Benefits Guide 2017 - Federal Signal
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Benefits Guide 2017
New Hire Benefit Checklist Welcome to Federal Signal
First things first... First you must log in to our Completed 2017
Visit the Ultipro online Employee
Self Service portal, see page 6 for
Ultipro…
Deadline
✓
details Complete your benefits enrollment on-line:
• Log on to n12.ultipro.com
We are pleased to provide this guide to selecting and using our Benefit Plans.
• Designate dependents, beneficiaries and emergency contacts Within
You will need your Ultipro
username and password
• Elect Healthcare or Dependent Care FSA 31 days of We care about our employees, and this benefit guide is designed as part of the onboarding
• Elect your HSA contribution if enrolling in the Date of Hire
Username: Typically your first initial Healthy Advantage Medical Plan
• PRINT a copy of your confirmation
process to give you the answers you need, and to assist you in enrolling in our programs.
followed by your last name. If you have
a common last name, there may be a If You … Take Action Deadline Federal Signal is committed to providing you with the information and resources you
number after your name. See your local
HR Representative or contact FS Ben- Log on to wellontarget.com and complete
the Health Assessment or you will pay an
need to make the best benefit choices. Making the right decisions for you and your
efits by phone or email for assistance. additional medical premium in 2017.
See contact information below. family is an important part of managing both your health and your personal
Submit the optional Physician Screening
Password: Your initial password is the Enrolled in a medical Form, found on page 51, that has been
finances. We strive to support your health and well-being through
last four digits of your social plan for yourself completed by your doctor.
security number. a variety of programs designed to help you to minimize your own
Create a new password: You will be
asked to create a new password after health risks and live a long and healthy life. Federal Signal
your initial login and choose your secu-
rity questions and answers in case you Your spouse or domestic partner must log is pleased to provide the tools and education to
on to wellontarget.com and complete the
need to retrieve your password in the
future.
Health Assessment or you will pay an ad-
ditional medical premium in 2017.
help you make the best decision for yourself
Complete
within 30
For assistance call the days of
and your family. We believe having choices
FS Benefits Helpline at 855.895.4333 Submit the optional Physician Screening eligibility
or email FSBenefits@federalsignal.com Form, found on page 51, that has been date is important and we offer high-quality
Enrolled your spouse completed by your doctor.
Follow-through required or domestic partner benefit plans to choose from.
in a medical plan
Some benefit elections will not Complete the Spouse/Domestic Partner
become effective unless you follow Eligibility Form (found on page 53) and
through and submit additional return form to Human Resources. Failure
to submit a completed and signed form
documentation or complete additional will result in the termination of coverage
steps. Use the checklist on this page for your spouse or domestic partner.
to make sure you don’t overlook any
necessary steps in the benefit
Enrolled a spouse,
enrollment process. domestic partner or Provide required documentation to Human
dependent child in Resources. See page 10 for details.
any benefit plan
If this is an electronic version of
the Federal Signal Benefit Guide, Elected Optional Life If you receive an Evidence of Insurability (EOI) Form from HR,
you will be able to: Insurance it must be mailed to Reliance Standard. See page 38.
Click on Table of Contents headings to jump to
that page or section
Go to web pages by clicking on hyperlinks
Review your paycheck and compare the benefit deductions with your confirmation
Send email to hyperlinked email addresses by statement to ensure all benefits you elected are effective. Alert your local HR
clicking on link, your default e-mail application representative to any discrepancies.
will launch and a blank e-mail, addressed to that Our Mission: Providing products and services to protect people and our planet
email address, will open.
Table of Contents An Introduction to Benefits
Benefit Enrollment Checklist............................inside front cover Benefit Enrollment When do I enroll?
An Introduction to Benefits.......................................……………..…5 Resources You must enroll for benefits or decline coverage by logging in to Ultipro
How to Access Ultipro.................................................................6
Making Changes................................………........................……..…7 This benefit guide
at n12.ultipro.com within 31 days of your date of hire.
You Must
Eligibility …………...................................................................…..…8
Confirming Eligibility….................................................…………..…9
Read this guide for an overview of your
benefit options. Plan Documents are
If you do not enroll on-line by this deadline you will default to no cover-
age for medical, dental, vision, optional life insurance and optional long- Take Action
available upon request. Summary Plan term disability buy-up coverage for the remainder of the plan year. You
Dependent Eligibility Documentation Requirements.................10 Within 31 days of your date of hire,
Descriptions are available from your will not be able to enroll until the next open enrollment period. In addi-
Family and Medical Leave Act ...……..........................................12 if you do not enroll as a new hire,
local HR and as downloads in Ultipro at tion, you will be required to provide evidence of insurability if you wish your coverage will default to no
Qualified Life Events……….....………………….……............................13 n12.ultipro.com. to enroll for optional life or long-term disability coverage at that time. coverage for medical, dental,
Medical Plans…….……....……………………….……..............................15 You will have an opportunity to make changes to your plans only dur- vision, optional life insurance and
Federal Signal Benefits Helpline
Medical Plan 2016 Contribution Rates………...................……......16 ing Open Enrollment each Fall for the following calendar year, or if you optional long-term disability buy
Compare Medical Plans…………...........................................….....17 Get answers to your questions about experience a Qualified Life Event. See page 13. up coverage for the remainder of
benefits and the enrollment process the plan year.
Health Savings Account (HSA)…….................................………......20 Monday through Friday, 8:00 a.m. to
HSA Eligible Medical Expenses……................................……….....21 5:00 p.m., Central Time. The next opportunity you will have
Flexible Spending Accounts (FSA)…..................................…….....22
When do benefits begin ? to enroll will be the next Open
•Call: 855.895.4333 Salaried employees’ benefits begin the 1st of the month coincident with or Enrollment period, unless you
Limited Purpose Flexible Spending Account (LPFSA)...............23
•Email: FSBenefits@federalsignal.com following your date of hire. Hourly employees’ benefits begin the 1st of the experience a Qualified Life Event.
Flexible Spending Accounts Contribution Worksheet................24 month following 60 days of service. See page 13.
HSA, HCA, or FSA— What’s the difference?…...........…….…….......25 Employee Self-Service through the
MDLive Virtual Medical Visits……...................................…….....25
Ultipro Portal: Who can I cover?
Prescription Drug Programs………....................................…….....26 Web address: You can enroll yourself and your eligible dependents. See page 10 for a com-
n12.ultipro.com plete description of eligible individuals. Tax Treatment of Benefits
Prescription Drug Coverage……....……….....................................27
Specialty Pharmacy Program…....…………...................................28 • Enroll or decline coverage How do I pay for benefits? Coverage for Coverage
Coordinating with Medicare…...................................................29 • Enroll eligible dependents yourself and for non-tax
You and the Company share the cost of most of your benefits. Your contri- tax eligible eligible
Condition Management Program…............................................29 • See page 6 for login instructions Benefit dependents dependents
bution for some of your benefits is deducted from your gross pay before
Blue Access for Members……………............................................30 federal, state and medicare taxes are calculated, thus reducing your tax Pre- After- Pre- After-
Blue Distinction Centers for Specialty Care………....….........….....31 Contact your local HR department liability. These pre-tax benefits are described as “tax favored.” Tax Tax Tax Tax
Dental Plan.......…….……………………………….......……….......…….......32 Corporate..........................855.895.4333
Under Internal Revenue Service rules, only individuals who qualify as
Medical ✓ ✓
Vision Plan……..………………………………………....……........................33 Elgin Sweeper....................847.622.7156 your tax dependents may receive tax-favored benefits. This means if your
Federal Signal Wellness Program ………...…..……..………………......34 Federal Signal/ domestic partner and your domestic partner’s child(ren) are covered on Dental ✓ ✓
FS Wellness Program FAQs……………..........................................35 University Park..................708.587.3064 our benefit plans, the portion of your contribution that you pay for their
coverage is deducted from your pay on an after-tax basis.
Additional Employee Benefits….................…….…...….................36 Guzzler...............................205.702.7738 Vision ✓ ✓
Mental Health and Substance Abuse….................…….…...….....36 Jetstream..........................832.590.1337
Tuition Assistance Plan…………………..…........................………......36
Life Insurance ………..…...………….…………….........................…....…38
Vactor................................815.673.3858 Optional Life ✓ ✓
Victor.................................708.587.3064
Disability ……….……..……...…………………………............................….39
Saving for Retirement...........………….......................................…40
Spouse Life ✓ ✓
Retirement Savings Overview…………......................................…41
Distribution of Retirement Savings………….............................…42 We are self-insured Child Life ✓ ✓
This guide is not a Plan document and
COBRA.......................................…................................…43 is provided for informational purposes Federal Signal is committed to providing quality employee benefit insur-
Our Benefit Plan Partners…………….....................................…44 only. Terms and conditions of our vari-
ous benefit Plans are contained within ance. We have chosen this approach because it gives us more control
Optional Long-term
Disability Buy-up ✓ ✓
Required Notices…………........................................................…..45 our Plan documents. over benefits and can lower costs for our employees.
4 5
Visit the Ultipro site to Enroll Making Changes
Ultipro is your
Enroll, Change & View Benefits
Benefits Life Events
benefits management tool The benefits you elect as a new hire will remain in effect for the remain-
der of the plan year, unless you experience a Qualified Life Event (QLE)
Eligible Status Changes
Once you have done your homework and
made your decisions, it’s time to log onto
1 Go to Federal Signal’s Ultipro site on the web at
n12.ultipro.com
that permits you to make changes. If you experience a QLE that affects
your benefits, login to Ultipro to initiate a life event. In most cases, you Review page 13 in this book for eligible
and login using your username must submit your life event within 31 days of the QLE. See page 13 for life events that qualify you to make
the Ultipro site to enroll, change or view
and password. more information. changes throughout the year to your
your benefit decisions.
benefits, such as:
Managing Your Plans
Ultipro is your benefits management tool
Changing your life insurance beneficiaries • Having Children
for your health and welfare benefits. You may add, remove, or change the designation percentages of your
Use Ultipro to: 2 From the homepage, go to the Myself tab and select
Life Events from the dropdown
beneficiaries for your company life insurance at any time by logging in to
Ultipro and navigating to Myself >Life Events >Designate Beneficiaries.
• Marriage/Partnership
• Divorce or Legal Separation
• Enroll in your benefits plans menu to begin. Consult You may not change your optional life insurance coverage level, unless you
• Review your current benefits coverage the Quick Tours and Tips experience a Qualified Life Event. • You (the Employee) Die
• Add/change your life insurance in the right column
Note: The beneficiary designation for your 401(k) Retirement Savings
beneficiaries for additional help. Plan is separate and must be designated with Vanguard. See page 41 for • A Dependent Dies
• Make changes to your plans during
directions on contacting Vanguard.
Open Enrollment or if you experience • Other Life Events
a Life Event
3 Personal information changes
• Use tools to help you manage your Before you continue, you should enter your
benefits
beneficiaries and dependents. Changes to personal information such as name and/or address changes,
You may add eligible tax changes, and direct deposit information can be made by contacting
You will need an dependents and your local HR representative.
Ultipro username enter contact
and password information at this time.
Username: Usually your first initial
4
followed by your last name. If you have
a common last name there may be a
Make your Benefit Elections. Enroll or decline coverage
number after your name. for each benefit offering on each of the Select a Plan
pages. Click the arrow button to proceed through all of
What if I don’t know my Username? the plans.
See your local HR Representative or
contact FS Benefits by phone or email.
See contact info below.
Password: Your initial sign on password 5 When you get to the confirmation page, scroll down to
see your new benefit elections below Current Benefits.
is the last four digits of your social If you need to make any changes, click on the Plan Type
security number. or Plan Details link to return to enrollment page. To
Create a new password: You will be continue at a later time, click on draft.
asked to create your own password
after your initial login and set your
security questions in case you need to
retrieve your password in the future. 6 Click the submit button at the top of the page to
complete your enrollment. You may return to make
changes within 31 days of your date of hire. When
For assistance call the
FS Benefits Helpline at 855.895.4333
you click OK, a confirmation page will display. Print a
or email FSBenefits@federalsignal.com copy of this page for your records.
6 7
Eligibility Confirming Eligibility
Who is eligible? Submit documentation within 30 days
Active employees as well as certain
Eligibility Guide Eligibility Certification
family members are eligible for benefits When you enroll a family member, you need to confirm he or she is
eligible. Look at the list of accepted documents on page 10 to learn Form can be found at the
if specific criteria are met. Your eligibility what you need to provide to get your family member covered. You back of this book
You are eligible for Federal Signal benefits if you are a: have 30 days from the date you add your family member to submit the
documentation. Spouse/Domestic Partner Eligibility forms are included Completed form due to HR
Changes to your • Salaried or hourly full-time employee, not subject to a collective in the back of this booklet or are available from your local HR repre- within 30 days
bargaining agreement, or of adding your
Dependent’s Eligibility • Part-time employee regularly scheduled to work at least 30 hours
sentative. If you do not submit documentation by the deadline or the
documentation is not approved, your dependent’s enrollment will be spouse/domestic partner
per week. canceled. to a Federal Signal medical plan
If an event occurs and your dependent
no longer meets all of the eligibility
criteria; i.e. changes in your spouse’s If you are eligible for benefits, you may cover your dependents subject
to the eligibility criteria of the plan and the review of required docu-
employment or a dependent child
reaches the limiting age (see chart on mentation, see page 10 for details.
Eligibility rules for spouses or
pp. 10–11), it is your responsibility to domestic partners
remove the dependent from coverage
by initiating a Life Event in Ultipro. Both work at Federal Signal?
A Spouse/Domestic Partner Eligibility Certification form will be required
You may not elect coverage as an employee and receive coverage as an- for any spouse or domestic partner enrolled in a Federal Signal medical
If you fail to remove the ineligible de- other employee’s dependent. Also, only one Federal Signal parent may plan. If your spouse or domestic partner is not employed you are still
pendent, you will continue to pay for cover eligible dependent children. required to certify that status by signing and returning the certification
coverage but any claims made after he form.
or she is no longer eligible for cover-
age will not be paid. Additionally, Your family members Option A: If your spouse or domestic partner is not employed, or em-
your dependent may lose their right ployed but not eligible for medical coverage, you may enroll them in a
Eligible family members include:
to continue coverage under COBRA if Federal Signal medical plan as their primary coverage. You will pay the
the Company is not notified within 60 • Spouse (same or opposite sex), unless legally separated
• Domestic partner (see criteria on pages 10–11) regular premium for coverage.
days of becoming ineligible.
• Dependent children to age 26 for medical coverage Option B: If your spouse or domestic partner is employed and enrolled
• Dependent children to age 19 or age 23 if a full-time student for in his or her employer’s medical plan, you may enroll them in a Federal
dental and vision Signal medical plan; however the Federal Signal medical plan will be
• Children over the age limit if: treated as secondary coverage for purposes of coordination of benefits.
• They are incapable of self-support due to a physical or mental You will pay the regular premium for coverage.
disability
Option C: If your spouse or domestic partner is employed and is eligible
• They are dependent on you for primary financial support, and
for coverage through his or her employer’s medical plan, but will not be
• They were disabled and covered on our plan prior to reaching covered on their employer’s plan, you may enroll them in a Federal Sig-
the limiting age nal medical plan as their primary medical coverage. You will pay a $200
per month premium in addition to the regular premium.
Eligible children include:
• Natural children The information you provide on the Spouse/Domestic Partner Eligibility
• Stepchildren Certification form must be true and correct. Any misrepresentations
• Legally adopted children constitute fraud and could result in disciplinary action up to and including
• Children for whom you are the legal guardian termination of employment.
• Children placed with you for adoption
• Child for whom you are required to provide coverage, pursuant to a
Qualified Medical Child Support Order (QMCSO)
• Children of your domestic partner who depend on you for support
and who live with you in a regular parent/child relationship (your
domestic partner must be eligible and enrolled in a Federal Signal
medical plan)
8 9
Dependent Eligibility Documentation Requirements
Action required
DEPENDENT’S RELATIONSHIP
Federal Signal requires that you verify your dependents’ eligibility. At ELIGIBILITY CRITERIA REQUIRED DOCUMENTATION
TO YOU
right is a chart listing acceptable documentation you can provide to cer-
tify your dependent’s eligibility. If you have questions about your depen-
dent’s eligibility see your HR representative. Spouse A person to whom you are legally married. - Copy of legal, presently valid marriage certificate. Must include the date of marriage,
Or
If you enroll your spouse in a Federal Signal medical plan, an eligibility certification form is - Copy of first page of joint federal tax return from the most recent tax year. Must indicate “married filing
same or opposite sex required. jointly” or “married filing separately” and contain the name of the employee and name of the spouse.
Eligibility rules for spouses or domestic partners (unless legally separated)
Must return the spouse/domestic partner eligibility certification.
Option A: If your spouse or domestic partner is not employed, or employed but
not eligible for medical coverage, you may enroll them in a Federal Signal medi-
cal plan as their primary coverage. You will pay the regular premium for cover-
age.
Domestic Partner A person of the same or opposite sex, with whom you have entered into a committed
relationship and meet all of the following criteria:
- Signed and notarized Declaration of Domestic Partnership from Federal Signal,
And
• Have a shared principal residence for the past 12 consecutive months; - Proof of joint residency and proof of financial interdependence as described in the declaration,
Option B: If your spouse or domestic partner is employed and enrolled in his or • Are both at least 18 years of age; Or
• Are not related to one another in a way that would prohibit marriage in your state - Copy of a Domestic Partnership Registration Certificate from any city, county, or state offering the ability to
her employer’s medical plan, you may enroll them in a Federal Signal medical of residence; register domestic partnership.
plan; however the Federal Signal medical plan will be treated as secondary cov- • Do not currently have any other domestic partner and are not legally married to
erage for purposes of coordination of benefits. You will pay the regular premium another person; Must return the spouse/domestic partner eligibility certification.
• Have not had a different domestic partner or spouse in the past 12 months;
for coverage. • Are financially interdependent.
Option C: If your spouse or domestic partner is employed and is eligible for If you enroll your domestic partner in a Federal Signal medical plan, an eligibility certifica-
coverage through his or her employer’s medical plan, but will not be covered on tion form is required.
their employer’s plan for 2017, you may enroll them in a Federal Signal medical
plan as their primary medical coverage. You will pay a $200 per month premium
in addition to the regular premium.
Your Children Your natural born child, legally adopted child, child legally placed with you for adoption, or
child of legal guardianship.
- Copy of birth certificate listing employee as a parent. Hospital birth record acceptable only for a child
under 6 months of age where a birth certificate is not available.
- Adoption paperwork containing the names of the employee and of the child,
Age Limitations: Child(ren) for whom you are required to provide coverage pursuant to a Qualified Medical Or
You have 30 days
Medical – to age 26, Child Support Order (QMCSO). - Copy of legal guardianship paperwork issued by a court of law containing the name of the employee and
Dental and Vision – to age 19, or the name of the child.
age 19 – 23 if a full-time student Or
- QMCSO containing the name of the employee and the name of the child.
from the date you add
your dependent to complete For newborns added within 31 days of their birth you need only provide the hospital certificate of live birth
and return the
Step Children Your spouse or domestic partner’s natural child, adopted child, or child of legal guardian-
ship for whom no other parent is legally responsible for providing health coverage.
A divorce decree, custody agreement, court order or Qualified Medical Child Support Order (QMCSO)
declaring the employee’s eligible and covered spouse or domestic partner legally responsible for providing
Eligibility Certification Form Age Limitations: Child(ren) for whom you are required to provide coverage pursuant to a Qualified Medi-
health coverage for the child.
Medical – to age 26, cal Child Support Order (QMCSO). If no such order is in place:
to your HR representative Dental and Vision – to age 19, or - Birth certificate indicating your eligible and covered spouse or domestic partner as the parent.
age 19 – 23 if a full-time student Your spouse or domestic partner must be eligible and covered on a Federal Signal medi- Your spouse or domestic partner must be eligible and covered on a Federal Signal medical plan.
cal plan. And
- Copy of first page of your federal tax return from the most recent tax year. Must contain the name of the
employee and the name of the child.
Form located at the back of this book
Disabled Children Over Age 26 Your or your spouse or domestic partner’s natural, step or legally adopted child as de-
scribed above
- Must meet the required documentation for the child type above,
(Medical Only) And
And
Provide one of the following:
FSBenefits@federalsignal.com Disabled Children Over Age 19 For whom you provide primary financial support and who is incapable of self-support - Physician’s statement or letter of disability containing the child’s name, date of disability, and confirmation
because of a mental or physical disability occurring prior to the attainment of age 26 (or of disability, signed by the physician within the past 12 months.
(Dental and Vision) age 19 for dental and vision) if they were covered by the plan prior to age 26 (or age 19 for - Letter of Determination of Disability from the Social Security Administration.
dental and vision).
855.895.4333
FS Benefits Helpline
10 11
Family and Medical Leave Act (FMLA) Qualified Life Events
Family Medical Leave (FML) benefits What is a Qualified Life
In accordance with the Family and Medical Leave Act (FMLA), eligible employees are entitled to take unpaid leaves of
Dependent child coverage Event?
absence under the FMLA and our written FMLA policy (available from your local HR representative and on our intranet).
A Qualified Life Event (QLE) is an event
In order to be an “eligible employee” you must have completed at least twelve (12) months of employment, have worked Birth and adoption defined by the IRS that allows you to
a minimum of 1,250 hours in the past year, and work at a company location where we employ 50 or more employees Newborns are automatically covered under the parent’s medical plan make changes to your benefits elections.
within 75 miles. for the first 30 days after birth. However, you must enroll your newborn For example, you can make changes
within 31 days of the baby’s birth date for coverage to continue — even within 31 days of:
Generally, eligible employees are entitled to take up to twelve (12) weeks of FMLA leave in a rolling 12-month period if you already have coverage for other dependent children. • Your marriage, divorce, or legal separation
(measured backward from the date you commence FML) for their own serious health condition, the birth or adoption of • Establishment or dissolution of a domestic partnership
a child, the care of a spouse, child, or parent who has a serious health condition, or a qualifying exigency arising out of Dependent coverage begins • Birth, adoption, or placement for adoption of a child
the fact that the employee’s spouse, son, daughter or parent is a covered military member on covered active duty. A child becomes eligible at birth, adoption or when you gain custody. A • Death of your spouse, domestic partner or dependent
child may be covered by the medical plan until age 26. See Eligibility for • A change in employment status for you, your spouse,
more details. domestic partner or dependent
Eligible employees may take twenty-six (26) weeks of leave during a single 12-month period (measured forward from the
• You, your spouse, domestic partner or dependent loses
first day you take leave to care for the service member) to care for a covered service member with a serious injury or ill- coverage under another plan
ness if the eligible employee is the service member’s spouse, son, daughter, parent, or next of kin.
What to do when you have a child
• Solely with respect to the Dependent Care FSA—Any
FMLA leave may be granted on a continuous, intermittent, or reduced hours basis where applicable under the FMLA and • Submit a Life Event online within 31 days of the event to add your change in the number of qualifying dependents or
our FMLA Policy. child to your coverage. changes in the cost of a day care provider or dependent
care costs
• Log in to Ultipro, go to the Myself tab and select Life Events.
Please refer to the FMLA and our FMLA policy for the precise terms and conditions of FML at our Company which gov- • Submit the document(s) to verify eligibility to your HR Representa- You can make changes within 60 days of:
erns in the event of any discrepancy. tive. • A change in the eligibility of a covered dependent
• You or your dependent’s Medicaid or CHIP (Children’s
• You may want to verify and/or change your beneficiary information
Health Insurance Program) coverage is terminated as a
for your life insurance. result of loss of eligibility
• You can start a Dependent Care Flexible Spending Account (DCFSA) • You or your dependent becomes eligible for a premium
or increase the amount of your current election. assistance subsidy under Medicaid or CHIP
Filing your FML claim
To request FML, please contact your Dependent child is no longer eligible
local HR representative and our FML Dependent coverage ends
administrator, Matrix Absence Man- For dental and vision coverage, the age limit for dependent children is
agement, Inc. (Matrix). Matrix, the 19, or up to age 23 if they are unmarried and a full time student. The
administrator of our FML and disability age limit for medical coverage is 26. You must remove your child from
benefits, can be reached via phone or coverage within 60 days of the date they reach the limiting age.
you may file a claim online.
If you do not remove your overage dependent, you will continue to pay BE AWARE!
for coverage but no claims will be paid.
31 day deadline for
877.202.0055 COBRA adding dependents
Matrix Services When your child is no longer eligible, coverage will end for your child
after the date on which they become ineligible (i.e. the day after their and newborns
www.matrixeservices.com 26th birthday for medical). Coverage may be continued under COBRA
for up to 36 months. Read more about COBRA on page 43. You must make changes to
your benefits within 31 days
What to do when your dependent is no longer eligible
of your life event or wait un-
• Log in to Ultipro within 60 days of the date eligibility ends to remove
your dependent from your coverage.
til the next Open Enrollment
period. Coverage begins on
• You may want to verify or change your beneficiary information for
your life insurance. If you need to change your beneficiary for your the date of the event.
retirement savings plan, contact Vanguard for instructions.
12 13
Qualified Life Events Medical Plans
A dependent dies Marriage The most important decision Coverage levels
Human Resources is here to sup- If you wish to add your new spouse to your medical plan, be sure they • You only
Choosing the right medical plan may be the most important decision
port you in this difficult time. Refer meet the eligibility rules. The effective date of coverage is the marriage • You + Spouse or Domestic Partner
date. In order for your new spouse’s coverage to become effective you you make during your new hire enrollment period. You must visit Ul-
to the information and action
tipro at n12.ultipro.com to enroll in a medical plan. • You + Child(ren)
steps below. must:
• Family
• Contact your local HR repre- • Complete a Spouse/Domestic Partner Eligibility certification
sentative or call the FS Benefits (available in the back of this book, in Ultipro, or from your local How the plans work
You will receive your BCBS
Helpline and inform them of the HR representative) card via U.S. mail
death Both medical plans are administered by BlueCross BlueShield of Illinois
• You will need certified copies of • Present a copy of your marriage certificate to your HR and include the same network of doctors, hospitals and healthcare
the death certificate representative providers. You can use any provider you want but you’ll pay less and
• Make necessary changes to your receive a higher level of coverage when you use providers in the net-
benefits elections Domestic partnership work. Once you satisfy the annual deductible for your plan, you pay 20
• Update your life insurance On the one year anniversary of having met the eligibility criteria for a percent of the cost of most services, known as coinsurance. Both plans
beneficiaries
domestic partnership, the partnership becomes a QLE for the purposes cover in-network wellness services at no cost to you.
• Request a new W4 form to change
of our plan. (See chart on page 10). You may enroll your domestic part-
tax filing status if apropriate
ner and eligible dependents in Ultipro within 31 days of that anniversary
To help you cope with your loss, date. You must then establish your domestic partnership by completing
please contact our Employee As- the Domestic Partner Certification Form and submitting it along with
the required documentation for review and approval.
Choice of 2 Plans
sistance Program (EAP), page 36,
for grief counseling, resources, and
referrals for additional assistance. The Healthy Advantage Plan The Healthy Choice Plan
Divorce or legal separation
If you become divorced or legally separated, your spouse is no longer This plan has higher deductibles but lower premiums
You (the employee) die eligible for coverage. You must remove your spouse from coverage than the Healthy Choice Plan. This plan has lower deductibles but higher premi-
If you die while employed with ums than the Healthy Advantage Plan.
within 60 days of the date of the event. This plan features a Health Savings Account (HSA)
Federal Signal, your family mem- This plan includes a Company funded Health Care
which permits you to set aside money through payroll
bers can refer to the action steps Coverage will end the date of the divorce or legal separation. You will Reimbursement Account (HCA) to help cover the
deduction on a pre-tax basis. These funds can be used
and information shown below. be required to submit a copy of the divorce decree showing the date of higher deductible.
to pay for eligible healthcare expenses now and in the
divorce. Your former spouse may continue to be covered under COBRA future.
• Contact the local HR represen- for up to 36 months. See COBRA on page 43 of this book.
tative or call the FS Benefits Your HSA belongs to you. That means that you keep it
Helpline and inform them of the
death
even if you change employers; and the money in your
• Survivors are required to Changes in your spouse or domestic partner’s account is carried over from year to year.
present certified copies of the
death certificate employment
If your spouse or domestic partner changes jobs or becomes eligible for
Note: Health coverage for your medical coverage under an employer’s plan, they may continue cover-
surviving spouse and dependents age on our medical plan as primary coverage (an additional $200/month
ends on the date of death. premium will apply) or you may drop them from coverage. You must
complete and submit a new Spouse/DP eligibility certification.
Surviving family members, if
If your spouse or domestic partner loses coverage under their employ-
covered, may continue coverage
er’s medical plan, he or she can be enrolled under the Company’s medi-
under COBRA for up to 36 months.
cal plan. You must enroll them in Ultipro within 31 days of their loss of
They will only have to pay active
coverage and submit the Spouse/DP eligibility certification form to HR.
employee rates for coverage for
the first 12 months of COBRA.
14 15
Medical Plan 2017 Contribution Rates Compare Medical Plans
Side-by-side plan comparison
Key features of the medical plans are summarized at right. For full details and term
definitions, please refer to the Summary Plan Descriptions available on the Ultipro Healthy Advantage Plan Healthy Choice Plan
Portal home page. Plan Features with a with a
Health Savings Account (HSA) Health Care
The benefits described in this table are for in-network services only. If you receive Reimbursement Account (HCA)
services from an out-of-network provider you will have to meet a higher deductible
and receive a lower percentage coinsurance. BlueCross BlueShield of Illinois has an
extensive network of providers. Go to www.bcbsil.com to find a network provider.
Employee Only
$ 81.59 $107.32
Compensation based Employee + Spouse/
Domestic Partner $178.34 $224.96
medical premiums 2017 Monthly Employee
Contribution
Employee + Child(ren)
For new employees, this additional $159.60 $205.86
premium will be based on total annual
Family $305.65 $375.64
cash compensation in the year you are
hired and may apply only if you are en- HSA—The Company funds $750 for employee only; or HCA—The Company funds $750 for employee only; or
rolled in a Federal Signal medical plan $1,500 for employee + 1 or more dependents. $1,500 for employee + 1 or more dependents.
HSA accounts are funded quarterly with 1/4 of the annual company HCA accounts are funded on the date you become eligible
the following year. Healthcare Accounts contribution Flexible Spending Account:
Limited Purpose Flexible Spending Account: You can contribute pre-tax up to $2,600
You can contribute pre-tax up to $2,600
For a comparison of the different Healthcare Accounts, please see page 22
Additional monthly
2017 annual cash $2,000 if only employee is enrolled
$1,750 per individual or
medical plan $4,000 if employee + dependent(s) are enrolled
compensation Annual Deductible—Individual / Family $3,500 for 2 or more dependents
premium Prescription drugs apply to the deductible
$125,000 – The annual deductible is the amount you must pay out of your pocket before the plan pays benefits for applicable services.
$62.50
$174,999
$4,000 / $8,000 $3,750 / $7,500
$175,000 – Annual Out-of-Pocket Maximum—Individual / Family
$83.34
$224,999
Medical deductibles, copays, and coinsurance apply to the out-of-pocket maximum. When you reach the out-of-pocket maximum, your medical plan
pays 100% including prescription drugs.
$225,000 or
$166.67 100%, No Deductible, No Copay 100%, No Deductible, No Copay
greater
Wellness In-Network Only
Wellness benefits include routine physicals, mammograms, pap smears, prostate tests, digital rectal exams, colorectal cancer screenings, well child
care, and immunizations. No coverage for out-of-network wellness services.
80% After Deductible 80% After Deductible
Office Visits
Primary physicians include general practice, internal medicine, family practice, pediatricians, OB/GYN and mixed medical groups. All other
professionals are considered specialists.
80% After Deductible 80% After Deductible
Inpatient hospital and facility services include benefits for room and board, ancillary charges in a hospital or skilled nursing facility, preadmission testing,
800.526.6593 coordinated home health care, and hospice care.
Hospital and Facility Outpatient hospital and facility services include benefits for surgery, radiation therapy, chemotherapy, electroconvulsive therapy, renal dialysis treat-
BlueCross BlueShield ments, diagnostic services and cardiac rehabilitation services.
Outpatient surgery and diagnostic tests include X-rays, blood tests, CATs and MRIs.
www.bcbsil.com Medical Services Advisory Program (MSA) precertification is required before inpatient services are provided. Otherwise, a $500 reduction in benefits
will apply.
16 17
Compare Medical Plans Making Your Insurance Work for You
Where Should I Go for Care?
Healthy Choice Plan
Sometimes it’s easy to know when you Your
Healthy Advantage Plan should go to an emergency room (ER), Care
Plan Features with a Hours Relative Description Common Uses
with a Health Care
such as when you have severe chest pain Option
or unstoppable bleeding. Sometimes it’s Cost
Health Savings Account (HSA) Reimbursement Account (HCA)
not. Typically, 20–30% of ER visits are for Primary Office Usually low- Your physician's • General health issues
hours vary est out-of- office is gener-
non-emergency services that could have Provider's ally the best
• Health and annual
been handled elsewhere, saving you time pocket cost exams
Office place to go for
• Vaccinations
Blue Distinction Centers (BDC) For treatment of the follow- 80% coinsurance 80% coinsurance and money. non-emergency
ing: If treated at a BDC If treated at a BDC care. • Treat the flu and colds
Cardiac Care • Minor aches and pains
Knee and Hip Replacements 60% coinsurance 60% coinsurance So where do you go when you have an ear
Spine Surgery Treated at another in-network facility Treated at another in-network facility infection or are generally not feeling well? MD Live 24 hours, $40 per consul- Access to a • General Health:
Complex and Rare Cancers seven tation until de- board-certified Allergies, asthma, nausea,
Transplants days a ductible is met doctor available sinus infections
Bariatric Surgery All coinsurance applied after plan deductible is met. You have options for receiving in-network for Healthy 24 hours a day,
Many of these conditions require ongoing treatment; some of which can be done locally. Check with care that work with your schedule and give week • Pediatric Care:
Advantage Plan seven days a
BlueCross BlueShield to verify coverage and obtain pre-certification. you access to the right kind of care at the members week. Virtual vis- Cold, flu, ear problems,
its can be more pinkeye
right time. Here is a handy guide to help
MD Live $40 charge per consultation*. Charge applies
you decide the best place to receive care.
100% covered convenient and
Virtual physician visits by phone, online video or mobile app toward your deductible, use HSA funds to pay 100% covered for Healthy less expensive
See page 25 the charge Choice Plan than urgent care
members or an ER visit.
80% 80%
After Deductible After Deductible
Retail Similar Lowest out- Walk-in clinics • Common illnesses such
to retail of-pocket are often locat- as pink eye, strep throat
Health
Emergency Room Care
Emergency medical care includes severe, life-threatening emergency treatment that MD Live: Virtual Care Clinic*
store
hours
cost ed in stores and
pharmacies to • Minor wounds, abra-
meets emergency criteria. provide conve- sions and skin condi-
Emergency accident care includes benefits for the initial treatment of an accidental injury provided treatment nient, low-cost tions, such as poison ivy
is received by you or your dependent within 72 hours of the accident. treatment for
Virtual medical visits are a new way to minor medical
80% 80%
problems
After Deductible After Deductible
Urgent Care Facility consult with a licensed doctor for non-
If you visit an urgent care facility and your condition meets emergency criteria, Urgent Care Generally Usually lower Urgent care • Stomach pain
Provider* include out-of-pock- providers can • Minor falls and cuts
the emergency room benefit may apply.
emergency healthcare offered through evenings, et cost than offer care when
your physician is • Urinary tract infections
Chiropractic- Maximum 25 Visits 80% 80% weekends an ER visit
not available or • Household accidents
After Deductible After Deductible BCBS Illinois’ partner, MD Live. For details and holi- you don’t need
days • Sprains and strains
the level of care
$100 Copayment $100 Copayment
Colonoscopies and Then plan pays 100% Then plan pays 100%
on this new plan see page 25. an emergency
Sigmoidoscopies room provides.
Diagnostic when prescribed by a physician.
If you need to find an urgent care center you can use our Provider Finder®. Click
Out-Patient Therapy “Find a network provider” then “Find an Urgent Care Center.”
80% 80%
Physical- Maximum 70 visits
After Deductible After Deductible
Occupational- Maximum 45 visits To quickly and easily locate physicians, hospitals and urgent care providers from
Speech- Maximum 50 visits Do I need to pre-certify? your mobile device download the BCBSIL Find Doctors app.
Mental Health 80% 80% You can also contact Member Services at 888-802-8776 if you need help locating a
Out-Patient After Deductible After Deductible
Remember, it is your responsibility
provider. Health Advocates are available from 7 a.m. to 7 p.m. Central Time.
to call BlueCross BlueShield and
80% 80%
Mental Health After Deductible After Deductible
pre-certify the coverage you will re-
In-Patient ceive. If your physician pre-certifies
Mental health / substance abuse precertification is required before inpatient services are provide.
Otherwise, a $500 reduction in benefits will apply. for you, the coverage level may be
Other Services 70% 70%
different than you expect and YOU
See plan SPD for list After Deductible After Deductible will be responsible for the differ-
* IRS guidelines regarding HSA eligible medical plans prohibits us from covering this service without first meeting your deductible. ence.
Exclusions include services and supplies that do not meet accepted standards of medical practice, which are not medically necessary or for which benefits are available under other
insurance programs. For the complete list of exclusions, please refer to the Summary Plan Descriptions available on the Ultipro home page.
18 19Health Savings Account (HSA) HSA Eligible Medical Expenses
Opening an HSA HSA is the newest tool HSAs at tax time If you choose to enroll in the Healthy Advantage Plan you can use your HSA to HSA Bank Client
pay for a wide range of eligible medical expenses for yourself, your spouse or
Federal Signal will open your Health to combat high medical HSA Bank will issue Form 5498SA tax dependents. An eligible medical expense is defined as an expense that pays Assistance Center
for contributions and Form
Savings Account (HSA) if you are costs 1099SA for distributions each
for healthcare services, equipment, or medications as defined by the IRS. Funds Please contact the Client Assistance
Center at 800.357.6246
enrolled in the Healthy Advantage used to pay for eligible medical expenses are always tax-free.
Plan. There are three ways to fund An HSA can be a powerful fi- year. You must file a Form 8889 Monday - Friday, 7 a.m. - 9 p.m., CST
an HSA: nancial tool to pay for medical with your 1040 tax return in any HSA funds can be used to reimburse yourself for past medical expenses if the www.hsabank.com
expenses now and in the future. year you or your employer makes expense was incurred after your HSA was established. While you do not need to
• Federal Signal will contribute An HSA gives you a triple tax contributions to your HSA or HSA CONTRIBUTIONS
submit any receipts to HSA Bank, it is a good idea to save your bills and receipts
$750 to your account when you advantage: your contributions are you take distributions, even if all
enroll yourself only, or $1,500 for tax purposes.
when you enroll yourself plus
sheltered from income taxes, the contributions were Section 125 Maximums for 2017
one or more eligible depen- money grows tax-deferred, and pre-tax payroll deductions. (including employer
dents. the funds can be withdrawn tax-
contributions)
• You can fund your account free for qualified medical expens-
through pre-tax payroll deduc-
tions.
es. It’s like a supercharged flex-
ible spending account that never
FYI Individual: $3,400
Family: $6,750
• You can make tax deductible expires, and it can even serve as An HSA can have fees
deposits directly to your ac- extra retirement savings funds. like a checking account, +$1,000 Catch-up
count. contribution if 55 or older
see chart below Examples of eligible
• You can change your contribu-
tion at any time in Ultipro un- medical expenses* *This list is not comprehensive.
der the Life Events tab. It is provided to you with the un-
Acupuncture Osteopath
Federal Signal funds employee
How an HSA works Alcoholism treatment
Ambulance services
Oxygen
Pregnancy test kit
derstanding that HSA Bank is not
engaged in rendering tax advice.
HSAs in January, April, July, and Oc- Annual physical examination Podiatrist The information provided is not
tober. You will receive a prorated Federal Signal opens an HSA If you enroll in the Healthy Advantage Plan, Federal Signal will open Artificial limb or prosthesis Prescription drugs and medicines intended to be used to avoid fed-
contribution beginning the funding for you an HSA at HSA Bank. An HSA works like a personal healthcare check- Birth control pills (by prescription) (over-the-counter drugs are not eral tax penalties. For more de-
ing account with tax advantages. Chiropractor eligible medical expenses tailed information, please refer to
period after your eligibility date. If Childbirth/delivery unless prescribed by a doctor)
Federal Signal contributes Federal Signal will help you get started by contributing $750 if you IRS Publication 502 titled, “Medi-
you elect pre-tax payroll contribu- Convalescent home (for medical Prenatal care & postnatal treat-
to your account elect individual coverage; or $1,500 if you cover yourself and at least cal and Dental Expenses,” Catalog
tions, deductions will be deducted one dependent, prorated on a quarterly basis. treatment only) ments
Crutches Psychiatrist Number 15002Q. Publications can
from your paycheck. You will re- be ordered directly from the IRS
ceive Federal Signal’s contribution You can contribute to your You can contribute up to a total of $3,400 pre-tax to your HSA for Doctor’s fees Psychologist
account individual coverage, or $6,750 if you cover yourself and at least one Dental treatments (including x- Smoking cessation programs by calling 1-800-TAXFORM. If tax
to your HSA even if you don’t make dependent, plus an additional $1,000 if you are or will be age 55 dur- rays, braces, dentures, fillings, oral Special education tutoring advice is required, you should seek
contributions of your own. ing the plan year. (The total includes both individual and Company surgery) Surgery the services of a professional.
contributions.) Once you have $5,000 in your HSA you may direct how Dermatologist Telephone or TV equipment to
the money is invested. Diagnostic services assist the hearing or vision ** Insurance premiums qualify as
Pay healthcare expenses Pay out of your pocket for healthcare expenses and let your Health Disabled dependent care impaired an eligible medical expense: while
Savings Account grow for future qualified expenses, or use your ac- Drug addiction therapy Therapy or counseling continuing coverage under COBRA;
count to pay for healthcare expenses. Fertility enhancement (including Medical transportation expenses for qualified long-term care cov-
800.357.6246 A list of qualified expenses can be found on page 21; or visit
www.irs.gov for more information.
in-vitro fertilization) Transplants erage; coverage while receiving
HSA Bank Guide dog (or other service ani- Vaccines unemployment compensation; for
mal) Vasectomy any healthcare coverage for those
Rollover your balance and take The money left in your HSA at the end of the plan year rolls over to
www.hsabank.com it with you if you leave Federal the next year. The money is tax exempt and is always yours even if
Gynecologist Vision care over age 65 including Medicare
Signal you change health plans or leave Federal Signal. Hearing aids and batteries (Including eyeglasses, contact (except Medicare supplemental
Hospital bills lenses, lasik surgery)
Insurance premiums** Weight loss programs (for a spe- coverage).
HSA over age 65 When you turn 65 and are enrolled in Medicare parts A or B,
Contributing to contributions to an HSA can no longer be made to your account. Laboratory fees cific disease diagnosed by a physi- 800.357.6246
Including employee and employer contributions. Lactation expenses cian – such as obesity, hyperten-
your HSA Lodging (away from home for sion, or heart disease) HSA Bank
AVOID FEES! Review charges at Monthly paper statement fee $0.75
www.hsabank.com and register ATM withdrawal fee $2 outpatient care) Wheelchairs
for internet banking to avoid Point-of-sale purchase with your PIN fee $2 Nursing home X-rays www.hsabank.com
fees Non-sufficient funds fee $30 Nursing services
Obstetrician
20 21Flexible Spending Accounts (FSA) Limited Purpose Flexible Spending Account (LPFSA)
Enroll in an FSA Healthcare FSA “Benny” Card A Limited Purpose FSA (LPFSA) is a healthcare flexible spending Important information
account that you can contribute to if you are enrolled in the Healthy
Flexible Spending Accounts (FSAs) Use the Healthcare FSA to pay for The Benny card is a debit card that Advantage Plan with the Health Savings Account (HSA). You can use an •You can only receive reimbursement
allow you to save pre-tax dollars expenses your health plan does can be used to access funds in your for eligible dental and vision expenses
not cover for you, or your depen- LPFSA to pay for eligible out-of-pocket dental and vision expenses only.
from your paycheck to pay for dents, such as medical, prescrip- Healthcare FSA. If you enroll in a that you incur through December 31,
Such expenses include:
eligible expenses as defined by the tion drug and dental deductibles, Healthcare FSA, you will receive 2017
IRS. Federal Signal offers Health- copayments and coinsurance, or your Benny card in the mail. Once • Dental and orthodontia care; such as fillings, X-rays, crowns and
care and Dependent Care FSAs vision expenses. Over-the-counter you activate your card, you can braces •You have until March 31, 2018 to sub-
medications are not an eligible mit expenses for reimbursement
administered by UMR, Inc. FSA expense unless prescribed by use it to pay for eligible healthcare • Vision care, including eyeglasses, contact lenses, eye exams and
your doctor and obtained from a expenses. vision correction procedures
• You may incur eligible expenses pharmacy. •You can use your LPFSA funds for
from your eligibility date through
eligible expenses incurred by you,
December 31, 2017. You cannot use FSA funds to pay
Important for Benny your spouse and your eligible tax
• You have until March 31, 2018 to
for expenses incurred by your
domestic partner or domestic
What is a limited purpose FSA? dependents
submit expenses for reimbursement partner’s children unless you claim Card Users A limited purpose FSA (LPFSA) is much like a typical, general purpose
them on your federal tax return. Keep your receipts and/or explana- healthcare FSA. However, under a LPFSA, eligible expenses are limited to
• Funds in your Healthcare FSA may You are responsible for ensuring •You cannot receive reimbursement for
not be used for day care expenses that submitted expenses are quali- tion of benefits—UMR may request qualified dental and vision expenses only for you, your spouse, and your an eligible expense more than once
and Dependent Care FSA funds may fied. documentation to verify eligibility eligible dependents. You cannot use a LPFSA for medical expenses.
not be used for healthcare expenses of the transactions.
You can contribute up to $2,600 to •You may carry over up to $500 of
• You may only be reimbursed for a Healthcare FSA. If you do not produce a receipt or Here’s how a LPFSA works: you can save money from your paycheck unused funds to the following plan
eligible expenses as determined by explanation of benefits, your debit before taxes are taken out. You can then use your pre-tax LPFSA dollars year
IRS rules If you enroll in the Healthy Advan- card privileges may be suspended to pay for eligible vision or dental expenses throughout the plan year.
tage Plan and you also contribute and any future claims will be offset
Visit fhs.umr.com/print/UM0075. to a Healthcare FSA, you may only You save money on expenses like dental services, vision exams, and
pdf for a list of eligible and use your FSA funds for dental and by the unsubstantiated amount. eyeglasses. You cannot use a LPFSA for medical expenses.
ineligible expenses. An FSA calcu- vision expenses. This is known as a Keep track of your Benny card ac-
lator can be found on UMR.com Limited Purpose FSA. See page 23 tivity on www.mybenny.com.
under Tools & Resources. for more information.
Dependent Care FSA Why should I consider a limited purpose FSA? IRS Rules about LPFSA that
Rollover of unused funds you should know about:
IRS rules do not allow you to contribute to a health savings account
Use the Dependent Care FSA to Up to $500 of unused funds in
your Healthcare FSA may be rolled (HSA) if you are covered by any non-qualifying health plan, including
pay for dependent care expenses
that allow you and your spouse or over to the next plan year. The IRS a general purpose healthcare FSA. By limiting FSA reimbursements to No double-dipping:
domestic partner to work, look for requires that funds over $500 not dental and vision care expenses, you (or your spouse) remain eligible
used for qualified expenses during Expenses reimbursed under your
work or attend school full-time. to participate in both a LPFSA and an HSA. Participating in both plans
the plan year be forfeited. limited purpose FSA cannot be
You can contribute up to $5,000 allows you to maximize your savings and tax benefits.
reimbursed under any other plan
to the Dependent Care FSA (up to
Benny Cards will be mailed or program – including an HSA. Ex-
$2,500 if you are married and file
to you. penses reimbursed under the LPFSA
separate tax returns) to care for: How do I access my LPFSA funds? may not be deducted when you file
Use your Benny card or submit a reimbursement form to UMR. your tax return.
• A dependent child under age 13 who
qualifies as a dependent on your
800.826.9781
federal tax return; or UMR Inc.
• An adult family member (your spouse Timing is everything:
or other adult) who is physically or www.umr.com Expenses must be incurred between
mentally incapable of self-care and
dependent on you for financial sup- your eligiblity date and
port December 31, 2017. This means
• Use it or Lose it rule—The IRS re- 800.826.9781 the date of service must be within
quires that unused funds remaining FSA Debit Card Basics
in your Dependent Care FSA after all UMR Inc. these dates and not when you pay
eligible expenses have been paid will for the service.
be forfeited Visit www.irs.gov and review publications 502 and 503 for www.umr.com
• Pay these expenses directly and file complete details about FSAs and IRS rules.
claims with UMR for reimbursement
22 23You can also read
