Explore What Fits Your Lifestyle - FIND THE RIGHT BENEFITS FOR YOU 2020 Benefits Guide - Halliburton

 
Explore What Fits Your Lifestyle - FIND THE RIGHT BENEFITS FOR YOU 2020 Benefits Guide - Halliburton
Explore What Fits Your Lifestyle …             2020 Benefits Guide
                                                 U.S. Employees
FIND THE RIGHT BENEFITS FOR YOU

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Explore What Fits Your Lifestyle - FIND THE RIGHT BENEFITS FOR YOU 2020 Benefits Guide - Halliburton
IN THIS GUIDE                                                                           Eligibility and Enrollment
                                                                                        Halliburton works hard to make sure you have a competitive total rewards package, which includes valuable health
Eligibility and Enrollment. . . . . . . . . . . . . . . . . . . . . . . 2
                                                                                        and welfare benefits.
What’s New for 2020 . . . . . . . . . . . . . . . . . . . . . . . . . .  3
                                                                                        Your wellbeing is a team effort. While it’s up to you to make healthy choices, we’re committed to giving you the tools
                                                                                        and support you need to make those choices. And when you’re working hard to make the right decisions for you
HEALTH BENEFITS                                                                         and your family, we’ll have your back.
Medical. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7    Whether you are an active employee making changes during Annual Enrollment, or a new hire selecting Halliburton
                                                                                        benefits for the first time, start by learning about all of your options, then choose the benefits that work for you.
Flexible Spending
Accounts (FSAs). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
                                                                                        WHEN TO ENROLL FOR 2020 BENEFITS
Dental. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
                                                                                         Type of Employee                               Enrollment Period                          Benefits Effective Date
Vision . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16

                                                                                         Current Employees                              October 4 – October 18, 2019               January 1, 2020
INCOME PROTECTION BENEFITS
                                                                                         New Hire: Regular                              Within 30 days of your date of hire        Your date of hire
Life Insurance/Accidental Death
& Dismemberment. . . . . . . . . . . . . . . . . . . . . . . . . . . . 18                New Hire: Operator Assistant Trainee           Within 30 days of your date of hire        Your 90th day of employment

Long-Term Disability
(LTD) Insurance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18          DO I HAVE TO ENROLL?
                                                                                        It’s always a good idea to review your benefit choices each year. As an active employee, most of your current benefits
WORK/LIFE BENEFITS                                                                      will automatically roll over to 2020. If you want to participate in a Flexible Spending Account, Health Savings Account,
Employee Assistance                                                                     or elect Flex Days, you must actively enroll in these benefits each year.
Program (EAP) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20          As a new hire, if you want Halliburton benefits, you need to actively enroll within 30 days of your date of hire.
Flex Days . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20      You automatically receive the following benefits from Halliburton, at no cost to you:
                                                                                        • Basic Life Insurance of one times your annual benefits base pay, up to $50,000
Halliburton Family Care Program. . . . . . . . . . . . . . . . 21
                                                                                        • Basic Accidental Death and Dismemberment insurance equal to your annual benefits base pay, up to $200,000
Leaves of Absence. . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
                                                                                        • Long-Term Disability insurance is 40% of your annual benefits base pay
RETIREMENT BENEFITS                                                                     • LiveWell wellness program

The Halliburton Retirement
& Savings Plan. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23          Can I Make Changes During the Year?
                                                                                        You can only make changes if you experience a qualified change-in-status (such as a marriage or birth of a child) and
IMPORTANT CONTACTS & LEGAL NOTICES                                                      report the change within 30 days. If you add a dependent to coverage, you must provide eligibility documentation
                                                                                        within 30 days of the event. If you have a change-in-status event (for example, the birth of a child) after the annual
Important Contacts. . . . . . . . . . . . . . . . . . . . . . . . . . . 25
                                                                                        enrollment period, but before the next plan year begins, you can make changes on the Total Rewards website
Compliance and                                                                          www.halliburton.com/totalrewards. The system will prompt you to also change your enrollment elections for
Legal Notices. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27         the next year. Or, you can call the Halliburton Benefits Center at 1-866-321-0964 for assistance.

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Explore What Fits Your Lifestyle - FIND THE RIGHT BENEFITS FOR YOU 2020 Benefits Guide - Halliburton
What’s New for 2020
Every year, Halliburton evaluates our benefits programs to ensure they are sustainable and competitive within our market. Here is an overview of the changes for 2020.

 What’s Changing                               Details

                                                 This new online tool helps you understand and make decisions about your Life Insurance coverage. Use Benefit Scout to learn
 NEW
                                                 more about your coverage options and costs by answering a few simple questions to determine the coverage that will best fit your
 Benefit Scout
                                                 needs and budget. Access Benefit Scout at www.lifebenefits.com/halliburton.

                                                 We have expanded our Family Care Program to include backup care for your dependents. If you have an urgent need for backup
 NEW
                                                 dependent care, you can receive up to 5 days of care annually through Bright Horizons. Visit https://clients.brighthorizons.com/
 Backup Dependent Care
                                                 halliburton for more details.

                                                 Beginning in 2020, Fidelity will become our new HSA administrator. Fidelity replaces ConnectYourCare. You must be enrolled
 NEW
                                                 in the Consumer Choice Plan to contribute to a Health Savings Account. If you have a current HSA balance, you must agree to
 Administrator for the Health
                                                 have ConnectYourCare close your account and transfer your HSA balance to Fidelity. You will receive more information directly
 Savings Account (HSA)
                                                 from Fidelity about the transfer.

                                                 Halliburton offers the opportunity to enroll in a legal plan through Beacon Health that’s included in the Halliburton Employee
                                                 Assistance Program (EAP). The legal plan is provided to you at no cost and gives you access to all the attorneys in your area
 Legal Benefit via Beacon Health
                                                 which can help you with legal matters such as alimony, adoptions, foreclosures and more. You also have access to mediation
                                                 professionals which can help you with resolving cases like divorce, child custody, real estate issues, car accidents and more.

                                                 Halliburton is proud to announce that beginning January 1, 2020, you can purchase up to 8 times your annual salary for life
 Voluntary Life Insurance
                                                 insurance – this change increased from 2019 of 6 times annual salary.

                                                 Our LiveWell program administrator changed to Virgin Pulse on September 10, 2019. Check out the updated LiveWell program – visit
 LiveWell Program
                                                 the Halliburton Total Rewards website at www.halliburton.com/totalrewards and click on the LiveWell icon on the scrolling toolbar.

                                                 Healthcare costs continue to rise and are a significant investment for the Company. Effective January 1, 2020, you will see a modest
 Medical Plan Contributions                      increase in the amount you pay for medical coverage. Halliburton continues to subsidize 75% of the overall cost for medical coverage.
                                                 For detailed information on your premiums, visit the Halliburton Total Rewards website at www.halliburton.com/totalrewards.

                                                 Effective January 1, 2020, you will see a modest increase in the amount you pay for dental coverage. Halliburton continues to
 Dental Plan Contributions
                                                 share a portion of the cost of dental coverage, while many other organizations do not.

                                                 Starting January 1, 2020, vacation days will accrue on a daily basis. If you terminate employment, the amount of unused vacation
 Vacation Accruals
                                                 payout you will receive will be based on the amount of time accrued, less the time you have already used, as of your separation date.

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Explore What Fits Your Lifestyle - FIND THE RIGHT BENEFITS FOR YOU 2020 Benefits Guide - Halliburton
Who is Eligible                                               How to Enroll                                             Looking for HR Information Fast?
• All regular full-time employees working                     The Total Rewards site is the source for all of your      Check out HR4Hal! Our new online community is
  a minimum of 30 hours per week                              benefit needs, available from any device, anytime,        designed to help you find information quickly and easily.
                                                              anywhere. To enroll, first review your benefit options.   You can search for information, browse the latest HR
• All regular part-time employees working
                                                                                                                                                 offerings, and collaborate with
  a minimum of 20 hours per week
                                                                                                                                                 peers and HR subject matter
• Eligible dependents                                                                                                                            experts. Can’t find what you’re
Full-time employees classified as project-hire or temporary                                                                                      looking for? Post your question
are only eligible for the Consumer Choice Medical Plan                                                                                           to the community!
(CCP) after satisfying work hour requirements.                                                                                                   To access HR4Hal, simply enter
                                                                                                                                                 “HR4Hal” in the address bar
Spousal Medical Surcharge                                                                                                                        of your Internet Explorer (IE) or
                                                                                                                                                 Edge web browser when on the
If you elect coverage for your spouse under a                                                                                                    Halliburton network.
Halliburton medical program and your spouse has
medical coverage offered through his or her employer,
a $200 spousal medical surcharge will be added to your        When you’re ready to make your selections,                Health Care Claims Advocacy Service
monthly medical contribution each month on a pre-tax          follow the steps below:                                   Healthcare can be confusing – especially dealing with
basis, even if your spouse declines to participate in the                                                               claims issues. If you have problems that you can’t
                                                              1.    isit www.halliburton.com/totalrewards,
                                                                   V
other medical coverage.                                                                                                 get resolved, contact the Participant Advocates at the
                                                                   then log in with your user name and password.
The spousal medical surcharge does not apply if:                   Or, you can go to HR4Hal and search for the          Halliburton Benefits Center. This is a special service
                                                                   Human Resources Toolkit. In the Toolkit, click       offered to you and your covered dependents to provide
• You are enrolled in the Consumer Choice Plan (CCP)
                                                                   on the Employee Benefits link, then from the         assistance in resolving benefit issues such as:
• Your spouse is Medicare-eligible and does not have               Benefits home page, in the text box, click           • Resolve questions of denial of benefits
  coverage offered by his or her employer or retiree               “here” to single sign on and go directly to
  medical coverage through his or her former employer                                                                   • Correct balance/billing/payment problems
                                                                   the Total Rewards website.
• Your spouse is employed by Halliburton                                                                                • Resolve coordination of benefits disputes
                                                              2.   Click Health and Benefits to begin.
                                                                                                                          among multiple carriers
If your spouse does not have other coverage available,        3.   In the Annual Enrollment sidebar or the
you must certify that fact as a new hire and at each                                                                    • Assist with complaints regarding provider services
                                                                   upper left corner, select Get Started.
Annual Enrollment period or be financially responsible                                                                  • Support for the appeals process with health plans
for the surcharge.                                            4.   Click Start Your Enrollment.
                                                                                                                        If you are unable to resolve your questions or issues
                                                              5.   Enroll in your benefits.
                                                                                                                        after talking with the provider and/or the Claims
                                                                                                                        Administrator, contact Health Care Claims Advocacy. To
                                                                                                                        reach a Health Care Claims Advocate call the Halliburton
                                                                                                                        Benefit Center at 1-866-321-0964 or 1-857-362-5980,
                                                                                                                        7:30 a.m. to 7:30 p.m. Central Time, Monday-Friday.

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Explore What Fits Your Lifestyle - FIND THE RIGHT BENEFITS FOR YOU 2020 Benefits Guide - Halliburton
Other Helpful Information                                     When You Can Make Changes
on the Total Rewards Site                                     During the Year
• Elect to receive all of your benefit communications         You can enroll in or make changes to your benefits once
  electronically by clicking on the Health & Benefits icon.   per year, either during the Annual Enrollment period or
                                                              within 30 days of your hire date. However, there are
• Visit the Message Center to see emails or mailed
                                                              limited circumstances that allow you to make election
  communication from the Halliburton Benefits Center
                                                              changes during the coverage period, including a qualified
  (under Menu > My Account > Communications >
                                                              change-in-status. These include:
  Message Center > Personal Documents)
                                                              • Marriage
• Use your dashboard to visit provider websites and
  view your current benefits.                                 • Divorce
• Select “Change Your Benefits” to change your                • Birth
  elections after a qualified change-in-status life event.    • Adoption
• Select “Secure Chat” to chat privately with a               • Death of spouse/dependent                                      Need Help?
  customer service representative.
                                                              • Loss of other coverage
• Click on Health & Benefits under the Knowledge                                                                               Search… Check out HR4Hal, our new online search
  Center tab to find useful articles, tools and videos.       When you experience a qualified change-in-status or              engine designed to help you get quick answers to
                                                              other special event, be sure to call the Halliburton             your HR and benefits questions. You can access
Halliburton Total Rewards is available for your use both      Benefits Center or log on to Halliburton Total Rewards           HR4Hal from HalWorld.
during Annual Enrollment and throughout the year – use        and make any necessary changes within 30 days. You
it to access tools like the Benefits Guide, your Summary                                                                                           Talk... If you need to speak with
                                                              will be informed of any changes in your cost for benefits.
of Benefits Coverage and Summary Plan Description.                                                                                                 someone, call the Halliburton
                                                              If you do not make changes within 30 days of the event,
                                                              you will not be able to change your coverage until the                               Benefits Center at 1‑866‑321‑0964,
It’s Time to Review Your Beneficiaries!                       next Annual Enrollment period.                                                       (if dialing internationally, use your
                                                                                                                               country’s AT&T access number– to find your number,
Halliburton is encouraging everyone to review and
                                                                                                                               click here) or 1‑857‑362‑5980, 7:30 a.m. to 7:30 p.m.
update your beneficiaries by 2020. To review or make          Enrolling Your Dependents                                        Central Time, Monday – Friday.
changes, visit the following websites:
                                                              Even if you experience a life event such as a birth,
• Life and Accidental Death & Dismemberment                                                                                    Chat… Use the chat feature during normal business
                                                              your plans will not automatically add a new dependent
  www.halliburton.com/totalrewards                                                                                             hours by clicking on the Secure Chat link, located on
                                                              to your coverage. You must call or go online to add your
                                                                                                                               your health and benefits dashboard.
• Retirement Plan www.netbenefits.com                         dependents to the benefits they need within 30 days,
                                                              and then verify their eligibility by providing the appropriate
Please review and update your beneficiaries today!
                                                              documentation within 30 days. If you do not add your
                                                              dependent or verify your dependent’s eligibility, they will
                                                              not be covered, and your next opportunity to add them
                                                              will be during the next Annual Enrollment period.

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Explore What Fits Your Lifestyle - FIND THE RIGHT BENEFITS FOR YOU 2020 Benefits Guide - Halliburton
Health Benefits

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Explore What Fits Your Lifestyle - FIND THE RIGHT BENEFITS FOR YOU 2020 Benefits Guide - Halliburton
Medical
Halliburton offers you a choice of medical plans. Eligibility for all plans depends on your home ZIP code on file with the Halliburton Benefits Center.

• Basic Preferred Provider Organization (Basic PPO)                        • Standard Preferred Provider Organization (Standard PPO)                             • Consumer Choice Plan (CCP)
• Basic Deductible Medical Plan (Basic DMP)                                • Standard Deductible Medical Plan (Standard DMP)                                     • Consumer Choice Out-of-Area Plan (OOA)
The comparison charts below show the differences between each plan. Always remember that you can save money by using in-network providers.
Log on to www.halliburton.com/totalrewards for more information on your medical plan options.

 BASIC PPO, STANDARD PPO AND CONSUMER CHOICE PLAN (CCP) AT-A-GLANCE

                                                                           Basic PPO                                                 Standard PPO                                                        CCP

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

  Individual Deductible                                                  $800                          $800                         $1,500                        $1,500                       $2,700*                        $2,700*

  Family Deductible                                                    $1,600                        $1,600                        $3,000                         $3,000                         $5,400                        $5,400

  HALLIBURTON CONTRIBUTION
                                                                                N/A                                                          N/A                                                    Up to $1,200
  TO YOUR HSA

  Individual Out-of-Pocket
                                                                       $4,250                        $8,500                         $4,250                        $8,500                         $4,750                        $9,500
  Maximum

  Family Out-of-Pocket Maximum                                         $8,500                       $17,000                         $8,500                       $17,000                         $9,500                       $19,000

                                                                                                  50% of                                                      50% of                                                        50% of
  Co-Insurance (Paid by Plan)                                             70%                                                         80%                                                          80%
                                                                                          allowed amount                                              allowed amount                                                allowed amount

  Routine Office Visit                                                                           50% after                                                   50% after                      80% after                      50% after
                                                                          70%                                                         80%
  (Primary Care/Specialist)                                                                      deductible                                                  deductible                     deductible                     deductible

  Emergency Room**                                            $200 plus 70% after deductible                               $200 plus 80% after deductible                                      80% after deductible

  Annual Physical Exam/                                                                          50% after                                                   50% after
                                                                        100%                                                         100%                                                         100%                            50%
  Preventive Care                                                                                deductible                                                  deductible

*Due to inflation adjustments in the IRS code, the 2020 CCP and CCP Out-Of-Area plans must have an annual deductible that is not less than $2,800 for family coverage. In 2020, if you have family members on the plan, the individual
deductible will increase from $2,700 to $2,800. Each family member must meet $2,800 until the total amount of deductible expenses paid by all family members meets the overall family deductible of $5,400.

**Emergency Room copay waived if admitted.

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Explore What Fits Your Lifestyle - FIND THE RIGHT BENEFITS FOR YOU 2020 Benefits Guide - Halliburton
BASIC DMP, STANDARD DMP AND CONSUMER CHOICE OUT-OF-AREA PLAN AT-A-GLANCE

                                                                                                   Basic DMP                                                Standard DMP                                    CCP Out-of-Area

                                                                                In-Network                      Out-of-Network               In-Network                     Out-of-Network                             Out-of-Area

    Individual Deductible                                                                $800                                  $800                $1,500                               $1,500                               $2,700*

    Family Deductible                                                                  $1,600                               $1,600                 $3,000                               $3,000                                 $5,400

    HALLIBURTON CONTRIBUTION TO YOUR HSA                                                                N/A                                                         N/A                                        Up to $1,200

    Individual Out-of-Pocket Maximum                                                   $4,250                               $4,250                 $4,250                               $4,250                                 $4,750

    Family Out-of-Pocket Maximum                                                       $8,500                               $8,500                 $8,500                               $8,500                                 $9,500

    Co-Insurance (Paid by Plan)                                                           70%                                  70%                    80%                                  80%                                   80%

    Routine Office Visit (Primary Care/Specialist)                                        70%                                  70%                    80%                                  80%               80% after deductible

    Annual Physical Exam/Preventive Care                                                100%                                  100%                   100%                                 100%                                  100%

*Due to inflation adjustments in the IRS code, the 2020 CCP and CCP Out-Of-Area plans must have an annual deductible that is not less than $2,800 for family coverage. In 2020, if you have family members on the plan, the individual
deductible will increase from $2,700 to $2,800. Each family member must meet $2,800 until the total amount of deductible expenses paid by all family members meets the overall family deductible of $5,400.

What is the DMP?
DMP stands for Deductible Medical Plan. If you live in a ZIP code that is considered “out-of-area” based on the provider network, then you will automatically be enrolled in one of the
DMPs. The DMP pays benefits at the network level, even though you live outside of the network, which helps save you money on healthcare costs.

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Explore What Fits Your Lifestyle - FIND THE RIGHT BENEFITS FOR YOU 2020 Benefits Guide - Halliburton
Prescription Drug Coverage — All Plans*
  PRESCRIPTION DRUG COVERAGE AT-A-GLANCE

                                                                                   Basic and Standard PPO/DMP                             CCP/CCP Out-of-Area                            CCP

                                                                                                                                                     In-Network            Out-of-Network**

  Prescription Drug Deductible                                                                                            $50          Medical deductible applies   Medical deductible applies

  RETAIL PHARMACY: Prescription Drug Coverage – You Pay***

  Generic 30-Day Supply                                                                                                   $15               20% after deductible         50% after deductible

                                                                                                                          25%
  Preferred Brand 30-Day Supply                                                                                                             20% after deductible         50% after deductible
                                                                                    Minimum: $25/Maximum: $100

                                                                                                                          45%
  Nonpreferred Brand 30-Day Supply                                                                                                          20% after deductible         50% after deductible
                                                                                    Minimum: $45/Maximum: $100

  MAIL PHARMACY: Prescription Drug Coverage – You Pay

  Generic 90-Day Supply                                                                                                   $30               20% after deductible         50% after deductible

                                                                                                                          25%
  Preferred Brand 90-Day Supply                                                                                                             20% after deductible         50% after deductible
                                                                                    Minimum: $65/Maximum: $200

                                                                                                                          45%
  Nonpreferred Brand 90-Day Supply                                                                                                          20% after deductible         50% after deductible
                                                                                   Minimum: $115/Maximum: $250

                                                                                                                          35%
  Specialty Pharmacy****                                                                                                                    20% after deductible         50% after deductible
                                                                                    Minimum: $30/Maximum: $300

* Refer to the Summary Plan Description (SPD) for information on prescription drug coverage out-of-pocket maximums.
** Out-of-Network subject to reasonable and customary limits.
*** Maximum of two fills of a maintenance medication at a retail pharmacy; for additional fills, you pay the full cost.
****Minimum and maximum copay amounts depend on day supply.

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Explore What Fits Your Lifestyle - FIND THE RIGHT BENEFITS FOR YOU 2020 Benefits Guide - Halliburton
How the Consumer Choice Plan (CCP) Works
The Consumer Choice Plan has the lowest premiums of any of your plan options, and it may enable you to
contribute to a tax-free Health Savings Account (HSA) – a combination that can help you build up savings over time.
Here’s how it works:
Step 1: Preventive care is covered at 100% in-network. Certain maintenance medications are also covered at
100%, but you pay the full cost of the remainder of your medical care until you reach your deductible. You can use
the funds in your HSA or your Limited Purpose Health Care FSA (vision and dental costs only) to cover these costs.
Step 2: Your expenses are offset by the contribution Halliburton makes to your HSA and the tax savings you
gain when you contribute your own funds.
Step 3: Once you meet the annual deductible, you share the cost of services by paying a percentage
(called co-insurance) for covered health care expenses and prescription drugs.

Step 4: You pay co-insurance until you reach the annual out-of-pocket maximum. You can use the funds in your
HSA or your Limited Purpose Health Care FSA to cover these after deductible co-insurance costs.

Step 5: After you reach your annual out-of-pocket maximum, the plan pays 100% of covered costs for the
remainder of the year. If you go out-of-network for care, you may incur additional costs that are not included in the
out-of-pocket maximum. Like other medical expenses, these costs can be paid using the balance in your HSA.

How the Health Savings Account (HSA) Works
                                                                                                                          HSA by the Numbers
The HSA is a savings account used to pay for qualifying health care. Anyone enrolled in the Halliburton CCP may be                                                            $7,100
                                                                                                                              $7,000
eligible to take advantage of the HSA and receive company contributions, deposited on a prorated basis throughout
                                                                                                                                                                                       $1,200
the year. You may not be eligible to contribute to an HSA if you have other health coverage in addition to the CCP.           $6,000
You may also contribute your own funds to your HSA on a pre-tax basis.
                                                                                                                              $5,000
You must elect a new contribution amount each year. The HSA contribution amount you elected in a
previous year will not roll over. If you are age 55 or older, you can contribute an additional $1,000 annually to your        $4,000
                                                                                                                                                       $3,550
HSA. There is no limit on how much money you can accumulate and roll over from year to year!
                                                                                                                              $3,000                            $600                   $5,900
Once your Fidelity HSA balance reaches $1,000, it is eligible for a self-directed investment account where you choose
                                                                                                                              $2,000
your investments. Investment accounts link directly to your HSA for easy movement of funds back and forth. Through
                                                                                                                                                                $2,950
an investment account, you have access to a wide range of fund choices to suit your individual needs and financial
goals. The funds are managed by JP Morgan, Wells Fargo, Fidelity, PIMCO and others. Fidelity has a number of funds
with no investment minimum.                                                                                                                           2020 Individual       2020 Employee +
                                                                                                                                                      Contribution          Dependent(s)
Note: This is a sample list of fund providers; your specific options may vary. You can view your personal funds options                               Amounts               Contribution Amounts

by accessing your online account.                                                                                           Halliburton’s Contributions If You Open an HSA with Fidelity
                                                                                                                            Your Maximum Allowed Contributions
                                                                                                                            Total Maximum Contributions for 2020

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Other Programs
Autism Benefits                                                                                                           Teladoc
Halliburton offers enhanced coverage for Applied                                                                          When you have an injury or illness, Halliburton offers
Behavior Analysis (ABA), an effective, proven treatment                                                                   an alternative to visiting your doctor’s office for care.
for individuals suffering from Autism Spectrum Disorder.                                                                  With Teladoc, you can talk with a qualified doctor over
This benefit is available for pre-certified participants.                                                                 the phone and receive treatment for your condition –
                                                                                                                          all from the comfort of your own home.
If you have a covered family member with an Autism
Spectrum Disorder diagnosis who is in ABA care
now, please call Beacon Health Options, your ABA
administrator, at 1-800-769-3041. Provide Beacon with
your current provider’s name and contact information.
If your provider is in the Beacon network, all you need
to do is continue care and the in-network provider will
submit claims and obtain precertification.
If your provider is not in the Beacon ABA network,             Infertility Benefits
then Beacon will reach out to your ABA provider and            Halliburton provides assistance for employees struggling
determine if they can be added to the Beacon network.          with infertility. You have access to up to $20,000 of
The Beacon representative will also explain a special          covered services for each enrolled individual,
90-day transition plan for moving to a new provider, if your   per lifetime. Infertility coverage includes:
current provider chooses not to join Beacon’s network.                                                                    This service is not an alternative to your regular
                                                               • Evaluation and basic medical workups
For questions, contact Beacon at 1-800-769-3041                                                                           medical provider, but it is an excellent way to
                                                               • Artificial Insemination (AI) or                          access acute, non-emergency care at any time.
or the Halliburton Employee Assistance Program
                                                                 Intrauterine Insemination (IUI)                          A copay will apply for each use of Teladoc based
at 1-866-761-4540.
                                                               • Reproductive procedures, including                       on your medical plan, and will apply toward your
                                                                 In-Vitro Fertilization (IVF)                             out-of-pocket maximum:

                                                               • Therapeutic drugs including self-injectable options      • PPO or DMP: $10 copay per call

                                                               • Egg, embryo and sperm cryopreservation,                  • CCP: $40 fee per call
                                                                 thawing transfer and storage
                                                               Coverage does not include experimental or
                                                               unproven procedures.
                                                               For details on your infertility benefits, contact BCBSTX
                                                               at 1-800-521-2227.

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TAKE ACTION WITH
PREVENTIVE CARE
Preventive care is covered at 100% in-network, but
that’s not the only reason to get your annual checkup.
Preventive care can catch many conditions early,
sometimes before symptoms even begin.

Urgent Care vs. Emergency Room
When an illness or injury strikes, it’s important to know
where to go to get the care you need, when you need
it. If it can’t wait for an appointment with your regular
doctor, think about visiting:
• A
   n urgent care center – A much less expensive
  option than an emergency room, urgent care should
  be used for medical situations which are serious, but
  not quite emergencies. When looking for urgent care
  centers, watch out for “freestanding” emergency
  rooms. These may have the same look and feel of
  urgent care centers, but will charge you emergency
  room prices if you receive care there.
• T
   he emergency room – Serious, life-threatening
  issues should be treated at an emergency room.
  It is the most expensive option for care, and you
  may be in for a long wait depending on your condition.
                                                            Airrosti Pain Management
  If your issue is not an emergency, consider urgent        You can access a safe and highly effective alternative to
  care instead.                                             surgery, pain management, and long-term chiropractic
                                                            or physical therapy treatment programs through Airrosti.
No matter what kind of care you require, you’ll always
                                                            Services are covered at the in-network rate through
save money by staying in-network. That’s because in-
                                                            BCBSTX. Airrosti can help with conditions including back
network providers have agreed to offer services at lower
                                                            pain, carpal tunnel syndrome, headaches and migraines.
prices. You can easily find in-network providers using the
                                                            To find an Airrosti provider, visit www.airrosti.com.
BCBSTX provider finder app, available on both the Apple
App Store and Google Play for Android.

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LiveWell Tobacco Cessation Program
Halliburton supports you in your quest to be tobacco-        Employees hired prior to January 1, 2020 must complete
free. Tobacco-free employees receive a 50% medical           the program’s requirements between January 1, 2020
premium discount! To qualify for this discount, you          and April 30, 2020. Employees hired on or after that
must certify that:                                           date must complete the program’s requirements within
1.   You and your spouse, if applicable, have not            4 months of their hire date.
     used tobacco products in the last 12 months.            To enroll in the Tobacco Cessation Coaching Program, call
2.   You will continue to avoid tobacco products             1-877-278-5244, Monday - Thursday 7:00 a.m. to 10:00
     as long as you receive this incentive.                  p.m., Friday, 7:00 a.m. to 6 p.m., and Saturday, 10:00
                                                             a.m. to 2:00 p.m. Central Time, or visit the Halliburton
These certifications are subject to the Halliburton Code
                                                             Total Rewards website at www.halliburton.com/
of Business Conduct.
                                                             totalrewards and click the LiveWell icon on the
If you can’t certify that you and your spouse are tobacco-   scrolling toolbar to schedule your call online. Virgin Pulse
free, you may qualify for an opportunity to earn the same    coaches are certified experts who will work with you
premium discount by identifying yourself and/or your         by phone to help answer your health questions and set
spouse as a tobacco user during Annual Enrollment,           goals for becoming tobacco-free. You can also enroll
or upon hire, by choosing “Yes” to the election              in the Tobacco Free Journey by visiting the Halliburton
commitment to enroll in and complete the LiveWell            Total Rewards site and clicking the LiveWell icon on the
Tobacco Cessation Program.                                   scrolling toolbar.
To complete the program, you and/or your spouse have         If it is medically inadvisable for you to complete the
the choice to complete either four coaching calls or         telephone coaching program or the online Tobacco
the online Tobacco Free Journey through the LiveWell         Free Journey, we will work with you (and, optionally,
Tobacco Cessation program. Your receipt of the non-          with your doctor) to develop another way for you
tobacco user incentive is subject to verification of         to earn the incentive. We will accommodate your
your completion of the program. If you do not meet           doctor’s recommendations regarding what is medically
the requirements, you will lose the non-tobacco              appropriate for you. Get the Virgin Pulse mobile app to
user incentive, and your medical and any optional life       access all of the LiveWell Tobacco Cessation Program
insurance payroll contributions will be updated to the       tools and resources to help you improve your health —
tobacco rate.                                                on the go!

                                                                             BACK        TOC      NEXT                      13
Flexible Spending Accounts (FSAs)
FSAs help you save money on your taxes by allowing you to use pre-tax dollars to pay for eligible medical and dependent day care expenses. Here is an overview
of the different types of accounts available to you. Note that any FSA funds not used by December 31, 2020 will be forfeited.

  FLEXIBLE SPENDING ACCOUNTS AT-A-GLANCE

          Account                Can Be Used By         Annual Contribution Amounts                            Eligible Expenses                         When Funds Are Available

                                                                                                               Medical deductibles and co-insurance
                                     Employees in                                                                                Dental deductibles
                                                                                                                                                             Full amount is available
  Health Care FSA                     the DMP or                        $120 to $2,700                              Non-cosmetic dental treatments
                                                                                                                                                                    January 1, 2020
                                       PPO Plans                                                                                   Laser eye surgery
                                                                                                                                         Vision care

                                                                                              Medical expenses after you meet your CCP deductible
  Limited Purpose                Employees in the                                                                                                            Full amount is available
                                                                        $120 to $2,700        Dental deductible and non-cosmetic dental treatments
  Health Care FSA                       CCP Plan                                                                                                                    January 1, 2020
                                                                                                                                    Vision expenses

                                                                                                                                   Day care centers
                                                                                                                        Elder/dependent care facility
  Dependent Day Care            All benefits-eligible                                                                                                     Funds available as they are
                                                                        $120 to $5,000                                                 Private sitters
  FSA                                   employees                                                                                                        deposited into your account
                                                                                                                        Nursery school or preschool
                                                                                                                                          Day camp

                                                              FSA DEBIT CARD
                                                              The Health Care and Limited Purpose FSAs come                   A valid receipt must show the date of purchase or
                                                              with a debit card that you can use to pay for expenses.         service, amount of purchase or service, description
                                                              If you use your card for payments, be sure to save              of item or service, name of merchant or service
                                                              your receipts. You may be required to confirm that you          provider and name of patient. Documentation can
                                                              used your card to pay for an eligible expense. If you           be submitted through ConnectYourCare’s website,
                                                              cannot or do not provide documentation (your receipt)           www.connectyourcare.com, or through the
                                                              supporting the eligible expense, your card will be              ConnectYourCare mobile app.
                                                              suspended and the unsupported expense could be
                                                              taxed as a result. Your Explanation of Benefits, which
                                                              you will receive from your medical or dental provider,
                                                              can also serve as documentation.

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Dental
You have two dental coverage options: the Dental Preferred Provider Organization (DPPO) and the Dental Health Maintenance Organization (DHMO). To enroll in the DHMO,
you must live in an eligible DHMO area.
The DPPO allows you to choose any dentist, whether in or out-of-network; however, out-of-network service costs more. With the DHMO, you will only receive benefits when
you visit in-network providers. You must choose a primary care dentist — if you do not choose one, the DHMO will appoint one for you; however, you can contact Cigna at a
later date to choose a different primary care dentist.

  BENEFIT PROVISIONS (IN-NETWORK)

                                                                                       DPPO                                                           DHMO

                                                                            In-Network                       Out-of-Network

  Individual Deductible                                                             $50                                   $50                                               None

  Preventive Services                                                    100% Covered                           90% Covered                                        100% Covered

  Basic Services                                                   80% after deductible                  50% after deductible                                    Copay structure*

  Major Services                                                   50% after deductible                  50% after deductible                                    Copay structure*

  Orthodontia/Lifetime Maximum                                            50% / $1,500                          50% / $1,500                Copay structure / 24-month treatment*

  Annual Maximum                                                                 $1,500                               $1,500                                                None

  * Visit the HR4Hal community for DHMO copays.

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Vision
     Vision coverage helps you manage the cost of routine eye care expenses like exams,
     contact lenses and eyeglasses for you and your eligible dependents.

                                                                                      In-Network                               Out-of-Network

       Eye Exam (One per calendar year)                                               100% after $10 copay                    Up to $50 after $10 copay

       Prescription Glasses*
       Lenses
       – Single Vision                                                                100% after $20 copay                    Up to $50 after $20 copay
       – Lined Bifocal                                                                100% after $20 copay                    Up to $75 after $20 copay
       – Lined Trifocal                                                               100% after $20 copay                   Up to $100 after $20 copay

                                                                              Up to $170 allowance after
       Frames (One per calendar year)                                       $20 copay; 20% discount off                       Up to $70 after $20 copay
                                                                                 amount over allowance

       Contact Lenses instead of                                               Up to $150 allowance for
       prescription glasses                                                contacts; up to $60 copay on                           Up to $105 allowance
       (not medically necessary)*                                            contact lens fitting exam**

                                                                            100% after $20 copay when                      Up to $210 after $20 copay
       Medically Necessary Contact Lenses***
                                                                               specific criteria are met                  when specific criteria are met

                                                                                Medical eyecare services
                                                                                  related to Type 1 and 2
       Diabetic Eyecare Program                                                                                                            Not covered
                                                                                 diabetes; $20 copay for
                                                                                  medical eyecare exam

      * One pair of prescription glasses or contacts every plan year, beginning in January, but not both in the same year.
      ** Fitting and evaluation to ensure the proper fit of contact lens materials.
      *** These conditions include aphakia, anisometropia, high ametropia, nystagmus, keratoconus and correction of
      extreme visual acuity problems that are not correctable with glasses, and following cataract surgery.

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Income Protection
       Benefits

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Life Insurance/Accidental Death & Dismemberment
LIFE INSURANCE
Life Insurance provides financial protection for you and your family in the event of a covered death. Basic coverage is
company-paid and is equal to your annual benefit base pay, up to $50,000. You may choose to purchase extra coverage
for yourself and your family. Remember, when you reach the next age band, you will receive a modest cost increase.

  Coverage                                                                                                          Optional Life Insurance

                                                                                   Increments of 1 to 8 times annual benefit base pay,
  Employee*
                                                                                             up to $3 million including basic coverage

                                                                                  $10,000, or from ½ to 3½ times employee’s annual
  Spouse*                                                                                benefit base pay; coverage may not exceed
                                                                                  employee coverage, or $250,000, whichever is less.

  Child(ren) under age 25                                                                                                     $10,000 per child

 * May require evidence of insurability (EOI).
 ENROLLMENT FOR DEPENDENTS: If you elect voluntary life coverage for a spouse or child, you will now be required to provide dependent eligibility
  verification documents.

                                                                                                                                                     Long-Term Disability
ACCIDENTAL DEATH AND DISMEMBERMENT (AD&D)
Halliburton provides basic AD&D coverage at no cost to you, equal to your annual base pay, up to $200,000.
                                                                                                                                                     (LTD) Insurance
You may choose to purchase extra coverage for yourself and your family.                                                                              Halliburton provides employees with basic LTD to assist
                                                                                                                                                     you with a portion of your income if you become ill or
                                                                                                                                                     injured and cannot work. LTD begins paying monthly
  Coverage                                                                                                                    Optional AD&D
                                                                                                                                                     benefits when you have been continuously disabled for
                                                                                                                                                     an approved 26 weeks.
                                                                                   Increments of $50,000, up to $1 million or 10 times
  Employee*
                                                                                     your annual benefit base pay — whichever is less.
                                                                                                                                                             Coverage                  Optional LTD
                                                                                            Increments of $50,000, up to $1 million or
  Spouse*                                                                       10 times your annual benefit base pay — whichever is                    Basic LTD                      40% of your income
                                                                                    less. May not exceed employee coverage amount.
                                                                                                                                                                                      An additional 10% or
  Child(ren) under age 25                                                                                                    $50,000 per child         Additional Coverage
                                                                                                                                                                                      20% of your income
 * May require evidence of insurability (EOI).
                                                                                                                                                       Maximum Benefit                 $25,000 per month

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Work/Life Benefits

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Employee Assistance
Program (EAP)
Halliburton strongly encourages you to take
advantage of the EAP, which can help you and
your eligible dependents work through a variety
of personal difficulties. Some of the issues the
EAP can assist with include:
• Depression, stress, anxiety, worry and guilt
• Communication issues
• Parent/child relations
• Marriage and family issues,
  including separation and divorce
• Alcohol and drug problems
• Personal tragedy, grief and bereavement
EAP services are free and confidential. You will work
with a trained professional who will make a preliminary
assessment of your needs in person or over the phone.
EAP counselors will either help you directly or refer you to
the appropriate resources. Call the EAP at 1-281-575-3200
or 1-866-761-4540, or access the EAP resources online at
www.achievesolutions.net/halliburton.

Flex Days
During Annual Enrollment, you have the opportunity
to purchase extra days off. However, it is important to
discuss any vacation plans with your manager before
purchasing flex days. You must re-elect flex days each
year during enrollment – they will not automatically
carry over into the next year. Any unused flex days will
be forfeited at the end of the year, even if you had a
change to your work schedule.

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Leave of Absence:
                                                                                                               Medical and Paid Bonding
                                                                                                               Halliburton supports your need to take a leave of
                                                                                                               absence from work for medical reasons or family
                                                                                                               bonding time. We assist you financially by offering
                                                                                                               the medical and bonding leave of absence programs,
                                                                                                               which cover all or a portion of your pay while you
                                                                                                               are out, if you are eligible.

                                                                                                               Service Requirement for Paid Leave
                                                                                                               You are required to have completed 6 months of service
                                                                                                               (from your most recent date of hire) to be eligible for
                                                                                                               any leave of absence with pay. This includes:
                                                                                                               • Medical Leave of Absence (MLOA)
                                                                                                               • Paid Bonding Leave

                                                                                                               Medical Leave of Absence
                                                                                                               Pay Schedule

Halliburton Family Care Program                                                                                Paid medical leave of absence is paid based on the
                                                                                                               following tiers (as described further in our policies).
The Family Care Program supports Halliburton families with a variety of enhanced benefits, including:          For questions regarding any leave of absence program,
• Five Dependent Sick Days: After six months of service with Halliburton, you may use up to five days          contact FHOUMEDICAL@halliburton.com.
  of paid time off to care for a member of your immediate family.
• Enhanced Adoption Assistance: Halliburton now provides a lifetime maximum reimbursement
  of $20,000 per employee for adoption expenses.                                                                 Weeks of Leave                      Percentage of Pay
• Paid Bonding Benefit: You may be able to elect either eight weeks of paid parental bonding leave, or
                                                                                                                 1-8                                               100%
  a payment of two weeks’ salary in lieu of taking a paid leave within 30 days of a birth or final adoption.
• NEW Backup Dependent Care Coverage: Halliburton offers employees up to 5 days of backup care                   9-16                                                80%
  assistance annually. Your Bright Horizons Back-Up Care™ benefit can find a welcoming child care center
  or wonderful in-home caregiver when you need one.                                                              17-26                                               60%
• Family Care Program Advisor: You have access to a single point of contact, who can provide education
  and guidance to help you understand your Halliburton benefits and resources.

For more information on your family care benefits, contact the Program at FHOUFAMILY@halliburton.com.

                                                                                  BACK        TOC      NEXT                                                              21
Retirement Benefits

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The Halliburton Retirement & Savings Plan
The Halliburton Retirement & Savings Plan is designed to help you build your retirement account for when it’s time to          Discretionary Company Contribution
finally retire and relax. You contribute to the plan, and Halliburton provides matching contributions. The Company matches
                                                                                                                               Each year by December 31, the Company will determine
the first 4% of the income you contribute to your account, and 50 cents per dollar for the next 2%, for a total match of 5%.
                                                                                                                               if an additional discretionary contribution will be made
                                                                                                                               to employee’s retirement accounts. If this contribution
                                                                                                                               is made, it will be calculated as a percentage of your
   1% - 4% of Eligible Annual Pay               5% - 6% of Eligible Annual Pay
                                         +                                           =      5% Maximum Total Match             annual eligible pay. Because it’s not always easy to set
    Matched dollar for dollar                   Matched 50 cents per dollar
                                                                                                                               aside money for retirement, any such contribution will be
 If you choose not to contribute at least 6% of your earnings into your account, you’re leaving money on the table.            deposited into your account regardless of whether or not
                                                                                                                               you are making contributions to the plan.

                                                                                                                               Investment Options
                                                                                                                               The Halliburton Retirement & Savings Plan offers two
                                                                                                                               types of investment options:
                                                                                                                               • Target Date Portfolios – This can help take the
                                                                                                                                 guesswork out of selecting investment options.
                                                                                                                                 They can help balance out your investment risks by
                                                                                                                                 rebalancing them as you move throughout your career
                                                                                                                                 and get closer to reaching your retirement age.
                                                                                                                               • Single Focus Strategies – You can choose to build
                                                                                                                                 and manage your own portfolio by choosing from 10
                                                                                                                                 different options.
                                                                                                                               You can always find investment and plan information at
                                                                                                                               www.halliburton.com/totalrewards, where you can
                                                                                                                               view your account and investment choices at any time.

                                                                                 BACK         TOC     NEXT                                                                            23
Important Contacts
            & Legal Notices

24   BACK   TOC   NEXT
Important Contacts
                                                                            866-321-0964
                                                    International: Use your country’s A&T
Halliburton Benefits Center                                 access code or 857-362-5980
                                                       www.halliburton.com/totalrewards

Medical – BlueCross BlueShield of Texas   800-521-2227 or 804-673-1177 (outside the U.S.)
Policy #054632                                               www.bcbstx.com/halliburton

                                                                     Phone 800-835-2362
Telemedicine – Teladoc
                                                                        www.teladoc.com

                                                                       800-669-3589 or
Prescription Drugs – Express Scripts                   AT&T access code +800-497-4641
Retail Drug Policy #HALESGRX                                          (outside the U.S.)
Mail Order Drug Policy #HALESGRX
                                                                www.express-scripts.com

Dental – Cigna                                                              800-244-6224
HMO Policy #3174656
PPO Policy #3174656                                                    www.mycigna.com

Vision – Vision Service Plan                                                 800-877-7195
Policy #12056558                                                            www.vsp.com

                                                                             866-321-0964
Health Savings Account – Fidelity
                                                                    www.netbenefits.com

                                                                            877-292-4040
                                                         Fax documents to: 443-681-4601

Flexible Spending Accounts (FSAs) –                                       Mailing Address:
ConnectYourCare                                          307 International Circle Suite 200
                                                                   Hunt Valley, MD 21030
                                                                              410-891-1000
                                                              www.connectyourcare.com

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Important Contacts
 Life Insurance – Securian Financial                                                       866-293-6047
 Policy #33781                                                                     www.lifebenefits.com

 AD&D – Life Insurance Company of North America,
                                                                                           800-238-2125
 a Cigna Company
                                                                                        www.cigna.com
 Policy #OK980004

 Long-Term Disability – Life Insurance Company of
                                                        800-352-0611 or 610-758-7001 (outside the U.S.)
 North America, a Cigna Company
                                                                                        www.cigna.com
 Policy #FLK980049

                                                                          281-575-3200 or 866-761-4540
 Employee Assistance Program
                                                                   www.achievesolutions.net/halliburton

 Mental Health and Substance Abuse Program –                                               800-769-3041
 Beacon Health Options                                                   www.beaconhealthoptions.com

                                                                                           877-278-5244
 LiveWell Wellness Program – Virgin Pulse
                                                                   www.join.virginpulse.com/halliburton

                                                                                           866-321-0964
 Retirement & Savings Plan – Fidelity
                                                                                   www.netbenefits.com

                                                                                           866-321-0964
                                                    International: Use your country’s A&T access code or
 Leave of Absence Program – ReedGroup                                                      857-362-5980
                                                                      www.halliburton.com/totalrewards
                                                                        FHOUMEDICAL@halliburton.com

 Family Care Program                                                     FHOUFAMILY@halliburton.com

                                                                            1-877-BH-CARES (242-2737)
 Backup Dependent Care Program
                                                            https://clients.brighthorizons.com/halliburton

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Compliance and Legal Notices
This communication provides a brief overview of           There are no guarantees that participation under the           The Women’s Health and Cancer
the benefit choices that will be offered to eligible      benefit plans described in this material will remain           Rights Act of 1998
Halliburton U.S. employees for 2020. It is not a          unchanged in future years. Halliburton reserves the
                                                                                                                         Under Halliburton’s Medical Program, coverage will
complete description of the choices or a complete         right to change, suspend, amend or terminate the plans
                                                                                                                         be provided to an employee or covered dependent
description of the plans. Detailed information is         described in this material at any time, in whole or in part.
                                                                                                                         who is receiving benefits for a medically necessary
available in your Summary Plan Description.               This means that the plans may be:
                                                                                                                         mastectomy and who elects breast reconstruction
                                                          • Discontinued in their entirety,                              after the mastectomy for:
For questions about your benefits, please contact the
Halliburton Benefits Center, Monday through Friday,       • Changed to provide different levels of benefits,             • Reconstruction of the breast on which a
at 1-866-321-0964 (if dialing internationally, use your   • Changed to provide for different cost sharing between          mastectomy has been performed,
country’s AT&T access number), or 1-857-362-5980,           the Company and participants, or                             • Surgery and reconstruction of the other
from 7:30 a.m. to 7:30 p.m. Central Time. You can also
                                                          • Changed in any other way.                                      breast to produce a symmetrical appearance,
log on to www.halliburton.com/totalrewards for
information or to initiate a private chat session.        Any such change or termination shall be solely at the          • Prostheses, or
                                                          discretion of the Company. You will be notified if any         • Treatment of physical complications of all states
Every effort has been made to provide clear and           such change or termination occurs.                               of mastectomy, including lymphedemas.
accurate information about Halliburton’s benefit plans.
However, in the event of a discrepancy between these                                                                     This coverage will provide benefits in consultation
materials, the Plan’s Summary Plan Description, and                                                                      with the attending physician and the patient, and will
the other official Plan documents, the other official                                                                    be subject to the same deductibles and co-insurance
Plan documents will govern.                                                                                              provided for the mastectomy.

                                                                                                                         IRS Form 1095-C
                                                                                                                         If you are enrolled in the Halliburton medical plan,
                                                                                                                         a 1095-c tax form will be issued to you and,
                                                                                                                         if applicable, your covered dependents.

                                                                          BACK        TOC      NEXT                                                                               27
Premium Assistance Under Medicaid                              If you live in one of the following states, you may be
and The Children’s Health Insurance                            eligible for assistance paying your employer health plan
Program (CHIP)                                                 premiums. The following list of states is current as of
                                                               July 31, 2019. Contact your state for more information
If you or your children are eligible for Medicaid or
                                                               on eligibility.
CHIP and you’re eligible for health coverage from your
employer, your state may have a premium assistance
program that can help pay for coverage, using funds              ALABAMA – Medicaid
from their Medicaid or CHIP programs. If you or your
children aren’t eligible for Medicaid or CHIP, you won’t         Website: http://myalhipp.com/
be eligible for these premium assistance programs but            Phone: 1-855-692-5447
you may be able to buy individual insurance coverage
through the Health Insurance Marketplace. For more               ALASKA – Medicaid
information, visit www.healthcare.gov.
                                                                 The AK Health Insurance Premium Payment Program
If you or your dependents are already enrolled in
                                                                 Website: http://myakhipp.com/
Medicaid or CHIP and you live in a state listed below,
                                                                 Phone: 1-866-251-4861
contact your state Medicaid or CHIP office to find out if
                                                                 Email: CustomerService@MyAKHIPP.com
premium assistance is available.
                                                                 Medicaid Eligibility:
If you or your dependents are NOT currently enrolled             http://dhss.alaska.gov/dpa/Pages/medicaid/default.aspx
in Medicaid or CHIP, and you think you or any of your
dependents might be eligible for either of these                 ARKANSAS – Medicaid
programs, contact your state Medicaid or CHIP office or
dial 1-877-KIDS-NOW or www.insurekidsnow.gov to                  Website: http://myarhipp.com/
find out how to apply. If you qualify, ask your state if it      Phone: 1-855-MyARHIPP (855-692-7447)
has a program that might help you pay the premiums for
an employer-sponsored plan.                                      COLORADO – Health First Colorado (Colorado’s
                                                                 Medicaid Program) & Child Health Plan Plus (CHP+)
If you or your dependents are eligible for premium
assistance under Medicaid or CHIP, as well as eligible           Health First Colorado Website:
under your employer plan, your employer must allow               https://www.healthfirstcolorado.com/
you to enroll in your employer plan if you aren’t already        Health First Colorado Member Contact Center:
enrolled. This is called a “special enrollment” opportunity,     1-800-221-3943/ State Relay 711
and you must request coverage within 60 days of being            CHP+: Colorado.gov/HCPF/Child-Health-Plan-Plus
determined eligible for premium assistance. If you have          CHP+ Customer Service: 1-800-359-1991/
questions about enrolling in your employer plan, contact         State Relay 711
the Department of Labor at www.askebsa.dol.gov or
call 1-866-444-EBSA (3272).

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FLORIDA – Medicaid                                       MAINE – Medicaid

Website: http://flmedicaidtplrecovery.com/hipp/          Website: http://www.maine.gov/dhhs/ofi/public-
Phone: 1-877-357-3268                                    assistance/index.html
                                                         Phone: 1-800-442-6003
GEORGIA – Medicaid
                                                         MASSACHUSETTS – Medicaid and CHIP
Website:
https://dch.georgia.gov/documents/medicaid-eligibility   Website:
Click on Health Insurance Premium Payment (HIPP)         http://www.mass.gov/eohhs/gov/departments/
Phone: 404-656-4507                                      masshealth/
                                                         Phone: 1-800-862-4840
INDIANA – Medicaid
                                                         MINNESOTA – Medicaid
Healthy Indiana Plan for low-income adults 19-64
Website: http://www.in.gov/fssa/hip/                     Website:
Phone: 1-877-438-4479                                    http://mn.gov/dhs/people-we-serve/seniors/health-
All other Medicaid                                       care/health-care-programs/programs-and-services/
Website: http://www.indianamedicaid.com                  medical-assistance.jsp
Phone 1-800-403-0864                                     Phone: 1-800-657-3739

IOWA – Medicaid                                          MISSOURI – Medicaid

Website: http://dhs.iowa.gov/hawk-i                      Website:
Phone: 1-800-257-8563                                    http://www.dss.mo.gov/mhd/participants/pages/hipp.htm
                                                         Phone: 573-751-2005
KANSAS – Medicaid

Website: http://www.kdheks.gov/hcf/                      MONTANA – Medicaid
Phone: 1-785-296-3512
                                                         Website: http://dphhs.mt.gov/
KENTUCKY – Medicaid                                      MontanaHealthcarePrograms/HIPP
                                                         Phone: 1-800-694-3084
Website: https://chfs.ky.gov
Phone: 1-800-635-2570                                    NEBRASKA – Medicaid

LOUISIANA – Medicaid                                     Website: http://www.ACCESSNebraska.ne.gov
                                                         Phone: (855) 632-7633
Website:                                                 Lincoln: (402) 473-7000
http://dhh.louisiana.gov/index.cfm/subhome/1/n/331       Omaha: (402) 595-1178
Phone: 1-888-695-2447

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NEW HAMPSHIRE – Medicaid                               OKLAHOMA – Medicaid and CHIP

 Website: https://www.dhhs.nh.gov/ombp/medicaid         Website: http://www.insureoklahoma.org
 Phone: 603-271-5218                                    Phone: 1-888-365-3742
 Hotline: NH Medicaid Service Center
 at 1-888-901-4999                                      OREGON – Medicaid

 NEW JERSEY – Medicaid and CHIP                         Website:
                                                        http://healthcare.oregon.gov/Pages/index.aspx
 Medicaid Website:                                      http://www.oregonhealthcare.gov/index-es.html
 http://www.state.nj.us/humanservices/dmahs/            Phone: 1-800-699-9075
 clients/medicaid/
 Medicaid Phone: 609-631-2392                           PENNSYLVANIA – Medicaid
 CHIP Website: http://www.njfamilycare.org/index.html
 CHIP Phone: 1-800-701-0710                             Website:
                                                        http://www.dhs.pa.gov/provider/medicalassistance/
 NEW YORK – Medicaid                                    healthinsurancepremiumpaymenthippprogram/
                                                        index.htm
 Website:                                               Phone: 1-800-692-7462
 https://www.health.ny.gov/health_care/medicaid/
 Phone: 1-800-541-2831                                  RHODE ISLAND – Medicaid

 NEVADA – Medicaid                                      Website: http://www.eohhs.ri.gov/
                                                        Phone: 855-697-4347
 Medicaid Website: http://dhcfp.nv.gov
 Medicaid Phone: 1-800-992-0900                         SOUTH CAROLINA – Medicaid

 NORTH CAROLINA – Medicaid                              Website: https://www.scdhhs.gov
                                                        Phone: 1-888-549-0820
 TTY: Maine relay 711
 Website: https://dma.ncdhhs.gov/                       SOUTH DAKOTA – Medicaid
 Phone: 919-855-4100
                                                        Website: http://dss.sd.gov
 NORTH DAKOTA – Medicaid                                Phone: 1-888-828-0059

 Website:                                               TEXAS – Medicaid
 http://www.nd.gov/dhs/services/medicalserv/medicaid/
 Phone: 1-844-854-4825                                  Website: http://gethipptexas.com/
                                                        Phone: 1-800-440-0493

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Paperwork Reduction Act Statement
UTAH – Medicaid and CHIP                              To see if any other states have added a premium
                                                      assistance program since July 31, 2019, or for more         According to the Paperwork Reduction Act of 1995 (Pub.
Medicaid Website: https://medicaid.utah.gov/          information on special enrollment rights, contact either:   L. 104-13) (PRA), no persons are required to respond to a
CHIP Website: http://health.utah.gov/chip             U.S. Department of Labor                                    collection of information unless such collection displays a valid
Phone: 1-877-543-7669                                 Employee Benefits Security Administration                   Office of Management and Budget (OMB) control number.
                                                      www.dol.gov/agencies/ebsa                                   The Department notes that a Federal agency cannot conduct
VERMONT– Medicaid                                     1-866-444-EBSA (3272)                                       or sponsor a collection of information unless it is approved by
                                                      U.S. Department of Health and Human Services                OMB under the PRA, and displays a currently valid OMB control
Website: http://www.greenmountaincare.org/            Centers for Medicare & Medicaid Services                    number, and the public is not required to respond to a collection
Phone: 1-800-250-8427                                 www.cms.hhs.gov                                             of information unless it displays a currently valid OMB control
                                                      1-877-267-2323, Menu Option 4, Ext. 61565                   number. See 44 U.S.C. 3507. Also, notwithstanding any other
VIRGINIA – Medicaid and CHIP                                                                                      provisions of law, no person shall be subject to penalty for
                                                                                                                  failing to comply with a collection of information if the collection
Medicaid Website:
                                                                                                                  of information does not display a currently valid OMB control
https://www.coverva.org/assistance
                                                                                                                  number. See 44 U.S.C. 3512.
Medicaid Phone: 1-800-432-5924
CHIP Website: https://www.coverva.org/assistance                                                                  The public reporting burden for this collection of information

CHIP Phone: 1-855-242-8282                                                                                        is estimated to average approximately seven minutes per
                                                                                                                  respondent. Interested parties are encouraged to send
WASHINGTON – Medicaid                                                                                             comments regarding the burden estimate or any other aspect
                                                                                                                  of this collection of information, including suggestions for
Website:                                                                                                          reducing this burden, to the U.S. Department of Labor,
http://www.hca.wa.gov/free-or-low-cost-health-care/                                                               Employee Benefits Security Administration, Office of Policy
program-administration/premium-payment-program                                                                    and Research, Attention: PRA Clearance Officer, 200
Phone: 1-800-562-3022 ext. 15473                                                                                  Constitution Avenue, N.W., Room N-5718, Washington, DC
                                                                                                                  20210 or email ebsa.opr@dol.gov and reference the OMB
WEST VIRGINIA – Medicaid                                                                                          Control Number 1210-0137.

                                                                                                                  OMB Control Number 1210-0137 (expires 12/31/2019)
Website: http://mywvhipp.com/
Toll-free phone: 1-855-MyWVHIPP (1-855-699-8447)

WISCONSIN – Medicaid and CHIP

Website: https://www.dhs.wisconsin.gov/
publications/p1/p10095.pdf
Phone: 1-800-362-3002

WYOMING – Medicaid

Website: https://wyequalitycare.acs-inc.com/
Phone: 307-777-7531

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