Benefits Guide 2021 - Federal Signal Corporation
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Benefits Guide 2021
New Hire Benefit Checklist Welcome to Federal Signal
First things first... Completed 2021
Visit the UltiPro Employee Benefits
portal, see page 6 for details
Log in to our UltiPro portal… Deadline
✓ We are pleased to provide this guide to selecting and using our Benefit Plans.
Complete your benefits enrollment on-line:
You will need your UltiPro • Log in to n12.ultipro.com We care deeply about our employees.
username and password • Designate dependents, beneficiaries and emergency contacts
• Review this guide and enroll in the plans/benefits that fit your needs Within This benefit guide is designed to give you
Username: Typically your first initial • Provide local HR with dependent eligibility documentation 31 days of
followed by your last name. If you have • Elect Healthcare or Dependent Care FSA Date of Hire the answers you need and to assist you in
• Elect your HSA contribution if enrolling in the
a common last name, there may be Healthy Advantage Medical Plan enrolling in our programs. Understanding
a number after your name. See your • PRINT a copy of your confirmation
local HR Representative or contact the many, real challenges we have all
FS Benefits by phone or email for If You … Take Action Deadline recently faced during the global pandemic,
assistance. See contact information
below.
1) Log in to wellontarget.com and complete
the Health Assessment
we have worked hard to identify benefit
Password: Your initial password is the
AND cost savings and pass those savings along
last four digits of your social 2) Submit the Physician Screening Form,
found on page 51, that has been completed
to you. We understand that making the
security number. Enrolled in a medical by your doctor (for new hires only, this is right decisions for you and your family is
plan for yourself optional). Note: Suspended at this time
Create a new password: You will be due to COVID-19 and will be revisited in Q1 an important part of managing both your
asked to create a new password after 2021.
your initial login and choose your health and your personal finances. Federal
You will pay an additional medical premium
security questions and answers in case if these requirements are not met. Signal is committed to providing you with
you need to retrieve your password in
the future. the information and resources you need
Your spouse should:
For assistance call the
1) Log in to wellontarget.com and to make the best benefit choices. We
complete the Health Assessment
FS Benefits Helpline at 855.895.4333 Complete strive to support the many dimensions
or email FSBenefits@federalsignal.com AND within 30
days of
of your well-being through our Company
2) Submit the Physician Screening Form,
Follow-through required found on page 51, that has been completed eligibility Wellness Program, along with a variety
by your doctor (for new hires only, this is date
Some benefit elections will not optional). Note: Suspended at this time of benefit providers offering additional
due to COVID-19 and will be revisited in Q1
become effective unless you follow Enrolled your spouse
2021. educational tools and resources to
through and submit additional in a medical plan
documentation or complete additional You will pay an additional medical premium assist you in navigating healthcare and
steps. Use the checklist on this page if these requirements are not met.
retirement planning decisions for yourself
to make sure you don’t overlook any Complete the Spouse Eligibility Form and your family. We believe having choices
necessary steps in the benefit (found on page 53) and return form to
enrollment process. Human Resources. Failure to submit a is important and we are proud to offer
completed and signed form will result in
the addition of the $250/month surcharge comprehensive and affordable benefits to
If this is an electronic version of for coverage for your spouse.
help you live well!
the Federal Signal Benefit Guide, Enrolled a spouse in Provide required documentation to Human
you will be able to: any benefit plan Resources. See page 10 for details.
Click on Table of Contents page numbers to
jump to that page or section Elected Optional Life If you receive an Evidence of Insurability (EOI) Form from HR,
Insurance it must be mailed to Prudential. See page 38.
Go to web pages by clicking on hyperlinks Our Mission: We are relentless in our commitment to our customers to building
Send email to hyperlinked email addresses by and to delivering equipment of unmatched quality that moves material,
clicking on link, your default e-mail application Review your paycheck and compare the benefit deductions with your confirmation
will launch and a blank e-mail, addressed to that statement to ensure all benefits you elected are effective. Alert your local HR cleans infrastructure, and protects the communities where we work and live.
email address, will open. representative to any discrepancies.
Table of Contents An Introduction to Benefits
Benefit Enrollment Checklist............................inside front cover Benefit Enrollment When do I enroll?
An Introduction to Benefits.......................................……………..…5 Resources You must enroll for benefits or decline coverage by logging in to UltiPro
Visit UltiPro to Enroll....................................................................6
Making Changes................................………........................……..…7 This benefit guide
at n12.ultipro.com within 31 days of your date of hire.
You Must
Eligibility …………...................................................................…..…8
Confirming Eligibility….................................................…………..…9
Read this guide for an overview of your
benefit options. Plan Documents are
If you do not enroll on-line by this deadline you will default to no
coverage for medical, dental, vision, optional life insurance and optional Take Action
Dependent Eligibility Documentation Requirements.................10 available upon request. Summary Plan long-term disability buy-up coverage for the remainder of the plan year. Within 31 days of your date of hire,
Family and Medical Leave Act ...……..........................................12 Descriptions are available from your You will not be able to enroll until the next open enrollment period. In if you do not enroll as a new hire,
local HR and as downloads in UltiPro at addition, you will be required to provide evidence of insurability if you
Qualified Life Events……….....………………….……............................13 your coverage will default to no
n12.ultipro.com. wish to enroll for optional life or long-term disability coverage at that
Medical Plans…….……....……………………….……..............................15 coverage for medical, dental,
time. vision, optional life insurance and
Medical Plan 2021 Contribution Rates………...................……......16 Federal Signal Benefits Helpline
Compare Medical Plans…………...........................................….....17 You will have an opportunity to make changes to your plans only during optional long-term disability buy
Get answers to your questions about Open Enrollment each Fall for the following calendar year, or if you up coverage for the remainder of
Making Your Insurance Work for You .........................................19 benefits and the enrollment process experience a Qualified Life Event. See page 13. the plan year.
Health Savings Account (HSA)…….................................………......20 Monday through Friday, 8:00 a.m. to
HSA Eligible Medical Expenses……................................……….....21 5:00 p.m., Central Time. The next opportunity you will have
When do benefits begin ? to enroll will be the next Open
Flexible Spending Accounts (FSA)…..................................…….....22 •Call: 855.895.4333 Salaried employees’ benefits begin the 1st of the month coincident with or Enrollment period, unless you
Limited Purpose Flexible Spending Account (LPFSA)...............23
•Email: FSBenefits@federalsignal.com following your date of hire. Hourly employees’ benefits begin the 1st of the experience a Qualified Life Event.
HSA, HCA, or FSA— What’s the difference?…...........…….…….......24 month following 60 days of service. See page 13.
MDLIVE Virtual Medical Visits……...................................…….....25 UltiPro Employee Portal:
Prescription Drug Programs………....................................…….....26 Who can I cover?
Prescription Drug Coverage……....……….....................................27 Weblink: n12.ultipro.com You can enroll yourself and your eligible dependents. See page 10 for a
Specialty Pharmacy Program…....…………...................................28 complete description of eligible individuals. Tax Treatment of Benefits
• Enroll or decline coverage
Coordinating with Medicare…...................................................29
Condition Management Program…............................................29 • Enroll eligible dependents How do I pay for benefits? Coverage for yourself and tax
• See page 6 for login instructions You and the Company share the cost of benefits. Your contribution for eligible
Blue Access for Members……………............................................30 Benefit dependents
Blue Distinction Centers for Specialty Care………....….........….....31 some of your benefits is deducted from your gross pay before federal,
If you have questions, please contact state and medicare taxes are calculated, thus reducing your tax liability.
Dental Plan.......…….……………………………….......……….......…….......32 your local HR department. Pre-Tax After-Tax
These pre-tax benefits are described as “tax favored.”
Vision Plan……..………………………………………....……........................33
Federal Signal Wellness Program ………...…..……..………………......34 Under Internal Revenue Service rules, only individuals who qualify as
Medical ✓
Wellness Program FAQs…….....………..........................................35 your tax dependents may receive tax-favored benefits.
Additional Employee Benefits….................…….…...….................36
Dental ✓
Mental Health and Substance Abuse….................…….…...….....36 We are self-insured
Tuition Assistance Plan…………………..…........................………......36 Federal Signal is committed to providing quality employee benefits. We
have chosen this approach because it gives us more control over benefits
Vision ✓
Life Insurance ………..…...………….…………….........................…....…38
and can lower costs for our employees.
Disability ……….……..……...…………………………............................….39
Differences between any benefit
Optional Life ✓
Saving for Retirement...........………….......................................…40 summary contained in this Benefit
Retirement Savings Overview…………......................................…41 Guide and the applicable plan document
Distribution of Retirement Savings…………...............................…42 are not intended; however, if there are Spouse Life ✓
any differences, the relevant provisions
COBRA.......................................…...........................................…43 of the applicable plan document will
Our Benefit Plan Partners……………..........................................…44 govern. Child Life ✓
Required Notices…………........................................................…..45 IRS announcements may impact on a
Physician Screening Form..........................................................51 permanent or a temporary basis how
certain benefits are administered and
Optional Long-term
Disability Buy-up ✓
Eligibility Certification Form......................................................53 may or may not be reflected in the text
in this material at the time of printing.
4 5
Visit UltiPro to Enroll Making Changes
UltiPro is your Benefits Life Events
benefits management tool Enroll, Change & View Benefits The benefits you elect as a new hire will remain in effect for the
remainder of the plan year, unless you experience a Qualified Life Event
Once you have done your homework and
made your decisions, it’s time to log in to
1 Go to Federal Signal’s UltiPro portal on the web at
n12.ultipro.com
(QLE) that permits you to make changes. If you experience a QLE that
affects your benefits, login to UltiPro to initiate a life event. In most
Eligible Status Changes
Review page 13 in this book for eligible
and login using your username cases, you must submit your life event within 31 days of the QLE. See life events that qualify you to make
the UltiPro portal to enroll, change or view
and password. page 13 for more information. changes throughout the year to your
your benefit decisions.
benefits, such as:
Managing Your Plans
UltiPro is your benefits management tool
Designating your beneficiaries • Having Children
2
for your health and welfare benefits.
From the homepage, go to the Myself tab and select Life Insurance • Marriage
Use UltiPro to: Life Events from the dropdown You may add, remove, or change the designation percentages of your
menu to begin. Consult beneficiaries for your company life insurance at any time by logging in to
• Divorce or Legal Separation
• Enroll in your benefit plans
• Review your current benefits coverage the Quick Tours and Tips UltiPro and navigating to Myself >Life Events >Designate Beneficiaries. • You (the Employee) Die
• Add/change your life insurance in the right column You may only change your optional life insurance coverage level, if you
beneficiaries for additional help. experience a Qualified Life Event. • A Dependent Dies
• Make changes to your benefits during
Open Enrollment or if you experience • Other Life Events
a Qualified Life Event 401(K) Retirement Savings Plan
You will need your 3 Before you continue, you should enter your
beneficiaries and dependents.
The beneficiary designation for your 401(k) Retirement Savings Plan is a
separate action and must be designated with Vanguard. See page 41 for
UltiPro username You may add eligible directions on contacting Vanguard.
dependents.
and password Healthcare Savings Accounts (HSAs)
Username: Usually your first initial You may designate beneficiaries for your HSA accounts on the HSA Bank
followed by your last name. If you have website. See page 20 for HSA Bank contact information.
a common last name there may be a
4
number after your name.
Make your Benefit Elections. Enroll or decline coverage
What if I don’t know my Username? for each benefit offering on each of the Select a Plan
See your local HR Representative or pages. Click the next arrow to proceed through all of Personal information changes
contact FS Benefits by phone or email. the plans.
See contact information below. Changes to personal information such as name and/or address
changes, tax changes, and direct deposit information can be
Password: Your initial password is the
5
made by contacting your local HR representative.
last four digits of your social When you get to the confirmation page, scroll down to
security number. see your new benefit elections below Current Benefits. If you have an HSA account, please contact HSA Bank directly if
If you need to make any changes, click on the Plan Type you have a change of address. See page 20 for HSA Bank contact
Create a new password: You will be or Plan Details link to return to enrollment page. To
asked to create your own password information.
after your initial login and set your continue at a later time, click on draft.
security questions in case you need to
retrieve your password in the future.
For assistance call the
FS Benefits Helpline at 855.895.4333
6 Click the submit button at the top of the page to
complete your enrollment. You may return to make
changes within 31 days of your date of hire. When
or email FSBenefits@federalsignal.com you click OK, a confirmation page will display. Print a
copy of this page for your records.
6 7
Eligibility Confirming Eligibility
Who is eligible? Submit documentation within 30 days
Active employees as well as certain
Eligibility Guide Spouse Eligibility
family members are eligible for benefits When you enroll a family member, you need to confirm he or she Certification Form can be
is eligible. Look at the list of accepted documents on page 10 to
if specific criteria are met. Your eligibility learn what you need to provide to get your family member covered. found at the back of this
You are eligible for Federal Signal benefits if you are a: You have 30 days from the effective date of coverage to submit the book
documentation. Spouse Eligibility forms are included in the back of this
Changes to your • Salaried or hourly full-time employee, or booklet or are available from your local HR representative. If you do not Completed form due to HR
• Part-time employee regularly scheduled to work at least 30 hours within 30 days
Dependent’s Eligibility per week, and
return the form in thirty days or the documentation is not approved,
of adding your spouse
you will pay an additional $250 monthly medical premium until the
• Not subject to a collective bargaining agreement form is returned and primary medical eligibility is approved. to a Federal Signal medical plan
If an event occurs and your dependent
no longer meets all of the eligibility
criteria; i.e. changes in your spouse’s If you are eligible for benefits, you may cover your dependents Please provide documentation to your local HR representative as soon
employment or a dependent child subject to the eligibility criteria of the plan and the review of required as possible.
reaches the limiting age (see chart on documentation, see page 10 for details.
pp. 10–11), it is your responsibility to
remove the dependent from coverage
by initiating a Life Event in UltiPro. Both work at Federal Signal?
You may not elect coverage as an employee and receive coverage as
If you fail to remove the ineligible another employee’s dependent. Also, only one Federal Signal parent
dependent, you will continue to pay may cover eligible dependent children.
for coverage but any claims made
after he or she is no longer eligible for Eligibility rules for spouses
coverage will not be paid. Additionally, Your family members
your dependent may lose their right to A Spouse Eligibility Certification form will be required for any spouse
Eligible family members include:
continue coverage under COBRA if the enrolled in a Federal Signal medical plan. If your spouse is not employed
Company is not notified within 60 days • Spouse (same or opposite sex), unless legally separated you are still required to certify that status by signing and returning the
of becoming ineligible. • Dependent children to age 26 certification form.
• Children age 26 and over if:
• They are incapable of self-support due to a physical or mental Option A: If your spouse is not employed, or employed but not eligible
disability for medical coverage, you may enroll them in a Federal Signal medical
• They are dependent on you for primary financial support, and plan as their primary coverage. You will pay the regular premium for
• They were disabled and covered on our plan prior to reaching coverage.
age 26.
Option B: If your spouse is employed and enrolled in his or her
Eligible children include: employer’s medical plan, you may enroll them in a Federal Signal
medical plan; however the Federal Signal medical plan will be treated as
• Natural children
secondary coverage for purposes of coordination of benefits. You will
• Legally adopted children pay the regular premium for coverage.
• Children for whom you are the legal guardian
• Children placed with you for adoption Option C: If your spouse is employed and is eligible for coverage
• Child for whom you are required to provide coverage, pursuant to a through his or her employer’s medical plan, but will not be covered on
Qualified Medical Child Support Order (QMCSO) their employer’s plan, you may enroll them in a Federal Signal medical
• Stepchildren (your spouse must be enrolled in a Federal Signal plan as their primary medical coverage. You will pay a $250 per month
Medical Plan) premium in addition to the regular premium.
The information you provide on the Spouse Eligibility Certification form
must be true and correct. Any misrepresentations constitute fraud and
could result in disciplinary action up to and including termination of
employment.
8 9
Dependent Eligibility Documentation Requirements
Action required
DEPENDENT’S RELATIONSHIP
Federal Signal requires that you verify your dependents’ eligibility. To ELIGIBILITY CRITERIA REQUIRED DOCUMENTATION
TO YOU
the right is a chart listing acceptable documentation you can provide
to certify your dependent’s eligibility. If you have questions about your
dependent’s eligibility, see your HR representative. Spouse A person to whom you are legally married. - Copy of presently valid marriage certificate. Must include the date of marriage,
or;
Same or opposite sex - Copy of page(s) of federal tax return from the most recent tax year. Must indicate
“married filing jointly” or “married filing separately” and contain the name of the
Eligibility rules for spouses (unless legally separated)
employee and the spouse.
Option A: If your spouse is not employed, or employed but not eligible for
medical coverage, you may enroll them in a Federal Signal medical plan as their
primary coverage. You will pay the regular premium for coverage.
Must return the Spouse Eligibility Certification Form
Option B: If your spouse is enrolled in his or her employer’s medical plan, you
may enroll them in a Federal Signal medical plan; however the Federal Signal
medical plan will be treated as secondary coverage for purposes of coordination
of benefits. You will pay the regular premium for coverage. Your Children Your natural born child, legally adopted child, child legally placed with you - Copy of birth certificate listing the employee as a parent. (Hospital birth record
pending adoption, or child of legal guardianship. acceptable for a child under 6 months of age where a birth certificate is not available.)
Option C: If your spouse is eligible for medical coverage through his or her To age 26 for medical, dental and vision - Copy of final adoption decree containing the name of the employee and the child,
employer, but will not be covered on their employer’s plan, you may enroll them Child for whom you are required to provide coverage pursuant to a - Copy of placement letter from court or adoption agency for pending adoptions,
in a Federal Signal medical plan as their primary medical coverage. You will pay a Qualified Medical Child Support Order (QMCSO). - Copy of assignment of legal guardianship issued by a court of law containing the name
of the employee and the child,
$250 per month premium in addition to the regular premium.
- Copy of QMCSO containing the name of the employee and the child,
or;
- Copy of page(s) of federal tax return from the most recent tax year containing the name
of the employee and the child.
You have 31 days Step Children Your spouse’s natural child, adopted child, or child of legal guardianship - Copy of divorce decree, custody agreement, court order, or Qualified Medical Child
for whom no other parent is legally responsible for providing health Support Order (QMCSO) declaring the employee’s eligible and covered spouse legally
from your date of hire, or To age 26 for medical, dental and vision coverage. responsible for providing health coverage for the child.
the date of a Qualified Life Your spouse must be eligible and covered on a Federal Signal medical If no such order is in place:
plan. - Copy of birth certificate indicating your eligible and covered spouse as the parent,
Event that allows you to add and;
- Copy of the page(s) of your federal tax return from the most recent tax year containing
your dependent, to the name of the employee and the child.
complete and return the
Eligibility Certification
Disabled Children Age 26 You or your spouse’s natural, step or legally adopted child as described - Must meet the required documentation for the child type above,
Form and other required and over above for whom you provide primary financial support and who is and;
Form located at the back of this book incapable of self-support because of a mental or physical disability if - Provide a Disabled Dependent Certification from Blue Cross Blue Shield of Illinois
documentation to your they were disabled and covered on a Federal Signal medical plan prior to completed by a physician.
reaching age 26.
HR representative Coverage subject to approval of disabled dependent status as determined solely by
Blue Cross Blue Shield of Illinois.
10 11
Family and Medical Leave Act (FMLA) Qualified Life Events
Family Medical Leave (FML) benefits What is a Qualified Life
In accordance with the Family and Medical Leave Act (FMLA), eligible employees are entitled to take unpaid leaves of Dependent child coverage Event?
absence under the FMLA and our written FML policy (available from your local HR representative and on our intranet).
A Qualified Life Event (QLE) is an event
In order to be an “eligible employee” you must have completed at least twelve (12) months of employment, have worked a Birth or adoption defined by the IRS that allows you to
minimum of 1,250 hours in the past year, and work at a company location where we employ 50 or more employees within Newborns are automatically covered under the parent’s medical plan make changes to your benefits elections.
75 miles. for the first 30 days after birth. However, you must enroll your newborn For example, you can make changes
within 31 days of the baby’s birth date for coverage to continue — even within 31 days of:
Generally, eligible employees are entitled to take up to twelve (12) weeks of Family Medical Leave (FML) in a rolling if you already have coverage for other dependent children. • Your marriage, divorce, or legal separation
12-month period (measured backward from the date you commence FML) for their own serious health condition, the birth • Birth, adoption, or placement for adoption of a child
or adoption of a child, the care of a spouse, child, or parent who has a serious health condition, or a qualifying exigency Dependent coverage begins • Death of your spouse or dependent
arising out of the fact that the employee’s spouse, son, daughter or parent is a covered military member on covered active A child becomes eligible at birth, adoption or when you gain custody. • A change in employment status for you, your spouse, or
duty. dependent
What to do when you have a child • You, your spouse, or dependent loses coverage under
another plan
Eligible employees may take twenty-six (26) weeks of leave during a single 12-month period (measured forward from the • Submit a Life Event online within 31 days of the event to add your
• Solely with respect to the Dependent Care FSA—Any
first day you take leave to care for the service member) to care for a covered service member with a serious injury or illness child to your coverage. change in the number of qualifying dependents or
if the eligible employee is the service member’s spouse, son, daughter, parent, or next of kin. • Log in to UltiPro, go to the Myself tab and select Life Events. changes in the cost of a day care provider or dependent
care costs
• Submit the document(s) to verify eligibility to your local HR
FML may be granted on a continuous, intermittent, or reduced hours basis where applicable under the FMLA and our FML Representative. You can make changes within 60 days of:
Policy. • You may want to verify and/or change your beneficiary information • A change in the eligibility of a covered dependent
for your life insurance. • You or your dependent’s Medicaid or CHIP (Children’s
Please refer to the FMLA and our FML policy for the precise terms and conditions of FML at our Company which governs Health Insurance Program) coverage is terminated as a
in the event of any discrepancy. • You can start a Dependent Care Flexible Spending Account or result of loss of eligibility
increase the amount of your current election. • You or your dependent becomes eligible for a premium
assistance subsidy under Medicaid or CHIP
Filing your FML claim
To request FML, please contact your When does dependent child coverage end?
local HR representative and Prudential.
Prudential, the administrator of our FML The age limit for coverage of dependent children under a parent’s plan is
and disability benefits, can be reached age 26 for medical, dental and vision. Your child’s last day of coverage is
via phone or you may file a claim online. the end of the month in which they turn 26. Coverage may be continued
under COBRA for up to 36 months. Read more about COBRA on page 43.
Log in to UltiPro within 60 days of the date eligibility ends to remove BE AWARE!
your dependent from your coverage.
877-367-7781 31 day deadline for
Prudential adding dependents
and newborns
www.prudential.com/
mybenefits You must make changes to
your benefits within 31 days
of your life event or wait un-
til the next Open Enrollment
period. Coverage begins on
the date of the event.
12 13
Qualified Life Events Medical Plans
A dependent dies Marriage The most important decision Coverage levels
Human Resources is here to If you wish to add your new spouse to your medical plan, be sure they • You only
Choosing the right medical plan may be the most important
support you in this difficult time. meet the eligibility rules. The effective date of coverage is the marriage • You + Spouse
date. In order for your new spouse’s coverage to become effective you decision you make during your enrollment period. You must visit
Refer to the information and
UltiPro at n12.ultipro.com to enroll in a medical plan. • You + Child(ren)
action steps below. must:
• Family
• Contact your local HR • Complete a Spouse Eligibility Certification
representative or email FS (available in the back of this book, as a download in UltiPro, or How the plans work
You will receive a BCBS card
Benefits and inform them of the from your local HR representative) via U.S. mail upon initial
death All medical plans are administered by BlueCross BlueShield of Illinois
• Present a copy of your marriage certificate to your HR and include the same network of doctors, hospitals and healthcare enrollment, or in the event
• You will need certified copies of
the death certificate representative you change plans during
providers. You can use any provider you want but you’ll pay less
Open Enrollment or a QLE
• Make necessary changes to your and receive a higher level of coverage when you use providers in the
benefits elections network. Once you satisfy the annual deductible for your plan, you pay
• Update your life insurance 20 percent of the cost of most services, known as coinsurance. All plans
beneficiaries Divorce or legal separation cover in-network wellness services at no cost to you.
• Request a new W4 form to change If you become divorced or legally separated, your spouse is no longer
tax filing status if appropriate eligible for coverage. You must remove your spouse from coverage
within 60 days of the date of the event.
To help you cope with your loss,
please contact our Employee
Coverage will end the date of the divorce or legal separation. You will
Choice of 3 Plans
Assistance Program (EAP), page
be required to submit a copy of the divorce decree showing the date of
36, for grief counseling, resources,
divorce. Your former spouse may continue to be covered under COBRA
and referrals for additional
assistance.
for up to 36 months. See COBRA on page 43 of this book. The Healthy Saver The Healthy Advantage The Healthy Choice
You (the employee) die Plan Plan Plan
If you die while employed with Changes in your spouse’s employment This high deductible plan has This plan has higher This plan has lower deductibles
Federal Signal, your family the lowest premiums. deductibles but lower but higher premiums than the
If your spouse changes jobs or becomes eligible for medical coverage premiums than the Healthy Healthy Advantage Plan.
members can refer to the action
under an employer’s plan, they may continue coverage on our medical Choice Plan.
steps and information shown This plan includes a Health
plan as primary coverage (an additional $250/month premium will apply)
below. Savings Account (HSA)
or you may drop them from coverage. You must complete and submit a This plan features a Health This plan includes a
which permits you to set
new Spouse Eligibility Certification form. Savings Account (HSA) which Company funded Health Care
• Contact the local HR aside money through payroll
representative or email FS If your spouse loses coverage under their employer’s medical plan, he or deduction on a pre-tax permits you to set aside Reimbursement Account
Benefits and inform them of the she can be enrolled under the Company’s medical plan. You must enroll basis. There is no employer money through payroll (HCA) to help cover the higher
death them in UltiPro within 31 days of their loss of coverage and submit the deduction on a pre-tax basis. deductible.
contribution to this HSA.
• Survivors are required to In addition, the Company
present certified copies of the Spouse Eligibility Certification form. Limited purpose FSA is
death certificate available with this plan (for funds $750 for employee only;
dental and vision expenses). or $1,500 for employee + one
or more dependents. These
Note: Health coverage for your funds can be used to pay for
surviving spouse and dependents eligible healthcare expenses
ends on the date of death. now and in the future.
Surviving family members, if 855.895.4333
covered, may continue coverage
under COBRA for up to 36 months.
FS Benefits Helpline
They will only have to pay active FSBenefits@federalsignal.com
employee rates for coverage for
the first 12 months of COBRA.
14 15
Compare Medical Plans
Side-by-side plan comparison
Key features of the medical plans are summarized
at right. For full details and term definitions, Healthy Saver Plan Healthy Advantage Plan Healthy Choice Plan
please refer to the Summary Plan Descriptions Plan Features with a with a with a
available on the UltiPro home page. Health Savings Account (HSA) Health Savings Account (HSA) Health Care
Reimbursement Account (HCA)
The benefits described in this table are for in-
network services only. If you receive services
from an out-of-network provider you will have
to meet a higher deductible and receive a lower
percentage coinsurance. BlueCross BlueShield Employee Only $51.48 $114.03 $148.65
of Illinois has an extensive network of providers.
Go to www.bcbsil.com to find a network Employee + Spouse $124.05 $249.23 $311.61
2021 Monthly Employee
provider. Contribution
Employee + Child(ren) $98.03 $223.05 $285.16
Family $295.00 $427.17 $520.34
Compensation based HSA—No Company funding for this plan HSA—The Company funds $750 for employee only; or HCA—The Company funds $750 for employee only; or
medical premiums Limited Purpose Flexible Spending Account (LPFSA):
$1,500 for employee + 1 or more dependents.
Company contributions to the HSA accounts are prorated and funded after
$1,500 for employee + 1 or more dependents.
HCA accounts are funded on the date you become eligible
Healthcare Accounts You can contribute pre-tax up to $2,750 each pay period Healthcare Flexible Spending Account (HCFSA):
This additional premium will be based Limited Purpose Flexible Spending Account (LPFSA): You can contribute pre-tax up to $2,750
on total annual cash compensation in You can contribute pre-tax up to $2,750
the year of your hire and applies only For a comparison of the different Healthcare Accounts, please see page 22
if you are enrolled in a Federal Signal
medical plan the following year. $3,000 if only employee is enrolled $2,000 if only employee is enrolled
$1,750 per individual or $3,500 for 2 or more dependents
Prescription copays and coinsurance do not apply to the medical
$5,000 if employee + dependent(s) are enrolled $4,000 if employee + dependent(s) are enrolled
Annual Deductible—Individual / Family plan deductible, but do apply to your out-of-pocket maximum,
Additional monthly Prescription drugs apply to the deductible, see page 26 Prescription drugs apply to the deductible, see page 26
see page 26
2020 annual cash
medical plan
compensation
premium The annual deductible is the amount you must pay out of your pocket before the plan pays benefits for applicable services.
$125,000 –
$75.00 $6,000/ $10,000 $4,000 / $8,000 $3,750 / $7,500
$174,999 Annual Out-of-Pocket Maximum—
Individual / Family
$175,000 – Medical deductibles, copays, and coinsurance apply to the out-of-pocket maximum. When you reach the out-of-pocket maximum, your medical plan pays 100% including prescription drugs.
$104.18
$224,999
100%, No Deductible, No Copay 100%, No Deductible, No Copay 100%, No Deductible, No Copay
$225,000 or
$216.67 Wellness In-Network Only
greater Wellness benefits include routine physicals, mammograms, pap smears, prostate tests, digital rectal exams, colorectal cancer screenings, well child care, and immunizations.
No coverage for out-of-network wellness services.
80% After Deductible 80% After Deductible 80% After Deductible
Office Visits
Primary physicians include general practice, internal medicine, family practice, pediatricians, OB/GYN and mixed medical groups. All other professionals are considered specialists.
80% After Deductible 80% After Deductible 80% After Deductible
Inpatient hospital and facility services include benefits for room and board, ancillary charges in a hospital or skilled nursing facility, preadmission testing, coordinated home health care, and hospice care.
800.526.6593 Hospital and Facility
Outpatient hospital and facility services include benefits for surgery, radiation therapy, chemotherapy, electroconvulsive therapy, renal dialysis treatments, diagnostic services and cardiac rehabilitation services.
Outpatient surgery and diagnostic tests include X-rays, blood tests, CATs and MRIs.
BlueCross BlueShield Medical Services Advisory Program (MSA) precertification is required before inpatient services are provided. Otherwise, a $500 reduction in benefits will apply.
www.bcbsil.com
16 17
Compare Medical Plans Making Your Insurance Work for You
Where Should I Go for Care? Care
Your
Hours Relative Description Common Uses
Healthy Choice Plan Sometimes it’s easy to know when you Option
with a should go to an emergency room (ER), Cost
Plan Features Healthy Saver Plan Healthy Advantage Plan
with a with a Health Care such as when you have severe chest pain Your Office Usually Your physician's • General health issues
hours vary lowest out- office is
Health Savings Account (HSA) Health Savings Account (HSA) Reimbursement Account or unstoppable bleeding. Sometimes it’s Doctor generally the
• Health and annual
(HCA) not. Typically, 20–30% of ER visits are for of-pocket exams
best place to
cost • Vaccinations
non-emergency services that could have go for non-
• Treat the flu and colds
been handled elsewhere, saving you time emergency care.
80% coinsurance 80% coinsurance 80% coinsurance • Minor aches and pains
Blue Distinction Centers (BDC) For and money.
If treated at a BDC If treated at a BDC If treated at a BDC
treatment of the following: Telehealth A “virtual visit”
Cardiac Care with a health
Knee and Hip Replacements 60% coinsurance 60% coinsurance 60% coinsurance So where do you go when you have an ear Virtual Visit care provider,
Spine Surgery Treated at another facility Treated at another facility Treated at another facility infection or are generally not feeling well? through a phone
Transplants call or video
Bariatric Surgery All coinsurance applied after plan deductible is met. You have options for receiving in-network chat.
Many of these conditions require ongoing treatment; some of which can be done locally. Check with BlueCross BlueShield to verify care that work with your schedule and give
coverage and obtain pre-certification. See page 25.
you access to the right kind of care at the
MD Live $44 charge per consultation*. Charge $44 charge per consultation*. Charge right time. Here is a handy guide to help MD Live 24 hours, $44 per Access to a • General Health:
Virtual physician visits by phone, you decide the best place to receive care. seven consultation board-certified Allergies, asthma, nausea,
online video or mobile app
applies toward your deductible, use applies toward your deductible, use 100% covered Virtual Visit until doctor available sinus infections
HSA funds to pay the charge HSA funds to pay the charge days a
See page 25 deductible 24 hours a day,
week • Pediatric Care:
is met for seven days a
Healthy week. Virtual Cold, flu, ear problems,
80% 80% 80% Advantage Plan visits can be pinkeye
After Deductible After Deductible After Deductible members more convenient
Emergency Room Care
Emergency medical care includes severe, life-threatening emergency treatment that MD Live: Virtual Care 100% covered
and less
expensive than
meets emergency criteria. for Healthy urgent care or an
Emergency accident care includes benefits for the initial treatment of an accidental injury provided treatment is received by you or your Choice Plan ER visit.
dependent within 72 hours of the accident. members
Virtual medical visits are a new way to See page 25.
80% 80% 80%
Urgent Care Facility After Deductible After Deductible After Deductible
consult with a licensed doctor for non- Retail Similar Lowest out- Walk-in clinics • Common illnesses such
to retail of-pocket are often as pink eye, strep throat
If you visit an urgent care facility and your condition meets emergency criteria, Clinics* located in stores
the emergency room benefit may apply. store cost
emergency healthcare offered through hours and pharmacies • Minor wounds,
to provide
Chiropractic- Maximum 25 Visits 80% 80% 80%
convenient, abrasions and skin
After Deductible After Deductible After Deductible BCBS Illinois’ partner, MD Live. For details low-cost conditions, such as
treatment for poison ivy
$100 Copayment $100 Copayment $100 Copayment
Colonoscopies and Then plan pays 100% Then plan pays 100% Then plan pays 100% on this new plan see page 25. minor medical
Sigmoidoscopies problems
Diagnostic when prescribed by a physician. Urgent Care Generally Usually lower Urgent care • Migraines or headaches
Provider* include out-of- providers can • Back pain
Out-Patient Therapy evenings, pocket cost offer care when
80% 80% 80% • Urinary tract infection
Physical- Maximum 70 visits your physician is
After Deductible After Deductible After Deductible weekends than an ER
Occupational- Maximum 45 visits not available or • Cuts that need stitches
and visit
Speech- Maximum 50 visits Do I need to pre-certify? holidays
you don’t need
the level of care
• Sprains and strains
Mental Health 80% 80% 80% • Animal bites
Out-Patient After Deductible After Deductible After Deductible Remember, it is your responsibility an emergency
room provides.
to call BlueCross BlueShield and pre-
80% 80% 80%
Mental Health After Deductible After Deductible After Deductible certify coverage. If your physician If you need to find a doctor or hospital use the BCBSIL Provider Finder®.
In-Patient
pre-certifies for you, the coverage
Mental health / substance abuse precertification is required before inpatient services are provide. You may also contact Member Services at 888-802-8776 if you need help locating a
Otherwise, a $500 reduction in benefits will apply. level may be different than you provider. Health Advocates are available from 7 a.m. to 7 p.m. Central Time.
Other Services 70% 70% 70% expect and YOU will be responsible
See plan SPD for list After Deductible After Deductible After Deductible for the difference. Contact our 24/7 Nurseline at 800-765-7298 if you need help deciding where
to receive care after hours.
* IRS guidelines regarding HSA eligible medical plans prohibits us from covering this service without first meeting your deductible. See page 25.
Exclusions include services and supplies that do not meet accepted standards of medical practice, which are not medically necessary or for which benefits are available under other * Planning ahead gives you the best opportunity to select an in-network
insurance programs. For the complete list of exclusions, please refer to the Summary Plan Descriptions available on the UltiPro home page.
provider in an emergency situation.
18 19Health Savings Account (HSA) HSA Eligible Medical Expenses
HSA Accounts HSA is a tool to combat HSAs at tax time You can use your HSA to pay for a wide range of eligible medical expenses for HSA Bank Client
yourself, your spouse or tax dependents. An eligible medical expense is defined
If you enroll in the Healthy Saver Plan high medical costs HSA Bank will issue Form 5498SA as an expense that pays for healthcare services, equipment, or medications as Assistance Center
or the Healthy Advantage Plan you give for contributions and Form Please contact the Client Assistance
An HSA can be a powerful financial 1099SA for distributions each defined by the IRS. Funds used to pay for eligible medical expenses are always
Federal Signal permission to share your tool to pay for medical expenses Center at 800.357.6246
contact information with HSA Bank so year. You must file a Form 8889 tax-free.
now and in the future. An HSA Monday - Friday, 7 a.m. - 9 p.m., CST
it can start to open an HSA account in with your 1040 tax return in any
gives you a triple tax advantage: year you or your employer makes www.hsabank.com
your name. If HSA Bank needs additional your contributions are sheltered HSA funds can be used to reimburse yourself for past medical expenses if the
personal information from you to open contributions to your HSA or expense was incurred after your HSA was established. While you do not need to
from income taxes, the money you take distributions, even if all
your account, it will send you a letter. grows tax-deferred, and the funds HSA CONTRIBUTIONS
Please respond to this letter or your contributions were Section 125 submit any receipts to HSA Bank, it is a good idea to save your bills and receipts
can be withdrawn tax-free for pre-tax payroll deductions. for tax purposes.
account will be closed. If you are asked
for the name of your employer, tell them
qualified medical expenses. It’s like Maximums for 2021
a supercharged flexible spending
Federal Signal Corporation. account that never expires, and it How Does Federal Signal IRS announcements may affect how certain benefits are administered, on a (including employer
• You may fund your account through
can even serve as extra retirement Fund Employee HSAs? permanent or temporary basis, and may or may not be reflected in the text in contributions)
savings funds. this Benefits Guide at the time of printing. See page 25.
pre-tax payroll deductions. You will receive a prorated Individual: $3,600
• You may make tax deductible deposits contribution, if you elect the Family: $7,200
directly to your account. Healthy Advantage Plan, after each Visit www.irs.gov for more information.
• You are responsible for complying with pay period beginning after you are +$1,000 Catch-up
the tax code. enrolled and eligible for coverage.
If you elect pre-tax payroll contribution if 55 or older
You may change your contribution at any contributions, deductions will be Examples of eligible
time in UltiPro under the Life Events tab. deducted from your paycheck.
You will receive Federal Signal’s
medical expenses* *This list is not comprehensive.
contribution to your HSA even if Acupuncture Osteopath It is provided to you with the
How an HSA works you don’t make contributions of
your own.
Alcoholism treatment
Ambulance services
Oxygen
Pregnancy test kit
understanding that HSA Bank is not
engaged in rendering tax advice.
Annual physical examination Podiatrist The information provided is not
Federal Signal contributes Federal Signal will contribute $750 if you elect individual coverage; or $1,500 if you cover yourself and at least one Artificial limb or prosthesis Prescription drugs and medicines intended to be used to avoid federal
to Healthy Advantage Plan HSA dependent. Federal Signal contributions are pre-tax and pro-rated. Employee contributions are funded through pre-tax Birth control pills (by prescription) (over-the-counter drugs are not tax penalties. For more detailed
accounts only payroll deductions from your paycheck. Chiropractor eligible medical expenses information, please refer to IRS
You can contribute to your account You can contribute up to a total of $3,600 pre-tax to your HSA for individual coverage, or $7,200 if you cover yourself and Childbirth/delivery unless prescribed by a doctor) Publication 502 titled, “Medical
at least one dependent, plus an additional $1,000 if you are or will be age 55 during the plan year. (The total includes Convalescent home (for medical Prenatal care & postnatal and Dental Expenses,” Catalog
both individual and Company contributions.) Once you have $5,000 in your HSA you may direct how the money is invested. treatment only) treatments
Crutches Psychiatrist Number 15002Q. Publications can
Rollover your balance and take it with The money left in your HSA at the end of the plan year rolls over to the next year. The money is tax-exempt and is always
you if you leave Federal Signal yours even if you change health plans or leave Federal Signal. Doctor’s fees Psychologist be ordered directly from the IRS
Dental treatments (including Smoking cessation programs by calling 1-800-TAXFORM. If tax
HSA over age 65 If you are enrolled in Medicare parts A or B, contributions to an HSA can no longer be made to your account. Including
employee and employer contributions. Please contact FSBenefits@federalsignal.com in advance of your enrollment to x-rays, braces, dentures, fillings, Special education tutoring advice is required, you should seek
stop employer contributions/employee deductions. oral surgery) Surgery the services of a professional.
Dermatologist Telephone or TV equipment to
Monitoring your HSA Bank account It is your responsibility to ensure this account has been opened, and remains open, at the bank. If the account is not open,
Diagnostic services assist the hearing or vision ** Insurance premiums qualify as
Federal Signal is unable to deposit both your employee deductions and employer contributions to your account. Use the
HSA Bank website or its app to monitor transactions in your account. Disabled dependent care impaired an eligible medical expense: while
Drug addiction therapy Therapy or counseling continuing coverage under COBRA;
HSA Bank account debit card HSA Bank will mail a card to you at your address of record within its systems. A replacement card may be obtained, but its
cost must be paid by you, not Federal Signal. Fertility enhancement (including Medical transportation expenses for qualified long-term care
in-vitro fertilization) Transplants coverage; coverage while receiving
Account fees and other charges Please make yourself aware of potential account or service charges by reviewing information available from HSA bank. Guide dog (or other service Vaccines
During your employment Federal Signal pays your monthly account maintenance fee.
unemployment compensation; for
animal) Vasectomy any healthcare coverage for those
Investing your HSA account balance See the HSA Bank website or app for information on this topic. Gynecologist Vision care over age 65 including Medicare
Address change Please notify HSA Bank if you have a change of address. See their website for contact information to make this change. Hearing aids and batteries (Including eyeglasses, contact (except Medicare supplemental
Hospital bills lenses, lasik surgery)
Beneficiary designations If you wish to designate beneficiaries for your HSA account, you MUST do this in the HSA Bank system.
Insurance premiums** Weight loss programs (for a coverage).
800.357.6246 Laboratory fees specific disease diagnosed by 800.357.6246
Lactation expenses a physician – such as obesity,
HSA Bank Lodging (away from home for hypertension, or heart disease) HSA Bank
outpatient care) Wheelchairs
www.hsabank.com Nursing home X-rays www.hsabank.com
Nursing services
Obstetrician
20 21Flexible Spending Accounts (FSA) Limited Purpose Flexible Spending Account (LPFSA)
Enroll in an FSA Healthcare FSA Debit Card A Limited Purpose FSA (LPFSA) is a healthcare flexible spending Important information
account that you can contribute to if you are enrolled in an HSA
Flexible Spending Accounts (FSAs) Use the Healthcare FSA to pay for The debit card can be used to access eligible plan. •You can only receive reimbursement
allow you to save pre-tax dollars expenses your health plan does not funds in your Healthcare FSA. If for eligible dental and vision expenses
from your paycheck to pay for eligible cover for you, or your dependents, you enroll in a Healthcare FSA, you
such as medical, prescription You may contribute up to $2,750 to an LPFSA. The minimum annual that you incur through December 31,
expenses as defined by the IRS. will receive your debit card in the
Federal Signal offers Healthcare and drug and dental deductibles, contribution is $100. You can use an LPFSA to pay for eligible out-of- 2021
Dependent Care FSAs administered copayments and coinsurance, or mail. Once you activate your card, pocket dental and vision expenses only. Such expenses include:
vision expenses. Over-the-counter you can use it to pay for eligible •You have until March 31, 2022 to sub-
by UMR, Inc. medications are not an eligible • Dental and orthodontia care; such as fillings, X-rays, crowns and
FSA expense unless prescribed by healthcare expenses. mit expenses for reimbursement
• You may incur eligible expenses braces
your doctor and obtained from a
from your eligibility date through pharmacy. • Vision care, including eyeglasses, contact lenses, eye exams and •You can use your LPFSA funds for
December 31, 2021.
vision correction procedures eligible expenses incurred by you,
• You have until March 31, 2022 to You may contribute up to $2,750
submit expenses for reimbursement to a Healthcare FSA. The minimum your spouse and your eligible tax
annual contribution is $100. dependents
• Funds in your Healthcare FSA may
not be used for day care expenses What is a limited purpose FSA?
If you enroll in the Healthy
and Dependent Care FSA funds may Advantage Plan and you also A limited purpose FSA (LPFSA) is much like a typical, general purpose •You cannot receive reimbursement for
not be used for healthcare expenses contribute to a Healthcare FSA, an eligible expense more than once
healthcare FSA. However, under a LPFSA, eligible expenses are limited to
• You may only be reimbursed for you may only use your FSA funds
for dental and vision expenses. This qualified dental and vision expenses only for you, your spouse, and your
eligible expenses as determined by
is known as a Limited Purpose FSA. eligible dependents. You cannot use a LPFSA for medical expenses. •You may carry over up to $500 of
IRS rules
See page 23 for more information. unused funds to the following plan
Visit fhs.umr.com/print/UM0075. Here’s how a LPFSA works: you can save money from your paycheck
pdf for a list of eligible and ineligible Important for Debit before taxes are taken out. You can then use your pre-tax LPFSA dollars
year
expenses. An FSA calculator can be Rollover of unused funds Card Users to pay for eligible vision or dental expenses throughout the plan year.
found on UMR.com under Tools & You save money on expenses like dental services, vision exams, and
Keep your receipts and/or
Resources. Up to $500 of unused funds in
your Healthcare FSA may be explanation of benefits—UMR may eyeglasses. You cannot use a LPFSA for medical expenses.
rolled over at the end of 2021 request documentation to verify
Dependent Care FSA to the next 2022 plan year. The eligibility of the transactions.
Use the Dependent Care FSA to pay IRS requires that funds in your If you do not produce a receipt or Why should I consider a limited purpose FSA? IRS Rules about LPFSA that
for dependent care expenses that account in excess of the rollover explanation of benefits, your debit you should know about:
amount, not used for qualified IRS rules do not allow you to contribute to a health savings account
allow you and your spouse to work, card privileges may be suspended
expenses during the plan year, be (HSA) if you are covered by any non-qualifying health plan, including
look for work or attend school full- and any future claims will be offset
time. You can contribute a minimum forfeited. a general purpose healthcare FSA. By limiting FSA reimbursements to No double-dipping:
by the unsubstantiated amount.
of $100 annually, and up to $5,000 Keep track of your debit card activity dental and vision care expenses, you (or your spouse) remain eligible
Expenses reimbursed under your
to the Dependent Care FSA (up to on www.wexhealthcard.com. to participate in both a LPFSA and an HSA. Participating in both plans
limited purpose FSA cannot be
$2,500 if you are married and file allows you to maximize your savings and tax benefits.
reimbursed under any other plan
separate tax returns) to care for:
or program – including an HSA. Ex-
• A dependent child under age 13 who penses reimbursed under the LPFSA
qualifies as a dependent on your How do I access my LPFSA funds? may not be deducted when you file
federal tax return; or
• An adult family member (your spouse Debit Cards will be mailed to Use your debit card or submit a reimbursement form to UMR. your tax return.
or other adult) who is physically you.
or mentally incapable of self-care
and dependent on you for financial Timing is everything:
support 800.826.9781 Expenses must be incurred between
• Use it or Lose it rule—The IRS
requires that unused funds remaining UMR Inc. your eligiblity date and
in your Dependent Care FSA after all December 31, 2021. This means
eligible expenses have been paid will www.umr.com 800.826.9781 the date of service must be within
be forfeited
• Pay these expenses directly and file UMR Inc. these dates and not when you pay
claims with UMR for reimbursement for the service.
Visit www.irs.gov and review publications 502 and 503 for www.umr.com
complete details about FSAs and IRS rules.
22 23You can also read
