2022 Open Enrollment Employee Benefits Guide
←
→
Page content transcription
If your browser does not render page correctly, please read the page content below
2022 Open Enrollment Employee Benefits Guide
Letter From the President & CEO
In a year filled with uncertainty, it is important to know there are some things you can count on, which is why
Primoris is committed to providing a comprehensive benefits package. At Primoris, we know how important
benefits are to your wellbeing as well as that of your family. That’s why we work hard to provide options designed
to improve your quality of life.
Our benefits support your health, help you maintain work-life balance, protect the people and things you care
about, and help secure your financial future into retirement. This year, all benefit-eligible employees must re-
enroll, even if you are not making any changes, to continue your benefits in 2022.
I encourage each of you to carefully review the information provided in this guide, as well as on the UKG Pro
site. Although this is a busy time of year, it is important to take the time to understand our offerings and make
selections aligned with you and your family’s needs.
If you need help or have questions, you can reach out to the Primoris Benefits Team a benefits@prim.com or
call 833-PRIM-BEN (833-774-6236).
Stay safe and stay well,
Tom McCormick
President and CEO
2
Table of Contents
4 What’s New for 2022
Scan for Your Plans!
5 Eligibility and Enrollment
7 Ready for Open Enrollment?
Scan with your smartphone to
8 Medical and Pharmacy Benefits
access enrollment materials
16 Health Savings Account online anytime.
18 Flexible Spending Accounts
20 Dental Benefits
21 Vision Benefits
22 Survivor Benefits
25 Income Protection
26 Retirement Planning
28 Additional Benefits
30 Required Notices
32 Important Contacts
See page 30 for important information concerning Medicare Part D coverage.
In this Guide, we use the term company to refer to Primoris Services Corporation. This Guide is intended to describe the eligibility requirements, enrollment procedures, and coverage
effective dates for the benefits offered by the company. It is not a legal plan document and does not imply a guarantee of employment or a continuation of benefits. While this Guide is a tool
to answer most of your questions, full details of the plans are contained in the Summary Plan Descriptions (SPDs), which govern each plan’s operation. Whenever an interpretation of a plan
benefit is necessary, the actual plan documents will be used.
uilding Better Opportunities
B
at Primoris
Our employees are at the core of our success, helping us serve our customers with innovation and
excellence. To continue to build our business and be a leader in every market we serve, we want to
implement innovative ways to partner with our employees for the long run. Unlike prior years, you will
not automatically be re-enrolled in your Benefits. You must re-enroll November 8th - November 19th, or
you will not have Benefits in 2022.
What’s New For 2022! ˌ Plan design changes to the Core Medical Plan -
Deductibles and Maximums for 2022 are increasing
Good news! Most of your benefits are staying the same, except
CORE MEDICAL PLAN 2021 2022
for some new programs and expanded features!
SINGLE
ˌ NEW Added Programs Available January 2022: $1,500 $2,000
DEDUCTIBLE
ʢ Pre-planned Surgical Services | SurgeryPlusTM FAMILY
$3,000 $4,000
DEDUCTIBLE
- SurgeryPlus TM
is a new benefit available to all
SINGLE OUT-OF-
members enrolled in the BCBS medical plan at no $5,000 $6,000
POCKET MAXIMUM
cost. SurgeryPlus TM
provides members access to a FAMILY OUT-OF-
$10,000 $12,000
network of high-quality surgeons and dedicated Care POCKET MAXIMUM
Advocates who can take the stress out of planning
ˌ Medical Employee Contributions Increasing January 2022:
for a surgery. Plus a portion of your deductible and
coinsurance may be completely waived. You aren’t ʢ All employee medical contributions will go up in
required to use SurgeryPlusTM , but the potential 2022. We have been able to avoid any contribution
savings will make it worth your while to check it out! increases to our medical benefits for the past five
years. But the year-over-year increases in healthcare
ʢ Medical Decision Support | ConsumerMedical - costs are now to the point where we must make some
The team of experts at ConsumerMedical, including changes.
doctors and nurses, will help you understand your
diagnosis and all treatment options, find the right ʢ Tenured Based Contributions – Hourly Employees
doctor or hospital for your needs, get a second will move to tenured based contributions. We are
opinion if you need one, and help you cope with your making this change because our hourly and Craft
medical condition. There is no cost to use this benefit. employees are a key part of our workforce. The
It is voluntary, confidential, and available to all BCBS longer an employee works for us, the stronger their
members when you need it. skillset and knowledge base becomes. And over time
they can share their knowledge and skills with other
ʢ Infertility Benefit Now Included - Combined employees, continually building a stronger workforce.
medical and Rx coverage for infertility benefits has
been added to the BCBS Medical Plans for a lifetime ʢ Log in to your Benefits portal to review the 2022
maximum of $25,000, at no additional contribution Medical Employee Contributions
cost to employees.
ˌ NEW Expanded Benefit Effective January 2022:
ʢ Basic Life Insurance Benefit Increasing - Salaried
and Hourly Admin employees will see the maximum
benefit for Basic Life and AD&D insurance (paid for
by Primoris) increase to 1x salary (up to a maximum of
$100,000). Hourly employees will receive a benefit of
$25,000, regardless of their hourly rate.
4
E ligibility and Enrollment
Primoris’ benefits are designed to support your unique needs.
Eligibility How to Enroll
If you are an active, non-union full-time employee of Primoris 1. To start your enrollment, visit Benefits.Prim.com or visit
who is regularly scheduled to work 30 hours a week, you the UKG Pro Mobile App and select View or Enroll. The
are eligible to participate in medical, dental, vision, life and Primoris Benefits website is accessible from any computer
disability plans, and additional benefits. and is mobile enabled for your phone or tablet.
ʢ Download the UKG Pro Mobile App from the Apple or
When Coverage Begins Google Play app stores
Coverage for benefits elected during Open Enrollment are ʢ Company Access Code: HRPSC75201
effective on January 1, 2022. The premiums associated with
2. You will be prompted to sign in to your UKG Pro Employee
those elections are withheld each pay period in 2022.
portal. Enter your UKG Pro User ID (Employee ID +
4-leading zeros, ex. EE ID = 12345 , UKG Pro User ID =
Dependents 0000012345) and Password. If you are logging in for
the first time, your password is your DOB entered as
Dependents eligible for coverage include:
MMDDYYYY.
ˌ Your legal spouse (or common-law spouse
3. Once logged in, start your enrollment process by selecting
where recognized).
Manage My Benefits and follow the steps through the
ˌ Children up to age 26 (includes birth children,
end. Your elections will not be recorded until you save and
stepchildren, legally adopted children, children placed
accept. You will know you have completed your enrollment
for adoption, foster children, and children for whom you
once you come to the confirmation page. Once you are
or your spouse have legal guardianship).
finished, you can print your confirmation statement, or
ˌ Dependent children 26 or more years old, unmarried, if you have an email on file, you will receive an email
and primarily supported by you and incapable of self- confirming that your 2022 enrollment choices have been
sustaining employment by reason of mental or physical saved.
disability (periodic certification may be required).
4. If you have any questions or wish to enroll over the
Verification of dependent eligibility may be required phone, you can call the Primoris Benefits Team at
upon enrollment. 833-PRIM-BEN (833-774-6236).
Your deadline to enroll is Friday November 19th.
Note
Even if you are not making any changes, you MUST re-enroll no later than November 19, 2021, if you wish to continue
your benefits in 2022. Open Enrollment is your annual chance to choose your benefits, unless you have a qualifying life
event, such as marriage or the birth/adoption of a child.
5
Now’s the Time to Enroll!
What are Qualifying Life Events?
You can update your benefits when you start a new job or during Open Enrollment. But changes in your life called Qualifying Life
Events (QLEs) determined by the IRS can allow you to enroll in health insurance or make changes outside of these times.
When a Qualifying Life Event occurs, you have 30 days to request changes to your coverage. Your change in coverage must be
consistent with your change in status.
Common qualifying events include:
ˌ A change in the number of dependents (through birth or
adoption or if a child is no longer an eligible dependent)
ˌ A change in a spouse’s employment status (resulting in a
loss or gain of coverage)
ˌ A change in your legal marital status (marriage, divorce,
or legal separation)
ˌ A change in employment status from full time to part
time, or part time to full time, resulting in a gain or loss
of eligibility
ˌ Eligibility for coverage through the Marketplace
ˌ Changes in address or location that may affect coverage
ˌ Entitlement to Medicare or Medicaid
Some lesser-known qualifying events are:
ˌ Turning 26 and losing coverage through a parent’s plan
ˌ Death in the family (leading to change in dependents or
loss of coverage)
ˌ Changes that make you no longer eligible for Medicaid
or the Children’s Health Insurance Program (CHIP)
Reach out to Primoris’ Human Resources with questions
regarding specific life events and your ability to request
changes. Don’t miss out on a chance to update your benefits!
6
R eady for Open Enrollment ?
Primoris covers a significant amount of your benefit costs. Your contributions for medical, dental, and
vision benefits are deducted on a pre-tax basis, lessening your tax liability. Employee contributions
vary depending on the level of coverage you select — typically, the more coverage you have, the higher
your portion.
Open Enrollment Action Items
Update your personal information.
If you’ve experienced any life changes since the last Open Enrollment period — such as the birth of a child
or a move — you may need to change your elections or update your pertinent details.
Double-check covered medications.
If you make any changes to your plan, consider how it affects your prescriptions.
Review available plans’ deductibles.
Foresee a lot of medical needs this year? You might want a lower deductible. If not, you could switch to a
higher deductible plan and enjoy lower premiums.
Consider your HSA or FSA.
An HSA or FSA can help cover healthcare costs, including dental and vision services and prescriptions.
Adding one of these accounts to your benefits can help with your long-term financial goals
Check your networks.
Going in-network often saves you money. Check for any plan changes to make sure your go-to providers
and pharmacy are still your best bet.
Enroll in your benefits.
When you are ready, enroll in your benefits online. To start your enrollment, visit Benefits.Prim.com or visit
the UKG Pro Mobile App.
7
M edical and Pharmacy Benefits
Medical and Pharmacy benefits are provided through Blue Cross Blue Shield of Texas (BCBS). This
means you will have one ID card for medical and pharmacy. Consider the physician networks, premiums,
and out-of-pocket costs for each plan when choosing the right plan for you and your family. Keep in
mind your choice is effective for the entire 2022 plan year unless you have a qualifying life event.
Medical Plan Summary
This chart summarizes the 2022 medical coverage provided by BCBS. All covered services are subject to medical necessity as
determined by the plan. Please note that all out-of-network services are subject to Reasonable and Customary (R&C) limitations.
Premium contributions for medical are deducted from your paycheck on a pre‑tax basis. Your level of coverage determines your monthly
contributions. Visit Benefits.Prim.com to review the 2022 weekly and bi-weekly Medical Plan Contributions.
PREMIER PLAN CORE PLAN BASE PLAN
IN-NETWORK IN-NETWORK IN-NETWORK
DEDUCTIBLE
INDIVIDUAL $1,000 $2,000 $2,000
FAMILY $2,000 $4,000 $4,000
COINSURANCE 80% 80% 70%
ANNUAL OUT-OF-POCKET MAXIMUM (INCLUDES DEDUCTIBLE)
INDIVIDUAL $4,000 $6,000 $5,500
FAMILY $8,000 $12,000 $11,000
COPAYS/COINSURANCE
IN-NETWORK IN-NETWORK IN-NETWORK
PREVENTIVE CARE 100% 100% 100%
PRIMARY CARE $25 $30 70%*
SPECIALIST SERVICES $45 $50 70%*
DIAGNOSTIC CARE 80%* 80%* 70%*
URGENT CARE $100 $100 70%*
EMERGENCY ROOM $150 $150 70%*
*After deductible
Helpful Information About Deductibles and Out-of-Pocket How to Find a Provider:
Maximums
Visit www.bcbstx.com (Select: Blue Choice PPO Network) or
ˌ Under the Base Plan, the entire Family Deductible must call Customer Care at 800-521-2227 for a list of Blue Cross Blue
be met for benefits begin to pay out for an individual Shield network providers.
family member. The entire Family Out-of-Pocket
maximum must be met before the plan pays in full for
any family member.
ˌ Under the Core and Premier Plan, once one family
member meets the Individual Deductible, benefits begin
to be paid for that individual. Once one family member
meets the Individual Out-of-Pocket maximum, the plan
pays covered benefits in full for that individual.
8
Pharmacy Plan Summary
Your BCBS medical plan uses the Traditional Select pharmacy network. This includes many major chain and independent
pharmacies throughout the country, including Walgreens, CVS, HEB, Walmart, Sam’s Club and other independent pharmacies.
Remember, always ask your doctor if there is a generic of your medication. To find a list of participating pharmacies, visit
www.bcbstx.com or myprime.com and click on “Find Pharmacies.”
PREMIER PLAN CORE PLAN BASE PLAN
IN-NETWORK IN-NETWORK IN-NETWORK
RX DEDUCTIBLE $0 $0 Medical Deductible applies
RETAIL RX (30-DAY SUPPLY)
GENERIC $10 $10 70%*
PREFERRED $45 $45 70%*
NON-PREFERRED $60 $75 70%*
SPECIALTY DRUGS $60 $150 70%*
MAIL ORDER RX (30-DAY SUPPLY)
GENERIC $20 $20 70%*
PREFERRED $90 $90 70%*
NON-PREFERRED $120 $150 70%*
*After deductible
Pharmacy Plan Provisions
Performance Drug List: Medications not on the Performance Drug List (PDL) are not covered by the plan. The drug list also
identifies preferred drugs that are more affordable. Copays and out-of-pocket cost will be higher if you choose a non-preferred
drug. If you are taking or are prescribed a drug that is non-preferred or not on the drug list, ask your doctor about therapeutic
alternatives.
Prior Authorization: Some prescription drugs require authorization before a prescription can be filled. Prior authorization is
designed to promote patient safety and use of the drug as intended by the manufacturer and the FDA. Visit www.bcbstx.com/
Primoris/Prescription-Drugs to review the current Drug List.
Mandatory Prime Specialty: Due to the high cost and complexity around Specialty medications, members are required to use the
Prime Specialty Pharmacy to fill all specialty medication prescriptions. The Prime Specialty Pharmacy will provide members with the
personalized support and care needed to successfully manage their condition to achieve better outcomes. Members are allowed
two grace fills at a retail pharmacy.
Non-Sedated Antihistamines Exclusion: Non-sedating antihistamines (i.e. Claritin, Zyrtec, Allegra, Loratadine, etc.) will be
excluded from coverage under the Pharmacy Plan due to the abundance of over-the-counter products available on the market.
Note
Take advantage of mail-order options for your prescriptions. You can get
your meds delivered conveniently and often at a lower price.
9
now Before You Go:
K
Out-of-Pocket Cost
It is important to understand the features of your medical plans. These are
the types of payments you’re responsible for:
Copay
The fixed amount you pay for healthcare services at the time you receive them.
Deductible
The amount you must pay for covered services before your insurance begins paying its
portion/coinsurance.
Out-of-Pocket Maximum
The most you will pay during the plan year before your insurance begins to pay 100% of
the allowed amount.
Coinsurance
Your percentage of the cost of a covered service. If your office visit is $100 and your
coinsurance is 20% (and you’ve met your deductible but not your out-of-pocket maximum),
your payment would be $20.
10New Benefits Available for 2022
Primoris is pleased to offer these new valuable benefits at no cost to all active employees and
dependents enrolled in the medical plan.
Pre-Planned Surgical Services | ConsumerMedical
SurgeryPlusTM If you are facing a serious medical condition or considering
Have an upcoming surgery? Primoris offers a supplemental surgery, finding the right doctor for your needs to important.
benefit for planned non-emergency surgeries for those ConsumerMedical can ensure you get high-quality care by
enrolled in the Primoris Medical Plan. SurgeryPlusTM
provides helping you:
a personalized concierge experience with a dedicated Care ˌ Find the best doctors and hospitals in your area and
Advocate, as well as access to high-quality care through a BCBS network
network of providers.
ˌ Verify any doctor’s credentials, skills, and experience
By using SurgeryPlusTM , you may save money through waived treating your condition
deductibles and coinsurance. When you call SurgeryPlus , aTM
ˌ Get a second opinion from top specialists (in-person and
Care Advocate can help you choose the right surgeon, schedule
virtually)
appointments, coordinate medical record transfers and travel
arrangements, and provide all the information you need as you ˌ Connect with experts in your diagnosis from leading
make your healthcare decisions. medical institutions
Covered procedures may include orthopedics, spine, general
surgery, gynecology, ear nose and throat, gastrointestinal,
cardiac, and pain management.
Note
Additional information about these new benefit
programs will be mailed to your home in January 2022.
11How to Pick a Plan
What plan is right for you? Consider any medical needs you foresee for the upcoming plan year, your overall health, and any
medications you currently take.
How does a PPO (Preferred Provider How does a HDHP (High Deductible Health
Organization) work - Premier and Core Plan) work - Base Plan?
Plans? ˌ You’ll pay less in premiums. (Think less money from your
ˌ You’ll pay more in premiums, but perhaps less at the paycheck.)
time of service. ˌ You’ll pay for the full cost of non-preventive medical
ˌ You can choose from a network of providers who offer a services until you reach your deductible.
fixed copay for services. ˌ You can also use a Health Savings Account in
ˌ If you expect to need more medical care this year or you conjunction, which provides a safety net for unexpected
have a chronic illness, the PPO may be the right choice medical costs and tax advantages.
for you to ensure your healthcare needs are covered. ˌ If you expect to mostly use preventive care (which is
covered), this plan could be for you.
12P reventive Care
Routine checkups and screenings are considered preventive, so they’re often paid at 100% by
your insurance.
Keep up to date with your primary care physician to stay on top of your overall health. Under the U.S. Patient Protection and
Affordable Care Act (PPACA), some common covered services include:
Wellness visits, physicals, and
standard immunizations
Screenings for blood pressure, cancer,
cholesterol, depression, obesity, and diabetes
Pediatric screenings for hearing, vision,
obesity, and developmental disorders
Anemia screenings, breastfeeding support,
and pumps for pregnant and nursing women
Iron supplements (for children ages
6 to 12 months at risk for anemia)
Don’t miss out on these covered services. But remember that diagnostic care to identify health risks is covered according to plan benefits,
even if done during a preventive care visit. So, if your doctor finds a new condition or potential risk during your appointment, the services
may be billed as diagnostic medicine and result in some out-of-pocket costs. Read over your benefit summary to see what specific
preventive services are provided to you.
What about the COVID-19 vaccine?
The COVID-19 vaccine itself is considered preventive. The vaccine is available at no cost for those enrolled on the Primoris
Medical Plans.
13W here to Go for Care
You’re feeling sick, but your primary care physician is booked through the end of the month. You have a
question about the side effects of a new prescription, but the pharmacy is closed. Instead of rushing to
the emergency room or relying on questionable information from the internet, consider all of your site-
of-care options.
Nurse Line
When to Use Types of Care* Costs and Time Considerations**
You need a quick answer to a health A nswers to questions regarding: ˌ Usually available 24 hours a day,
issue that does not require immediate ˌ Symptoms 7 days a week
medical treatment or a physician visit. ˌ Self-care/home treatments ˌ Typically free as part of your
ˌ Medications and side effects medical insurance
ˌ When to seek care
Telemedicine
When to Use Types of Care* Costs and Time Considerations**
You need care for minor illnesses and ˌ Cold & flu symptoms ˌ Usually a first-time consultation
ailments but would prefer not to leave ˌ Allergies fee and a flat fee or copay for any
home. These services are available by ˌ Bronchitis visit thereafter
phone and online (via webcam). ˌ Urinary tract infection ˌ Usually immediate access to care
ˌ Sinus problems ˌ Prescriptions through telemedicine
or virtual visits not allowed in all states
Primary Care Center
When to Use Types of Care* Costs and Time Considerations**
You need routine care or treatment for a ˌ Routine checkups ˌ Often requires a copay and/or
current health issue. Your primary doctor ˌ Immunizations coinsurance
knows you and your health history, can ˌ Preventive services ˌ Normally requires an appointment
access your medical records, provide routine ˌ Manage your general health ˌ Usually little wait time with
care, and manage your medications. scheduled appointment
Urgent Care Center Emergency Room
When to Use When to Use
Do Your You need care quickly, but it is not a true You need immediate treatment for a serious life-
emergency. Urgent care centers offer treatment threatening condition. If a situation seems life threatening,
Homework
for non‑life‑threatening injuries or illnesses. call 911 or your local emergency number right away.
What may seem like
an urgent care center Types of Care* Types of Care*
could actually be a
ˌ Strains, sprains ˌ Minor infections ˌ Heavy bleeding ˌ Spinal injuries
standalone ER. These
ˌ Minor broken ˌ Minor burns ˌ Chest pain ˌ Severe head injury
facilities come with a
bones (e.g., finger) ˌ X-rays ˌ Major burns ˌ Broken bones
higher price tag, so ask
for clarification if the
word “emergency”
Costs and Time Considerations** Costs and Time Considerations**
appears in the ˌ Often requires a copay and/or coinsurance ˌ O
ften requires a much higher copay and/or
company name. usually higher than an office visit coinsurance
ˌ Walk-in patients welcome, but waiting periods ˌ Open 24/7, but waiting periods may be longer
may be longer (urgency decides order) because patients with life-threatening emergencies
will be treated first
*This is a sample list of services and may not be all inclusive. ˌ Ambulance charges, if applicable, will be separate
**Costs and time information represent averages only and are not tied to a specific condition
and may not be in-network
or treatment.
14V irtual Medicine
When you’re under the weather, there’s no place like home. And when you’re constantly on the go,
scheduling a doctor’s appointment can easily move down your priority list. Virtual medicine is a
convenient and easy way to connect with a doctor on your time.
For those enrolled in a BCBS medical plan, there is a virtual MDLIVE doctors can treat many medical conditions, including:
medicine benefit through MDLIVE for you and your enrolled ˌ Cold & flu ˌ Respiratory infection
dependents. MDLIVE offers on-demand access to board-
ˌ Allergies ˌ Pink eye
certified doctors through online video, telephone, or secure
email. General health issues can be addressed at home for a ˌ Bronchitis ˌ Sore throat
copay of $25 per consultation. Virtual medicine is useful for ˌ Bladder infection/ ˌ Stomachache
after-hours non-emergency care, when your primary care urinary tract infection
ˌ Sinus problems
doctor is unavailable, if you need prescriptions or refills or
if you’re traveling. Virtual visits aren’t good for conditions
requiring exams or tests, complex or chronic problems, or Access Virtual Visits
emergencies like sprains or broken bones. Visit mdlive.com/bcbstx to request a virtual visit. After you
MDLIVE doctors can share information with your primary care register and request an appointment, you’ll pay your portion
physician with your consent. Please note of the service costs and enter a virtual waiting room. During
that some states do not allow physicians to prescribe your visit, you can talk to a doctor about your health concerns,
medications via telemedicine. For more information, visit symptoms, and treatment options.
mdlive.com/bcbstx.
Note
A virtual visit or Facetime directly with your primary
care physician (vs. MDLIVE) might also be an option —
and typically costs the same as an office visit.
15H ealth Savings Account
Want funds handy to help cover out-of-pocket healthcare expenses? A Health Savings Account (HSA) is
a personal healthcare bank account used to pay for qualified medical expenses. HSA contributions and
withdrawals for qualified healthcare expenses are tax free. You must be enrolled in a High Deductible
Health Plan (HDHP) to participate.
If you are enrolled in the Base Plan you can open a Health
Savings Account with HSA Bank. An HSA is a tax advantaged
account that you can use to help pay for qualified healthcare
Tax-free Interest
expenses - including medical, prescription drug, dental and
vision expenses - for you, your spouse and/or tax dependent(s),
even if they are not covered by your plan.
If you enroll in the Base Plan, Primoris will contribute $250 for
single coverage and $500 for family coverage annually.
Check out IRS Publication 502 on www.irs.gov for a complete Employer Contributions
list of eligible expenses. (pre-tax)
Eligibility
You are eligible to contribute to an HSA if:
ˌ You are enrolled in an HSA-eligible High Deductible
Health Plan (Primoris’ Base Plan). Voluntary Contributions
ˌ You are not covered by your spouse’s non-HDHP.
ˌ Your spouse does not have a Healthcare Flexible
HSA
Spending Account or Health Reimbursement Account.
ˌ You are not eligible to be claimed as a dependent on
someone else’s tax return.
ˌ You are not enrolled in Medicare or TRICARE.
ˌ You have not received Department of Veterans
Affairs medical benefits in the past 90 days for
non-service-related care. (Service-related care will
not be taken into consideration.) Tax-free Payments
(for qualified medical expenses)
Note
Not sure how much to contribute? Think about how much you may need in order to
cover any anticipated or emergency medical services this year. Consider contributing
the amount of your plan’s in-network deductible so you know you’re covered.
16You Own Your HSA HSA Funding Limits
Your HSA is a personal bank account that you own and The IRS places an annual limit on the maximum amount that
administer. You decide how much you contribute, when to can be contributed to HSAs. For 2022, contributions (which
use the money for medical services and when to reimburse include any employer contribution) are limited to the following:
yourself. You can save and roll over HSA funds to the next year
if you don’t spend them all in the calendar year. You can even
HSA FUNDING LIMITS
let funds accumulate year over year to use for eligible expenses EMPLOYEE $3,650
in retirement. HSA funds are also portable if you change FAMILY $7,300
plans or jobs. There are no vesting requirements or forfeiture CATCH‑UP CONTRIBUTION
Additional $1,000
(AGES 55-65)
provisions.
Primoris provides an HSA employer contribution that will be
How to Enroll deposited on a quarterly basis.
You must elect the Base Plan with Primoris to enroll. Submit all EMPLOYER HSA CONTRIBUTION
HSA enrollment materials to HSA Bank and choose the amount EMPLOYEE $250
to contribute on a pre-tax basis. Primoris will establish an HSA FAMILY $500
account in your name and send your contribution each pay
period once bank account information has been provided HSA contributions over the IRS annual contribution limits
and verified. ($3,650 for individual coverage and $7,300 for family coverage
for 2022) are not tax deductible and are generally subject to a
6% excise tax.
HSAs and Taxes
If you’ve contributed too much to your HSA this year, you have
HSA contributions are made through payroll deduction on
two options:
a pre-tax basis when you open an account with HSA Bank.
The money in your HSA (including interest and investment ˌ Remove the excess contributions and the net income
earnings) grows tax free. When the funds are used for qualified attributable to the excess contribution before you file
medical expenses, they are spent tax free. your federal income tax return (including extensions).
You’ll pay income taxes on the excess removed.
Per IRS regulations, if HSA funds are used for purposes other
ˌ Leave the excess contributions in your HSA and pay 6%
than qualified medical expenses and you are younger than age
excise tax on them. Next year consider contributing less
65, you must pay federal income tax on the amount withdrawn,
than the annual limit to your HSA.
plus a 20% penalty tax.
The Primoris HSA is established with HSA Bank. You may
be able to roll over funds from another HSA. For more
enrollment information, contact the Primoris Benefit Team at
benefits@prim.com or 833-PRIM-BEN (833-774-6236).
17F lexible Spending Accounts
Take control of your spending! A Flexible Spending Account (FSA) is a special tax-free account you put
money into to pay for certain out-of-pocket expenses. Primoris offers two different Flexible Spending
Account Options through WEX/Discovery - Healthcare FSA and Dependent Care FSA.
Healthcare Flexible Spending Dependent Care Flexible Spending
Account Account
You can contribute up to $2,750 annually for qualified medical In addition to the Healthcare FSA, you may opt to participate
expenses (deductibles, copays, coinsurance, menstrual in the Dependent Care FSA — even if you don’t elect any
products, PPE, over-the-counter medications, etc.) with pre-tax other benefits. Set aside pre-tax funds into a Dependent Care
dollars, which reduces your taxable income and increases your FSA for expenses associated with caring for elderly or child
take-home pay. You can even pay for eligible expenses with an dependents. Unlike the Healthcare FSA, reimbursement from
FSA debit card at the same time you receive them — no waiting your Dependent Care FSA is limited to the total amount that is
for reimbursement. currently deposited in your account.
ˌ With the Dependent Care FSA, you can set aside up to
$5,000 to pay for child or elder care expenses on a
pre-tax basis.
ˌ Eligible dependents include children under 13 and a spouse
or other individual who is physically or mentally incapable
of self-care and has the same principal place of residence
as the employee for more than half the year.
ˌ Expenses are reimbursable if the provider is not
your dependent.
ˌ You must provide the tax identification number or
Social Security number of the party providing care to be
reimbursed.
This account covers dependent day care expenses that are
necessary for you and your spouse to work or attend school full
time. Eligible expenses include:
ˌ In-home babysitting services (not provided by
a dependent)
ˌ Care of a preschool child by a licensed nursery or day
care provider
ˌ Before- and after-school care
ˌ Day camp
ˌ In-house dependent day care
18Using the Account
Use your FSA debit card at doctor and dentist offices,
pharmacies, and vision service providers. It cannot be
used at locations that do not offer services under the plan,
unless the provider has also complied with IRS regulations. Note
The transaction will be denied if you use the card at an
ineligible location. You can use your FSA funds to pay for deductibles,
copays, coinsurance, menstrual products, over-the-
Submit a claim form along with the required documentation. counter medications, and more.
Contact the Primoris Benefits Team at benefits@prim.com
or 833-PRIM-BEN (833-774-6263) with reimbursement
questions. If you need to submit a receipt, WEX/Discovery will
notify you. Always save receipts for your records.
While FSA debit cards allow you to pay for services at point of
sale, they do not remove the IRS regulations for substantiation.
Always keep receipts and Explanation of Benefits (EOBs) for any
debit card charges. Without proof an expense was valid, your
card could be turned off and the expense deemed taxable.
General Rules
The IRS has the following rules for Healthcare and Dependent
Care FSAs:
ˌ Expenses must occur during the 2022 plan year.
ˌ Funds cannot be transferred between FSAs.
ˌ You cannot participate in a Dependent Care FSA
and claim a dependent care tax deduction at the
same time.
ˌ You must “use it or lose it” — any unused funds will
be forfeited.
ˌ Up to $500 may be rolled over to the next plan year at
the end of 2022 for Healthcare FSAs.
ˌ You cannot change your FSA election in the middle of
the plan year without a qualifying life event.
ˌ Terminated employees have ninety (90) days following
termination to submit FSA claims for reimbursement.
ˌ Those considered highly compensated employees (family
gross earnings were $125,000 or more last year) may have
different FSA contribution limits. Visit
www.irs.gov for more info.
19D ental Benefits
Like brushing and flossing, visiting your dentist is an essential part of your oral health. Primoris offers
dental through Delta Dental.
Stay In-Network
If your dentist doesn’t participate in Delta Dental’s network, your out-of-pocket costs will be higher, and you are subject to any
charges beyond the Reasonable and Customary (R&C). To find a network dentist, visit Delta Dental at www.deltadentalins.com.
Dental Premiums
Dental premium contributions are deducted from your paycheck on a pre-tax basis. Your tier of coverage determines your
premium.
Dental Plan Summary
This chart summarizes the dental coverage provided by Delta Dental for 2022.
DENTAL PLAN
CONTRIBUTIONS
MONTHLY WEEKLY
EMPLOYEE ONLY $13.30 $3.07
EMPLOYEE + SPOUSE $25.66 $5.92
EMPLOYEE + CHILD(REN) $24.22 $5.59
EMPLOYEE + FAMILY $40.78 $9.41
IN-NETWORK OUT-OF-NETWORK
CALENDAR YEAR MAXIMUM
PER PERSON $1,500 per person $1,500 per person
COVERED SERVICES
PREVENTIVE SERVICES
Oral Exams, Routine Cleanings, Bitewing X-rays, Fluoride Applications, 100% 100% of R&C fee
Sealants, Space Maintainers, Panoramic X-rays
BASIC SERVICES 80% 80% of R&C fee
Full Mouth X-rays, Fillings, Oral Surgery, Simple Extractions
MAJOR SERVICES
Oral Surgery, Complex Extractions, Denture Adjustments and Repairs, 50% 50% of R&C fee
Root Canal Therapy, Periodontics, Crowns, Dentures, Bridges
ORTHODONTICS 50% 50% of R&C fee
Dependent Child(ren) Only
ORTHODONTIC LIFETIME MAXIMUM $1,500 $1,500
Note
Oral health is linked to your overall health — keeping your mouth healthy can protect
you from cardiovascular disease, pregnancy complications, and pneumonia.
20V ision Benefits
Getting your eyes checked regularly is important even if you don’t wear glasses or contacts. We provide
quality vision care for you and your family through VSP.
Vision Premiums
Vision premium contributions are deducted from your paycheck on a pre-tax basis. Your tier of coverage determines your premium.
Vision Plan Summary
This chart summarizes the vision coverage provided by VSP for 2022.
VISION PLAN W/SAFETY
VISION PLAN GLASSES
CONTRIBUTIONS
MONTHLY WEEKLY MONTHLY WEEKLY
EMPLOYEE ONLY $6.20 $1.43 $7.78 $1.80
EMPLOYEE + SPOUSE $11.29 $2.60 $12.87 $2.97
EMPLOYEE + CHILD(REN) $11.83 $2.73 $13.41 $3.09
EMPLOYEE + FAMILY $18.24 $4.21 $19.82 $4.57
IN-NETWORK FREQUENCY
EXAMS
EXAM COPAY $10 Once every 12 months
LENSES
MATERIAL COPAY $25
SINGLE VISION 100% after copay
Once every 12 months
BIFOCAL 100% after copay
TRIFOCAL 100% after copay
CONTACTS (IN LIEU OF LENSES AND FRAMES)
FITTING AND EVALUATION** $200 allowance
Once every 24 months
SAFETY GLASSES $100 Allowance
FRAMES
ALLOWANCE Up to $220 Once every 12 months
*After copay
**Fitting and Evaluation fee applied to contact lens allowance.
Note
Early detection of vision conditions like diabetic
retinopathy leads to more effective treatment and cost
savings.
21S urvivor Benefits
It’s hard to think about, but it’s important to have a plan in place to provide for your family if
something were to happen to you. Survivor benefits provide financial protection in the event of an
unexpected event.
Basic Life and Accidental Death and
Dismemberment (AD&D) Insurance
Primoris provides employees with Basic Life and AD&D
insurance as part of your basic coverage through The Hartford,
which guarantees that your spouse or other designated
survivor(s) continue to receive benefits after death.
ˌ Salaried and Hourly Admin employees Basic Life
and AD&D insurance is one times your annual salary, up
to $100,000.
ˌ Hourly employees Basic Life and AD&D insurance
is a flat $25,000.
Naming a Beneficiary
Your beneficiary is the person you designate to receive your
Life insurance benefits in the event of your death. This includes
any benefits payable under Basic Life. You receive the benefit
payment for a dependent’s death under the The Hartford
insurance.
Name a primary and contingent beneficiary to make your
intentions clear. Indicate their full name, address, Social
Security number, relationship, date of birth, and distribution
percentage. Please note that in most states, benefit payments
cannot be made to a minor. If you elect to designate a minor as
beneficiary, all proceeds may be held under the beneficiary’s
name and will earn interest until the minor reaches age 18.
Contact the Primoris Benefits Team or your own legal counsel
with any questions.
22Voluntary Life and AD&D Insurance
You may wish for extra coverage for more peace of mind. Eligible employees may purchase additional Voluntary Life and AD&D
insurance through The Hartford. Premiums are paid through after-tax payroll deductions.
VOLUNTARY EMPLOYEE LIFE/AD&D
COVERAGE AMOUNT $10,000 increments
WHO PAYS Employee
BENEFITS PAYABLE Upon death
MAXIMUM BENEFIT $500,000
EVIDENCE OF INSURABILITY (EOI) REQUIRED For amounts over $300,000 or 3x your annual salary
VOLUNTARY SPOUSE LIFE/AD&D
COVERAGE AMOUNT $5,000 increments
WHO PAYS Employee
BENEFITS PAYABLE Upon death
MAXIMUM BENEFIT $250,000 or 100% of the Employee’s Voluntary Life amount
EVIDENCE OF INSURABILITY (EOI) REQUIRED For amounts over $25,000
VOLUNTARY CHILD LIFE/AD&D
COVERAGE AMOUNT $10,000
WHO PAYS Employee
BENEFITS PAYABLE Upon death
MAXIMUM BENEFIT $10,000
EVIDENCE OF INSURABILITY (EOI) REQUIRED No
23VOLUNTARY LIFE INSURANCE
RATES/$1,000 (MONTHLY)
AGE
EMPLOYEE / SPOUSE
(AS OF JANUARY 1, 2022)
Under 25 $0.091
25-29 $0.091
30-34 $0.101
35-39 $0.117
40-44 $0.180
45-49 $0.300
50-54 $0.462
55-59 $0.764
60-64 $0.920
65-69 $1.851
70+ $2.986
Child(ren) $0.083
*Benefits subject to age reduction schedule
VOLUNTARY AD&D
EMPLOYEE $0.046
SPOUSE $0.059
CHILD $0.059
TO CALCULATE HOW MUCH YOUR VOLUNTARY LIFE COVERAGE WILL COST:
$ ÷ 1,000 = $ x Age Based Rate = $
Benefit Elected Monthly Premium
24I ncome Protection
You and your loved ones depend on your regular income. That’s why Primoris offers disability coverage
to protect you financially in the event you cannot work as a result of a debilitating injury. A portion of
your income is protected until you can return to work or you reach retirement age.
Short Term Disability Insurance Long Term Disability Insurance
Short Term Disability (STD) benefits are available at no cost if Long Term Disability (LTD) benefits are available at no cost if
enrolled in a Primoris medical plan. STD insurance replaces enrolled in a Primoris medical plan. LTD insurance replaces 60%
60% of your income if you become partially or totally disabled of your income if you become partially or totally disabled for
for up to 26 weeks. Certain exclusions, along with pre-existing an extended time. Certain exclusions, along with pre-existing
condition limitations, may apply. See your plan documents or condition limitations, may apply. See your plan documents or
the Primoris Benefits Team for details. the Primoris Benefits Team for details.
WEEKLY MAXIMUM BENEFIT 60% of earnings MONTHLY MAXIMUM BENEFIT $10,000
ELIMINATION PERIOD 7 days ELIMINATION PERIOD 180 days
MAXIMUM BENEFIT PERIOD 26 weeks Payments will last for as
* Employees who reside in California may receive disability benefits long as you are disabled
through the state. or until you reach
MAXIMUM BENEFIT PERIOD
your Social Security
Normal Retirement Age,
whichever is sooner.
Note
Employees not enrolled in the Medical Plan will share
in the cost for the Disability Plans with Primoris.
25R etirement Planning
No matter what point of your career you’re in, it’s never a bad time to think about your future and save
for retirement.
Contributing to a 401(k) account now can help keep you Contributing to the Plan
financially secure later in life. The Primoris 401(k) plan provides
you with the tools you need to prepare. The deferred contribution limit set annually by the IRS is
$19,500 for 2022.
PLAN AT A GLANCE
If you are age 50 or older this year and you already contribute
PLAN NAME Primoris 401(k) Plan
the maximum allowed to your 401(k) account, you may also
RECORDKEEPER T. Rowe Price make a “catch-up contribution.” This additional deposit
WEBSITE rps.troweprice.com accelerates your progress toward your retirement goals. The
ELIGIBILITY Upon date of hire maximum catch-up contribution is $6,500 for 2022 — for a
Primoris will match your 401(k) combined total contribution allowance of $26,000.
contribution dollar of dollar on the first
COMPANY MATCH 3% and then $0.50 on the dollar for the Not sure if you’re getting close to the annual contribution limit?
next 2%, for a total of 4%
Our payroll system tracks how much you’ve contributed. If you
started at the company mid-year, let the Payroll Department
All About 401(k) know how much you contributed at your previous employer so
that can be factored in.
This employer-sponsored retirement account can help your
future self by saving money — tax free — from your paycheck.
The sooner you participate in a 401(k), the more time your
assets have to grow.
Eligible employees can invest for retirement while receiving tax
advantages. Administrative services are provided by T. Rowe
Price. You may start making pre-tax contributions into the plan
upon date of hire.
Pre-tax vs. Roth 401(k): What’s the difference? If you
contribute to your 401(k) pre-tax, your contributions are
taken out before taxes each pay period, which will lower your
annual taxable income. Pre-tax contributions grow on a tax-
deferred basis and you won’t pay taxes on these dollars until a
distribution is taken at retirement. If you choose the available
Roth 401(k), contributions are deducted from your paycheck
after taxes — so although you are paying taxes on those dollars
now, you won’t pay taxes when you withdraw during retirement.
26How Much Should I Save? Investing in the Plan
Industry standards suggest saving at least 12% to 15% of your It’s up to you how to invest the assets. The Primoris 401(k) plan
income, including Primoris’ generous matching contribution. If offers a selection of investment options for you to choose from.
you can’t afford to save that much, make sure to save up to the You may change your investment choices any time. For more
matching amount so you don’t leave free money behind. details, visit rps.troweprice.com.
Changing or Stopping Your Vesting
Contributions Vesting refers to how much of your 401(k) funds you can
You may change the amount of your contributions any take with you if or when you leave Primoris. With our vesting
time. Changes are effective as soon as administratively feasible schedule, each year you’ll own a greater percentage of the
and remain in effect until you modify them. You company’s matching contributions. When you’re fully vested,
may also discontinue your contributions and start them you’ll own 100% of the contributions. You always own and are
again at any time. fully vested in your own personal 401(k) contributions.
Consolidating Your Retirement
Savings
If you have an existing qualified retirement plan (pre-tax) with
a previous employer, you may transfer that account into the
plan any time. Contact T. Rowe Price at 800-922-9945
for details.
Note
The average American starts saving for retirement at
Regardless of which retirement account you choose or how
age 27. But it’s never too late! (Source: Annuity.org)
much you contribute, remember to think of it as a long-term
strategy. Dipping into the account early will jeopardize the
quality of your retirement and you may be subject to early
withdrawal penalties from the IRS.
27A dditional Benefits
Primoris wants you to succeed in all aspects of life, so we offer a variety of additional benefits to make
your day-to-day easier.
Employee Assistance Program
We’re here for you when you need help. Our Employee
Assistance Program (EAP) - through The Hartford - helps
manage you and your family’s total health, including mental,
emotional, and physical. And there’s no cost to you — whether
or not you’re enrolled in a company-sponsored medical plan.
Through the EAP, you have access to mental health assistance
and legal and financial help from professionals. You also have
24-hour access to helpful resources by phone, and the EAP
benefit includes face-to-face visits per issue with a licensed
professional. All services provided are confidential and will not
be shared with Primoris. You may access information, benefits,
educational materials, and more by phone at
800-964-3577 or online at Guidanceresources.com.
The Program provides referrals to help with:
ˌ Emotional health and wellbeing
ˌ Alcohol or drug dependency
ˌ Marriage or family problems
ˌ Job pressures
ˌ Stress, anxiety, depression
ˌ Grief and loss
ˌ Financial or legal advice
28Supplemental Health Benefits
Primoris offers several ways for you to supplement your medical plan coverage. This additional
insurance can help cover unexpected expenses, regardless of any benefits you may receive from your
medical plan. Coverage is available for yourself and your dependents and is offered at discounted
group rates through MetLife.
Accident Coverage Hospital Indemnity
Accidents happen. You can’t always prevent them, but you can Hospital Indemnity Coverage Hospital Indemnity Coverage
take steps to reduce the financial impact. Accident coverage, through MetLife pays cash benefits directly to you if you have a
available through MetLife, provides benefits for you and covered stay in a hospital or intensive care unit. You can use the
your covered family members if you have expenses related benefits from this policy to help pay for your medical expenses
to an accident that occurs at work or outside of work. Health such as deductibles and copays, travel cost, food and lodging,
insurance helps with medical expenses, but this coverage or everyday expenses such as groceries and utilities.
is an additional layer of protection that can help you pay
deductibles, copays, and even typical day-to-day expenses HOSPITAL INDEMNITY HIGH LOW
such as a mortgage or car payment. Benefits under this plan
WEEKLY CONTRIBUTIONS
are payable to you, to use as you wish.
EMPLOYEE ONLY $2.50 $1.25
ACCIDENT INSURANCE HIGH LOW EMPLOYEE + SPOUSE $9.00 $4.50
WEEKLY CONTRIBUTIONS EMPLOYEE + CHILD(REN) $5.00 $2.50
EMPLOYEE ONLY $2.50 $1.25 EMPLOYEE + FAMILY $11.00 $5.50
EMPLOYEE + SPOUSE $4.50 $2.25
EMPLOYEE + CHILD(REN) $5.50 $2.75
EMPLOYEE + FAMILY $6.50 $3.25
Critical Illness Coverage
Critical Illness coverage through MetLife pays a lump-sum benefit if you are diagnosed with a covered disease or condition. You
can use this money however you like; for example: to help pay for expenses not covered by your medical plan, lost wages, childcare,
travel, home health care costs or any of your regular household expenses.
WEEKLY $30,000 OF COVERAGE $15,000 OF COVERAGE
CONTRIBUTIONS
EMPLOYEE EMPLOYEE EMPLOYEE + EMPLOYEE EMPLOYEE EMPLOYEE EMPLOYEE + EMPLOYEE
AGE
ONLY + SPOUSE CHILD(REN) + FAMILY ONLY + SPOUSE CHILD(REN) + FAMILY
Under 25 $1.80 $2.70 $2.70 $3.60 $0.90 $1.35 $1.35 $1.80
25-29 $2.10 $3.30 $3.00 $4.20 $1.05 $1.65 $1.50 $2.10
30-34 $2.70 $4.20 $3.60 $5.10 $1.35 $2.10 $1.80 $2.55
35-39 $3.30 $5.40 $4.20 $6.00 $1.65 $2.70 $2.10 $3.00
40-44 $4.80 $7.20 $5.40 $8.10 $2.40 $3.60 $2.70 $4.05
45-49 $6.90 $10.50 $7.50 $11.40 $3.45 $5.25 $3.75 $5.70
50-54 $10.60 $15.30 $11.10 $16.20 $5.25 $7.65 $5.55 $8.10
55-59 $15.30 $21.90 $16.20 $22.50 $7.65 $10.95 $8.10 $11.25
60-64 $22.20 $31.20 $23.10 $32.10 $11.10 $15.60 $11.55 $16.05
65-69 $32.40 $44.70 $33.30 $45.60 $16.20 $22.35 $16.65 $22.80
70-74 $43.50 $60.60 $44.40 $61.50 $21.75 $30.30 $22.20 $30.75
75+ $58.80 $84.00 $59.70 $84.60 $29.40 $42.00 $29.85 $42.30
29Required Notices When Will You Pay A Higher Premium (Penalty) To Join A
Medicare Drug Plan?
Important Notice from Primoris Services Corporation About You should also know that if you drop or lose your current coverage with
Primoris Services Corporation and don’t join a Medicare drug plan within
Your Prescription Drug Coverage and Medicare under the 63 continuous days after your current coverage ends, you may pay a higher
Blue Cross Blue Shield of Texas Premier Plan, Blue Cross premium (a penalty) to join a Medicare drug plan later.
Blue Shield of Texas Core Plan and Blue Cross Blue Shield If you go 63 continuous days or longer without creditable prescription drug
coverage, your monthly premium may go up by at least 1% of the Medicare
of Texas HSA Plan(s) base beneficiary premium per month for every month that you did not have that
Please read this notice carefully and keep it where you can find it. This coverage. For example, if you go nineteen months without creditable coverage,
notice has information about your current prescription drug coverage with your premium may consistently be at least 19% higher than the Medicare base
Primoris Services Corporation and about your options under Medicare’s beneficiary premium. You may have to pay this higher premium (a penalty) as
prescription drug coverage. This information can help you decide whether or long as you have Medicare prescription drug coverage. In addition, you may
not you want to join a Medicare drug plan. If you are considering joining, you have to wait until the following October to join.
should compare your current coverage, including which drugs are covered
at what cost, with the coverage and costs of the plans offering Medicare
prescription drug coverage in your area. Information about where you can get
For More Information about This Notice or Your Current
help to make decisions about your prescription drug coverage is at the end of Prescription Drug Coverage…
this notice.
Contact the person listed at the end of these notices for further information.
There are two important things you need to know about your current coverage NOTE: You’ll get this notice each year. You will also get it before the next
and Medicare’s prescription drug coverage: period you can join a Medicare drug plan, and if this coverage through
Primoris Services Corporation changes. You also may request a copy of this
1. Medicare prescription drug coverage became available in 2006 notice at any time.
to everyone with Medicare. You can get this coverage if you join a
Medicare Prescription Drug Plan or join a Medicare Advantage Plan For More Information about Your Options under Medicare
(like an HMO or PPO) that offers prescription drug coverage. All
Medicare drug plans provide at least a standard level of coverage set Prescription Drug Coverage…
by Medicare. Some plans may also offer more coverage for a higher More detailed information about Medicare plans that offer prescription drug
monthly premium. coverage is in the “Medicare & You” handbook. You’ll get a copy of the
handbook in the mail every year from Medicare. You may also be contacted
2. Primoris Services Corporation has determined that the prescription directly by Medicare drug plans.
drug coverage offered by the Blue Cross Blue Shield of Texas Premier
Plan, Blue Cross Blue Shield of Texas Core Plan and Blue Cross For more information about Medicare prescription drug coverage:
Blue Shield of Texas HSA Plan plan(s) is, on average for all plan
» Visit www.medicare.gov
participants, expected to pay out as much as standard Medicare
» Call your State Health Insurance Assistance Program (see the inside
prescription drug coverage pays and is therefore considered
back cover of your copy of the “Medicare & You” handbook for their
Creditable Coverage. Because your existing coverage is Creditable
telephone number) for personalized help
Coverage, you can keep this coverage and not pay a higher premium
» Call 1-800-MEDICARE (1-800-633-4227).
(a penalty) if you later decide to join a Medicare drug plan.
TTY users should call 1-877-486-2048
If you have limited income and resources, extra help paying for Medicare
When Can You Join A Medicare Drug Plan? prescription drug coverage is available. For information about this extra help,
You can join a Medicare drug plan when you first become eligible for Medicare visit Social Security on the web at www.socialsecurity.gov, or call them at
during a seven-month initial enrollment period. That period begins three 1-800-772-1213 (TTY 1-800-325-0778).
months prior to your 65th birthday, includes the month you turn 65, and
continues for the ensuing three months. You may also enroll each year from Remember: Keep this Medicare Part D notice. If you decide to join one
October 15th through December 7th. of the Medicare drug plans, you may be required to provide a copy of
this notice when you join to show whether or not you have maintained
However, if you lose your current creditable prescription drug coverage,
creditable coverage and, therefore, whether or not you are required to
through no fault of your own, you will also be eligible for a two (2) month
pay a higher premium (a penalty).
Special Enrollment Period (SEP) to join a Medicare drug plan.
What Happens To Your Current Coverage If You Decide to Date: January 1, 2022
Join A Medicare Drug Plan? Name of Entity/Sender: Primoris Services Corporation
If you decide to join a Medicare drug plan, your current Contact—Position/Office: Human Resources
Primoris Services Corporation coverage will not be affected. For most persons Address: 2300 N Field St Suite 1900
covered under the Plan, the Plan will pay prescription drug benefits first, and Dallas, TX 75201
Medicare will determine its payments second. For more information about Phone Number: 214-740-5600
this issue of what program pays first and what program pays second, see the
Plan’s summary plan description or contact Medicare at the telephone number
or web address listed herein.
If you do decide to join a Medicare drug plan and drop your current
Primoris Services Corporation coverage, be aware that you and your
dependents will not be able to get this coverage back.
30Women’s Health and Cancer Rights Act Unless the event giving rise to your special enrollment right is a loss of
coverage under Medicaid or CHIP, you must request enrollment within 30 days
If you have had or are going to have a mastectomy, you may be entitled to after your or your dependent’s(s’) other coverage ends (or after the employer
certain benefits under the Women’s Health and Cancer Rights Act of 1998 that sponsors that coverage stops contributing toward the coverage).
(WHCRA). For individuals receiving mastectomy-related benefits, coverage
will be provided in a manner determined in consultation with the attending If the event giving rise to your special enrollment right is a loss of coverage
physician and the patient, for: under Medicaid or the CHIP, you may request enrollment under this plan
» All stages of reconstruction of the breast on which the mastectomy within 60 days of the date you or your dependent(s) lose such coverage under
was performed; Medicaid or CHIP. Similarly, if you or your dependent(s) become eligible for a
» Surgery and reconstruction of the other breast to produce a state-granted premium subsidy towards this plan, you may request enrollment
symmetrical appearance; under this plan within 60 days after the date Medicaid or CHIP determine that
» Prostheses; and you or the dependent(s) qualify for the subsidy.
» Treatment of physical complications of the mastectomy, including
lymphedema. In addition, if you have a new dependent as a result of marriage, birth,
adoption, or placement for adoption, you may be able to enroll yourself and
These benefits will be provided subject to the same deductibles and your dependents. However, you must request enrollment within 30 days after
coinsurance applicable to other medical and surgical benefits provided under the marriage, birth, adoption, or placement for adoption.
this plan. For deductibles and coinsurance information applicable to the plan
in which you enroll, please refer to the summary plan description. If you would To request special enrollment or obtain more information, contact
like more information on WHCRA benefits, please contact Human Resources at Human Resources at 214-740-5600.
214-740-5600.
HIPAA Privacy and Security
The Health Insurance Portability and Accountability Act of 1996 deals with how
an employer can enforce eligibility and enrollment for health care benefits, as
well as ensuring that protected health information which identifies you is kept
private. You have the right to inspect and copy protected health information
that is maintained by and for the plan for enrollment, payment, claims and
case management. If you feel that protected health information about you is
incorrect or incomplete, you may ask your benefits administrator to amend
the information. For a full copy of the Notice of Privacy Practices, describing
how protected health information about you may be used and disclosed and
how you can get access to the information, contact Human Resources at
214-740-5600.
HIPAA Special Enrollment Rights
If you are declining enrollment for yourself or your dependents (including your
spouse) because of other health insurance or group health plan coverage, you
may be able to later enroll yourself and your dependents in this plan if you
or your dependents lose eligibility for that other coverage (or if the employer
stops contributing towards your or your dependents’ other coverage).
Loss of eligibility includes but is not limited to:
» Loss of eligibility for coverage as a result of ceasing to meet the plan’s
eligibility requirements (i.e. legal separation, divorce, cessation of
dependent status, death of an employee, termination of employment,
reduction in the number of hours of employment);
» Loss of HMO coverage because the person no longer resides or works
in the HMO service area and no other coverage option is available
through the HMO plan sponsor;
» Elimination of the coverage option a person was enrolled in, and
another option is not offered in its place;
» Failing to return from an FMLA leave of absence; and
» Loss of coverage under Medicaid or the Children’s Health Insurance
Program (CHIP).
31You can also read
