EMPLOYEE BENEFITS GUIDE 2021
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2021 //// EMPLOYEE BENEFITS GUIDE
WELCOME
Table of Contents Welcome
Welcome................................................................................... 2 We are pleased to offer you a comprehensive
Eligibility and Enrollment...................................................... 3 benefits package intended to protect your well-
HealthiestYou Telemedicine / Wellness........................... 4 being and financial health. This guide is your
Medical Coverage................................................................... 6 opportunity to learn more about the benefits
available to you and your eligible dependents,
GoodRx..................................................................................... 8
effective January 1–December 31, 2021.
Allstate Supplemental Plans................................................ 9
Each year during Open Enrollment, you have the
Dental Coverage...................................................................10 opportunity to make changes to your benefit plans. The
Vision Coverage....................................................................11 enrollment decisions you make this year will remain
in effect through December 31, 2021. To get the best
Life and AD&D Insurance...................................................12 value from your health care plan, please take the time
Disability Insurance..............................................................13 to evaluate your coverage options and determine which
plans best meet the health care and financial needs of you
Employee Assistance Program..........................................14 and your family. After Open Enrollment, you may make
Additional Benefits..............................................................15 changes to your benefit elections only when you have a
Qualifying Life Event.
Required Notices..................................................................16
Important Contacts
COVERAGE CARRIER PHONE WEBSITE/EMAIL
https://member.healthiestyou.com/
Telemedicine HealthiestYou 866-703-1259
login
Medical IMS 800-687-5944 www.imstpa.com
Accident, Critical Illness,
Allstate 800-ALLSTATE www.allstate.com
Hospital Indemnity
Dental Ameritas 800-487-5553 www.ameritas.com
Vision Ameritas 800-659-2223 www.ameritas.com
Life and AD&D Insurance Mutual of Omaha 800-775-8805 www.mutualofomaha.com
Disability Insurance Mutual of Omaha 800-775-8805 www.mutualofomaha.com
Employee Assistance Program Mutual of Omaha 800-316-2796 www.mutualofomaha.com/eap
Employee Response Center Higginbotham 866-419-3518 helpline@higginbotham.net
2 BCB TRANSPORT
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ELIGIBILITY AND ENROLLMENT
You are eligible for benefits if you are a regular, Qualifying Life Events
full-time employee working an average of 30
Your benefit elections remain in effect for the entire
hours per week. Your coverage is effective the
plan year until the following Open Enrollment. You may
first of the month after you have completed 30 only change coverage during the plan year if you have a
days of full-time employment. Qualifying Life Event, and you must do so within 31 days
of the event.
You may also enroll eligible dependents for benefits
coverage. The cost to you for dependent coverage Marriage, divorce, legal separation or annulment
depends on the number of dependents you enroll and the
Birth, adoption or placement for adoption of an
particular plans you choose. When covering dependents,
eligible child
you must select the same plans for your dependents as
you select for yourself. Death of a spouse or child
Change in your spouse’s employment that affects
Eligible Dependents Include benefits eligibility
Change in your child’s eligibility for benefits (e.g.,
Your legal spouse
reaching the age limit)
Children under the age of 26 regardless of student,
Change in residence that affects your eligibility for
dependency or marital status
coverage
Children over the age of 26 who are fully dependent
Significant change in coverage or cost in your, your
on you for support due to a mental or physical
spouse’s or child’s benefit plans
disability and who are indicated as such on your
federal tax return FMLA Leave, COBRA event, court judgment or
decree
Enrollment Becoming eligible for Medicare or Medicaid
Receiving a Qualified Medical Child Support Order
Your benefit elections remain in effect for the entire plan
If you have a Qualifying Life Event and want to request a
year. You may only change coverage during the plan year
midyear change, you must notify Human Resources and
if you have a Qualifying Life Event, and you must do so
complete your election changes within 31 days following
within 31 days of the event.
the event. Be prepared to provide documentation to
support the Qualifying Life Event.
If you (and/or your dependents) have Employee Response Center
Medicare or will become eligible for Do you have questions about your benefits or need
Medicare in the next 12 months, federal help enrolling? Contact our Employee Response
Center at 866-419-3518 or email helpline@
law gives you more choices about your higginbotham.net. The Employee Response Center is
available Monday – Friday from 8:00 a.m. – 5:00 p.m.
prescription drug coverage. Please see
CST. If you reach voicemail your call will be returned
page 16 for more details. on the next business day.
2021 // Employee Benefits Guide 3
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HEALTHIESTYOU TELEMEDICINE / WELLNESS
HealthiestYou™ gives you FREE 24/7/365 Expert Medical Services
access to U.S. board certified qualified doctors
Get expert advice to help understand and manage your
and therapists through the convenience of a
medical diagnosis and treatment plans.
phone, mobile device or computer. This is a
great alternative to urgent care and can also be Expert Medical Opinion – request a second opinion
on an existing diagnosis or course of treatment
a convenient option in lieu of a doctor’s visit.
Ask the Expert – get answers to questions about
medical conditions, treatment options or symptoms
HEALTHIESTYOU TELEMEDICINE Find a Best Doctor – get help locating a specialist in
your area
Critical Case Support – a clinical team assigned
during the crucial first hours after an emergency to
See a doctor Save Search for work with on-site medical teams
24/7 Money care nearby Treatment Decision Support – receive guidance and
Talk to a licensed Find the Locate a
doctor by phone lowest-cost physician or
education on treatment options
or video from prescriptions in a pharmacy Medical Records eSummary – collect and organize
anywhere your area near you
your medical records in a single secure place
HealthiestYou can help you with many medical Nutrition Services
conditions, including:
You can speak with a registered dietitian for help with
Cold/flu Mental health staying healthy, eating right, or managing a health
Respiratory infection Neck and back care condition like diabetes or high blood pressure. Schedule
Behavioral health care Expert medical your visit seven days a week (7 a.m. to 9 p.m. local time),
services talk to a registered dietician by phone or video and get a
Dermatology issues personalized diet plan to meet your health needs.
Allergies Nutrition services
Talk to a Doctor in Four Easy Steps
1. Register – Register yourself and your dependents
online at www.healthiestyou.com/login.
HealthiestYou is provided to you by
2. Request – Schedule or arrange an on-demand visit
BCB Transport at no cost to you! through the mobile app, online or by calling
866-703-1259.
3. Visit – A consulting physician will contact you about
your health care issue.
4. Resolve – The physician will post a visit summary
to your file for you to access online or through the
mobile app.
4 BCB TRANSPORT
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HEALTHIESTYOU TELEMEDICINE / WELLNESS
HealthiestYou App
Download the HealthiestYou app to your mobile device
to access general and expert medical services, price
transparency tools, find a provider in your area, and much
more. Search “HealthiestYou” or “HY.”
Download the app to start using your free
healthcare services:
HEALTHIESTYOU FREE SERVICES
Talk to a doctor 24/7
$0 Visit Fee
Speak to a licensed doctor by phone or
video 24/7 from anywhere
Expert Medical Services
$0 Visit Fee
Receive a second opinion on an existing
diagnosis and treatment for any condition
Mental Health
$0 Visit Fee
Talk to a therapist seven days a week from
wherever you are
Back Care
$0 Visit Fee
Relieve your back pain through guided
videos with a certified health coach
Dermatology
$0 Visit Fee
Upload photos of your condition to the
app and get a treatment plan from a
dermatologist within two business days
Nutrition
$0 Visit Fee
Speak to a registered dietician by phone
or video
Wellness
If you get an annual physical and register with
HealthiestYou, you will be entered into a raffle for a great
wellness prize!
2021 // Employee Benefits Guide 5
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MEDICAL COVERAGE
The medical plan options through IMS protect you Availability of Summary Health Information
and your family in the event of illness or injury. Your plan offers three health coverage options. To
Premium contributions are deducted from your paycheck on help you make an informed choice and compare your
a pretax basis. You have a choice of three plans: options, a Summary of Benefits and Coverage (SBC)
is available summarizing important information about
Healthy Saver MEC your health coverage options in a standard format.
Consumer Choice MVP The SBC is available on the web at www.paycom.com
or by contacting Human Resources.
Wellness Advantage MVP
Plan Highlights Participant Advocate Program
Routine preventive services are covered at 100%. IMS has developed this program to assist you in
understanding your benefits and the resources
Physicians: The network for the Healthy Saver MEC plan
available to you. Contact your Participant Advocate
will be PHCS Specific Services network. The network for
at 800-687-5944 to assist with the following:
the MVP plans will be the PHCS Practitioner & Ancillary
Only network. In order to receive maximum benefits, Utilize your medical plan to its fullest potential
please make every effort to choose a provider who
Check your claim status
participates in the network. Provider participation can
be determined at the website listed below or through Locate providers
your Participant Advocate. Hospitals and Facilities: Assistance with comparing provider billing
Participants are not limited to a set group of providers. invoices with the EOB you receive from IMS
The plan will simply reimburse providers on a set fee Provide guidance when you are billed more than
schedule as outlined in the plan document. what you should be billed
The plans pay 150% of what Medicare would charge
for a service. If a doctor or facility charges more than Steps for Success
150% of what Medicare would charge, you could be
responsible for the remaining balance (called balance 1. Visit your provider and show your ID card
billing). Always request an estimate from your provider 2. Do not pay your medical bill until you receive your
before scheduling a procedure. EOB from IMS
3. If the medical bill and the EOB amounts match, pay
Refer to the individual plan Schedule of Benefits for a
your provider the amount due. If they do not match,
complete list of covered services.
call your Patient Advocate at 800-687-5944
Find a Provider Provider Networks for
Medical Plans
Contact IMS for assistance locating in-network providers
and facilities:
Healthy Saver MEC – PHCS Specific Services Network
Call – 800-687-5944 Consumer Choice MVP and Wellness Advantage
Online – Visit www.imstpa.com/findaprovider MVP – PHCS Practitioner & Ancillary Only Network
6 BCB TRANSPORT
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Medical Premium Discount
MEDICAL COVERAGE If you enroll in one of our medical plans, you will receive a
discount of $50/month if you are a non-tobacco user.
Tobacco Definition: For the purpose of this program, “use of tobacco products”
includes any use of cigarettes, e-cigarettes, vaping devices, pipes, cigars or any other
tobacco products regardless of frequency or method of use.
Medical Benefits Summary
HEALTHY SAVER CONSUMER CHOICE WELLNESS ADVANTAGE
MEC1 MVP2 MVP2
Network PHCS PHCS PHCS
Calendar Year Deductible
Individual $0 $6,500 $0
Family $0 $13,700 $0
Calendar Year Out-of-Pocket
Maximum
Individual $6,500 $6,500 $2,000
Family $13,000 $13,700 $13,200
You Pay You Pay You Pay
Preventive Care $0 $0 $0
Telemedicine (HealthiestYou) $0 $0 $0
Primary Care Visit $20 copay $50 copay + 40% $20 copay
Specialist Visit $40 copay $70 copay + 40% $40 copay
Diagnostic X-ray and Lab $50 copay $0 after deductible $50 copay
Complex Diagnostic
$400 copay $0 after deductible $400 copay3
MRI, CT, PET
Urgent Care $50 copay $70 copay + 40% $50 copay
Emergency Room Not covered $0 after deductible3 $400 copay3
Hospitalization Not covered $0 after deductible3 $400 copay3
Durable Medical Equipment
Not covered $0 after deductible3 Negotiated Rate3
($2,500 maximum benefit)
Sleep Studies
Not covered $0 after deductible3 Negotiated Rate3
(Up to 2 per year)
Prescription Drugs
Generic Up to $10 copay $0 after deductible Up to $40 copay
Preferred brand name Not covered $0 after deductible Not covered
Non-preferred brand name Not covered Not covered Not covered
Weekly Cost per Paycheck4
Non-Tobacco Tobacco Non-Tobacco Tobacco Non-Tobacco Tobacco
Employee Only $23.38 $35.88 $89.13 $101.63 $133.47 $145.97
Employee + Spouse $58.38 $70.88 $202.00 $214.50 $299.55 $312.05
Employee + Child(ren) $63.38 $75.88 $165.45 $177.95 $245.26 $257.76
Employee + Family $94.13 $106.63 $275.08 $287.58 $408.10 $420.60
1
Only in-network preventive care covered.
2
Out-of-network benefits are included; however, there is not a contract amount or maximum to limit your out-of-pocket costs. Using out-of-network providers could
lead to substantial balance billing. See the plan’s Schedule of Benefits for a complete list of covered in-network and out-of-network services.
3
Plan only pays 150% of Medicare allowable.
4
Rates are based on 48 deductions per year.
If you have a health factor that makes it unreasonably difficult or medically inadvisable for you to achieve the requirements of this program to qualify for the incentive/s, please
contact Human Resources and we will work with you &/or your physician to develop an alternative. The purpose of this program is to promote health and prevent disease by
alerting BCB Transport employees to potential health risks. This program is confidential and HIPAA compliant. Protected Health Information will only be collected in aggregate
form in order to design programs for the purpose of addressing BCB Transport’s overall risk/s. Any information shared will not be disclosed except in accordance with HIPAA laws.
2021 // Employee Benefits Guide 7
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GOODRX
Purchasing your prescription medications GoodRx Benefits
through your insurance plan may not be lower
Compare Prices – Prescription drug prices are not
than paying cash. At GoodRx, you can view
regulated and can vary by more than $100 between
prices, coupons, discounts and savings tips on pharmacies. GoodRx collects prices and discounts
your prescription medications. from more than 60,000 U.S. pharmacies.
Prescription drug prices are not regulated. The cost of Print Coupons – Print coupons online and bring them
a prescription may differ by more than $100 between to your pharmacy or show the coupon on your phone
pharmacies across the street from each other! GoodRx through the mobile app.
gathers current prices and discounts to help you find Save Up to 80% – Show the coupon to your
the lowest cost pharmacy for your prescriptions. The pharmacist for up to 80% savings on your
average GoodRx customer saves $276 a year on their medications.
prescriptions.
When using GoodRx instead of your insurance, the
amount you pay will not be automatically applied
toward your deductible. You may want to contact your
insurance company to find out if you can submit receipts
for prescriptions purchased using GoodRx.
GoodRx is a free service and no personal information
is required.
Access GoodRx Anytime
Download the GoodRx app to your mobile device or
search online at www.goodrx.com. Enter your drug’s
name in the search field and click the Find the Lowest
Price button.
8 BCB TRANSPORT
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ALLSTATE SUPPLEMENTAL PLANS
As a complement to our core benefits programs,
BCB Transport offers you the opportunity to
purchase additional coverage in case of serious
accidents or illnesses. These programs are
provided by AllState.
Accident Insurance
Accident Insurance pays a fixed benefit direct to you
in the event of an accident, regardless of any other
coverage you may have. Benefits are paid according to
a fixed schedule for accident related expenses including
hospitalizations, fractures and dislocations, emergency
room visits, major diagnostic exams and physical therapy.
Refer to the Summary of Benefits and Coverage for cost
and benefit details.
Critical Illness Insurance
Critical Illness insurance helps pay the cost of nonmedical
expenses related to a covered critical illness or cancer.
The plan provides you a lump sum benefit payment
upon diagnosis of a covered critical illness or cancer to
help cover expenses such as lost income, out-of-town
treatments, special diets, daily living and household
upkeep costs.
Hospital Indemnity Insurance
Hospital Indemnity insurance provides financial
assistance to enhance your current medical coverage.
The plan provides a cash benefit for hospital
confinements. This benefit is paid direct to you.
2021 // Employee Benefits Guide 9
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DENTAL COVERAGE
Our dental plan options help you maintain of your choice, but your level of coverage may vary based
on the provider you see for services. You could pay more
good oral health through affordable options for
if you use an out-of-network provider.
preventive care, including regular checkups and
other dental work. Online Access
Premium contributions are deducted from your paycheck Visit www.ameritas.com to create your secure member
on a pretax basis. Coverage is provided through Ameritas. account. Receive instant access to ID cards, plan benefits,
You have a choice of two dental plans: dental cost estimator and claims information.
Base Plan
Prescription Drug Savings Card
Buy-Up Plan
Included with your dental coverage, Ameritas offers
Both options are DPPO plans and offer in-network and
discounts on prescription drugs. To find a pharmacy, visit
out-of-network care. You may select the dental provider
ameritas.com/rxpricing or call 877-684-0032.
Dental Benefits Summary
BASE PLAN1 BUY-UP PLAN1
Ameritas Dental Network In-Network only2 In-Network only2
Calendar Year Deductible
Individual $50 $50
Family $150 $150
Calendar Year Benefit Maximum
$1,000 $1,500
Per Individual
You Pay You Pay
Preventive Services $0 $0
Basic Services 20% after deductible 20% after deductible
Major Services 50% after deductible 50% after deductible
Orthodontic Calendar Year
$1,000 per calendar year $1,500 per calendar year
Benefit Maximum
Orthodontic Services
50% 50%
Children under age 19
Weekly Cost per Paycheck3
Employee $5.00 $6.29
Employee + Spouse $10.22 $12.97
Employee + Child(ren) $10.33 $13.34
Employee + Family $15.92 $20.56
1
Earn Rewards – Visit your dentist at least once per year and begin earning rewards. Apply your rewards to covered dental procedures later in the year.
2
Using in-network providers will save you money. You may go to an out-of-network provider and the plan will reimburse you based on the Maximum
Allowable Charge. You may be balance-billed for the difference.
3
Rates are based on 48 deductions per year.
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VISION COVERAGE
Our vision plan provides quality care to help deducted from your paycheck on a pretax
basis. Coverage is provided through Ameritas
preserve your health and eyesight. In addition to
using the VSP Network.
identifying vision and eye problems, regular exams
can detect certain medical issues such as diabetes Online Access
and high cholesterol.
Visit www.ameritas.com to create your secure
You may seek care from any licensed optometrist, member account. Receive savings, instant
ophthalmologist or optician, but plan benefits are better if access to ID cards, plan benefits and claims
you use an in-network provider. Premium contributions are information.
Vision Benefits Summary
VISION PLAN
VSP Network In-Network Out-of-Network
You Pay Reimbursement
Exam $10 copay Up to $40
Lenses
Single Vision $25 copay Up to $40
Lined Bifocals $25 copay Up to $60
Lined Trifocals $25 copay Up to $80
Lenticular $25 copay Up to $80
$25 copay + 20% off
Frames Up to $45
balance over $150
Contacts
Elective Up $60 fitting/ Up to $105
evaluation, then
$150 allowance
Medically Necessary $25 copay Up to $210
Benefit Frequency
Exam Once every 12 months
Lenses Once every 12 months
Frames Once every 12 months
Contact Lenses
Once every 12 months
(in lieu of eyeglasses)
Weekly Cost per Paycheck1
Employee Only $1.45 How to Find a Vision
Employee + Spouse $3.06 Provider
Employee + Child(ren) $3.59
Visit www.ameritas.com or www.vsp.com or
Employee + Family $5.30 call 800-659-2223 to find an in-network vision
1
Rates are based on 48 deductions per year. provider.
2021 // Employee Benefits Guide 11Back to Table of Contents
LIFE AND AD&D INSURANCE
Life and Accidental Death and Dismemberment Voluntary Life and AD&D
(AD&D) insurance are important parts of your
You may purchase additional Life and AD&D insurance
financial security, especially if others depend on
through Mutual of Omaha for you and your eligible
you for support. dependents. If you decline Voluntary Life and AD&D
Your beneficiary(ies) can use life insurance coverage to insurance when first eligible, Evidence of Insurability
pay off your debts, such as credit cards, mortgages and (EOI) — proof of good health — may be required before
other final expenses. AD&D coverage provides specified coverage is approved. You must elect Voluntary Life and
benefits for a covered accidental bodily injury that AD&D coverage for yourself in order to elect coverage
causes dismemberment (e.g., the loss of a hand, foot or for your spouse or children.
eye). In the event that death occurs from an accident,
100% of the AD&D benefit would be payable to your
VOLUNTARY LIFE AND AD&D
beneficiary(ies).
AVAILABLE COVERAGE
Increments of $10,000 up to five
Basic Life and AD&D Employee
times annual salary not to exceed
$500,000
Guaranteed Issue $100,000
Basic Life and AD&D insurance are provided at no cost
to you through Mutual of Omaha. You are automatically Increments of $5,000 up to 100%
of employee amount not to exceed
covered at $10,000 for each benefit. As you grow older, Spouse
$250,000
your Life and AD&D coverage amount reduces to 65% Guaranteed Issue $30,000
of the original amount at age 65 and 50% of the original Child(ren) Increments of $1,000 up to $10,000
amount at age 70.
You may increase existing coverage by $10,000 up to
the Guarantee Issue amount without providing proof of
good health.
Designating a Beneficiary
A beneficiary is the person or entity you designate
to receive the death benefits of your Life and AD&D
insurance policies. You can name more than one
beneficiary and you can change beneficiaries at any
time. If you name more than one beneficiary, you
must identify the share for each.
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DISABILITY INSURANCE
Disability insurance provides partial income
protection if you are unable to work due to
a covered accident or illness. We offer Short
Term Disability (STD) and Long Term Disability
(LTD) insurance for you to purchase through
Mutual of Omaha.
Voluntary Short Term Disability
STD coverage pays a percentage of your weekly salary
for up to 11 weeks if you are temporarily disabled and
unable to work due to an illness, non-work related
injury or pregnancy. STD benefits are not payable if the
disability is due to a job-related injury or illness.
VOLUNTARY SHORT TERM DISABILITY
Voluntary Long Term Disability
Benefits Begin - Injury or illness 15th day
Percentage of Earnings You Receive 60% LTD insurance pays a percentage of your monthly salary
Maximum Weekly Benefit $1,500 for a covered disability or injury that prevents you from
working for more than 90 days. Benefits begin at the
Maximum Benefit Period 11 weeks
end of an elimination period and continue while you are
Pre-existing Condition Exclusion 3/12* disabled up to a maximum of five years.
*Benefits may not be paid for any condition treated within three months prior to
your effective date until you have been covered under this plan for 12 months. If you are enrolling in LTD after your initial eligibility, you
will need to submit Evidence of Insurability (EOI) — proof
of good health — for approval.
VOLUNTARY LONG TERM DISABILITY
Benefits Begin 91st day
Percentage of Earnings You Receive 60%
Maximum Monthly Benefit $6,000
Maximum Benefit Period 5 years
Pre-existing Condition Exclusion 12/12*
*Benefits may not be paid for any condition treated within twelve months prior to
your effective date until you have been covered under this plan for 12 months.
2021 // Employee Benefits Guide 13Back to Table of Contents
EMPLOYEE ASSISTANCE PROGRAM
BCB Transport provides an Employee
Assistance Program (EAP) to help you and
family members cope with a variety of personal
or work-related issues.
Available to all employees and their eligible dependents,
Mutual of Omaha provides confidential counseling and
support services. The EAP is available 24 hours a day,
seven days a week and is provided at no cost to you.
Program Features
The program can give you information, advice and
support on everyday issues, including:
Relationships
Work/life balance
Stress and anxiety
Grief and loss
Child and elder care resources
Substance abuse
Our Employee Assistance Program offers you:
Unlimited telephonic access to EAP professionals,
24/7
3 face-to-face visits with a qualified professional for
any member of your family
Telephone assistance and referral
Service for employees with eligible dependents
Resources, services and support in the community
Legal assistance and financial services
Access to a library of education articles, handouts and
resources via the website
How to Contact the EAP
Call – 800-316-2796
Online – Visit www.mutualofomaha.com/eap
14 BCB TRANSPORTBack to Table of Contents
ADDITIONAL BENEFITS
BCB Transport gives you the opportunity to
purchase a variety of voluntary products to
cover your additional needs. These programs
are offered through Mutual of Omaha.
Hearing Discount
The Hearing Discount Program through Amplifon gives
you access to hearing testing, low price guarantee,
60-day risk free trial period and two years of batteries
with purchase. To activate your benefit, visit www.
amplifonusa.com/mutualofomaha or call 888-534-1747.
A Patient Care Advocate will assist in finding a hearing
care provider near you.
Will Preparation
Creating a will is an important investment in your future.
With Epoq, Inc., you can quickly and easily create a FREE
personalized will tailored to your needs from the comfort
of your home. Log on to www.willprepservices.com, use
the code MUTUALWILLS to register, then answer some
simple questions and download or print any documents
instantly.
Worldwide Travel Assistance and
Identity Theft
This program provides travel assistance for you and your
dependents if you are traveling more than 100 miles
from home. Representatives can help with trip planning
or assist in an emergency while traveling. They can find
translation, interpreter or legal services, along with
assist with lost baggage, emergency funds, document
replacement and more. They can also help if your identity
has been stolen with education, prevention and recovery
information.
Access this service by calling 800-856-9947 (within the
U.S.) or 312-935-2658 (outside the U.S. by calling collect).
2021 // Employee Benefits Guide 15Back to Table of Contents
REQUIRED NOTICES
WOMEN’S HEALTH AND CANCER coverage stops contributing toward the other coverage).
RIGHTS ACT OF 1998 If you or your dependents lose eligibility under a Medicaid
plan or CHIP, or if you or your dependents become
In October 1998, Congress enacted the Women’s Health
eligible for a subsidy under Medicaid or CHIP, you may be
and Cancer Rights Act of 1998. This notice explains
able to enroll yourself and your dependents in this plan.
some important provisions of the Act. Please review this
You must provide notification within 60 days after you or
information carefully.
your dependent is terminated from, or determined to be
As specified in the Women’s Health and Cancer Rights eligible for, such assistance.
Act, a plan participant or beneficiary who elects breast
Marriage, Birth or Adoption
reconstruction in connection with a mastectomy is also
entitled to the following benefits: If you have a new dependent as a result of a marriage,
birth, adoption, or placement for adoption, you may be
• All stages of reconstruction of the breast on which the
able to enroll yourself and your dependents. However,
mastectomy was performed;
you must enroll within 31 days after the marriage, birth,
• Surgery and reconstruction of the other breast to or placement for adoption.
produce a symmetrical appearance; and
For More Information or Assistance
• Prostheses and treatment of physical complications of
To request special enrollment or obtain more information,
the mastectomy, including lymphedema.
contact:
Health plans must determine the manner of coverage in
BCB Transport, LLC
consultation with the attending physician and the patient.
Human Resources
Coverage for breast reconstruction and related services
221 Airport Drive
may be subject to deductibles and coinsurance amounts
Mansfield, TX, 76063
that are consistent with those that apply to other benefits
682-518-1162
under the plan.
YOUR PRESCRIPTION DRUG
SPECIAL ENROLLMENT RIGHTS COVERAGE AND MEDICARE
This notice is being provided to ensure that you
Please read this notice carefully and keep it where you
understand your right to apply for group health insurance
can find it. This notice has information about your current
coverage. You should read this notice even if you plan to
prescription drug coverage with BCB Transport, LLC
waive coverage at this time.
and about your options under Medicare’s prescription
Loss of Other Coverage or Becoming Eligible for drug coverage. This information can help you decide
Medicaid or a state Children’s Health Insurance Program whether or not you want to enroll in a Medicare drug
(CHIP) plan. Information about where you can get help to make
If you are declining coverage for yourself or your decisions about your prescription drug coverage is at the
dependents because of other health insurance or group end of this notice.
health plan coverage, you may be able to later enroll If neither you nor any of your covered dependents are
yourself and your dependents in this plan if you or your eligible for or have Medicare, this notice does not apply to
dependents lose eligibility for that other coverage (or you or the dependents, as the case may be. However, you
if the employer stops contributing toward your or your should still keep a copy of this notice in the event you or a
dependents’ other coverage). However, you must enroll dependent should qualify for coverage under Medicare in
within 31 days after your or your dependents’ other the future. Please note, however, that later notices might
coverage ends (or after the employer that sponsors that supersede this notice.
16 BCB TRANSPORTBack to Table of Contents
REQUIRED NOTICES
1. Medicare prescription drug coverage became should review the Plan’s summary plan description to
available in 2006 to everyone with Medicare. You can determine if and when you are allowed to add coverage.
get this coverage through a Medicare Prescription If you cancel or lose your current coverage and do not
Drug Plan or a Medicare Advantage Plan that offers have prescription drug coverage for 63 days or longer
prescription drug coverage. All Medicare prescription prior to enrolling in the Medicare prescription drug
drug plans provide at least a standard level of coverage, your monthly premium will be at least 1% per
coverage set by Medicare. Some plans may also offer month greater for every month that you did not have
more coverage for a higher monthly premium. coverage for as long as you have Medicare prescription
2. BCB Transport, LLC has determined that the drug coverage. For example, if nineteen months lapse
prescription drug coverage offered by the BCB without coverage, your premium will always be at least
Transport, LLC medical plan is, on average for all plan 19% higher than it would have been without the lapse in
participants, expected to pay out as much as the coverage.
standard Medicare prescription drug coverage pays For more information about this notice or your current
and is not considered Creditable Coverage. prescription drug coverage:
Because your existing coverage is, on average, at least as Contact the Human Resources Department at 682-518-
good as standard Medicare prescription drug coverage, 1162.
you can keep this coverage and not pay a higher premium
NOTE: You will receive this notice annually and at other
(a penalty) if you later decide to enroll in a Medicare
times in the future, such as before the next period you
prescription drug plan, as long as you later enroll within
can enroll in Medicare prescription drug coverage and if
specific time periods.
this coverage changes. You may also request a copy.
You can enroll in a Medicare prescription drug plan when
For more information about your options under
you first become eligible for Medicare. If you decide
Medicare prescription drug coverage:
to wait to enroll in a Medicare prescription drug plan,
you may enroll later, during Medicare Part D’s annual More detailed information about Medicare plans that
enrollment period, which runs each year from October offer prescription drug coverage is in the “Medicare &
15 through December 7 but as a general rule, if you delay You” handbook. You will get a copy of the handbook
your enrollment in Medicare Part D after first becoming in the mail every year from Medicare. You may also be
eligible to enroll, you may have to pay a higher premium (a contacted directly by Medicare prescription drug plans.
penalty). For more information about Medicare prescription drug
coverage:
You should compare your current coverage, including
which drugs are covered at what cost, with the coverage • Visit www.medicare.gov.
and cost of the plans offering Medicare prescription • Call your State Health Insurance Assistance Program
drug coverage in your area. See the Plan’s summary plan (see the inside back cover of your copy of the
description for a summary of the Plan’s prescription drug “Medicare & You” handbook for their telephone
coverage. If you don’t have a copy, you can get one by number) for personalized help.
contacting BCB Transport, LLC at the phone number or
• Call 1-800-MEDICARE (1-800-633-4227). TTY users
address listed at the end of this section.
should call 877-486-2048.
If you choose to enroll in a Medicare prescription
If you have limited income and resources, extra help
drug plan and cancel your current BCB Transport, LLC
paying for Medicare prescription drug coverage is
prescription drug coverage, be aware that you and your
available. Information about this extra help is available
dependents may not be able to get this coverage back. To
from the Social Security Administration (SSA) online at
regain coverage, you would have to re-enroll in the Plan,
www.socialsecurity.gov, or you can call them at 800-772-
pursuant to the Plan’s eligibility and enrollment rules. You
1213. TTY users should call 800-325-0778.
2021 // Employee Benefits Guide 17Back to Table of Contents
REQUIRED NOTICES
Remember: Keep this Creditable Coverage notice. If you a full copy of the Notice of Privacy Practices describing
enroll in one of the new plans approved by Medicare how protected health information about you may be
which offer prescription drug coverage, you may be used and disclosed and how you can get access to the
required to provide a copy of this notice when you join information, contact the Human Resources Department.
to show whether or not you have maintained creditable Complaints: If you believe your privacy rights have
coverage and whether or not you are required to pay a been violated, you may complain to the Plan and to
higher premium (a penalty). the Secretary of Health and Human Services. You will
January 1, 2021 not be retaliated against for filing a complaint. To file a
BCB Transport, LLC complaint, please contact the Privacy Officer.
Human Resources BCB Transport, LLC
221 Airport Drive Human Resources
Mansfield, TX, 76063 221 Airport Drive
682-518-1162 Mansfield, TX, 76063
682-518-1162
NOTICE OF HIPAA PRIVACY Conclusion
PRACTICES PHI use and disclosure by the Plan is regulated by a
federal law known as HIPAA (the Health Insurance
This notice describes how medical information about you
Portability and Accountability Act). You may find these
may be used and disclosed and how you can access this
rules at 45 Code of Federal Regulations Parts 160 and
information. Please review it carefully.
164. The Plan intends to comply with these regulations.
The Health Insurance Portability and Accountability Act This Notice attempts to summarize the regulations. The
of 1996 (HIPAA) imposes numerous requirements on regulations will supersede any discrepancy between the
employer health plans concerning the use and disclosure information in this Notice and the regulations.
of individual health information. This information known
as protected health information (PHI), includes virtually
all individually identifiable health information held by a PREMIUM ASSISTANCE UNDER
health plan – whether received in writing, in an electronic MEDICAID AND THE CHILDREN’S
medium or as oral communication. This notice describes
the privacy practices of the Employee Benefits Plan
HEALTH INSURANCE PROGRAM (CHIP)
(referred to in this notice as the Plan), sponsored by If you or your children are eligible for Medicaid or CHIP
BCB Transport, LLC, hereinafter referred to as the plan and you are eligible for health coverage from your
sponsor. employer, your State may have a premium assistance
program that can help pay for coverage using funds from
The Plan is required by law to maintain the privacy of
their Medicaid or CHIP programs. If you or your children
your health information and to provide you with this
are not eligible for Medicaid or CHIP, you won’t be eligible
notice of the Plan’s legal duties and privacy practices with
for these premium assistance programs but you may be
respect to your health information. It is important to note
able to buy individual insurance coverage through the
that these rules apply to the Plan, not the plan sponsor as
Health Insurance Marketplace. For more information, visit
an employer.
www.healthcare.gov.
You have the right to inspect and copy protected health
If you or your dependents are already enrolled in
information which is maintained by and for the Plan for
Medicaid or CHIP and you live in a State listed, contact
enrollment, payment, claims and case management. If
your State Medicaid or CHIP office to find out if premium
you feel that protected health information about you
assistance is available.
is incorrect or incomplete, you may ask the Human
Resources Department to amend the information. For
18 BCB TRANSPORTBack to Table of Contents
REQUIRED NOTICES
If you or your dependents are NOT currently enrolled COLORADO – MEDICAID AND CHIP
in Medicaid or CHIP, and you think you or any of your
Health First Colorado (Medicaid) website:
dependents might be eligible for either of these programs, https://www.healthfirstcolorado.com/
contact your State Medicaid or CHIP office or dial 1-877- Health First Colorado Member Contact Center:
KIDS NOW or go to www.insurekidsnow.gov to find out 1-800-221-3943/State Relay 711
CHP+: https://www.colorado.gov/pacific/hcpf/child-health-plan-
how to apply. If you qualify, you can ask your State if it plus
has a program that might help you pay the premiums for CHP+ Customer Service: 1-800-359-1991/State Relay 711
an employer-sponsored plan. Health Insurance Buy-In Program (HIBI):
https://www.colorado.gov/pacific/hcpf/health-insurance-buy-
If you or your dependents are eligible for premium program
assistance under Medicaid or CHIP, as well as eligible HIBI Customer Service: 1-855-692-6442
under your employer plan, your employer must allow FLORIDA – MEDICAID
you to enroll in your employer plan if you are not already Website: https://www.flmedicaidtplrecovery.com/
enrolled. This is called a “special enrollment” opportunity, flmedicaidtplrecovery.com/hipp/index.html
Phone: 1-877-357-3268
and you must request coverage within 60 days of being
determined eligible for premium assistance. If you have GEORGIA – MEDICAID
questions about enrolling in your employer plan, contact Website: https://medicaid.georgia.gov/health-insurance-premium-
the Department of Labor at www.askebsa.dol.gov or call payment-program-hipp
Phone: 678-564-1162 ext. 2131
1-866-444-EBSA (3272).
INDIANA – MEDICAID
If you live in one of the following States, you may be
Healthy Indiana Plan for low-income adults 19-64
eligible for assistance paying your employer health plan
Website: http://www.in.gov/fssa/hip/
premiums. The following list of States is current as of Phone: 1-877-438-4479
July 31, 2020. Contact your State for more information All other Medicaid
Website: http://www.indianamedicaid.com
on eligibility.
Phone: 1-800-403-0864/1-800-457-4584
IOWA – MEDICAID AND CHIP
ALABAMA – MEDICAID Medicaid Website:
https://dhs.iowa.gov/ime/members
Website: http://www.myalhipp.com/ Medicaid Phone: 1-800-338-8366
Phone: 1-855-692-5447 Hawki Website:
ALASKA – MEDICAID http://dhs.iowa.gov/Hawki
Hawki Phone: 1-800-257-8563
The AK Health Insurance Premium Payment Program
Website: http://myakhipp.com/ KANSAS – MEDICAID
Phone: 1-866-251-4861 Website: http://www.kdheks.gov/hcf/default.htm
Email: CustomerService@MyAKHIPP.com Phone: 1-800-792-4884
Medicaid Eligibility:
http://dhss.alaska.gov/dpa/Pages/medicaid/default.aspx KENTUCKY – MEDICAID
ARKANSAS – MEDICAID Kentucky Integrated Health Insurance Premium Payment Program
(KI-HIPP) Website:
Website: http://myarhipp.com/ https://chfs.ky.gov/agencies/dms/member/Pages/kihipp.aspx
Phone: 1-855-MyARHIPP (1-855-692-7447) Phone: 1-855-459-6328
CALIFORNIA– MEDICAID Email: KIHIPP.PROGRAM@ky.gov
KCHIP Website: https://kidshealth.ky.gov/Pages/index.aspx
Website: https://www.dhcs.ca.gov/services/Pages/TPLRD_CAU_ Phone: 1-877-524-4718
cont.aspx Kentucky Medicaid Website: https://chfs.ky.gov
Phone: 1-800-541-5555/FAX: 916-440-5676
2021 // Employee Benefits Guide 19Back to Table of Contents
REQUIRED NOTICES
LOUISIANA – MEDICAID NEW YORK – MEDICAID
Website: www.medicaid.la.gov or www.ldh.la.gov/lahipp Website: https://www.health.ny.gov/health_care/medicaid/
Phone: 1-888-342-6207 (Medicaid hotline) or 1-855-618-5488 Phone: 1-800-541-2831
(LaHIPP)
NORTH CAROLINA – MEDICAID
MAINE – MEDICAID
Website: https://medicaid.ncdhhs.gov
Website: http://www.maine.gov/dhhs/ofi/applications-forms Phone: 919-855-4100
Phone: 1-800-442-6003
TTY: Maine relay 711 NORTH DAKOTA – MEDICAID
Private Health Insurance Premium Webpage: Website: http://www.nd.gov/dhs/services/medicalserv/medicaid/
https://www.maine.gov/dhhs/ofi/applications-forms Phone: 1-844-854-4825
Phone: 800-977-6740 TTY: Maine Relay 711
OKLAHOMA – MEDICAID
MASSACHUSETTS – MEDICAID
Website: http://www.insureoklahoma.org
Website: http://www.mass.gov/eohhs/gov/departments/ Phone: 1-888-365-3742
masshealth/
Phone: 1-800-862-4840 OREGON – MEDICAID
MINNESOTA – MEDICAID Website: http://healthcare.oregon.gov/Pages/index.aspx
http://www.oregonhealthcare.gov/index-es.html
Website: https://mn.gov/dhs/people-we-serve/children-and- Phone: 1-800-699-9075
families/health-care/health-care-programs/programs-and-services/
medical-assistance.jsp PENNSYLVANIA – MEDICAID
Phone: 1-800-657-3739 Website: https://www.dhs.pa.gov/providers/Providers/Pages/
MISSOURI – MEDICAID Medical/HIPP-Program.aspx
Phone: 1-800-692-7462
Website: http://www.dss.mo.gov/mhd/participants/pages/hipp.htm
Phone: 573-751-2005 RHODE ISLAND – MEDICAID AND CHIP
MONTANA – MEDICAID Website: http://www.eohhs.ri.gov/
Phone: 855-697-4347 or 401-462-0311 (Direct RIte Share Line)
Website: http://dphhs.mt.gov/MontanaHealthcarePrograms/HIPP
Phone: 1-800-694-3084 SOUTH CAROLINA – MEDICAID
NEBRASKA – MEDICAID Website: https://www.scdhhs.gov
Phone: 1-888-549-0820
Website: http://www.ACCESSNebraska.ne.gov
Phone: 1-855-632-7633 SOUTH DAKOTA - MEDICAID
Lincoln: 402-473-7000 Website: http://dss.sd.gov
Omaha: 402-595-1178 Phone: 1-888-828-0059
NEVADA – MEDICAID TEXAS – MEDICAID
Website: http://dhcfp.nv.gov Website: http://gethipptexas.com/
Phone: 1-800-992-0900 Phone: 1-800-440-0493
NEW HAMPSHIRE – MEDICAID UTAH – MEDICAID AND CHIP
Website: http://www.dhhs.nh.gov/oii/hipp.htm Medicaid Website: https://medicaid.utah.gov
Phone: 603-271-5218 CHIP Website: http://health.utah.gov/chip
Toll free number HIPP program: 1-800-852-3345 ext.5218 Phone: 1-877-543-7669
NEW JERSEY – MEDICAID AND CHIP VERMONT– MEDICAID
Medicaid Website: Website: http://www.greenmountaincare.org/
http://www.state.nj.us/humanservices/dmahs/clients/medicaid/ Phone: 1-800-250-8427
Medicaid Phone: 609-631-2392
CHIP Website: http://www.njfamilycare.org/index.html VIRGINIA – MEDICAID
CHIP Phone: 1-800-701-0710
Website: https://www.coverva.org/hipp/
Medicaid Phone: 1-800-432-5924
CHIP Phone: 1-855-242-8282
20 BCB TRANSPORTBack to Table of Contents
REQUIRED NOTICES
WASHINGTON – MEDICAID CONTINUATION OF COVERAGE
Website: https://www.hca.wa.gov/ RIGHTS UNDER COBRA
Phone: 1-800-562-3022
Under the Federal Consolidated Omnibus Budget
WEST VIRGINIA – MEDICAID Reconciliation Act of 1985 (COBRA), if you are covered
Website: http://mywvhipp.com/ under the BCB Transport, LLC group health plan you and
Toll Free Phone: 1-855-MyWVHIPP (1-855-699-8447)
your eligible dependents may be entitled to continue your
WISCONSIN – MEDICAID AND CHIP group health benefits coverage under the BCB Transport,
Website: https://www.dhs.wisconsin.gov/badgercareplus/ LLC plan after you have left employment with the
p-10095.htm company. If you wish to elect COBRA coverage, contact
Phone: 1-800-362-3002
your Human Resources Department for the applicable
WYOMING – MEDICAID deadlines to elect coverage and pay the initial premium.
Website: https://health.wyo.gov/healthcarefin/medicaid/programs-
Plan Contact Information
and-eligibility/
Phone: 1-800-251-1269 BCB Transport, LLC
Human Resources
To see if any other States have added a premium 221 Airport Drive
assistance program since July 31, 2020, or for more Mansfield, TX, 76063
information on special enrollment rights, you can 682-518-1162
contact either:
U.S. Department of Labor
Employee Benefits Security Administration
www.dol.gov/agencies/ebsa
1-866-444-EBSA (3272)
U.S. Department of Health and Human Services
Centers for Medicare & Medicaid Services
www.cms.hhs.gov
1-877-267-2323, Menu Option 4, Ext. 61565
2021 // Employee Benefits Guide 21Back to Table of Contents
REQUIRED NOTICES
NOTICE REGARDING WELLNESS Protections from Disclosure of Medical Information
PROGRAM We are required by law to maintain the privacy
and security of your personally identifiable health
The employee wellness program is a voluntary program
information. Although the wellness program may use
administered according to federal rules permitting
aggregate information it collects to design a program
employer-sponsored wellness programs that seek to
based on identified health risks in the workplace, the
improve employee health or prevent disease, including
wellness program will never disclose any of your personal
the Americans with Disabilities Act of 1990, the Genetic
information either publicly or to the employer, except
Information Nondiscrimination Act of 2008, and the
as necessary to respond to a request from you for a
Health Insurance Portability and Accountability Act, as
reasonable accommodation needed to participate in
applicable, among others. If you choose to participate
the wellness program, or as expressly permitted by law.
in the wellness program you may be asked to complete
Medical information that personally identifies you that
a voluntary health risk assessment or “HRA” that
is provided in connection with the wellness program will
asks a series of questions about your health-related
not be provided to your supervisors or managers and
activities and behaviors and whether you have or had
may never be used to make decisions regarding your
certain medical conditions (e.g., cancer, diabetes, or
employment.
heart disease). You may also be asked to complete a
biometric screening, which could include a blood test Your health information will not be sold, exchanged,
for certain medical conditions such as diabetes, heart transferred, or otherwise disclosed except to the extent
disease, etc. You are not required to complete the HRA permitted by law to carry out specific activities related
or to participate in the blood test or other medical to the wellness program, and you will not be asked or
examinations. required to waive the confidentiality of your health
information as a condition of participating in the wellness
However, employees who choose to participate in the
program or receiving an incentive. Anyone who receives
wellness program may qualify for an incentive. Although
your information for purposes of providing you services
you are not required to complete a HRA or biometric
as part of the wellness program will abide by the same
screening, the wellness program may specify that only
confidentiality requirements.
employees who do so will qualify for the incentive.
Additional incentives may be available for employees who In addition, all medical information obtained through
participate in certain health-related activities or achieve the wellness program will be maintained separate from
certain health outcomes. your personnel records, information stored electronically
will be encrypted, and no information you provide as
If you are unable to participate in any of the health-
part of the wellness program will be used in making
related activities or achieve any of the health outcomes
any employment decision. Appropriate precautions will
required to earn an incentive, you may be entitled to a
be taken to avoid any data breach, and in the event a
reasonable accommodation or an alternative standard.
data breach occurs involving information you provide in
You may request a reasonable accommodation or an
connection with the wellness program, we will notify you
alternative standard by contacting Human Resources.
immediately.
If you choose to participate in a HRA and/or biometric
You may not be discriminated against in employment
screening, information from your HRA and results from
because of the medical information you provide as part
your biometric screening will be used to provide you
of participating in the wellness program, nor may you be
with information to help you understand your current
subjected to retaliation if you choose not to participate.
health and potential risks and may also be used to offer
you services through the wellness program. You also are If you have questions or concerns regarding this notice, or
encouraged to share your results or concerns with your about protections against discrimination and retaliation,
own doctor. please contact Human Resources.
22 BCB TRANSPORTBack to Table of Contents
NOTES
2021 // Employee Benefits Guide 23This brochure highlights the main features
of the BCB Transport employee benefits
program. It does not include all plan rules,
details, limitations and exclusions. The terms
of your benefit plans are governed by legal
documents, including insurance contracts.
Should there be an inconsistency between
this brochure and the legal plan documents,
the plan documents are the final authority.
BCB Transport reserves the right to change
or discontinue its employee benefits plans
at any time.
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