Explore What Fits Your Lifestyle - FIND THE RIGHT BENEFITS FOR YOU 2020 Benefits Guide - Halliburton
←
→
Page content transcription
If your browser does not render page correctly, please read the page content below
Explore What Fits Your Lifestyle … 2020 Benefits Guide
U.S. Employees
FIND THE RIGHT BENEFITS FOR YOU
TOC NEXT
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.
2 BACK TOC NEXT
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.
BACK TOC NEXT 3
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.
4 BACK TOC NEXT
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.
BACK TOC NEXT 5
Health Benefits 6 BACK TOC NEXT
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.
BACK TOC NEXT 7
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.
8 BACK TOC NEXT
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.
BACK TOC NEXT 9
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
10 BACK TOC NEXTOther 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.
BACK TOC NEXT 11TAKE 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.
12 BACK TOC NEXTLiveWell 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 13Flexible 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.
14 BACK TOC NEXTDental
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.
BACK TOC NEXT 15Vision
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.
16 BACK TOC NEXTIncome Protection
Benefits
BACK TOC NEXT 17Life 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
18 BACK TOC NEXTWork/Life Benefits BACK TOC NEXT 19
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. 20 BACK TOC NEXT
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 21Retirement Benefits 22 BACK TOC NEXT
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 23Important Contacts
& Legal Notices
24 BACK TOC NEXTImportant 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
BACK TOC NEXT 25Important 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
26 BACK TOC NEXTCompliance 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 27Premium 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).
28 BACK TOC NEXTFLORIDA – 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
BACK TOC NEXT 29NEW 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
30 BACK TOC NEXTPaperwork 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
BACK TOC NEXT 31BACK TOC UW300116
You can also read
