New TSI Holdings, Inc. Benefit Guide 2021
←
→
Page content transcription
If your browser does not render page correctly, please read the page content below
New TSI Holdings, Inc. Benefit Guide 2021
What’s Inside
Be er Benefits, Be er You.
At New TSI Holdings, Inc., we believe that you, our employees, are our most important asset and Everybody
Ma ers. Helping you and your families achieve and maintain good health—physical, emo(onal and finan-
cial—is the reason New TSI Holdings, Inc., offers you this benefits program. We’re connected and All In, so
we are providing you with this overview to help you understand the benefits that are available to you and
how to best use them. Please review it carefully and make sure to ask about any important issues that are
not addressed here. A list of plan contacts is provided at the back of this summary.
While we’ve made every effort to make sure that this guide is comprehensive, it cannot provide a complete
descrip(on of all benefit provisions. For more detailed informa(on, please refer to your plan benefit book-
lets or summary plan descrip(ons (SPDs). The plan benefit booklets determine how all benefits are paid.
Our benefits site can be accessed via the intranet under Employee Life / Benefits or externally at
h p://mybenefits.mysportsclubs.com.
The benefits in this summary are effec"ve:
January 1, 2021 – December 31, 2021
Benefits Eligibility Sec(on 125
and Benefit Elec(ons Changes
WHO IS ELIGIBLE? WHO IS NOT ELIGIBLE?
Full-(me team members who meet eligibility requirements will Family members who are not eligible for coverage include
qualify for the benefits outlined in this overview. Please see the (but are not limited to):
eligibility sec(on below for specific details. You can enroll your- Parents, grandparents, and siblings.
self and the following family members in our plans. Any individual who is covered as an employee of New TSI
• Your spouse (the person who you are legally married to Holdings, Inc. cannot also be covered as a dependent.
• under state law, including a same-sex spouse) or qualified Employees who work less than an average of 25 hours per
domes(c partner. week, contract employees, or employees residing outside the
• Your children: United States or in Puerto Rico.
• Under the age of 26 are eligible to enroll in medical WHEN CAN I ENROLL?
coverage. They do not have to live with you or be en-
rolled in school. They can be married and/or living and Coverage for regular full-(me employees begins on the 1st of
working on their own. the month following 60 days of employment. Variable hour
• Over age 26 ONLY if they are incapacitated due to a employees will be eligible to enroll if they meet the 25-hour
disability and primarily dependent on you for support. threshold on the first of the 14th month following date of
• Named in a Qualified Medical Child Support Order hire.
(QMCSO) as defined by federal law. Open enrollment is the one (me each year that employees
Please refer to the Summary Plan Descrip(on for complete de- can elect or make changes to their benefit elec(ons without a
tails on how benefits eligibility is determined. qualifying life event.
ELIGIBILITY Make sure to no(fy the Benefits Department right away at
benefits@tsiclubs.com or 914-347-4009 x1477 if you do have
There are two classifica(ons of employees: a qualifying life event and need to make a change (add or
• Regular Full-Time (generally club managers – GMs, FMs, FS, drop) to your coverage elec(on. These changes include (but
CSMs, corporate staff) - Employees who are reasonably ex- are not limited to):
pected to work 30+ hours/week are considered Regular Full-
Time and are eligible for healthcare benefits on the first of • Birth or adop(on of a baby or child
the month following 60 days of employment. • Loss of other healthcare coverage
• Variable Hour (generally, non-managerial club employees • Eligibility for new healthcare coverage
including welcome team, clean team, PTs, GEIs, SCFK In- • Marriage
structors, MCs, etc.) - Employees who are expected to work • Divorce
less than 30 hours per week are considered “Variable Hour” Please be aware that you have 31 days from the date of the
and placed into a one-year wai(ng period when they are qualifying event to make any changes to your insurance and
hired, called an ini(al measurement period (IMP) and if they submit the required suppor(ng documenta(on. If you do not
sa(sfy the minimum hours requirement (average of 25 submit the documenta(on within the 31 days, then you will
hours/week), they are eligible for health benefits on the first have to wait un(l the next Open Enrollment period to make
of the 14th month following their hire date. Each year, em- changes which would be effec(ve on the first of the upcom-
ployees in this category are measured again to determine ing calendar year.
their eligibility status for the upcoming plan year.
If you are a regular full-(me employee as defined above, you and
your dependents are eligible for health plan coverage the first of
the month following 60 days.
If you are a variable hour employee as defined above, you will be
placed into a one-year measurement period upon hire to deter-
mine your eligibility for benefits (employees must average at
least 25 hours/week.) AIer that, on an annual basis, your hours
will be measured to determine if you are eligible for health cov-
erage for the upcoming plan year. Your health benefits status will
remain in effect for 12 months.
For more specific examples, please refer to the detailed explana-
(on on the company intranet.Making the Most of Your Benefits Program
Helping you and your family members stay healthy and making sure you use your benefits program to its best
advantage is our goal in offering this program. Here are a few things to keep in mind.
AN APPLE A DAY
STAY WELL!
Ea(ng moderately and well really does help keep the doctor
Harder than it sounds, of course, but many health problems are
away. Stay away from fat-heavy, processed foods and in-
avoidable. Take ac(on—from ea(ng well, to geMng enough
stead focus on whole grains, vegetables, and lean meats to
exercise and sleep. Taking care of yourself takes care of a lot
be the healthiest you can be.
of poten(al problems.
EMERGENCY ROOM ALTERNATIVES
ASK QUESTIONS AND STAY INFORMED
Did you know most ER visits are unnecessary? Use them
Know and understand your op(ons before you decide on a
only in a true emergency—like any situa(on where life,
course of treatment. Informed pa(ents get be er care. Ask for
limb, and vision are threatened. Otherwise, call your doc-
a second opinion if you’re at all concerned.
tor, your nurse line, or go to an Urgent Care clinic. You’ll
save a lot of money and (me!
GET A PRIMARY CARE PROVIDER
Having a rela(onship with a PCP gives you a trusted person BE MED WISE!
who knows your unique situa(on when you’re having a health
Always follow your doctor’s and pharmacist’s instruc(ons
issue. Visit your PCP or clinic for non-emergency healthcare
when taking medica(ons. You can worsen your condi(on(s)
by not taking your medica(on or by skipping doses. If your
GOING TO THE DOCTOR? medica(on is making you feel worse, contact your doctor.
To get the most out of your doctor visit, being organized
and having a plan helps. Bring the following with you:
• Your plan ID card
• A list of your current medica(ons
• A list of what you want to talk about with your doctor
If you need a medica(on, you could save money by asking
your doctor if there are generics or generic alterna(ves for
your specific medica(on.Medical
Medical coverage provides you with benefits that help keep you healthy like preven(ve care screenings and access to urgent
care. It also provides important financial protec(on if you have a serious medical condi(on. New TSI provides you with com-
prehensive medical/Rx coverage through Aetna with the choice of three plans: Value Plan, Core Plan, and Premium Plan. All
plans offer In-Network and Out-of-Network coverage. The Value plan is only offered to those employees earning less than
$13.25/hr for ACA compliance purposes. However, an employee earning less than $13.25/hr may buy up to either the Core or
Premium plan. Employees making over $13.25/hr can only select the Core or Premium Plans.
Aetna Value Plan *
Only available to employees
Aetna Core Plan Aetna Premium Plan
earning less
Available to all benefit eligible Available to all benefit eligible
than $13.25/hr with an op(on
employees employees
to buy up to Core and Premium
plans
Aetna Choice POS II Aetna Choice POS II Aetna Choice POS II
In-Network In-Network In-Network
Annual Deduc"ble $3,000 $2,000 $1,500
$6,000 $4,000 $3,000
Annual Out-of-Pocket Max $6,000 $5,000 $4,000
$12,000 $10,000 $8,000
Life"me Max Unlimited Unlimited Unlimited
Coinsurance Employee pays 30% Employee pays 20% Employee pays 10%
Office Visit
$30 copay $30 copay $30 copay
Primary Provider
$50 copay $50 copay $50 copay
Specialist
Preven"ve Services Plan pays 100% Plan pays 100% Plan pays 100%
Chiroprac"c Care $50 copay $50 copay $50 copay
Diagnos"c Lab and X-ray Deduc(ble & Coinsurance Deduc(ble & Coinsurance Deduc(ble & Coinsurance
Diagnos"c Complex Imaging Deduc(ble & Coinsurance Deduc(ble & Coinsurance Deduc(ble & Coinsurance
Inpa"ent Hospitaliza"on Deduc(ble & Coinsurance Deduc(ble & Coinsurance Deduc(ble & Coinsurance
Outpa"ent Surgery Deduc(ble & Coinsurance Deduc(ble & Coinsurance Deduc(ble & Coinsurance
Urgent Care $50 copay $50 copay $50 copay
Emergency Room $300 copay $300 copay $300 copay
(copay waived if admi ed) (copay waived if admi ed) (copay waived if admi ed)
*Please Note:
1) The Aetna Value Plan is only available to those earning less than $13.25/hour.
Aetna Value Plan Aetna Core Plan Aetna Premium Plan
Out-of-Network Out-of-Network Out-of-Network
Annual Deduc"ble $6,000 $5,000 $5,000
$12,000 $10,000 $10,000
Coinsurance Employee pays 40% Employee pays 40% Employee pays 40%
Annual Out-of-Pocket Max $12,000 $12,000 $12,000
$24,000 $24,000 $24,000
*Please Note:
2) Out-of-network claims are subject to deduc(ble + coinsurance; copays are not applicable.Prescrip(on Drugs
Prescrip(on drug coverage provides a benefit that is important to your overall health, whether you need a prescrip-
(on for a short-term health issue like bronchi(s or an ongoing condi(on like high blood pressure.
If you enroll in medical coverage, you will automa(cally receive coverage for prescrip(on drugs.
Aetna Value Plan Aetna Core Plan Aetna Premium Plan
In-Network Out-of-Network In-Network Out-of-Network In-Network Out-of-Network
Prescrip"on Drug
Deduc"ble
$100 / $300 $100 / $300 $100 / $300 $100 / $300 $100 / $300 $100 / $300
Annual Out-of-
Combined Combined Combined Combined Combined Combined
Pocket Limit
with medical with medical with medical with medical with medical with medical
Pharmacy
Generic $10 copay 30% of $10 copay 30% of $10 copay 30% of
Preferred Brand $45 copay submi ed cost $45 copay submi ed cost $45 copay submi ed cost
Non-preferred Brand $75 copay aIer copay $75 copay aIer copay $75 copay aIer copay
Supply Limit 30 days 30 days 30 days 30 days 30 days 30 days
Mail Order
$20 copay $20 copay $20 copay
Generic
$90 copay $90 copay $90 copay
Preferred Brand Not Covered Not Covered Not Covered
$150 copay $150 copay $150 copay
Non-preferred Brand
90 days 90 days 90 days
Supply Limit
Teladoc
Teladoc gives you access 24 hours, 7 days a week to a U.S. board-cer(fied doctor through the
convenience of phone, video or mobile app visits. Set up your account today so when you need
care now, a Teladoc doctor is just a call or click away for only a copay of $47.
To set up your account, follow the steps below:
1. Set up your account by phone or mobile app
• Online: Go to Teladoc.com/Aetna and click “set up account.”
• Mobile App: Download the app and click “ac(vate account.” Visit Teladoc.com/mobile to download the app.
• Call Teladoc: Teladoc can help you register your account over the phone.
2. Provide Medical History
• Your medical history provides Teladoc doctors with the informa(on they need to make an accurate diagnosis.
3. Request a Consult
• Once your account is set up request a consult any(me you need care and talk to a doctor by phone, web, or mo-
bile appDental
Regular visits to your den(sts can protect more than your smile; they can help protect your health. Recent studies
have linked gum disease to damage elsewhere in the body and den(sts are able to screen for oral symptoms of
many other diseases including cancer, diabetes, and heart disease.
New TSI gives you a choice between two dental plans, a DMO Plan and a PPO Plan.
Aetna Dental DMO Plan Aetna Dental PPO Plan
In-Network In-Network Out-of-Network
Calendar Year Deduc"ble
$0 $75 $75 (combined with in-network)
$0 $225 $225 (combined with in-network)
Annual Plan Maximum $1,000 (combined with in-
Unlimited $1,000
network)
Wai"ng Period
Late entrant penalty applies In-network limita(on
Diagnos"c and Preven"ve $0-$80 copay then plan pays
Plan pays 80% Plan pays 80%
100%
Basic Services
See contract for fee schedule Plan pays 50% aIer deduc(ble Plan pays 50% aIer deduc(ble
Major Services $6-$315 copay then plan pays
Plan pays 50% aIer deduc(ble Plan pays 50% aIer deduc(ble
100%
Orthodon"c Services See contract for fee schedule
Plan pays 50% Plan pays 50%
Orthodon(a $1,945 copay then plan pays
$1,000 $1,000 (combined with in-
Life(me Maximum 100% Unlimited
Covered network) Covered
Dependent Children Covered
Not covered Not covered
Full-(me Students Covered
Reward Provision Program for DPPO Plan Only. Eligible for $200 Annual Maximum increase for obtaining ANY preven(ve services
per each covered member. (Capped at three (mes). If no preven(ve services obtained, annual maximum will remain at current
level. Does not apply to Orthodon(a services.
Please Note: The DMO is not available in the following states: AL, AK, AR, HI, ID, LA, ME, MS, MT, NH, NM, ND, SC, SD, VT, WYVision
Rou(ne vision exams are important, not only for correc(ng vision but because they can detect other serious health
condi(ons. We offer you a vision plan through Vision Service Plan.
VSP Vision Plan
In-Network Out-of-Network
Examina"on
Benefit $10 copay then plan pays 100% $10 copay then reimbursement up to $45
Frequency 1 x every 12 months In-network limita(ons apply
Materials
$10 copay then reimbursement up to $45
$20 copay then plan pays 100%
In-network limita(ons apply
Eyeglass Lenses
Single Vision Lens
Bifocal Lens $20 copay then plan pays 100% of lens $20 copay then reimbursement up to $30
Trifocal Lens $20 copay then plan pays 100% of lens $20 copay then reimbursement up to $50
Frequency $20 copay then plan pays 100% of lens $20 copay then reimbursement up to $65
1 x every 12 months In-network limita(ons apply
Frames
Up to $180 plan pays (20% off amount over $180) Reimbursement up to $70
Benefit
1 x every 12 months In-network limita(ons apply
Frequency
Contacts (Elec"ve) Reimbursement up to $105 (in lieu of lenses and
Up to $180 (in lieu of lenses and frames)
Benefit frames)
1 x every 12 months
Frequency 1 x every 12 monthsCost of Coverage
New TSI helps to subsidize the benefit plans and pays for a por(on of your Medical coverage. Dental and Vision coverage is volun-
tary and paid for in full by the employee.
MEDICAL DENTAL —Voluntary
Aetna Value* Only DMO Pay Per Period Per Year
available to
employees earning
Employee Only $7.03 $182.78
less than $13.25/hr Pay Per Period Per Year
with an op(on to
Employee + 1 $12.54 $326.04
buy up to Core and
Premium Plans
Family $21.19 $550.94
Employee Only $51.72 $1,344.72
Employee + 1 $107.49 $2,794.74
Family $167.25 $4,348.50 DPPO Pay Per Period Per Year
Employee Only $13.43 $349.18
Aetna Core
Employee + 1 $25.59 $665.34
Available to all
Pay Per Period Per Year
benefit eligible
employees Family $38.15 $991.90
Employee Only $81.16 $2,110.16
Employee + 1 $182.15 $4,735.90 Vision—Voluntary
Family $283.46 $7,369.96
Pay Per Period Per Year
Aetna Premium
Available to all
Pay Per Period Per Year Employee Only $2.29 $59.54
benefit eligible
employees. Employee + 1 $4.60 $119.60
Employee Only $104.73 $2,722.98
Family $7.40 $192.40
Employee + 1 $219.71 $5,712.72
Family $340.38 $8,849.88
*Please note:
1) The Aetna Value plan is only available to those earning less than $13.25 / hourFlexible Spending Account
Flexible Accounts for health care and care can help you save money. The money you contribute to
is not taxed, and you withdraw the money tax-free when paying for eligible It can poten(ally
save or more on eligible and/or qualifying child and adult care In addi(on to
the savings, you also benefit from using pre-tax dollars to pay for things such as medical and
dental vision doctor and and day care
Note: You not able to use your FSA to pay for most over the counter drugs and medicines unless you have a
You not need a for and diabe(c supplies.
HEALTH CARE
The Health Care FSA allows you to put aside money before taxes are withheld so that you can pay for eligible medical,
and vision that are not by any other you and your qualifying
Due to IRS rules, the maximum amount you can contribute to a Health Care FSA in 2021 is
DEPENDENT CARE
The Care FSA allows you to put aside money before taxes are withheld so that you can pay to
care for an eligible child or adult while you and your you are married) work, look for work, or a end college
(this cannot be used for health care You can also contribute to this for care of a disa-
bled
You may contribute up to per year ($2,500 married and separately) on a before-tax basis to
Care FSA in
IMPORTANT FSA
Keep in mind; Flexible Spending Accounts (FSAs) are typically “use-it-or-lose-it” accounts. Due to a recent IRS change,
you may now rollover up to $500 in unused 2021 FSA contribu(ons to use for eligible expenses in 2022. You will forfeit
any money above $500 leI in the account at the end of the plan year, so it’s important to carefully es(mate your con-
tribu(on amount.
COMMUTER BENEFITS PLAN
Commuter Benefit Transit and Parking Plans are pre-tax benefit plans that are used to pay for the following:
• Monthly Bus, Train or Metro Passes
• Transporta(on between home and work in “Commuter Highway Vehicle”
• Parking provided at or near your business premises or parking provided on or near a loca(on from which you commute to
work.
The IRS pre-tax maximum for Transit is $270/month. The IRS pre-tax maximum for Parking is $270/month.
www.briweb.comLife Insurance
If you have loved ones who depend on your income for support, having life and accidental death insurance can help protect
your family’s financial security.
LIFE AND AD&D
Basic Life Insurance pays your beneficiary a lump sum if you die. AD&D provides another layer of benefits to either you or your
beneficiary if you suffer from loss of a limb, speech, sight, or hearing, or if you die in an accident. The cost of coverage is paid in
full by the company. Coverage is provided by MetLife Inc.
Employee Voluntary Life Rates
1 x Amount covered annual
Basic Life Amount earnings up to a maximum of Monthly
Bi-Weekly Annual Pre-
$25,000 Age Cost Per
Deduc"on mium
$10,000
1 x Amount covered annual 24 & Under $0.50 $0.23 $5.98
Basic AD&D Amount earnings up to a maximum of
$25,000 25 to 29 $0.60 $0.28 $7.28
30 to 34 $0.80 $0.37 $9.62
Voluntary Life 35 to 39 $0.90 $0.42 $10.92
Voluntary Life Insurance allows you to purchase addi(onal life 40 to 44 $1.00 $0.46 $11.96
insurance to protect your family’s financial security. Coverage
is provided by MetLife Inc. 45 to 49 $1.60 $0.74 $19.24
50 to 54 $2.70 $01.25 $32.50
Employee Voluntary Life Increments of $10,000 up to 55 to 59 $4.30 $1.98 $51.48
Amount $100,000
60 to 64 $6.60 $3.05 $79.30
Spouse Voluntary Life Increments of $5,000 up to 65 to 69 $13.80 $6.37 $165.62
Amount $100,000, but not to exceed 70 to 74 $24.60 $11.35 $295.10
Dependent Child Voluntary Voluntary Spouse Life Rates
$10,000
Life Amount
Monthly
Bi-Weekly Annual
Age Cost Per
Deduc"on Premium
$10,000
Voluntary Spouse and Child Life benefits are only eligible
for those employees who elect Voluntary Employee 24 & Under $0.55 $0.25 $6.50
Life themselves.
25 to 29 $0.55 $0.25 $6.50
Evidence of Insurability: Upon your ini(al eligibility date,
30 to 34 $0.64 $0.30 $7.80
you may elect up to 3x your base annual earnings (up to
$100,000), with no medical ques(ons asked. You may also 35 to 39 $0.88 $0.41 $10.66
elect up to $25,000 for your spouse (not to exceed 100% of 40 to 44 $1.19 $0.55 $14.30
your elec(on), with no medical ques(ons asked. For elec-
(ons over these guarantee issue amounts, you must com- 45 to 49 $1.74 $0.80 $20.80
plete an evidence of insurability form. 50 to 54 $2.77 $1.28 $33.28
During the annual open enrollment period, all elec(ons or 55 to 59 $5.02 $2.32 $60.32
increases require medical evidence.
60 to 64 $9.54 $4.40 $114.40
Beneficiary Reminder: Make sure that you have named
a beneficiary for your life insurance benefit. It’s important 65 to 69 $16.14 $7.45 $193.70
to know that many states require that a spouse be named 70 to 74 $30.01 $13.85 $360.10
as the beneficiary, unless they sign a waiver.
Voluntary Child Life Rate
$1.30 per $10,000 benefit.Short-Term Disability Insurance & EAP If you become disabled and cannot work, your financial security may be at risk. Protec(ng your income stream can provide you and your family with peace of mind. SHORT-TERM DISABILITY INSURANCE Short-Term Disability coverage pays you a benefit if you temporarily can’t work because of an injury, illness, or maternity leave. New TSI provides an op(onal salary con(nua(on plan through ShelterPoint. Under the Group STD Payroll Plan, you may receive replacement income for a period of up to 26 weeks in a 52-week period for a qualifying non-occupa(onal injury or illness. If you elect this op(onal benefit, you will receive 50% of your gross salary up to a maximum of $340 per week. STD benefits are available to eligible employees, except employees who reside in NY or NJ. Employees residing in these states have state mandated disability benefits. Weekly Benefit Amount Plan pays 50% of covered weekly Maximum Weekly Benefit $340 Benefits Begin ANer: Accident 7 days of disability Sickness 7 days of disability Maximum Payment Period* 26 weeks of disability *Maximum payment period is based on the first day you are disabled, not when benefits begin. EMPLOYEE ASSISTANCE PROGRAM New TSI provides an invaluable program for you to take advantage of, especially in (mes of emo(onal stress and financial worries. The EAP program provided through Aetna is available to all employees, dependents and members of your household, absolutely free, 24 hours a day and 365 days a year. It is strictly confiden(al. The phone number is 1-888-238-6232. Aetna has a professional staff of counselors that will guide you and help you deal with stress, addic(on, financial counseling, day- care issues, eldercare, anger management or just to provide you with resource informa(on for health and wellness just to name a few.
Benefit Resource Center
A claim not paying? Has the insurance company told you that the claim is in process for the last two months? Call the BRC! We
can work with the insurance carrier to iden(fy the reasons why the claim is not processing and work to get it paid.
The BRC can also assist with benefit clarifica(on. We can answer ques(ons like: “Do I have mail order prescrip(on benefits?”,
“How are physicals covered on my plan?”. Call a Benefit Specialist. We’d be happy to answer these ques(ons for you!
Services denied? The Benefit Resource Center is here to help. Our experience has allowed us to become well versed in wri(ng ap-
peal le ers. Give us a call. We’ll draI the appeal le er for you and submit it to the insurance company on your behalf.
QUESTIONS?
For general ques(ons regarding your benefit plans, please contact the Benefit Resource Center at 855-874-0835. You can also
send an email to BRCSouth@usi.com. Did your telephone call to your insurance carrier leave you more confused? The Benefit Re-
source Center (BRC) can help you understand what your insurance company is telling you.
For more detailed ques(ons regarding benefits eligibility, health insurance, 401(k), PTO, etc., you can contact the Benefits
Department directly at (914) 347-4009 extension #1477.
For more specific ques(ons regarding claims we have included a lis(ng of all of our health and welfare vendors and their contact
informa(on on the next page.
Benefit Resource Center is a service provided by USI Insurance Services.
Benefits Mobile App
The USIeb app gives on-the-go access to all of your benefit and insurance policy details, HR contact informa(on and more! Our
mobile benefits app provides a quick and simple way for you and your benefit plan par(cipants to access benefit
summaries and other important informa(on about your group plans. The app also offers the ability to take photos of ID cards
to store on the phone, as well as a way to easily locate carrier and HR contact informa(on—all in one place—24/7 and on the go.
Our app is free, available for iPhone and Android and the benefits include:
• BENEFIT INFORMATION
The app gives employees access to all of their benefit plan informa(on and
ID cards—all in one place.
• ACCESS ID CARDS
The app allows you to take and access images of your ID cards. Images
are stored on the phone itself; no personal health informa(on is transmi ed or
saved.
• GETTING IN TOUCH
The app provides you with a single loca(on to find contact informa(on for your
Human Resources team and the Benefit Resource Center as well as insurance
carriers.
Search for ‘usieb’ and download the free app. AIer scrolling through the intro pages
enter this code when prompted: 129098 for access to all benefit details.401(k)
401(K) SAVINGS PLAN
The New TSI Holdings, Inc. 401(k) Plan helps eligible employees save and invest for re(rement while receiving certain tax ad-
vantages. You can defer between 1-100% of your pay up to an annual maximum of $19,500. The catch-up limit for employees aged
50 and older is $6,500 per year. You can choose how your contribu(ons are invested and a Roth (aIer-tax) op(on is available as
well. Administra(ve and recordkeeping services for the 401(k) Savings Plan are provided by Principal Financial Group.
You must be at least 21 years of age to par(cipate in the 401(k) Plan. All employees are eligible to par(cipate in the 401(k) plan on
the first of the month following 90 days of employment unless they are under age 21 or reside in Puerto Rico.
To enroll or make changes to your 401(k) contribu(on, visit www.principal.com or call 1-800-547-7754.
For Assistance
If you need to reach our plan is their contact informa(on:
Plan Type Provider Phone Number Website
Medical Aetna 1-800-962-6842 www.aetna.com
Dental Aetna 1-877-238-6200 www.aetna.com
Vision VSP 1-800-877-7195 www.vsp.com
Medical and Dependent FSA Benefit Resource, Inc. 1-800-473-9595 www.briweb.com
Basic & Supplemental Life/AD&D MetLife 1-800-638-6420 www.metlife.com
Group Short Term Disability (STD) ShelterPoint 1-800-365-4999 www.shelterpoint.com
www.resourcesforliving.com
Employee Assistance Program (EAP) Aetna 1-888-238-6232 Username: Town Sports
Password: EAP
Commuter Benefits Benefit Resource, Inc. 1-800-473-9595 www.briweb.com
Enrollment System Benefit Plan Manager 1-800-788-7558 www.benefitplanmanager.com
Leaves of Absence Sedgwick 1-888-436-9530 h ps://(meoff.sedgwick.comKey Terms
MEDICAL/GENERAL TERMS
Out-of-Pocket Maximum – The most you would pay out-of-
Allowable Charge – The most that an in-network provider can pocket for covered services in a year. Once you reach your out
charge you for an office visit or service. -of-pocket maximum, the plan covers
Balance Billing – Non-network providers are allowed to charge 100% of eligible expenses.
you more than the plan’s allowable charge. This is called Balance Preven"ve Care – A rou(ne exam, usually yearly, that may
Billing. include a physical exam, immuniza(ons and tests for certain
Coinsurance – The cost share between you and the insurance health condi(ons.
company. Coinsurance is always a percentage totaling 100%. For PRESCRIPTION DRUG TERMS
example, if the plan pays 70%, you
are responsible for paying the remaining 30% of the cost. Brand Name Drug – A drug sold under its trademarked name.
A generic version of the drug may be available.
Copay – The fee you pay to a provider at the (me of service.
Generic Drug – A drug that has the same ac(ve ingredients as
Deduc"ble – The amount you have to pay out-of-pocket for ex- a brand name drug, but is sold under a different name. Gener-
penses before the insurance company will cover any benefit ics only become available aIer the patent expires on a brand
costs for the year (except for preven(ve care and other services name drug. For example, Tylenol is a brand name pain reliever
where the deduc(ble is waived). commonly sold under its generic name, Acetaminophen.
Explana"on of Benefits (EOB) – The statement you receive from Dispense as WriRen (DAW) – A prescrip(on that does not
the insurance carrier that explains how much the provider billed, allow for subs(tu(on of an equivalent generic or similar brand
how much the plan paid (if any) and how much you owe (if any). drug.
In general, you should not pay a bill from your provider un(l you
have received and reviewed your EOB (except for copays). Maintenance Medica"ons – Medica(ons taken
on a regular basis for an ongoing condi(on such as
Family Deduc"ble – The maximum dollar amount any one family high cholesterol, high blood pressure, asthma, etc. Oral con-
will pay out in individual deduc(bles in a year. tracep(ves are also considered a
Individual Deduc"ble – The dollar amount a member must pay maintenance medica(on.
each year before the plan will pay benefits for covered services. Non-Preferred Brand Drug – A brand name drug for which
In-Network – Services received from providers (doctors, hospi- alterna(ves are available from either the plan’s preferred
tals, etc.) who are a part of your health plan’s network. In- brand drug or generic drug list. There is generally a higher co-
network services generally cost you less than out-of-network payment for a non-preferred brand drug.
services. Preferred Brand Drug – A brand name drug that the plan has
Out-of-Network – Services received from providers selected for its preferred drug list. Preferred drugs are gener-
(doctors, hospitals, etc.) who are not a part of your ally chosen based on a combina(on of clinical effec(veness
health plan’s network. Out-of-network services generally cost and cost.
you more than in-network services. With some plans, such as Specialty Pharmacy – Provides special drugs for complex con-
HMOs and EPOs, out-of-network services are not covered. di(ons such as mul(ple sclerosis, cancer and HIV/AIDS.
Out-of-Pocket – Healthcare costs you pay using your own mon- Step Therapy – The prac(ce of star(ng to treat a medical con-
ey, whether from your bank account, credit card, Health Reim- di(on with the most cost effec(ve and safest drug therapy and
bursement Account (HRA), Health Savings Account (HSA) or Flexi- progressing to other more costly or risky therapy, only if nec-
ble Spending Account (FSA). essary.
DENTAL TERMS Major Services – Generally include restora(ve
Basic Services – Generally include coverage for fillings and oral dental work such as crowns, bridges, dentures, inlays and
surgery. onlays.
Diagnos"c and Preven"ve Services – Generally include rou(ne Orthodon"a – Some dental plans offer Orthodon(a services
cleanings, oral exams, x-rays, sealants and fluoride treatments. for children (and some(mes adults too) to treat alignment of
Most plans limit preven(ve exams and cleanings to two (mes a the teeth. Orthodon(a services are typically limited to a life-
year. (me maximum.
Endodon"cs – Commonly known as root canal therapy. Periodon"cs – Diagnosis and treatment of gum disease.
Implants – An ar(ficial tooth root that is surgically placed into Pre-Treatment Es(mate – An es(mate of how much the plan
your jaw to hold a replacement tooth or bridge. Many dental will pay for treatment. A pre-treatment es(mate is
plans do not cover implants. not a guarantee of paymentYou can also read
