ANNUAL ENROLLMENT 2019 - Petroleum Service Corporation
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2019
ANNUAL
ENROLLMENT
PSC
ANNUAL ENROLLMENT
Our Annual Benefits Enrollment
is around the corner!
Mark your calendars for Nov. 12th- Nov. 28th
Annual Enrollment will be a MANDATORY ENROLLMENT
for ALL employees. This means you MUST log on and
make changes to your current benefit elections. Please read
this document in its entirety to understand how changes
to 2019 benefits may impact you. To enroll in your benefits
and/or view and make plan changes for 2019, log into
www.mySGSbenefits.com or call the Benefits Center at
(855) 903-1131 between November 12th and November 28th.
This is your once-a-year opportunity to review your benefits and
make new elections for the upcoming year. Any changes that you
need to make after Annual Enrollment will require a Qualified
Life Event change such as a marriage, or birth of a child.
Once you review your current coverage, it is important that you
make an active election for the 2019 plan year to ensure your
decisions are captured. It is important that you:
• Update your benefit elections for all coverage including
medical, dental, vision and voluntary benefits made
available to you.
• Respond to questions concerning tobacco use and if you
are covering your spouse, whether or not he/she works and
has access to benefits through their employer.
• Review your beneficiary designations for life insurance and
update those as needed.
• Update your Flexible Spending Account elections.
LOOK!
It’s Time to Take Action!
Go to www.mySGSbenefits.com
Enter your first initial and last name, date of
birth and the last four digits of your Social
Security number.
2019 PLAN CHANGES
Additional information for each type of change is discussed below.
Medical New HSA Contribution Limits
Horizon BlueCross will continue to provide medical coverage The IRS has released the 2019 contribution limits: individual
and we will again use the National BlueCross BlueShield network limits have increased to $3,500 and families can contribute
of providers. Horizon plan design is remaining the same as it is up to $7,000 per year. You must pay close attention to
in 2018. your contribution as the combination of SGS and your own
contributions cannot exceed these limits.
New ID cards
New ID cards will be issued to include information on Telemedicine
telemedicine. Be sure to replace your current ID cards beginning Telemedicine will move from First Stop Health (FSH) to MDLIVE.
January 1, 2019. Telemedicine is a quick, convenient, and confidential way for
you to access a doctor from your home, office, or on the go -
Health Savings Accounts (HSA) anytime using technology! Doctors and therapists can help treat
HSAs will move from Benefit Wallet to Further. Horizon and provide prescription medication (when appropriate). The
BCBSNJ is working with Further, a leading Consumer Driven new cost for Telemedicine will be $10 for the Choice EPO plan
Health (CDH) spending and savings account administrator, to and $39 for the HDHP plans. MDLIVE will be integrated with
transition customers to their enhanced services and platform. Horizon to allow for cross-accumulation of deductibles and OOP
Due to this transition, there will be a blackout period with our maximums- which is an enhancement from FSH.
current HSA Administrator (Benefit Wallet) from December 15
through December 31, 2018. During this time contributions and Tobacco Surcharge
payments will be suspended. During Open Enrollment, employees must acknowledge if they
are a tobacco user. In 2019, a monthly Tobacco Surcharge of
$35 will go into effect. Tobacco users will have access to a
Tobacco cessation program through Horizon beginning January
1, 2019. If you complete two coaching sessions prior to March
30, 2019, you will be refunded the surcharge.
Panabridge Advantage Plan
Panabridge Advantage Plan is being eliminated and those
enrolled have the option to enroll in the three comprehensive
plans SGS offers. If you do not enroll during this enrollment
period, you will be defaulted to the Basic HDHP at the same
level of coverage you have today.
Wellness Plan
The SGS wellness plan will be administered by Horizon. As an
SGS plan participant, you have an opportunity to receive an
annual award for completing the required wellness activities by
the assigned deadlines. Both employees and covered spouses
are eligible to earn rewards. Refer to your 2019 Benefits Guide
on www.mySGSbenefits.com for more information.
LOOK! You CANNOT change
your benefit selections during the plan
year unless you have a qualifying life
event, such as marriage and/or the birth or
adoption of a child.
PHARMACY AT A GLANCE
SGS will replace Prime Therapeutics with OptumRx for prescription drug coverage. However, your deductible and
copay schedules will not change. Preferred Medication lists vary among pharmacy vendors and the new formulary list will
be released and posted at www.mySGSbenefits.com. When possible, consider the use of generic drugs to save money.
Be sure to present your OptumRx ID card to your pharmacy beginning January 1, 2019.
DENTAL
Dental coverage will now be provided through Horizon BCBSNJ. You will receive a separate ID card for your dental
plan. For employees that do not have access to a Horizon network dentist within 10 miles of their home zip code, the out-
of-area plan will be offered.
DENTAL OPTION DENTAL OPTION
PPO PLAN OUT-OF-AREA PLAN
Horizon Network Out-of-network Out-of-Network
ANNUAL DEDUCTIBLE (ADDITIONAL TO CALENDAR YEAR MAXIMUM)
EMPLOYEE $25 $50 $25
FAMILY $75 $100 $75
CALENDAR YEAR MAXIMUM
PER PERSON $1,500 $1,500
COVERED SERVICES (YOU ARE RESPONSIBLE FOR)
CLASS I - PREVENTIVE &
DIAGNOSTIC CARE
Oral Exams, Routine Cleanings,
0% 30% 0% / 20%
Full Mouth X-Rays, Bitewing
X-Rays, Fluoride Application,
Sealants
CLASS II -
BASIC RESTORATIVE CARE
Fillings, Space Maintainers,
20%* 30%* 20%*
Endodontics, Periodontics,
Simple Extractions,
Oral Surgery
CLASS III -
MAJOR RESTORATIVE CARE
50%* 50%* 50%*
Crowns, Dentures, Bridges,
Prosthesis over Implants
CLASS IV - ORTHODONTIA 50%* 50%
Dependent Children to age 19 Lifetime Max: $1,500 Lifetime Max: $1,500
MONTHLY PAYROLL DEDUCTION
EMPLOYEE ONLY $9.00 $9.00
EMPLOYEE + 1 $18.00 $18.00
EMPLOYEE + FAMILY $26.00 $26.00
*After Deductible
VISION
Vision coverage will now be provided by Horizon utilizing the Davis Vision Network. You will receive a separate ID card
for your vision plan.
HORIZON PANORAMA IVB
(HORIZON/DAVIS VISION VIEW NETWORK)
In-Network Out-of-Network
COVERED MATERIALS
LENSES
SINGLE VISION LENSES $25 Reimbursed up to $40
BIFOCAL LENSES $25 Reimbursed up to $60
$25 Reimbursed up to $80
TRIFOCAL LENSES
Lenticular: $25 Lenticular: Reimbursed up to $100
FRAMES
RETAIL FRAME EQUIVALENT $0 copay and amounts over $130 Reimbursed up to $50
CONTACT LENSES
NECESSARY $25 Reimbursed up to $225
ELECTIVE Up to $130 allowance Reimbursed up to $105
COPAYS
EXAMINATION $10 copay Reimbursed up to $50
MATERIALS $25 copay Limited reimbursements
BENEFIT FREQUENCY
EXAMINATION Once every 12 months
LENSES Once every 12 months
FRAMES Once every 24 months*
CONTACTS
Once every 12 months
(in lieu of Lenses and Frames)
MONTHLY PAYROLL DEDUCTION
EMPLOYEE ONLY $4.12
EMPLOYEE + SPOUSE $8.25
EMPLOYEE + CHILD(REN) $8.66
EMPLOYEE + FAMILY $12.08
*Enhanced $50 frame allowance is available at all Visionworks locations nationwide
($180 total allowance) plus a 20% discount on any overage (not applicable at Walmart, Sam's Club or Costco).
SURVIVOR BENEFITS
Basic and Supplemental Life
and AD&D
There will be no changes to the designs or benefits of
these plans.
• For Employees who have previously enrolled in
Supplemental Life – you may increase your current
coverage by up to $40,000 during Annual Enrollment
without Evidence of Insurability (up to the guarantee
issue amount of $500,000 or 4x salary)
• For Employees who have previously declined
Supplemental Life – all amounts elected during Annual
Enrollment will be subject to Evidence of Insurability (EOI)
• For Spouses who have previously enrolled in
Supplemental Life – you may increase your current
benefit coverage by $10,000 during Annual Enrollment
without Evidence of Insurability (up to the guarantee
issue amount of $30,000)
• For Spouses who have previously declined Supplemental
Life – all amounts elected during Annual Enrollment will
be subject to Evidence of Insurability (EOI)
INCOME PROTECTION
Short Term Disability
Current extended sick and maternity leave plans will be replaced in 2019 with a Short-Term Disability plan (company-paid
and employee-paid).
Length of Employment : More Length of Employment: Less
Plan Details
than One Year of Service than One Year of Service
60% of your pre-disability weekly pay up to
SGS provided coverage No cost to you $0
$400 of income replacement per week
Pre-existing Condition Exclusions* None 25% payable for up to 6 weeks
Voluntary coverage you may purchase Up to an additional $1,100 per week (maximum
Up to $1,500 per week But not to exceed 60% of
of $1,500 / week) But not to exceed 60% of your
You pay 100% of the premiums your pre-disability weekly pay.
pre-disability weekly pay.
Benefits Begin On the 15th day of absence due to an accident or illness
Maximum Benefit Period 24 weeks
Maximum Percentage of Income Replaced 60%
Bi-weekly Cost Per $100 of weekly benefit you $4.15
purchase on a voluntary basis.
*A pre-existing condition is a sickness or accidental injury for which, during the 3 months immediately before the effective date of your insurance or increased amount of insurance, you did
one or more of the following: received medical treatment, care, services or advice; or took prescribed drugs; or had medications prescribed.
Long Term Disability
No Changes.VOLUNTARY BENEFITS
Terminating Benefits- Beginning January 1, 2019,
SGS will no longer offer the following voluntary
benefits: Home/Auto Insurance, pet discount, and
legal
Voluntary Critical Illness and Accident plans will
now be provided by Voya. For a description of the
new plan designs and cost please refer to your
2019 Benefits at www.mySGSbenefits.com
SGS will now offer a voluntary Hospital Indemnity
plan that pays a flat benefit for eligible hospital
confinements
CHANGES TO BENEFITS ELIGIBILITY
New Hires – Hired on or after January 1, will be
eligible for benefits the first of the month coincident
or following their date of hire. Example: Hired February
1, Eligible February 1. Hired February 2, Eligible March 1.
Terminating Employees – Effective January 1, 2019,
coverage will end the last day of employment for terminating/
retiring employees.
Domestic Partners - Effective January 1, 2019, Domestic
Partners and children of Domestic Partners will no longer be
eligible dependents under any of the SGS plans.IMPORTANT CONTACTS
To enroll or ask questions about your benefits call the Benefits Center at 855-903-1131 or log into www.
mySGSbenefits.com.
MEDICAL SHORT TERM DISABILITY
Horizon Blue Cross Blue Shield AND LEAVES
of New Jersey Voya
800-355-2583 888-305-0602
HorizonBlue.com/sgs voya.absenceresources.com
Policy #s: 76192, 76193, 76200 Policy#: 69410-0
PHARMACY LONG TERM DISABILITY
OptumRx Voya
888-590-9881 888-305-0602
www.OptumRx.com www.voya.com/claims
Policy #: PSI3812 Policy #: 69410-0
TELEMEDICINE VOLUNTARY
Horizon CareOnline CRITICAL ILLNESS
877-716-5657 Voya
SGS.HorizonCareOnline.com 877-236-7564
Policy #: 69410-0
DENTAL
Horizon VOLUNTARY ACCIDENT
Horizonblue.com/dental Voya
1-800-4DENTAL 877-236-7564
Policy #: 76262 Policy #: 69410-0
VISION VOLUNTARY
Horizon HOSPITAL INDEMNITY
1-800-278-7753 client code 3161 Voya
Policy #: 76263 877-236-7564
Policy #: 69410-0
HEALTH SAVINGS
ACCOUNT VOLUNTARY
Horizon BCBSNJ IDENTITY THEFT
888-215-0025 PrivacyArmor Plus
Horizonblue.com/sgs 855-903-1131
FLEXIBLE SPENDING UNIVERSAL INSURANCE
ACCOUNTS TransAmerica
Horizon BCBSNJ 888-763-7474
888-215-0025
HorizonBlue.com/sgs SGS BENEFITS CENTER
855-903-1131
LIFE AND AD&D Monday - Friday
Voya 8:30 am - 8:00 pm EST
888-238-4840
www.voya.com/claims
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