triten 2014 guide - final 131101

8/10/2019 Triten 2014 Guide - FINAL 131101

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2014

BENEFIT GUIDE


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The information contained in this guide should in no way be construed as a promise or guarantee of employment or benefits.

The company reserves the right to modify, suspend, or terminate any plan at any time for any reason. If there is a conflict

between the information in this guide and the actual plan document or policies, the documents or policies will always govern.

Complete details about the benefits can be obtained by reviewing current plan descriptions, contracts, policies, and plan


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www.mybensite.com/trit

User ID: triten

Password: benefits

LETTER FROM HUMAN RESOURCES

Dear Triten Corporation Employees,

Triten Corporation offers a comprehensive benefit program which is designed to helpyou live a better life. We offer benefit plans and tools that can help you and your

family improve your physical, financial and personal health. This total healthapproach to benefits provides you with many resources to help you in all aspects ofife, and through lifes stages.

Effective January 1, 2014, we will offer the following coverages:

Medical and Prescription Drug Aetna HealthcareCompass Professional Health Services CompassVoluntary Dental PPO and Voluntary DHMO United HealthcareVoluntary Vision Vision Service Plan (VSP)Basic Life/AD&D and Optional Life/AD&D Mutual of OmahaVoluntary AD&D The HartfordVoluntary Short Term and Long Term Disability Mutual of Omaha

Employee Assistance Program (EAP) Mutual of OmahaVoluntary Critical Illness, Cancer and Accident AssurantFlexible Spending Account (FSA) Discovery Benefits401(k) Savings Plan Transamerica Retirement Solutions

Employee benefits can sometimes be difficult to understand. We try to keep it simpleand want to provide you with tools to help you understand them. Please review thisguide carefully, attend an annual enrollment meeting, view our customized website,or call Tritens Benefit Resolution Center if you have questions. Your benefits are avaluable part of your compensation. Making the most of your benefits starts withunderstanding the coverages and programs which are offered.

Because each employees benefit needs are unique, and they can change over time,you should carefully consider your options and choose the coverage that is best foryou and your family for the upcoming plan year. Changes made during the annualenrollment period will become effective on January 1, 2014. However, if therequested change requires Evidence of Insurability, then the change will not becomeeffective until approved by Mutual of Omaha or Assurant as applicable.

Annual enrollment is from November 7 - November 15, 2013. Remember, thechoices you make now will remain in effect for the entire plan year unless youexperience a family status change, which is defined within this guide.

f you have questions which you are unable to answer after reviewing our customized

website and/ or calling the Benefit Resolution Center, please contact the HumanResources Department.

Sincerely,

Amy SpillerVice President, Human Resources & Chief People Officer

If you (and/or yodependents) havMedicare or wbecome eligible fMedicare in thnext 12 months, new Federal Lagives you mochoices about yoprescription dru

coverage. Pleassee page 26 fmore details.


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INSIDE THIS GUIDE

Benefit News for 2014 5-6

Benefit Resources 8

Membership Guidelines 9

Medical 10-11

Prescription Drug Plan 12

Addi tional Benef its with Aetna 13

Dental 14

Vision andEmployee Assistance Program

15

Flexible Spending Account -Health Care and Dependent Care

16

Disability 17

Life and AD&D 18-19

Addi tional Benef its - Business TravelAccident and Worldwide Travel Ass istance

20

401(k) Savings Plan 21

Legal Updates 24-25

Medicare Part D Notice 26-27

Employer CHIP Notice 28-29

Reference Guide 30

Cancer, Accident and Critical Illness 22-23

What to do During Annual Enrollment 7

Compass Professional Health Services 12


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ANNUAL ENROLLMEN

Effective Date for AnnualEnrollment Changes

January 1, 2014

(unless your change requircompletion of an Evidence Insurability Form (EOI).

REMEMBER:The choices you make durannual enrollment will remin effect until the next annenrollment period unless yhave a family status changAd dit io nal infor mat io n

family status changes enclosed.

If you have any questioplease contact the BenResolution Center or the Department.

Annual Enro llmentAnnual Enrollment is from November 7 - November 15, 2013. The changes you make to yourbenefit elections will become effective on January 1, 2014, unless they require Evidence ofnsurability (EOI). If EOI is required, benefits will not become effective until approved by

Mutual of Omaha or Assurant as applicable.

MedicalAetna will continue to provide our Medical Insurance for 2014. There are a few changeseffective January 1, 2014. They are as follows:

Compass Professional Health ServicesCompass Professional Health Services is a medical, dental, and vision price containment andconcierge service that will be available to Triten employees and their family members startingJanuary 1, 2014. Please see page 12 for more details.

DentalUnited Healthcare will now provide our Voluntary Dental PPO and Voluntary DHMO.

United Healthcares Voluntary Dental PPO coverage includes a Maximum Rollover feature.Please see page 14 for more details.

VisionVision Service Plan (VSP) will continue to provide our vision insurance for 2014. Additionalnformation on the benefits and how to locate a network provider can be found on page 15.

Flexible Spending Account (FSA)The Healthcare FSA will have an annual maximum of $2,500 to the Healthcare FSA. TheDependent Care FSA will still have an annual maximum contribution of $5,000. Additionaldetails on the FSA can be found on page 16.

BENEFIT NEWS FOR 2014

BENEFIT EFFECTIVE JANUARY 1, 2014

COPAYS & DEDUCTIBLESOffice visits, Rx copays, and deductibles will count

toward your out-of-pocket maximum.


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Life/AD&DMutual of Omaha will continue to provide the Life/AD&D coverage for Triten. The beremains the same at $50,000 for both Life and AD&D. Additional information can be foon page 18.

Voluntary Life/AD&DYou also have the option to purchase additional Voluntary Life/AD&D through MutuOmaha for yourself, your spouse and your dependents. We strongly recommend thatreview your benefit elections and beneficiaries in BenefitSolver. Additional informationbe found on page 19.

Voluntary Short Term Disabil ity (STD)Voluntary Short Term Disability will be offered through Mutual of Omaha. The coverageprovide 60% of your weekly earnings up to a maximum benefit of $1,500 per week. Ifhave not purchased coverage in the past, annual enrollment is your opportunity to do

Additional information on the STD can be found on page 17.

Long Term Disability (LTD)Long Term Disability will continue to be provided through Mutual of Omaha. The beremains the same at 60% of your basic monthly earnings up to a monthly maximum beof $10,000. Additional information can be found on page 17.

Critical Illness, Cancer and AccidentThere are no changes to the Critical Illness, Cancer and Accident coverages through

Assurant. Additional information on these benefits can be found on pages 22 - 23.

BENEFIT NEWS FOR 2014


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DURING ANNUAL ENROLLMENT

What do I need to do during Annual Enrollment?

1. Review the enclosed information carefully.

2. If you have any unanswered questions, log onto -


Username - triten

Password - benefits

or, call the Benefit Resolution Center at: 1.888.445.8297

7:30 am - 5:30 pm / CST / M-F

3. Decide if you need to make any changes to your current benefit elections.

4. Enroll or make benefit election changes online with BenefitSolver.Login information is on page 8.

5. The Voluntary Dental election will carry forward to the new carrier. We stronglyrecommend that you review this election. If you are enrolled in the DHMO, youmust select a new dentist with in United Healthcares network.

6. Confirm that your beneficiaries are up-to-date for the Basic Life/AD&D and theVoluntary Life/AD&D.

7. If you want to participate in the Flexible Spending Account for 2014, you must re-enroll. Your current election will NOT carry forward.

8. If any of your elections require Evidence of Insurability, be sure to complete andreturn those forms.

9. Confirm your proper elections/deductions are shown on your first paycheck in 2014.


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BenefitSolver

In order to enroll or make changes, you must use our online benefit enrollment sysBenefitSolver.

If you are a first t ime user, you will need to regis ter.1. Go to www.benefitsolver.com

2. Click on Register

3. Type in your Social Security Number, Company Key (triten), and Date of Birt

Note! The Company Key is triten(it is case sensitive).

4. Read the Electronic Signature notification, click Accept

5. Enter in a User Name

6. Enter in and confirm a Password

Note! Make a note of the User Name and Password for future use.

7. Select a Security Phrase from the drop-down menu and enter in an answe

Note! There are 3 Security Phrases to choose from. This response is

used to reset a users password if forgotten.

8. Click Continue

9. Click Continue

10. Enter in the User Name and Passwordthat were just created. Click Login

Employee Benefits Website

The HR Departments goal is to educate employees on our available benefits. TriBenefits Website provides you access to your benefit summaries, claim forms, provfinder tools and customer service contacts. Information about your benefits is availabyou and your dependents whenever you need it. Visit the website today!

Benefit Resolution Center

Need additional help with a claim or understanding your benefits? The Benefit ResolCenter is available to assist you and your covered dependents with questions you may habout your health and welfare benefits such as:

Eligibility

Claims Resolution

Locating a Provider

Understanding your Explanation of Benefits

BENEFIT RESOURCES

Address: www.mybens ite.com/t ri ten

User ID: trit en

Password: benefits

Phone:1.888.445.8297

7:30 am - 5:30 pm / CST / M-F

Email: [email protected]

Fax: 713.358.5255


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Pre-Tax Payroll Deductions:

Medical, Dental, Vision, AD&D, Critical Illness, Cancer and Accident

To help offset your contributions for the medical, dental, vision, AD&D, Critical Illness, Cancerand Accident plans, we offer these benefits on a pre-tax basis through the Section 125 (orcafeteria) plan. By making your contributions for these benefits on a pre-tax basis, premium iswithheld from your pay before federal, state, and FICA taxes are calculated. This can reduce the

amount of taxes you pay per paycheck.

MEMBERSHIP GUIDELINES

Who is Eligible for Coverage?

All regular, full-time employees who work 25 hours per week will be eligible for benefits on thefirst day of the month following your date of hire.

For Medical Coverage -Dependent means: Your legal spouse (including common law); or a child who is: Under 26 years of age; or An unmarried child of any age who is medically certified as disabled and dependent on the

parent for support.

Child means: Your natural child; or your legally adopted child, including a child who has been placed for

adoption with the Covered Employee; Your stepchild; A child who has been placed under the legal guardianship of the Covered Employee.

Making Enrol lment Changes During the Year

n most cases, your benefit elections remain in effect for the entire plan year (January 1 -December 31). During each annual enrollment period, you will have the opportunity to reviewyour benefit elections and make changes for the coming year.

Certain coverages allow limited changes to elections during the year. Under these benefits,you may only make changes to your elections during the year if you have a change in familystatus.

Family status changes include:

Marriage or divorce

Gain or loss of an eligible dependent for reasons such as birth, adoption, court order,disability, death, marriage, or reaching the dependent child age limit

Changes in your spouses employment affecting benefit eligibility

Changes in your spouses benefit coverage with another employer that affects benefiteligibility

The change to your benefit elections must be consistent with the change in family status. Forexample, if you gain a new dependent due to birth, you may change your benefit elections toadd that dependent.

You have 30 days from the date of a family status change to complete a family statusevent enrollment/change online through BenefitSolver. Otherwise, you must wait until thenext annual enrollment period to make a change to your elections. In most cases, your

election will become effective the first of the month following your request.

Contact the HR Department for more detailed information.


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About Your Medical CoverageAetna Healthcare is one of the most widely recognized carriers worldwide. Aetna offerschoice of many providers and facilities for you to choose from as well as online servand discounts for you and your family members for certain services by just being enroin their plans.

Your Open Access Managed Choice (OAMC) POS plan will be administered by Aetna.matter where you live, you may take advantage of the extensive provider networks discounts arranged by Aetna Healthcare plans around the country. In most cases, should not have to file claim forms or pay anything except your copayments, deductibetc., in advance. This guide explains your coverage with the Aetna Healthcare progrFor more information, such as details about how the OAMC POS plan covers a particservice or drug, please read your certificate of coverage provided by Aetna or use onthe sources listed in the Reference Guide located at the back of this guide.

How Does the OAMC POS Plan Work?

Your out-of-pocket expense will be lower when you use the physicians, hospitals, and ohealthcare providers that participate in the Aetna OAMC POS network. While you dneed referrals or authorizations for most services, you receive the highest level of benewhen you use Preferred Providers. In some instances, prior approval may be requbefore services are rendered. In other words, Aetna must approve the need for the cbefore you seek it. To find Preferred Providers:

Visit www.aetna.comand click on Find a Doctor for information about Providthat are in the Open Access Managed Choice (OAMC) POS network.

Call AETNA OAMC at 1.888.416.2277 to find out if the provider you have selecis one of Aetnas network providers. On the Aetna website, you can also regto use the Aetna Navigator Tool to view your personal health information.

Benefits for most services require that you pay a deductible each year for in-netwproviders services and a higher deductible each year for out-of-network providservices. Once you have met your deductible, you share the cost of your care throcoinsurance.

Remember that you will pay more out of your pocket when you use out-of-netwproviders. The chart in this guide shows a comparison between benefits when you usenetwork providers and benefits when you use out-of-network providers. Also keep in mthat your health plan pays the Allowed Price for services and supplies. In-netwproviders agree to accept the Allowed Price as payment in full. When you use ounetwork providers, you must pay the difference between the Allowed Price and providers charge in addition to any deductibles and amounts that may apply.

What is an Aexcel Specialist?Specialists with the Aexcel designation are doctors in Aetnas performance network meet certain standards for clinical performance and efficiency. Aexcel Specialists available in the following areas: Cardiology, Cardiothoracic surgery, GastroenteroloGeneral surgery, Neurology, Neurosurgery, Obstetrics and gynecology, OrthopedOtolaryngology/ENT, Plastic surgery, Urology, and Vascular surgery.

Aetna chooses specialists for the Aexcel designation by reviewing clinical quality efficiency, such as hospital readmission rates after 30 days and complication rates. can save money on your office visit copay by visiting an Aexcel Specialist. AexSpecialists can be located on Aetnas website under Find a Doctor. They wildesignated as an Aexcel Specialist with a star by their name.

MEDICAL OAMC POS

To find an

in-network provider

1.888.416.2277or

www.aetna.com


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MEDICAL OAMC POS

AETNA IN-NETWORK OUT-OF-NETWORK

DEDUCTIBLE (Calendar Year)IndividualFamily

Penalty for Failure to Pre-Certify Hospitaland Facility Admissi ons

$750$1,500

N/A

$1,500$3,000

$400 per occurrence

OUT-OF-POCKET MAXIMUM - (Calendar Year)(Deductible & copays inclu ded)

IndividualFamily

$2,000$4,000

$4,000$8,000

PHYSICIAN OFFICE VISITPrimary Care Physician

Aexcel Specialist*Non-Aexcel Specialist

$25 copay$30 copay$50 copay

60% after deductible60% after deductible60% after deductible

PREVENTIVE CARE 100% 60% after deductible

INPATIENT HOSPITAL SERVICES 80% after deductible 60% after deductible

OUTPATIENT SURGERY EXPENSES 80% after deductible 60% after deductible

URGENT CARE FACILITY CHARGES $50 copay 60% after deductible

EMERGENCY ROOM FACILITY CHARGES $200 copay (waived if admitted)

PRESCRIPTION DRUGS - UP TO A 30 DAY SUPPLYGenericFormulary Brand NameNon-Formulary Brand Name

At a Participating Pharmacy:$5 copay

$40 copay$60 copay

MAIL ORDER - UP TO A 90 DAY SUPPLYGeneric

Formulary Brand NameNon-Formulary Brand Name

$10 copay

$80 copay$120 copay

LIFETIME MAXIMUM Unlimited

To find an

in-network provider

1.888.416.2277

orwww.aetna.com

Visit www.aetna.com

to find an Aexcel Special

Save money on your co

and coinsurance!

Save money on your R

copays by using Gener

medications!

Ask your doctor i f a

Generic is available anappropriate for you.

Addi tional informat ion cbe found on our Employ

Benefits Website at


under the Medical ta

* If Aexcel Specialists are not available in your area, the office visit copay for a Specialist is $35.

Reasons to Try Urgent Care Instead of the Emergency Room (ER)

No appointments needed

Convenient hours - some are open 7 days a week, with extended evening, weekend and holidayhours, just like the ER.

Less waiting - the average ER visit is 3 hours; while urgent care visits are generally an hour orless.

Lower prices - lower copays and out-of-pocket costs

Many locations - you can find a location near your home or job.

Fully staffed by doctors - clinics are overseen by doctors, with doctors providing the service.

How to Find an Urgent Care or Walk in ClinicVisit www.aetna.com. Click on Find a Doctor. Enter your location details. Choose Facilitiesunder Provider Category. Select Urgent Care Facilities or Walk in Clinics.

If your medical need is more than urgent - for example, characterized by chest pain, troublebreathing, bad bleeding or other symptoms that are serious or put your life at risk - you should gostraight to your local ER.


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The Aetna OAMC POS medical program includes a tiered prescription drug program is administered by Aetna. When you utilize your prescription benefits, a copaymenyour drugs will be required at the time of service. When accessing prescription benthrough your Aetna drug program, you will pay the following copayments for a 30-supply that you purchase from a retail pharmacy:

The Aetna Drug List is updated periodically to ensure that newer, more effective drugs included. To get the most updated list, log on to www.aetna.com for information abyour generic and brand name drug options. When you have your prescription filled, alwcheck to see if a generic drug is available. This will result in an out-of-pocket savingsyou.

Aetna Rx Home Delivery - Mail Order ProgramWhen you use the Aetna Rx Home Delivery mail order program your medications conveniently delivered directly to your home for a 90-day supply. Your copaymentsyour mail order drugs are as follows:

The mail order form can be downloaded at www.aetna.com or www.mybensite.com/trite

Compass Professional Health ServicesCompass Professional Health Services is a medical, prescription drug, dental, and visprice containment and concierge service that will be available to Triten employees and tfamily members in your household (spouse, children, parents and grandparentstheynot have to be covered by the Triten benefits) starting January 1, 2014.

Sample of services Compass can provide:

Unlimited access to a healthcare expert

Unbiased doctor recommendations

Hospital cost and quality information

Straight answers about you r benefits

Bill reconciliation

Insider information on saving money

Complete advisors for your healthcare

You can call Compass for assistance at 800.513.1667 oremail [email protected].

PRESCRIPTION DRUG PLAN

Generics $5 copay

Formulary brand name drugs $40 copay

Non-formulary brand name drugs $60 copay

Generics $10 copay

Formulary brand name drugs $80 copay

Non-formulary brand name drugs $120 copay


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ADDITIONAL BENEFITS WITH AETNA

Informed Health Line - 24/7 Nurselinenformed Health Line gives you 24-hour, toll-free access to a team of registered nurses

experienced in providing information on a variety of health topics. This service can help youearn about health conditions and medical procedures, or to improve the way you communicate

with your doctor.

nformed Health Line also features an audio health library, a recorded collection of more than2,000 health topics. The audio health library contains information about conditions anddiseases, age and gender-specific health issues, dental care, mental health, substance abuse,weight loss and more.

Beginning Right Maternity ProgramThe Beginning Right Maternity Program is designed to help you and your baby grow healthy -together.

f you enroll in the program, youll get materials on:

Prenatal care

Preterm labor symptoms

What to expect before/after delivery

Newborn care and more

Some women have health conditions or risk factors that could hurt their pregnancy. If you do,you can work with a nurse case manager to help you lower those risks.

To Enroll in the Beginning Right Maternit y Program call 1.800.272.3531.

Aetna NavigatorAetna Navigator is your secure website for planning and managing your health and health care.

Theres so much you can do on Aetna Navigator! Just log in to plan and manage your:

Health coverage and benefits estimate and compare costs

Care and Treatment find doctors, pharmacies and hospitals, compare hospitals

Health Records get a summary of doctor visits, medical tests, and prescriptions

Health and Wellness complete a Health Assessment, get healthy living tips, sign up fora wellness program

Claims get an explanation of how claims work, see your claims status, review anExplanation of Benefits

New members go to www.aetna.com and Register today.

Al ready signed up for Aetna Navigator? Log in to make the most of yourhealth plan.

Informed Health Line

1.800.556.1555

Available 24 hours a da7 days a week!

Beginning Right

1.800.272.3531

www.aetna.com


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Triten offers a dental program that allows you to choose between a Voluntary Dental H(DHMO) Plan or a Voluntary PPO Dental Plan offered through United Healthcare.

Voluntary DHMO Dental PlanWith this plan, you will receive all of your dental care within a network of dentists that affiliated with United Healthcare. When receiving services from network dentists youpay a copayment for most of your covered benefits at the time of service. You must sea primary dentist from the list of providers with United Healthcares Texas Select ManaCare DHMO Network. The primary dentist you select will assist you with the majorityour dental needs. Should there be a need to see a specialist, you must have a refefrom your primary dentist.

Voluntary PPO Dental PlanThe Voluntary PPO Dental Plan provides a variety of benefits and allows you to use dentist or specialist that you choose. Benefits are paid after any applicable deductible been met, up to the annual maximum.

Although you may visit any dentist you choose, you will receive maximum savings if visit an Options PPO 30 Network provider. Services provided by non-participadentists are based on usual and customary charges. Patients are responsible for feeexcess of usual and customary when visiting an out-of-network dentist.

If the cost of a proposed dental treatment exceeds $300, a predetermination review of ytreatment plan should be submitted to United Healthcare for an estimate of benepayable.

Max Multipl ier Rollover Benefit

With Max Multiplier Rollover, UHC will roll over a portion of your unused annual maxim

into your personal Maximum Rollover Account (MRA). The MRA can be used in fu

years, if you reach the plans annual maximum. The annual maximum rollover amou

$250. Plus if all of your claims for the year are for network providers, you could earnannual network bonus of $100.00.

To qualify, you must submit a claim for covered services for which a benefit paymen

issued, in excess of any deductible or copay, and you must not exceed the paid cla

threshold ($500) during the benefit year.

You and your covered dependents maintain separate MRAs based on your own c

activity. Each MRA may not exceed the MRA limit ($1,000). For more information, g

www.mybensite.com/triten and click on the Dental tab.

DENTAL

UNITED HEALTHCARE VOLUNTARY PPO DENTAL

ANNUAL DEDUCTIBLE (Calendar Year ) $50 per person (3 per family)

MAXIMUM BENEFIT (Calendar Year) $1,000 per covered person

PREVENTIVE SERVICESOral examinations, cleanings, x-rays

100%deductible waived

BASIC SERVICESFillings, simple extractions

80% after deductible

MAJOR SERVICESOral surgery, endodontics, periodontics, crowns,bridges and dentures

50% after deductible

ORTHODONTIA- Child under age 19 onlyLifetime Maximum

50%$1,000

To find an

in-network provider

1.877.816.3596

Group #: 813598

or

www.myuhcdental.com


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VISION AND EAP

Voluntary Vision

Triten provides employees the opportunity to enroll in vision coverage for you and your familymembers. The vision plan is offered by VSP.

Employee Assistance Program (EAP)When you need a trusted advisor to help you sort through personal issues that may affectyour work, health and general well-being, the Employee Assistance Program through Mutualof Omaha can help. The EAP is a free and confidential counseling service available toemployees and their immediate family members. The EAP provides you with:

24-hour toll-free phone access to EAP professionals 7 days a week Telephone assistance and referrals

Up to 6 in-person sessions with a licensed EAP counselor

The EAP can provide assistance for a variety of personal and professional matters, including:

Stress

Depression / Grief

Gambling and other addictive behaviors / Drug and alcohol abuse

Parenting and Relationships / Balancing work and home

Financial Issues

Life Changes / Mental Health

To find an

in-network provider

(VSP Choice Network)

1.800.877.7195

or

www.vsp.com

Please note: there is n

Vision ID card.

For additional

information, visit


EAP

www.mutualofomaha.com/

or

1.800.316.2796

VISION SERVICE PLAN (VSP) COPAY FREQUENCY

Coverage with VSP Doctors

WELLVISION EXAM $10 copay Every calendar year

PRESCRIPTION GLASSES $25 copay See frame and lenses

FRAME$130 allowance20% off amount over your allowance

Included inPrescription Glasses

Every other calendar year

LENSESSingle vision, lined bifocal and linedtrifocal lenses, Polycarbonates for children

Included inPrescription Glasses

Every calendar year

LENS OPTIONSStandard progressive lensesPremium progressive lensesCustom progressive lenses

Average 2025% off other lens options

$55$95 - $105

$150 - $175Every calendar year

CONTACTS (instead of glasses)$130 allowance for contacts; copay doesnot applyContact lens exam (fitting and evaluation)

Up to $60 Every calendar year

EXTRA SAVINGS AND DISCOUNTSGlasses and Sunglasses- 20% off additional glasses and sunglasses, including lens options, fromany VSP doctor within 12 months of your last WellVision Exam.Laser Vision Correction -Average 15% off the regular price or 5% off the promotional price;discounts only available from contracted facilities.

Coverage with Other ProvidersVisit www.vsp.com for details, if you pl an to see a provider other than a VSP doctor.

If you use an out-of-network provider, you will have a maximum allowance availablewhich is applied toward the total cost of your services.


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Discovery Benefits

1.866.451.3399

or

www.discoverybenefits.com

The Flexible Spending Accounts (FSAs), administered by Discovery Benefits, are funby employees with pre-tax dollars. FSAs provide a tax effective way to set aside moneycertain unreimbursed health care and dependent care expenses. Federal, State Social Security taxes are not withheld on dollars contributed toward the Flexible Spend

Accounts. This tax treatment is similar to the pre-tax treatment of dollars contribu

toward other flexible benefit options.

Changes to your election can only be made with a family status change and must be mwithin 30 days of the change in status. If any funds remain unused in your account(sthe end of the plan year and all claims have been processed, you will forfeit remaining balance. All claims must be incurred by December 31st and submiby March 31st of the following year in order to be cons idered for processing.

There are two types of flexible spending accounts.

Health Care Flexible Spending AccountYou can receive tax-free reimbursement from your Health Care Flexible Spending Accofor unreimbursed medical, dental, and/or vision expenses for you or an eligible dependThe maximum annual amount that you can contribute to this plan is $2,500 and minimum contribution amount is $600. You can use the account to receive reimbursemfor health-care related expenses such as:

Deductibles and co-pays,

Cost of eligible services above reasonable and customary limits or above otplan limits,

Transportation costs to receive care,

Over-the-counter medications (require a prescription),

Other health-related expenses not paid by other plans that are eligible for tadeduction by the I.R.C. Section 213(d) and 105.

Dependent Care Flexible Spending AccountYou can receive tax-free reimbursement from your Dependent Care Flexible Spend

Account for expenses that enable you to be gainfully employed for the period that you heligible dependents. The maximum annual amount that you can contribute to this pla$5,000 and the minimum amount is $100. If you are married and file separate FedIncome Tax Returns, the maximum annual amount you can each contribute is $2,5Eligible dependents under the account include:

A dependent under the age of 13 who is claimed as a dependent for purposes

A dependent that is physically or mentally incapable of taking care of himse

herself Dependent means any individual considered your dependent according

Section 152 of the I.R.C.

The Dependent Care Flexible Spending Account is NOT for medical, dental, or viexpenses for your dependents. It is strictly for the care of your dependents while youat work.

For a complete listing of ELIGIBLE / INELIGIBLEflexible spending account expensesto Discovery Benefits website at www.discoverybenefits.com or call 1-866-451-3399

FLEXIBLE SPENDING ACCOUNT


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DISABILITY

Voluntary Short Term Disability (STD)All eligible employees are given the opportunity to purchase Voluntary Short Term Disability(STD) insurance through payroll deduction. Voluntary STD insurance can help protect yourncome in the event of disability by providing you a benefit for injuries and sicknesses that are

not work related.

f you havent enrolled in the past, annual enrollment is your opportunity to enroll. Evidence ofnsurability does not apply to the STD, but there is a pre-existing condition limitation on the

plan.

Long Term Disabili ty (LTD)

Long Term Disability (LTD) is designed to replace a portion of your monthly salary in the eventof a covered disability. To prevent over-insurance, benefit payments are reduced by deductiblesources of income. Triten provides LTD coverage at no cost to all full-time, active employeeswho meet the eligibility requirements.

MUTUAL OF OMAHA LONG TERM DISABILITY

BENEFIT PERCENTAGE 60% of covered monthly pre-disability earnings

MAXIMUM MONTHLY BENEFIT $10,000

ELIMINATION PERIOD 180 days of disability

MAXIMUM BENEFIT DURATION

If you are disabled prior to age 62, benefits are payable toage 65 or your Social Security Normal Retirement Age.

At age 62 and older, the benefit will be based ona reduced benefit duration schedule.

PRE-EXISTING CONDITION LIMITATION 3 months prior / 12 months insured

MUTUAL OF OMAHA VOLUNTARY SHORT TERM DISABILITY

MAXIMUM WEEKLY BENEFIT $1,500

BENEFIT PERCENTAGE 60% of covered weekly earnings

ELIMINATION PERIOD Benefit begins on the 15th day for injury,sickness and pregnancy

MAXIMUM BENEFIT DURATION Up to 24 weeks

PRE-EXISTING CONDITION LIMITATION 3 months prior / 6 months insured


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Basic Life / Accidental Death and Dismemberment (AD&D)Life Insurance provides financial security for the people who depend on you. Ybeneficiaries will receive a lump sum payment if you pass away while employed by TrCorporation. All eligible employees are covered for Basic Life and Accidental Death

Dismemberment (AD&D) insurance at no cost

to you.

Voluntary AD&D InsuranceVoluntary AD&D Insurance may be purchased for you and your family members throThe Hartford. You may purchase this voluntary coverage in increments of $10,000 maximum of $500,000 (coverage in excess of $300,000 may not exceed 10 times ybasic annual salary).

If you purchase coverage for yourself, you may also purchase coverage for ydependents as follows:

Spouse Only: 60% of employee amountSpouse and Child(ren): 50% of employee amount / 10% of employee amountChild(ren) only: 15% of employee amount

Age reductions apply. For information on additional benefits such as Coma Benefit, Care benefit, Spouse Education benefit, Rehabilitation benefit, and Paralysis benefit, your Summary Plan Description.

LIFE AND AD&D

MUTUAL OF OMAHA BASIC LIFE / AD&D

BASIC L IFE / AD&D EMPLOYEE $50,000

DEPENDENT LIFE SPOUSE $5,000

DEPENDENT LIFE CHILDRENBirth to 14 Days14 Days to 25 Years

$500$2,000

AGE REDUCTION Benefit reduces 50% at age 75


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LIFE AND AD&D

Voluntary Life / AD&D Insurancen addition to the Basic Life and AD&D insurance provided by Triten, you also have the option

to purchase additional life insurance and AD&D coverage for yourself and your eligibledependents. You may make changes to your coverage amount during the annual enrollment

period.

n order to purchase coverage for your dependents, you must purchase employee coverage. Ifyou and your spouse work for Triten, you cannot cover each other as dependents, and onlyone of you may insure any dependent children.

Evidence of InsurabilityYou may be required to complete an Evidence of Insurability (EOI) form based on yourelection. If EOI is required, coverage will not become effective until approved by Mutual ofOmaha. The rules for Evidence of Insurability are listed below:

Currently Enrolled Employees - If you are currently enrolled for Voluntary Life insurance,you may be able to purchase another $10,000 of coverage for yourself without completingan EOI form. EOI is not required for a $10,000 increase if you are currently enrolled for anamount less than five times your annual earnings, up to $200,000. EOI is required for anyincrease in excess of $10,000 or if your new election will give you an amount of coveragein excess of $200,000. EOI is always required for an increase in dependent coverage.

Late Entrants - If you and your dependents were previously eligible for, but did not enrollin Voluntary Life, you are a late entrant. You are required to complete an EOI form.

New Hires (Timely Entrants) - If you are a new hire, and are applying within 31 days ofbecoming eligible, Application for coverage must be made within 31 days of meetingeligibility requirements. The guarantee issue amounts for new hires are shown in the boxabove.

Download an EOI form at www.mybensite.com/triten.

MUTUAL OF OMAHA VOLUNTARY LIFE / AD&D

EMPLOYEE COVERAGEBenefit AmountMaximum Benefit

Increments of $10,000 (minimum $20,000)5 times basic annual earnings, up to $500,000

GUARANTEE ISSUE(For New Hires Only)

Employee Guarantee IssueSpouse Guarantee IssueChild Guarantee Issue

5 times basic annual earnings, up to $200,000100% of employees benefit, up to $100,000

$10,000

DEPENDENT COVERAGE

Spouse Benefit AmountSpouse Maximum BenefitChild(ren) Benefit Amount

Increments of $5,000Up to 100% of employees benefit, up to $250,000

$5,000 or $10,000 (14 days to age 25)

AGE REDUCTIONBenefit reduces 50% at age 75.

Spouse coverage terminates when the employee reaches age 90.

To calculate your monthl y cost, please use the following formula:

____________ / $1,000 = ____________ x ____________ = $______________

Life Benefit Amount Rate Monthly Cost

RATE INFORMATION

(includes Life and AD&D

The employees age as o

January 1st

determines whirate applies to bo th the

employee and the spouse

AgeRate per

$1,000


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Travel Assis tance andIdentity Theft Assistance

In the U.S.

1.800.856.9947

Outside the U.S. call collect:

312.935.3658

ID #:

9900MOO2

Services available forbusiness and personal

travel.

Business Travel AccidentTriten provides Business Travel Accident insurance to all eligible employees. Tcoverage provides 24-hour protection for eligible employees when they are travellingcompany business for Triten. For additional information about this benefit, please con

Human Resources at 832.214.5056.

Worldwide Travel AssistanceMutual of Omaha provides worldwide travel assistance for you, your spouse dependent children on any single trip up to 90 days in length, and more than 100 mfrom home. Services are provided by AXA Assistance USA.

Pre-trip Assistance

Passport, visa or other required documentation for foreign travel

Travel, health advisories and inoculation information for foreign travel

Weather forecasts

Daily foreign currency exchange rates

Consulate and embassy locations

Immediate Attention for Emergencies While Traveling

While traveling more than 100 miles from home, call Travel Assistance toll-free 24/7immediate help.

Emergency Travel Support Services

Translation and interpreter services - 24/7 access

Locating legal services - referrals for local attorneys or consular offices

Baggage assistance - lost, stolen or delayed Emergency payment and cash - assistance in coordinating

Emergency messages - between you and your family and/or business associates

Documentation replacement

Medical Assistance - some of the services include: locating providers, emergeevacuation, transportation home for further treatment, coordination of medinsurance, assistance obtaining prescription drugs.

Identity Theft Assistance (whether at home or traveling)

Comprehensive ID theft assistance guide

Tips to defend against ID theft

Information regarding steps to recover from credit card and check fraud

Some limitations and exclusions apply. See www.mybensite.com/triten for additioinformation on travel and identity theft assistance.

** All services must be arranged and provided by AXA Assistance USA. No clafor reimbursement will be accepted. **

ADDITIONAL BENEFITS


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401(k) SAVINGS PLAN

401(k) Savings PlanTransamerica Retirement Solutions administers Tritens 401(k). All full-time, U.S. employeesare eligible to enroll in the plan upon hire. Tritens plan will allow you to defer a percentage ofyour compensation on a pre-tax basis for savings purposes. Triten matches 30% of your

employee contributions up to 5% of your pay. Additionally, you are deemed 100% vested after6 years of participation in the plan (note: you are always 100% vested in your employeecontributions to the plan). You may log on to Transamericas website at www.trsretire.comorcall them at 1.888.676.5512 to enroll, change investments, check balances, view transactionhistory and much more.

Contact the Mott Group with Morgan Stanley SmithBarney for 401(k) plan questions andnvestment Advice at 1.800.991.4015 or http://fa.smithbarney.com/themottgroup.

Transamerica

1.888.676.5512

or

www.trsretire.com

The Mott Group

1.800.991.4015

or

http://fa.smithbarney.cothemottgroup


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Cancer InsuranceCancer Insurance provides fixed benefits for early detection and covers treatmentcertain kinds of cancer, including related expenses such as screenings, hospconfinement, radiation, chemotherapy, surgery and more. Benefits are paid directly to

regardless of any coverage you may have and you can spend it in any way you choosyou elect coverage for yourself, you can elect coverage for your eligible family members

Key advantages of this p lan

Benefits are payable directly to you to be spent any way you choose

Pays in addition to any other coverage you may have

Coverage is portable - if you change jobs you can take your coverage with you

What benefits are payable under th is Cancer Insurance plan? You may choose from two levels of benefits based on the coverage you need. Benamounts will depend on the selection of Level 1 or Level 2 and premium will vary basedthe level of benefits selected.

Some examples of the benefits included are:

Initial diagnosis must occur on or after effective date of plan. Any condition for which yhave seen a medical practitioner or taken medication in the 12 months before ycoverage began is considered a pre-existing condition. Benefits are payable for a pexisting condition after 12 months of continuous coverage. A two-question proof of ghealth statement is required to become insured.

Accident InsuranceFor covered accidental injuries, fixed benefits are paid directly to you regardless of other coverage you may have and you can spend it any way you choose. Benefits are paccording to a fixed schedule that includes benefits for hospitalization, fractures,

dislocations, emergency room visits, major diagnostic exams, physical therapy and moryou of your dependent should die as a result of an accidental injury within 365 days wthe coverage remains in force, a death benefit is payable, too. If you elect coverageyourself, you can elect coverage for your eligible family members.

Key Advantages of Accident Insurance

Provides 24 hour a day coverage for on-and-off the job accidents

Benefits are payable directly to you to be spent any way you choose


No health questions or pre-existing conditions limitations

Coverage is portableif you change jobs you can take your coverage with you

CANCER AND ACCIDENT

ASSURANT - CANCER LEVEL 1 LEVEL 2

ANNUAL CANCER SCREENING TESTS $50 $75

HOSPITAL CONFINEMENT $200 daily $400 daily

OTHER CHEMOTHERAPYAND RADIATION

Benefit Year Max: $4,000 Benefit Year Max: $12,

ADDITIONAL LEVEL 2 BENEFITS First Occurrence (30 day wait applies): $5,000

Reconstructive Surgery: $350 - $2,500

Private Nursing Services: $125 Daily

For more information,

a complete Cancer

benefit summary and

rates, please visit

www.mybensite.com/triten.


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ACCIDENT AND CRITICAL ILLNESS

Limitations and/or exclusions may apply.

Critical Illness InsuranceCritical Illness pays up to 100% of your elected benefit if you are first diagnosed with a criticalllness after your coverage effective date. If you suffer more than one of the covered criticalllnesses, you can collect again if the condition is in a different procedure category and thereare at least 6 consecutive months between the diagnosis or procedure dates. If you suffer thesame critical illness again, you can collect an additional one-time payment of 25% of thepreviously paid benefit for a subsequent diagnosis of the same critical illness or procedure ifyou have been treatment-free for 18 months.

Key Advantages of Critical Illness Benefits are payable directly to you to be spent any way you choose

Benefits can help pay for your out-of-pocket medical and non-medical expenses your otherinsurance doesnt cover


Choice of two benefit levels

Coverage is portable - if you change jobs you can take your coverage with you

Any condition for which you have seen a medical practitioner or taken medication in the 12months before your coverage begins is considered a pre-existing condition. Benefits arepayable for a pre-existing condition after 12 months of continuous coverage. If you are a newhire, the employee guarantee issue amount is $5,000. If you are not a new hire, then coverages subject to EOI and the pre-existing condition limitation.


a complete Accident

benefit summary andrates, please visit


Critical Illness

coverage options -

You can purchase:

Up to $50,000 for yourse

Up to $25,000 for your

spouse*

$2,500 or $5,000 for you

children*

* Spouse and child amouncan not exceed 50% ofemployee election.


a complete Critical Illnes

benefit summary and

rates, please visit


ASSURANT - CRITICAL ILLNESS WHATS COVERED

CATEGORY 1:

Heart Attack

Heart Failure

Stroke

Coronary Bypass Surgery - limited to 25% ofelected benefit

CATEGORY 2:

Blindness

Major Organ Failure (excluding heart failure) End Stage Kidney Disease

Paralysis (excluding from stroke)

Coma

ASSURANT - ACCIDENT WHATS COVERED?

INITIAL EMERGENCY TREATMENTAmbulance Benefits: $200 ground, $1,500 air

Emergency Room Visit: $150

HOSPITAL CARE Initial Hospitalization: $1,000Daily Confinement: $250

ACCIDENTAL INJURIES

Fractures: $125 - $5,000

Dislocations: $100 - $4,000

Coma: $20,000

ACCIDENTAL DEATH ANDDISMEMBERMENT

$50,000 for employee

$25,000 for spouse

$12,500 for children

TRANSPORTATION BENEFIT $600 round trip


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HIPAA Special Enrollment Rights

Loss of Other Coverage If you are declining enrollment for yourself and/or your depend(including your spouse) because of other health insurance or group health plan coverage, you be able to enroll yourself and/or your dependents in this plan if you or your dependents lose eligi

for that other coverage or if the employer stops contributing towards your or your dependents ocoverage. To be eligible for this special enrollment opportunity, you must request enrollment wi30 days after your other coverage ends or after the employer stops contributing toward the ocoverage.

New Dependent as a Result of Marriage, Birth, Adoption or Placement for Adoption Ifhave a new dependent as a result of marriage, birth, adoption, or placement for adoption, you mbe able to enroll yourself and/or your dependents. To be eligible for this special enrollmopportunity, you must request enrollment within 30 days after the marriage, birth, adoptioplacement for adoption. Contact the HR Department to request a special enrollment.

Medicaid Coverage:

Tritens group health plan will allow an employee or dependent who is eligible, but not enrolledcoverage to enroll for coverage if either of the following events occur:

1.TERMINATION OF MEDICAID OR CHILDRENS HEALTH INSURANCE PROGRAM (CCOVERAGE- If the employee or dependent is covered under a Medicaid plan or under a State chealth plan and coverage of the employee or dependent under such a plan is terminated as a reof loss of eligibility.

2. ELIGIBILITY FOR PREMIUM ASSISTANCE UNDER MEDICAID OR CHIP- If the employedependent becomes eligible for premium assistance under Medicaid or a State child health pincluding under any waiver or demonstration project conducted under or in relation to such a pThis is usually a program where the state assists employed individuals with premium paymassistance for their employers group health plan rather than direct enrollment in a state Medprogram.

To be eligible for this special enrollment opportunity you must request coverage under the ghealth plan within 60 daysafter the date the employee or dependent becomes eligible for prem

assistance under Medicaid or CHIP or the date your or your dependents Medicaid or stsponsored CHIP coverage ends. To request special enrollment or obtain more information, plecontact the HR Department.

The Womens Health and Cancer Rights ActThe Womens Health and Cancer Rights Act requires group health plans that provide coveragemastectomy to provide coverage for certain reconstructive services. This law also requires written notice of the availability of the coverage be delivered to all plan participants upon enrollmand annually thereafter. This language serves to fulfill that requirement for this year.

These services include:

Reconstruction of the breast upon which the mastectomy has been performed;

Surgery/reconstruction of the other breast to produce a symmetrical appearance;

Prostheses; and Treatment for physical complications during all stages of mastectomy, including

lymphedemas.

In addition, the plan may not:

Interfere with a participants rights under the plan to avoid these requirements; or

Offer inducements to the healthcare provider, or assess penalties against the provider, inattempt to interfere with the requirements of the law.

However, the plan may apply deductibles, coinsurance, and copays consistent with other coverprovided by the Plan.

LEGAL UPDATES


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LEGAL UPDATES

Newborns and Mothers Health Protection Act

Federal law (Newborns and Mothers Health Protection Act of 1996) prohibits the plan from limiting amothers or newborns length of stay to less than 48 hours for a normal delivery or 96 hours for acesarean delivery or from requiring the provider to obtain pre-authorization for a stay of 48 hours or 96

hours, as appropriate. However, federal law generally does not prohibit the attending provider, afterconsultation with the mother, from discharging the mother or her newborn earlier than 48 hours for normaldelivery or 96 hours for cesarean delivery.

HIPAA Privacy Notice Update

HIPAA requires Triten to notify you that a Privacy Notice is available from the HR Department. To requesta copy of Tritens Privacy Notice or for additional information, please contact the HR Department at832.214.5228.

This 2014 Benefit Guide highlights recent plan design changes and is intended to fully complywith the requirements under the Employee Retirement Income Security Act (ERISA) as aSummary of Material Modifications and should be kept with your most recent Summary PlanDescription.


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Important Notice from Triten CorporationAbout Your Prescr ipt ion Drug Coverage and Medicare

Please read this notice carefully and keep it where you can find it. This notice h

information about your current prescription drug coverage with Triten Corporatand about your options under Medicares prescription drug coverage. Tinformation can help you decide whether or not you want to join a Medicare dplan. If you are considering joining, you should compare your current coveraincluding which drugs are covered at what cost, with the coverage and costs of plans offering Medicare prescription drug coverage in your area. Information abwhere you can get help to make decisions about your prescription drug coveragat the end of this not ice.

There are two important things you need to know about your currcoverage and Medicares prescription drug coverage:

1. Medicare prescript ion drug coverage became available in 2006 to everyone w

Medicare. You can get this coverage if you join a Medicare Prescription DPlan or join a Medicare Advantage Plan (like an HMO or PPO) that offprescription drug coverage. All Medicare drug plans provide at least a standlevel of coverage set by Medicare. Some plans may also offer more coverafor a higher monthly premium.

2. Triten Corporation has determined that the prescription drug coverage offeby Triten Corporations Medical Plan is, on average for all plan participanexpected to pay out as much as standard Medicare prescription drug coverpays and is therefore considered Creditable Coverage. Because your exis tcoverage is Creditable Coverage, you can keep this coverage and not pahigher premium (a penalty) if you later decide to join a Medicare drug plan.

When Can You Join A Medicare Drug Plan?

You can join a Medicare drug plan when you first become eligible for Medicare and eyear from October 15th to December 7th.

However, if you lose your current creditable prescription drug coverage, through no fauyour own, you will also be eligible for a two (2) month Special Enrollment Period (SEP

join a Medicare drug plan.

What Happens To Your Current Coverage If You Decide to Join A MedicaDrug Plan?

If you decide to join a Medicare drug plan, your current Triten Corporation coverage not be affected. Your current coverage pays for other health expenses in addition

prescription drugs. If you enroll in a Medicare prescription drug plan, you and yeligible dependents will still be eligible to receive all of your current health and prescripdrug benefits.

If you do decide to join a Medicare drug plan and drop your current Triten Corporacoverage, be aware that you and your dependents can only enroll back in the Plan duannual enrollment.

MEDICARE PART D NOTICE


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MEDICARE PART D NOTICE

When Will You Pay A Higher Premium (Penalty) To Join A Medicare Drug Plan?

You should also know that if you drop or lose your current coverage with the TritenCorporation and dont join a Medicare drug plan within 63 continuous days after your currentcoverage ends, you may pay a higher premium (a penalty) to join a Medicare drug plan

later.

If you go 63 continuous days or longer without creditable prescription drug coverage, yourmonthly premium may go up by at least 1% of the Medicare base beneficiary premium permonth for every month that you did not have that coverage. For example, if you go nineteenmonths without creditable coverage, your premium may consistently be at least 19% higherthan the Medicare base beneficiary premium. You may have to pay this higher premium (apenalty) as long as you have Medicare prescription drug coverage. In addition, you mayhave to wait until the following October to join.

For More Information About This Notice Or Your Current Prescription DrugCoverage

Contact the person listed below for further information. NOTE: Youll get this notice eachyear. You will also get it before the next period you can join a Medicare drug plan, and if thiscoverage through Triten Corporation changes. You also may request a copy of this notice at

any time.

For More Information About Your Options Under Medicare Prescription DrugCoverage

More detailed information about Medicare plans that offer prescription drug coverage is inthe Medicare & You handbook. Youll get a copy of the handbook in the mail every yearfrom Medicare. You may also be contacted directly by Medicare drug plans.

For more information about Medicare prescription drug coverage:

Visit www.medicare.gov Call your State Health Insurance Assistance Program (see the inside back cover

of your copy of the Medicare & You handbook for their telephone number) for

personalized help Call 1.800.MEDICARE (1.800.633.4227). TTY users should call 1.877.486.2048.

If you have limited income and resources, extra help paying for Medicare prescription drugcoverage is available. For information about this extra help, visit Social Security on the webat www.socialsecurity.gov, or call them at 1.800.772.1213 (TTY 1.800.325.0778).

Date: October 15, 2013Name of Sender: Triten CorporationContact: Amy Spiller / VP HR & Chief People Officer

Address: 3657 Briarpark Dr.Houston, TX 77042

Phone: 832.214.5000

Remember: Keep this Creditable Coverage notice. If you decide to join one of theMedicare drug plans, you may be required to provide a copy of this notice whenyou join to show whether or not you have maintained creditable coverage and,therefore, whether or not you are required to pay a h igher premium (a penalty).


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Medicaid and the Childrens Health Insurance Program (CHIP)

Offer Free Or Low-Cost Health Coverage To Children And Families

If you are eligible for health coverage from your employer, but are unable to afford the premiusome States have premium assistance programs that can help pay for coverage. These States

funds from their Medicaid or CHIP programs to help people who are eligible for employer sponshealth coverage, but need assistance in paying their health premiums.

If you or your dependents are already enrolled in Medicaid or CHIP and you live in a State libelow, you can contact your State Medicaid or CHIP office to find out if premium assistancavailable.

If you or your dependents are NOT currently enrolled in Medicaid or CHIP, and you think you orof your dependents might be eligible for either of these programs, you can contact your SMedicaid or CHIP office or dial 1.877.KIDS NOW or www.insurekidsnow.gov to find out hoapply. If you qualify, you can ask the State if it has a program that might help you pay the premifor an employer-sponsored plan.

Once it is determined that you or your dependents are eligible for premium assistance unMedicaid or CHIP, your employers health plan is required to permit you and your dependentenroll in the plan as long as you and your dependents are eligible, but not already enrolled in

employers plan. This is called a special enrollment opportunity, and you must request coverwithin 60 days of being determined eligible for premium assistance.

If you live in one of the following States, you may be eligible for assistance paying yemployer health plan premiums. The following list of States is current as of July 31, 2013.

You should contact your State for further information on eligibilit y

EMPLOYER CHIP NOTICE

ALABAMA MedicaidWebsite: http://www.medicaid.alabama.govPhone: 1-855-692-5447

ALASKA MedicaidWebsite: http://health.hss.state.ak.us/dpa/programs/medicaid/Phone (Outside of Anchorage): 1-888-318-8890

Phone (Anchorage): 907-269-6529

ARIZONA CHIPWebsite: http:/ /www.azahcccs.gov/applicantsPhone: (Outside of Maricopa County) 1-877-764-5437Phone: (Maricopa County) 602-417-5437

COLORADO MedicaidMedicaid Website: http://www.colorado.gov/Medicaid Phone (In-State): 1-800-866-3513Medicaid Phone (Out of State): 1-800-221-3943

FLORIDA MedicaidWebsite: https://www.flmedicaidtplrecovery.comPhone: 1-877-357-3268

GEORGIA Medicaid

Website: http://dch.georgia.gov/Click on Programs, then Medicaid, then HealthInsurance Premium Payment (HIPP)Phone: 1-800-869-1150

IDAHO Medicaid and CHIPMedicaid Website:www.accesstohealthinsurance.idaho.govMedicaid Phone: 1-800-926-2588CHIP Website: www.medicaid.idaho.govCHIP Phone: 1-800-926-2588

INDIANA MedicaidWebsite: http://www.in.gov/fssaPhone: 1-800-889-9949

IOWA MedicaidWebsite: www.dhs.state.ia.us/hipp/Phone: 1-888-346-9562

KANSAS MedicaidWebsite: https://www.kdheks.gov/hcf/Phone: 1-800-792-4884

KENTUCKY MedicaidWebsite: http://chfs.ky.gov/dms/default.htmPhone: 1-800-635-2570

LOUISIANA MedicaidWebsite: http://www.lahipp.dhh.louisiana.govPhone: 1-888-695-2447

MAINE MedicaidWebsite: http://www.maine.gov/dhhs/ofi/public-assistance/index.htmlPhone: 1-800-977-6740TTY: 1-800-977-6741

MASSACHUSETTS Medicaid and CHIPWebsite: http://www.mass.gov/MassHealthPhone: 1-800-462-1120

MINNESOTA MedicaidWebsite: http://www.dhs.state.mn.us/Click on Health Care, then Medical AssistancePhone: 1-800-657-3629

MISSOURI MedicaidWebsite: http://www.dss.mo.gov/mhd/participants/pages/hipp.htmPhone: 573-751-2005

MONTANA MedicaidWebsite: http://medicaidprovider.hhs.mt.gov/clientpages/clientindex.shtmlTelephone: 1-800-694-3084


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EMPLOYER CHIP NOTICE

NEBRASKA MedicaidWebsite: www.ACCESSNebraska.ne.govPhone: 1-800-383-4278

NEVADA MedicaidMedicaid Website: http://dwss.nv.gov/

Medicaid Phone: 1-800-992-0900

NEW HAMPSHIRE MedicaidWebsite: http://www.dhhs.nh.gov/oii/documents/hippapp.pdfPhone: 603-271-5218

NEW JERSEY Medicaid and CHIPMedicaid Website: http://www.state.nj.us/humanservices/dmahs/clients/medicaid/Medicaid Phone: 609-631-2392CHIP Website: http://www.njfamilycare.org/index.htmlCHIP Phone: 1-800-701-0710

NEW YORK MedicaidWebsite: http://www.nyhealth.gov/health_care/medicaid/Phone: 1-800-541-2831

NORTH CAROLINA MedicaidWebsite: http://www.ncdhhs.gov/dmaPhone: 919-855-4100

NORTH DAKOTA MedicaidWebsite: http://www.nd.gov/dhs/services/medicalserv/medicaid/Phone: 1-800-755-2604

OKLAHOMA Medicaid and CHIPWebsite: http://www.insureoklahoma.orgPhone: 1-888-365-3742

OREGON Medicaid and CHIPWebsite: http://www.oregonhealthykids.gov

http://hijossaludablesoregon.govPhone: 1-877-314-5678

PENNSYLVANIA MedicaidWebsite:http://www.dpw.state.pa.us/hippPhone: 1-800-692-7462

RHODE ISLAND MedicaidWebsite: www.ohhs.ri.govPhone: 401-462-5300

SOUTH CAROLINA MedicaidWebsite: http://www.scdhhs.govPhone: 1-888-549-0820

SOUTH DAKOTA MedicaidWebsite: http://dss.sd.gov

Phone: 1-888-828-0059

TEXAS MedicaidWebsite: https://www.gethipptexas.com/Phone: 1-800-440-0493

UTAH Medicaid and CHIPWebsite: http://health.utah.gov/uppPhone: 1-866-435-7414

VERMONT MedicaidWebsite: http://www.greenmountaincare.org/Telephone: 1-800-250-8427

VIRGINIA Medicaid and CHIPMedicaid Website: http://www.dmas.virginia.gov/rcp-HIPP.htmMedicaid Phone: 1-800-432-5924CHIP Website: http://www.famis.org/CHIP Phone: 1-866-873-2647

WASHINGTON MedicaidWebsite: http://hrsa.dshs.wa.gov/premiumpymt/Apply.shtmPhone: 1-800-562-3022 ext. 15473

WEST VIRGINIA MedicaidWebsite: http://dhhr.wv.gov/bms/Phone: 1-877-598-5820, HMS Third Party Liability

WISCONSIN MedicaidWebsite: http://www.badgecareplus.org/pubs/p-10095.htmPhone: 1-800-362-3002

WYOMING MedicaidWebsite: http://www.health.wyo.gov/healthcarefin/equalitycareTelephone: 307-777-7531

To see if any more States have added a premiumassistance program since July 31, 2013, or for moreinformation on special enrollment rights, you can contacteither:

U.S. Department of LaborEmployee Benefits Security Administrationwww.dol.gov/ebsa1-866-444-EBSA (3272)

U.S. Department of Health and Human ServicesCenters for Medicare and Medicaid Serviceswww.cms.hhs.gov

1-877-267-2323, Menu Option 4, ext. 61565

OMB Control Number 1210-0137(expires 9/30/2013)


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User ID: triten

Password: benefits

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REFERENCE GUIDE

BENEFIT CARRIER PHONE WEBSITE

Triten EmployeeBenefits Website


User ID: triten

Password: benefitsTriten BenefitResolution Center

1.888.445.8297 Email: [email protected]

Medical/RxOAMC POS

Aetna 1.888.416.2277 www.aetna.com

Informed Health Line(24/7 Nurseli ne)

Aetna 1.800.556.1555

Beginning Right(Maternity Management)

Aetna 1.800.272.3531

DentalUnited

Healthcare1.877.816.3596Group # 813598

www.myuhcdental.com

Vision VSP 1.800.877.7195 www.vsp.com

Employee AssistanceProgram (EAP)

Mutual ofOmaha

1.800.316.2796 www.mutualofomaha.com/e

Emergency Traveland Identity TheftAssistance

AXA AssistanceUSA

In the U.S1.800.856.9947Outside the U.S.

312.935.3658

Flexible SpendingAccounts (FSA)

DiscoveryBenefits

1.866.451.3399 www.discoverybenefits.com

Life and DisabilityMutual ofOmaha

Life Claims1.800.775.8805Disability Claims1.800.877.5176

www.mutualofomaha.com

Voluntary AD&D The Hartford 1.888.563.1124

401(k)Transamerica

Retirement

Solutions

1.888.676.5512 www.trsretire.com

HR Contacts Triten832.214.5228832.214.5056

www.triten.com

Cancer, Accident, andCritical Illness

Assurant 1.816.474.2345 www.assurantemployeebenefits

Compass Professional

Health ServicesCompass 1.800.513.1667

Email:

[email protected]


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