)                   20% off retail price over $140

Standard Plastic Lenses
(once every 12 months)                                                                 Plan pays up to:
n   Single Vision                                $10 Co-pay                                  $25
n   Bifocal                                      $10 Co-pay                                  $40
n   Trifocal                                     $10 Co-pay                                  $60
n   Standard Progressive Lens                    $10 Co-pay                                  $85
n   Premium Progressive Lens         $10, % of charge less $110 allowance                    $85

Contact Lenses
n Medically Necessary                       $0 Co-Pay: Paid in full                 Plan pays up to $200
n Conventional                   $155 allowance: 15% off retail price over $155     Plan pays up to $109
n Disposable                          $155 allowance; balance over $155             Plan pays up to $109

Contact Lens Fit and
n Standard                                          Up to $40                               N/A
n Premium                                         10% off Retail                            N/A

Laser Vision Correction         15% off retail price OR 5% off promotional price            N/A

           Coverage                 Bi-Weekly Cost
Employee Only                            $4.00
Employee + One Dependent                 $7.58
Family                                   $11.13


        Accident Insurance can help your family cover unexpected out-of-pocket expenses and
        supplement lost income due to a covered off-job accident. Accident Insurance covers a wide
        range of injuries and accident-related expenses such as hospitalization, emergency room visits,
        physical, occupational and speech therapy, accidental death and catastrophic accidents.

        Sample Coverage and Benefits
                    Treatment, Services, and Covered Injuries                    Coverage Amounts

        Initial Hospital Confinement (pays once/year)                                 $1,000

        Daily Hospital Confinement (pays daily)                                        $200

        Intensive Care (pays daily)                                                   $1,500

        Dislocations                                                                Up to $6,000

        Emergency Room Services                                                        $150

        Physical/Occupational/Speech Therapy (pays daily)                               $25

        The money is paid directly to you and you decide how to spend it. You can also purchase
        coverage for your spouse and dependent children.

                    Coverage                          Bi-Weekly Cost
        Employee Only                                     $5.34
        Employee and Spouse                               $8.64
        Employee and Child(ren)                           $9.97
        Family                                            $13.27

        Please see the specific plan document or plan summary on bswift while enrolling for specific
        coverage and benefits.

                                                  TOP 5 ACCIDENT RELATED CLAIMS
                                                  (BY OCCURRENCE)
                                                  n   Follow-up Care
                                                  n   Emergency Room Treatment
                                                  n   Physician Office Visit
                                                  n   Fracture
                                                  n   Hospitalization


       An illness or injury that keeps you out of work for a long period of time can be financially
       devastating for you and your family. Our Short-Term disability plan is designed to help protect
       your financial security by providing replacement income if you are ever disabled due to a
       non-work related injury or illness, including pregnancy. When you are disabled, your medical
       insurance generally covers most of your medical expenses, including doctor visits, physical
       therapy and prescription drugs. Disability benefits can help cover your day-to-day living
       expenses. This program is insured through Unum.

       Voluntary Short-Term Disability (STD)
       This voluntary benefit provides bi-weekly income benefits to covered employees. You are
       eligible to elect a benefit up to 60% of your monthly earnings subject to a $400 minimum and
       $5,000 maximum. In the event that you become disabled, the maximum period of payment is
       three months.

       Voluntary Whole Life Insurance - Unum
       Whole life insurance provides consistent coverage with premiums and benefits that won’t
       change as you grow older. The policy can build cash value over time — which you can
       apply toward a paid-in-full life policy or even borrow against later. It is offered to all eligible
       associates, ages 15–80, who are actively at work.

       Other features:
       n   Cash value — Accumulates at a guaranteed rate of 4.5%.* Over time, you can borrow from
           the cash value or use it to buy a reduced policy with no more premiums due.
       n   No physical exam — During your initial enrollment, you can get this insurance up to a
           specified amount without a health exam. You may be asked a few health questions.
       n   You own the policy — The payment is deducted from your paycheck and coverage
           becomes effective the first day of the month. You can keep the policy even if you leave or
           retire; Unum will bill you directly for the same premium amount.
       n   You can purchase policies for your spouse and eligible children.
       n   Rates are based on your age, tobacco status and the policy amount you elect.
       n   Please refer to the Policy form for more details and any limitations and exclusions.

       * The policy accumulates cash value based on a non-forfeiture interest rate of 4.5% and the 2001 CSO mortality table.
       The cash value is guaranteed and will be equal to the values shown in the policy. Cash value will be reduced by any
       outstanding loans against the policy.


        Critical Illness insurance can pay a $10,000 or $20,000 lump sum benefit at the diagnosis of a
        specified disease.
        Benefits are paid directly to you to use any way you see fit.
        n   Includes a Recurrence Benefit which provides an additional payout for a second occurrence
            of an initial critical illness for which a benefit was previously paid. Initial and subsequent
            diagnoses must be separated by at least 12 months.
        n   Health Screening Benefit – Unum will pay a health screening benefit of $50 upon submission
            of proof that a covered test was taken. This benefit can be paid out once per covered
            person per calendar year.
        n   Covered Spouses and Children are eligible for 50% of the insured employee benefit
        n   Does not include a pre-existing condition limitation.
        n   Rates are calculated based on age, policy amount and smoker status.
        n   This is a limited policy. Please refer to the Summary Plan Description for more details, any
            exclusions and policy limitations.
        n   Rates are based on issue age and will not increase for as long as you are enrolled in the
            plan. (Please see plan documents or bswift while enrolling for rates specific to you.)

                                                            PLAN 1                       PLAN 2
                   Covered Conditions
                                                       $10,000 Coverage             $20,000 Coverage

         Heart Attack (100%)                                 $10,000                      $20,000

         Stroke (100%)                                       $10,000                      $20,000

         Major Organ Transplant (100%)                       $10,000                      $20,000

         End Stage Renal Failure (100%)                      $10,000                      $20,000

         Coronary Artery Bypass Surgery (25%)                $2,500                        $5,000

         Invasive Cancer (100%)                              $10,000                      $20,000

         Carcinoma in Situ (25%)                             $2,500                        $5,000

         Benign Brain Tumor (100%)                           $10,000                      $20,000


       Tuition Reimbursement (Shift Managers Only)
       Border Foods Inc. offers educational assistance to its employees. It is the intention that this
       plan qualifies as a plan providing qualified educational assistance under Code Section 127 and
       will be non-taxable.
       Plan Limits: $1,000 annually
       Eligibility: Employees must have 1 year of service and work an average of 30 hours per week
       during the previous 52 weeks. They must also be in good standing with no performance,
       disciplinary, or attendance concerns.
       Education Covered and Expenses Reimbursed:
       For tuition to be reimbursed, the course(s) must be either
       a.) Undergraduate courses that are part of a degree program
       b.) Job related Graduate level courses
       Other expenses that are eligible for reimbursement include required books for college
       accredited courses.

                 Grade earned              Reimbursement amount
         “A” “B” or “Pass”                           100%

         “C”                                          75%

         Less than “C” or “Fail”                      0%

       Expectations & Continued Employment:
       Class schedules must not conflict with work. Employees must be employed with the Company
       when taking the course(s), when receiving reimbursement and 12 months afterwards. If
       employment ends within 12 months after of the reimbursement date, the Company requires
       repayment of all education costs reimbursed during the prior 12 months.
       Payment Procedure:
       Upon successful completion of the course, the employee must complete a Tuition
       Reimbursement Payment Request and provide proof of itemized expenses & final grades from
       the school. This information must be submitted to Miranda Ziebell. Upon receipt; she will
       request the applicable reimbursement.
       All tuition reimbursement requests must be pre-approved prior to registering for a course.
       For additional information or to receive pre-approval paperwork, please contact Maricela
       Alatorre at 763.489.2954 or malatorre@borderfoods.com.

       College Scholarships
       All Team members and Shift Managers employed for at least 90 days may be eligible for
       one of ten $1,000 college scholarships provided by Border Foods. Please contact Human
       Resources to learn more.

       Earned Vacation
       On an annual basis, Team Members and Shift Managers with 1 year of service earn a vacation
       amount of the average weekly hours worked in the previous year not to exceed 40 hours. Shift
       Managers can earn up to 2 times the average number of hours worked after 2 years of service.

        Legal Protection Plan – Legal Club of America
        This plan covers your entire family and includes: free and discounted legal care, life events
        counseling, and ID Theft protection including prevention, restoration and insurance. It also
        offers tax advice and preparation including a free tax return. For coverage details, see the
        benefit summary on the enrollment site.
                                  Coverage                   Per Paycheck
                                    Family                       $6.46

        Employee Assistance Program (EAP) - Unum
        The Company offers an EAP through Unum, administered by HealthAdvocate, free of charge,
        designed to help you and your dependents address life’s daily challenges. From workplace
        stress to a variety of family issues, the EAP provides confidential telephone consultations that
        can help and up to 3 in-person sessions, per issue, for you to talk with a counselor if needed.
        Contact the EAP at 800-854-1446 or learn more at www.unum.com/lifebalance.

        Worldwide emergency travel assistance program –
        Assist America, Inc. through Unum
        For travel 100 miles or more from your home you have 24-hour phone access to professionals
        who can help you in an emergency offering services such as connecting you with pre-qualified
        medical providers, access to western-style medicine, ambulance and air ambulance, lost/
        stolen medication replacement, and more.

        Various Discounts and Services
        The Work Number: The Work Number is an automated service that provides instant
        employment and income verification. To verify employment and or income verification, please
        have the verifier call 1-800-367-5690 or visit www.theworknumber.com and use the Border
        Foods employer code 11740 and your Social Security Number.
        Employee Meal Discount: All employees can receive a 20% discount on food purchased at
        any Border Foods restaurant when off duty. You must present paycheck stub or ID card.
        Workplace Banking: U.S. Bank offers perks to Company employees including: Free Checking,
        Free 1st Box of Checks, Free Internet Banking, discounts and preferred rates on various U.S.
        Banking services and more. See a banker for more information.
        Additional Discounted Services: Taco Bell offers multiple discounts that change often. Check
        out https://tb.hrdiscounts.com/perks/ for the latest discounts. Use SAVENOW to register.

        If you have questions about anything in this benefit guide please contact
        Any human resources related questions should be directed to your Border
        Foods HR Representative.


       Affordable Care Act (ACA): The Patient         Copayment: A set dollar amount you pay
       Protection and Affordable Care Act,            for network doctors’ office visits, emergency
       commonly called the Affordable Care Act        room services and prescription drugs.
       (ACA) is a United States federal statute
       signed into law by President Obama             Deductible: Total dollar amount, based on
       in March 2010. The law puts in place           the allowed amount, you must pay out of
       comprehensive health insurance reforms.        pocket for covered medical expenses each
                                                      calendar year before the plan pays for most
       Annual Maximum: Total dollar amount a          services. The deductible does not apply to
       plan pays during a calendar year toward        network preventive care and any services
       the covered expenses of each person            where you pay a copayment rather than
       enrolled.                                      coinsurance. Some of your dental options
                                                      also have an annual deductible, generally
       Out-of-Pocket Maximum: The maximum             for basic and major dental care services.
       amount of coinsurance a Plan member
       must pay towards covered medical               Brand Formulary Drugs: The brand
       expenses in a calendar year for both           formulary is an approved, recommended
       network and non-network services.              list of brand-name medications. Drugs
       Once you meet this out-of-pocket               on this list are available to you at a lower
       maximum, the Plan pays the entire              cost than drugs that do not appear on this
       coinsurance amount for covered services        preferred list.
       for the remainder of the calendar year.
       Deductibles and copays apply to the            Generic Drugs: These drugs are usually
       annual out-of-pocket maximum.                  most cost-effective. Generic drugs are
                                                      chemically identical to their brand-name
       Coinsurance: A percentage of the medical       counterparts. Purchasing generic drugs
       costs, based on the allowed amount, you        allows you to pay a lower out-of-pocket
       must pay for certain services after you meet   cost than if you purchase formulary or
       your annual deductible.                        non-formulary brand name drugs.

       Conversion: an employee changes or             Maintenance Drugs: Prescriptions
       “converts” her / his Group Life coverage to    commonly used to treat conditions that are
       an Individual Life Insurance policy without    considered chronic or long-term. These
       having to answer any medical questions.        conditions usually require regular, daily use
       Conversion is for an employee who is           of medicines. Examples of maintenance
       leaving her/his job, reducing hours, or has    drugs are those used to treat high blood
       reached the age when coverage may be           pressure, heart disease, asthma and diabetes.
       reduced or eliminated, and still wants to
       maintain the protection that life insurance


        Non-Formulary Drugs: These drugs are             Provider: Any type of health care
        not on the recommended formulary list.           professional or facility that provides
        These drugs are usually more expensive           services under your plan.
        than drugs found on the formulary. You may
        purchase brand-name medications that do          Network: A group of health care providers,
        not appear on the recommended list, but          including dentists, physicians, hospitals and
        at a significantly higher out-of-pocket cost.    other health care providers, that agrees to
                                                         accept pre-determined rates when serving
        PDP Fee: PDP Fee refers to the fees that         members.
        participating PDP dentists have agreed to
        accept as payment in full, subject to any        Qualifying Event: An occurrence that
        copayments, deductibles, cost sharing and        qualifies the Subscriber to make an
        benefits maximums.                               insurance coverage change outside of the
                                                         Open Enrollment window.
        Portability: An employee carries or “ports”
        her/his current Group Life coverage after        Reasonable and Customary Charge
        employment ends, without having to               (R&C): R & C fee refers to the Reasonable
        answer any medical questions. Portability is     and Customary (R&C) charge, which is
        for an employee who is leaving her/his job       based on the lowest of (1) the dentist’s
        and still wants to maintain the protection       actual charge, (2) the dentist’s usual charge
        that life insurance provides.                    for the same or similar services, or (3)
                                                         the charge of most dentist’s in the same
        Pre-tax Plan: A plan for active employees        geographic area for the same or similar
        that is paid for with pre-tax money. The         services as determined
        IRS allows for certain expenses to be paid       by MetLife.
        for with tax-free dollars. The state takes
        premiums out of your check before taxes          Specialty Drugs: Prescription medications
        are calculated, increasing your spendable        that require special handling, administration
        income and reducing the amount you owe           or monitoring. These drugs may be used
        in income taxes. Consequently, the IRS           to treat complex, chronic and often costly
        has tax laws that require you to stay in the     conditions.
        plans you select for a full plan year (January
        through December). You can only make
        changes during Open Enrollment or if you
        have a Qualifying Event.

        Primary Care Physician (PCP): The health
        care professional who monitors your
        health needs and coordinates your overall
        medical care, including referrals for tests or


       Your Next Steps
       After allowing one week for information processing, please complete the enrollment process.
       As a reminder, please complete this within 30 days of your promotion/hire date.
       1. Register for benefits at www.borderfoods.bswift.com (See below for detailed instructions)

          Benefits Online Enrollment
          Please complete this process within 30 days of hire/promotion
          Benefits enrollment process is quick, easy and is completed online. Be sure to have
          SSN and DOB information for you and your dependents ready!

          Your username will be your First Initial + Last Name + Month and Day of your birth.
          Your initial password will be the last four digits of your social security number. You will
          be prompted to change your password when you log in.


               Employee        Date of Birth     Employee SSN          Username         Initial Password

           Robert Smith         01/01/1975         123-45-6789         RSmith0101             6789

           Sarah Anderson       02/02/1980        111-222-3333       SAnderson0202            3333


        General Navigation
        You & Your Family: View/change your information (address, phone number, etc.), your
        dependents information or enter a Qualified Life Event (QLE).
        My Benefits: View your current coverage elections.

        To Change Benefit Elections:
        Benefit election changes outside of initial enrollment require a qualifying life event (QLE) and
        must be processed within 30 days of the QLE. Check with Human Resources for eligible QLEs.
        n   Log onto the bswift website
        n   Click on “My Benefits”, then “Life Events”
        n   Choose the applicable QLE
        n   Follow the prompts to make coverage changes

        To Change Personal or Dependent information:
        n   Log onto the bswift website
        n   Click on “My Profile”, then “Change my address” or “Edit dependent profiles”
        n   Enter your new information, click “Save”


        Benefit        Policy Number        Provider             Call                Visit

                                                             952-945-8000       www.medica.com
 Medical                  741938             Medica
                                                             800-952-3455      www.mymedica.com

 Critical Illness        R0534560             Unum           866-679-3054        www.unum.com
 Whole Life

                                              Unum /
 EAP                                                         800-854-1446   www.unum.com/lifebalance

 Dental Insurance         050986           Delta Dental                      www.deltadentalmn.org

 Vision Insurance         9745720            EyeMed          866-939-3633   www.eyemedvisioncare.com

 HSA and FSA           4706-0572-9952         TASC                             www.tasconline.com

For benefit support please email: benefits@borderfoods.com


        Special Enrollment Rights
        If you are declining enrollment for yourself or your dependents (including your spouse) because
        of other health insurance or group health plan coverage, you may be able to enroll yourself and
        your dependents in this plan if you or your dependents lose eligibility for that other coverage
        (or if the employer stops contributing towards your or your dependents’ other coverage).
        However, you must request enrollment within 30 days after your or your dependents’ other
        coverage ends (or after the employer stops contributing toward the other coverage).
        If you have a new dependent as a result of marriage, birth, adoption, or placement for
        adoption, you may be able to enroll yourself and your dependents. However, you must request
        enrollment within 30 days after the marriage, birth, adoption, or placement for adoption.
        If you decline enrollment for yourself or for an eligible dependent (including your spouse) while
        Medicaid coverage or coverage under a state children’s health insurance program is in effect,
        you may be able to enroll yourself and your dependents in this plan if you or your dependents
        lose eligibility for that other coverage. However, you must request enrollment within 60 days
        after your or your dependents’ coverage ends under Medicaid or a state children’s health
        insurance program.
        If you or your dependents (including your spouse) become eligible for a state premium
        assistance subsidy from Medicaid or through a state children’s health insurance program with
        respect to coverage under this plan, you may be able to enroll yourself and your dependents in
        this plan. However, you must request enrollment within 60 days after your or your dependents’
        determination of eligibility for such assistance.
        To request special enrollment or obtain more information, contact the Border Foods Human
        Resources Department.

        Newborns’ and Mothers’ Health Protection Act
        Under federal law, health care plans may not restrict any hospital length of stay in connection
        with childbirth for the mother or newborn child to less than 48 hours following a normal
        delivery, or less than 96 hours following a Cesarean section. However, federal law generally
        does not prohibit the mother’s or newborn’s attending provider, after consulting with the
        mother and with the mother’s consent, from discharging the mother or her newborn earlier than
        48 hours (or 96 hours as applicable).

        Women’s Health and Cancer Rights Act of 1998
        Under the Women’s Health and Cancer Rights Act, group health plans must make certain
        benefits available to participants of health plans who have undergone a mastectomy. In
        particular, plans that provide medical and surgical benefits for a mastectomy must also provide
        coverage for:
        n   Reconstruction of the breast on which the mastectomy has been performed
        n   Surgery and reconstruction of the other breast to produce a symmetrical appearance;
        n   External breast prostheses (breast forms that fit into a bra) that are needed before or during
            the reconstruction; and
        n   Treatment of physical complications in all stages of mastectomy, including lymphedemas.
        Coverage is determined by the health plan, in coordination with the physician and patient.


       Important Notice from Border Foods about your Prescription
       Drug Coverage and Medicare
       Please read this notice carefully and keep it where you can find it. This notice has information
       about your current prescription drug coverage with Border Foods and about your options
       under Medicare’s prescription drug coverage. This information can help you decide whether or
       not you want to join a Medicare drug plan. If you are considering joining, you should compare
       your current coverage, including which drugs are covered at what cost, with the coverage
       and costs of the plans offering Medicare prescription drug coverage in your area. Information
       about where you can get help to make decisions about your prescription drug coverage is at
       the end of this notice.
       There are two important things you need to know about your current coverage and Medicare’s
       prescription drug coverage:
       1. Medicare prescription drug coverage became available in 2006 to everyone with Medicare.
          You can get this coverage if you join a Medicare Prescription Drug Plan or join a Medicare
          Advantage Plan (like an HMO or PPO) that offers prescription drug coverage. All Medicare
          drug plans provide at least a standard level of coverage set by Medicare. Some plans may
          also offer more coverage for a higher monthly premium.
       2. Border Foods has determined that the prescription drug coverage offered by the Medica
          is, on average for all plan participants, expected to pay out as much as standard Medicare
          prescription drug coverage pays and is therefore considered Creditable Coverage. Because
          your existing coverage is Creditable Coverage, you can keep this coverage and not pay a
          higher premium (a penalty) if you later decide to join a Medicare drug plan.

       When Can You Join A Medicare Drug Plan?
       You can join a Medicare drug plan when you first become eligible for Medicare and each year
       from October 15th to December 7th.
       However, if you lose your current creditable prescription drug coverage, through no fault of
       your own, you will also be eligible for a two (2) month Special Enrollment Period (SEP) to join a
       Medicare drug plan.


        What Happens To Your Current Coverage If You Decide to Join A Medicare
        Drug Plan?
        If you decide to join a Medicare drug plan, your current Border Foods coverage will not be
        affected. If you or your dependents are Medicare Part D eligible, there are certain options
        available to you:
        • Retain your existing coverage and choose not to enroll in a Part D plan; or
        • Enroll in a Part D plan as a supplement to your existing coverage with Border Foods.
          Note: Information about the prescription drug plan provisions/options available to Medicare
          Part D eligible individuals is available at http://www.cms.hhs.gov/CreditableCoverage/
        If you do decide to join a Medicare drug plan and drop your current Border Foods coverage,
        be aware that you and your dependents will be able to get this coverage back during the
        qualified life event or the annual open enrollment period for Border Foods group plan.

        When Will You Pay A Higher Premium (Penalty) To Join A Medicare Drug Plan?
        You should also know that if you drop or lose your current coverage with Border Foods and
        don’t join a Medicare drug plan within 63 continuous days after your current coverage ends,
        you may pay a higher premium (a penalty) to join a Medicare drug plan later.
        If you go 63 continuous days or longer without creditable prescription drug coverage, your
        monthly premium may go up by at least 1% of the Medicare base beneficiary premium per
        month for every month that you did not have that coverage. For example, if you go nineteen
        months without creditable coverage, your premium may consistently be at least 19% higher
        than the Medicare base beneficiary premium. You may have to pay this higher premium (a
        penalty) as long as you have Medicare prescription drug coverage. In addition, you may have
        to wait until the following October to join.


Premium Assistance Under Medicaid and the Children’s Health Insurance Program (CHIP)
If you or your children are eligible for Medicaid or CHIP and you’re eligible for health coverage from your employer, your state may have
a premium assistance program that can help pay for coverage, using funds from their Medicaid or CHIP programs. If you or your children
aren’t eligible for Medicaid or CHIP, you won’t be eligible for these premium assistance programs but you may be able to buy individual
insurance coverage through the Health Insurance Marketplace. For more information, visit www.healthcare.gov.
If you or your dependents are already enrolled in Medicaid or CHIP and you live in a State listed below, contact your State Medicaid or
CHIP office to find out if premium assistance is available.
If you or your dependents are NOT currently enrolled in Medicaid or CHIP, and you think you or any of your dependents might be eligible
for either of these programs, contact your State Medicaid or CHIP office or dial 1-877-KIDS NOW or www.insurekidsnow.gov
to find out how to apply. If you qualify, ask your state if it has a program that might help you pay the premiums for an employer-sponsored
If you or your dependents are eligible for premium assistance under Medicaid or CHIP, as well as eligible under your employer plan, your
employer must allow you to enroll in your employer plan if you aren’t already enrolled. This is called a “special enrollment” opportunity,
and you must request coverage within 60 days of being determined eligible for premium assistance. If you have questions about
enrolling in your employer plan, contact the Department of Labor at www.askebsa.dol.gov or call 1-866-444-EBSA (3272).
If you live in one of the following states, you may be eligible for assistance paying your employer health plan premiums. The following list of
states is current as of January 31, 2020. Contact your State for more information on eligibility –

To see if any other states have added a premium assistance                 COLORADO – Health First Colorado (Colorado’s Medicaid
program since January 31, 2020, or for more information on                 Program) & Child Health Plan Plus (CHP+)
special enrollment rights, contact either:                                 Health First Colorado
U.S. Department of Labor
                                                                           1-800-221-3943 / State Relay 711
Employee Benefits Security Administration
                                                                           CHP+: https://www.colorado.gov/pacific/hcpf/child-health-
www.dol.gov/agencies/ebsa | 1-866-444-EBSA (3272)                         plan-plus
U.S. Department of Health and Human Services                               1-800-359-1991 / State Relay 711
Centers for Medicare & Medicaid Services                                   FLORIDA – Medicaid
www.cms.hhs.gov | 1-877-267-2323, Option 4, Ext. 61565                     http://flmedicaidtplrecovery.com/hipp/
                     OMB Control Number 1210-0137 (expires 1/31/2023)
                                                                           GEORGIA – Medicaid
ALABAMA – Medicaid                                                         https://medicaid.georgia.gov/health-insurance-premium-
http://myalhipp.com                                                        payment-program-hipp
1-855-692-5447                                                             1-678-564-1162, ext 2131
ALASKA – Medicaid                                                          INDIANA – Medicaid
The AK Health Insurance Premium Payment Program                            Healthy Indiana Plan for low-income adults 19-64
http://myakhipp.com/                                                       http://www.in.gov/fssa/hip/
1-866-251-4861                                                             1-877-438-4479
CustomerService@MyAKHIPP.com                                               All other Medicaid
Medicaid Eligibility                                                       http://www.indianamedicaid.com
http://dhss.alaska.gov/dpa/Pages/medicaid/default.aspx                     1-800-403-0864
ARKANSAS – Medicaid                                                        IOWA – Medicaid and CHIP (Hawki)
http://myarhipp.com/                                                       Medicaid
1-855-MyARHIPP (855-692-7447)                                              https://dhs.iowa.gov/ime/members
CALIFORNIA – Medicaid                                                      1-800-338-8366
https://www.dhcs.ca.gov/services/Pages/TPLRD_CAU_cont.aspx                 Hawki
1-800-541-5555                                                             http://dhs.iowa.gov/Hawki
                                                                           KANSAS – Medicaid


KENTUCKY – Medicaid                                               NORTH CAROLINA – Medicaid
Kentucky Integrated Health Insurance Premium Payment              https://medicaid.ncdhhs.gov/
Program (KI-HIPP)                                                 1-919-855-4100
https://chfs.ky.gov/agencies/dms/member/Pages/kihipp.aspx         NORTH DAKOTA – Medicaid
1-855-459-6328 | KIHIPP.PROGRAM@ky.gov                            http://www.nd.gov/dhs/services/medicalserv/medicaid/
KCHIP                                                             1-844-854-4825
https://kidshealth.ky.gov/Pages/index.aspx                        OKLAHOMA – Medicaid and CHIP
1-877-524-4718                                                    http://www.insureoklahoma.org
Medicaid                                                          1-888-365-3742
https://chfs.ky.gov                                               OREGON – Medicaid
LOUISIANA – Medicaid                                              http://healthcare.oregon.gov/Pages/index.aspx
www.medicaid.la.gov or www.ldh.la.gov/lahipp                      http://www.oregonhealthcare.gov/index-es.html
1-888-342-6207 (Medicaid hotline) or 1-855-618-5488 (LaHIPP)      1-800-699-9075
MAINE – Medicaid                                                  PENNSYLVANIA – Medicaid
http://www.maine.gov/dhhs/ofi/public-assistance/index.html        https://www.dhs.pa.gov/providers/Providers/Pages/Medical/
1-800-442-6003 | TTY: Maine relay 711                             HIPP-Program.aspx
MASSACHUSETTS – Medicaid and CHIP                                 1-800-692-7462
http://www.mass.gov/eohhs/gov/departments/masshealth/             RHODE ISLAND – Medicaid and CHIP
1-800-862-4840                                                    http://www.eohhs.ri.gov/
MINNESOTA – Medicaid                                              1-855-697-4347 or 401-462-0311 (Direct RIte Share Line)
https://mn.gov/dhs/people-we-serve/children-and-families/         SOUTH CAROLINA – Medicaid
health-care/health-care-programs/programs-and-services/           https://www.scdhhs.gov
medical-assistance.jsp                                            1-888-549-0820
  - Under ELIGIBILITY tab, see “what if I have other health
                                                                  SOUTH DAKOTA - Medicaid
MISSOURI – Medicaid
                                                                  TEXAS – Medicaid
MONTANA – Medicaid
                                                                  UTAH – Medicaid and CHIP
                                                                  Medicaid: https://medicaid.utah.gov
                                                                  CHIP: http://health.utah.gov/chip
NEBRASKA – Medicaid                                               1-877-543-7669
                                                                  VERMONT– Medicaid
Lincoln: 1-402-473-7000 | Omaha: 1-402-595-1178
NEVADA – Medicaid
                                                                  VIRGINIA – Medicaid and CHIP
                                                                  Medicaid: 1-800-432-5924
NEW HAMPSHIRE – Medicaid                                          CHIP: 1-855-242-8282
                                                                  WASHINGTON – Medicaid
Toll free number for the HIPP program: 1-800-852-3345, ext 5218
NEW JERSEY – Medicaid and CHIP
                                                                  WEST VIRGINIA – Medicaid
Medicaid: http://www.state.nj.us/humanservices/dmahs/clients/
                                                                  Toll-free: 1-855-MyWVHIPP (1-855-699-8447)
CHIP: http://www.njfamilycare.org/index.html                      WISCONSIN – Medicaid and CHIP
NEW YORK – Medicaid
https://www.health.ny.gov/health_care/medicaid/                   WYOMING – Medicaid

This brochure provides a summary of benefits under the Border Foods health and welfare plans. It is not intended to give advice and
does not provide every plan detail. Every effort has been made to ensure the accuracy of this brochure. However, if there are any
discrepancies between this guide and the actual plan documents that govern the plans, the plan documents will control in all cases.
You can also read