2020

TC TRANSCONTINENTAL
BENEFITS GUIDE
Hazleton, Sibley, Spartanburg
Thomasville, Tifton
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WHAT’S INSIDE
Welcome to Your 2020 Benefits.................3
Eligibility....................................................3
Enrollment.................................................4
Your Benefits At-A-Glance.........................5
Medical Benefits........................................6
Health Savings Account (HSA).................12
Dental Benefits........................................13
Vision Benefits.........................................15
Life, AD&D and Disability Insurance.......16
Accident, Critical Illness and
Hospital Indemnity Insurance.................17
Rally Wellness..........................................18
Tobacco Cessation Program....................19
Dependent Care Flexible
Spending Account (DCFSA)......................20
Health Advocate.......................................21
Additional Benefits..................................22
401(k) Retirement Savings Plan..............23
Value Added Benefits...............................24
Frequently Asked Questions (FAQs)........25
Important Contacts..................................26
Important Notices ...................................27

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Welcome to your 2020 Benefits
At TC Transcontinental, we believe that every employee contributes to our success.
That’s why we are pleased to offer a comprehensive benefits package that covers all
areas of your life and demonstrates our investment in you and your improved health.
This guide outlines the benefits available to you and the choices you have for yourself and your eligible
dependents. We encourage you to review your options and enroll in those that best meet your needs.
Participation is not automatic — you must take certain actions to participate in TC Transcontinental
benefits. If you have any questions about your benefit options, or need additional assistance with
enrollment, please contact your HR Representative.

ELIGIBILITY
All active, full-time employees regularly scheduled
to work 30 hours or more per week are eligible to
participate in the TC Transcontinental Employee
Benefits Program. As a benefits-eligible employee,
you may also enroll certain family members in the
medical, dental and vision insurance programs.
Eligible dependents include:
• Legal Spouse (“Spouse” means the person you
are legally married to as defined by the IRS, as
lawfully married under state laws where the
employee resides.)
• Domestic Partners in states where required by
law (CA, CO, HI, IL, NJ, OR, RI, WA)* (eligible for
dental and vision only)
• Natural born son, daughter, stepson or
stepdaughter
• Legally adopted child(ren)
• Child(ren) for whom you are an appointed
guardian
• Child(ren) recognized under a Qualified Medical
Child Support Order as having a right to enroll in
health care coverage
Dependent children are covered up to the end
of the month in which they turn age 26. If you
have an eligible child over the age of 26 who is
disabled, please see your HR Representative for
enrollment assistance. Proof of legal dependency
for all dependents may be required by TC
Transcontinental. Make sure you have the proper
proof of relationship when you add a dependent to
your insurance policy.
If employed on a full-time basis and has
coverage available through their employer,
your spouse is not eligible for medical coverage
through TC Transcontinental.
If You are Eligible for Medicaid
Depending on your income, you may be eligible for
free or low-cost medical care through Medicaid. Each
state has different guidelines about what income
levels qualify. Note that Medicaid eligibility is based
on household size and total household income. If you
gain or lose eligibility for Medicaid, you can enroll in
or drop TC Transcontinental coverage.

Visit www.medicaid.gov for

more information about Medicaid
eligibility in your state.

* Subject to change in laws.

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Enrollment
Open Enrollment Period
October 28 through November 15
Open Enrollment will run from October 28 through
November 15, 2019. The benefit choices you
make during Open Enrollment will be in effect
from January 1 to December 31, 2020, unless you
experience a Qualifying Life Event.
Note: New Hires must make initial enrollment
selections, or waive coverage, by the 30th day
from date of hire. The effective date for benefits
for new hires is the 1st of the month following
date of hire.
Changes During the Year
Open Enrollment is the only time you can make
changes to your elected benefits or add or remove
dependents from coverage, unless you have a
Qualifying Life Event, such as:
• Marriage, divorce or legal separation
• Death of a spouse or dependent child
• Birth, adoption or legal guardianship of a child
• Change in your, or your spouse’s, employment
status or work schedule
• Change in your dependents eligibility due to age
• Change in eligibility for Medicare or Medicaid
If you experience a Qualifying Life Event, you have
30 days to make a change through the Enrollment
Portal or to submit the appropriate required
documentation to Human Resources to make
changes to your current coverage.
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How to Enroll
You will use the TC Transcontinental Enrollment
Portal to enroll in your benefits either as a new
hire, during Open Enrollment or to make changes
to your benefits during the year if you experience a
Qualifying Life Event. You can also make changes
to your life insurance beneficiary information
through the site.
The enrollment portal includes interactive tools
and videos to help you learn more about your
benefits and other topics of interest. Using
this online enrollment portal, we hope that you
will find everything you need to make better
healthcare and benefit decisions.
Access the TC Transcontinental Enrollment Portal
at tctranscontinental.bswift.com and log in with:
• Username: The first initial of your first name and
your full last name. For example, John Smith’s
user name will be ‘jsmith’.
• Password: The last 4 digits of your Social
Security Number
Note: To complete enrollment for dependents,
you will need dates of birth and social security
numbers.
Your Benefits-At-A-Glance
COVERAGE PROVIDER BEGINS ENDS
Health Care • BCBS Medical • January 1st End of the month following
Insurance • ESI Pharmacy (open enrollment); or the date:

• MetLife Dental • 1st of the month following • of termination or

date of hire (new hires); or
• EyeMed Vision
• When you experience a
qualifying life event
Health Savings HSA Bank • Upon enrollment in any of
Account (HSA) the BCBS Medical plans
resignation
• you cease to qualify as
benefits-eligible
• you stop paying employee
contributions

Life, Accident & Lincoln Financial Group • 1st of the month following • The date of termination or
Disability Insurance date of hire (new hires) resignation
Dependent Care PayFlex • January 1st • The date you cease to
Flexible Spending (open enrollment); or qualify as benefits-eligible
Account (DCFSA) • 1st of the month following • The date you stop paying
date of hire (new hires) employee contributions

Voluntary Benefits • MetLife (Accident, Critical • January 1st (open

Illness, Hospital Indemnity) enrollment); or
• ID Sanctuary with Roadside • 1st of the month following
Assistance, Pharmacy, date of hire; or
Global Travel Assistance • Upon approval of
application for coverage
(MetLife only)

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Medical Benefits
TC Transcontinental has partnered with Blue Cross Blue Shield (BCBS) to help you and your family
receive the medical care you need at a reasonable cost and to help protect you against the catastrophic
costs of major illness or injury.

BCBS offers access to quality care and innovative health care solutions. BCBS’s BlueCard PPO provider
network of doctors and hospitals is one of the most extensive networks in the country.

Medical Plans
TC Transcontinental offers three plans — all
Consumer Driven Health Plans (CDHP’s) —
administered by Blue Cross Blue Shield of Florida.
The plans allow you and your family access to BCBS’s
nationwide network of doctors and hospitals. You can
go to any provider you choose, but the plans pay a
higher portion of the cost of your care when you use
an in-network provider.
When you need medical care, you pay for the full
cost of your services, after the BCBS discounts,
until you reach your annual deductible. Once you
reach your deductible, the plans generally cover
a percentage (depending on the plan you elect) of
the remaining in-network eligible expenses. The
exception to this is preventive care received in-
network, which is covered 100%, with no deductible.
If you go out-of-network for care, the plans generally
cover 50% of the remaining eligible expenses after
you meet your out-of-network deductible.
You are protected by the plans annual out-of-
pocket maximum. Once your expenses reach
the out-of-pocket maximum, the plan pays any
remaining eligible expenses at 100% for the rest of
the plan year.
One advantage of enrolling in a medical plan
is that you may be eligible to open a Health
Savings Account (HSA), which is an account that
you can use to help pay out-of-pocket health
expenses. When you enroll in any of the health
plans, TC Transcontinental will make a lump sum
contribution to your account. The contribution will
depend on the health plan you enroll in and your
coverage tier. See page 12 for more on HSAs.
Note: Deductibles and out-of-pocket maximums
reset each plan year (calendar year).

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Medical Benefits At-A-Glance
$1700 Plan $2800 Plan $4800 Plan
IN- OUT-OF- IN- OUT-OF- IN- OUT-OF-
NETWORK NETWORK NETWORK NETWORK NETWORK NETWORK
Deductible
(Employee / $1,700 / $3,400 $3,600 / $7,200 $2,800 / $5,600 $4,800 / $9,600 $4,800 / $9,600 $4,800 / $9,600
EE+1, Family)
Employee: $300 Employee: $400 Employee: $500
TC Transcontinental Employee + Spouse: $600 Employee + Spouse: $700 Employee + Spouse: $800
HSA Contribution Employee + Child(ren): $600 Employee + Child(ren): $700 Employee + Child(ren): $800
Family: $750 Family: $900 Family: $1,000
Out-of-Pocket
Maximum
(Employee / EE+1, $13,000 / $6,650 / $13,000 /
$3,400 / $6,800 $4,500 / $9,000 $5,600 / $6,800
Family) $26,000 $13,300 $26,000
Includes Deductible &
Coinsurance
Aggregate Family Aggregate Family True Family Aggregate
(Non-Embedded) (Non-Embedded) (Embedded)
Individual only policies are Individual only policies are Individual amounts with any
subject to the individual amount, subject to the individual amount, combination of family members
Deductible and
while individuals enrolled in while individuals enrolled in accumulate towards the family
Out-of-Pocket
policies with multiple members policies with multiple members amount. No one family member
Maximum
combine towards family amount. combine towards family amount. will go over the individual
Accumulation
This means that one member This means that one member deductible and individual out of
could contribute the entire could contribute the entire pocket maximum.
family deductible and family family deductible and family
out-of-pocket maximum. out-of-pocket maximum.
Lifetime Maximum Unlimited Unlimited Unlimited
20% after 50% after 20% after 50% after 30% after 50% after
Co-Insurance
deductible deductible deductible deductible deductible deductible
Covered at Covered at Covered at
Preventive Care Not Covered Not Covered Not Covered
100% 100% 100%
Emergency Room 20% after 20% after 20% after 20% after 30% after 30% after
Visit deductible deductible deductible deductible deductible deductible
Preventive
100% no 100% no 100% no
Prescription Drugs Not Covered Not Covered Not Covered
deductible deductible deductible
(IRS HSA list)
Non-Preventive Prescription Drugs
Retail After Deductible After Deductible After Deductible
Generic $10 Not Covered $10 Not Covered $10 Not Covered
Preferred Brand $35 Not Covered $35 Not Covered $35 Not Covered
Non-Preferred Brand $60 Not Covered $60 Not Covered $60 Not Covered
90 Day Supply After Deductible After Deductible After Deductible
Generic $25 Not Covered $25 Not Covered $25 Not Covered
Preferred Brand $87.50 Not Covered $87.50 Not Covered $87.50 Not Covered
Non-Preferred Brand $150 Not Covered $150 Not Covered $150 Not Covered

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Medical Benefits
Prescription Drug Coverage
The medical plans include prescription drug
coverage administered by Express Scripts. Your
cost depends on the type of prescription drug you
buy — either preventive or non-preventive.
Non-preventive prescription drugs: You pay the
entire cost until you have reached your deductible.
With all Plans, you pay $10 generic/$35 preferred
brand/$60
non-preferred brand. With all Plans, when
you reach your out-of-pocket maximum, all
prescription purchases are covered at 100%.
Preventive prescription drugs: With all Plans some
preventive drugs are covered at 100%. With all Plans,
you do not need to meet your deductible first before
the plans pay the full cost. Not all prescriptions are
considered preventive. The IRS has defined what
these drugs are. Be sure to speak to your doctor.
Manage your prescriptions, price out medications
or find retail pharmacies in your area by registering
online at express-scripts.com or download the
Express Scripts Mobile App.
Express Scripts Mobile App
Access and manage your prescriptions while on-the-
go by downloading the free Express Scripts Mobile
App available to iPhone, Blackberry and Android
users. Search for “Express Scripts” in your device’s
app store. When you download the app, you can:
• Use medication pricing tools
• Order refills
• Place home delivery orders
• Locate pharmacies
• View claims history
• Access your prescription ID card
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Smart90 Walgreens and CVS
“Smart90 Walgreens and CVS”, provides members
the ability to access 90-day supplies either through
Express Scripts home delivery or through Walgreens
and CVS pharmacy locations nationwide.
There are two things you need to do to avoid paying
full cost:
Get a three-month supply of your long-term medicine
instead of a one-month supply.
• Get your three-month supply:
• Delivered to you: Have your medicine delivered from
the Express Scripts Pharmacy
• Purchase at a Walgreens or CVS Retail Pharmacy
To find a Walgreens or CVS pharmacy that
participates in filling three-month supplies, log in
or register at express-scripts.com select “Manage
Prescriptions,” and look for a link directing you to
your future network. The pharmacy can tell you how
to transfer your prescription or start a new one.
Express Scripts Extended
Payment Program
Extended Payment Program EPP allows you to
spread your mail order prescription payments over
three credit or debit card installments so you don’t
have to pay all at once. And there’s no waiting—
your medication will be shipped after the very first
payment. To learn more, visit express-scripts.com.
Diabetes Program
Improved retail discounts for 90 day diabetes
medications through the Walgreens and CVS 90 day
Retail Program.
Medical Benefits
Additional BCBS Benefits
When you enroll in any of the medical plans, you
can take advantage of these additional benefits
through BCBS:
• Discount Programs – Save money on hearing
aids, hair restoration, weight loss programs,
acupuncture, fitness centers and more.
Visit MyHealthToolkitFL.com.
• 24-Hour Nurse Advisor – Speak to a registered
nurse 24/7 by calling 866.323.0664.
• Health Management – Work with a dedicated
health coach to answer questions and give
you advice about your diabetes, heart disease,
migraines or chronic respiratory conditions by
calling 855.838.5897.
• Maternity Care – Receive phone support from a
BCBS registered nurse throughout your pregnancy
by calling 855.838.5897.
• Personal Health Assessment & Wellness Tools –
Complete a free Personal Health Assessment
online at MyHealthToolkitFL.com.
• Tobacco Cessation – Receive support from health
coaches and tools for improved success in
quitting tobacco by calling 855.838.5897 to enroll.
• Weight Management – Reach your weight loss
goals with information and support from this
confidential program by calling 855.838.5897
to enroll.
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Teladoc
Quality care…anytime and anywhere with
Teladoc®
Why wait for the care you need now? Teladoc gives
you 24/7/365 access to a board-certified physician
through the convenience of phone or video consults.
Teladoc is an independent company that provides
telehealth consultation services on behalf of your
health plan.
The care you need Teladoc doctors can treat many of
the most common medical conditions, including:
• Cold and flu symptoms
• Allergies
• Bronchitis
• Urinary tract infections
• Respiratory infections
• Sinus problems
• And more!
They can also write prescriptions according to the
regulatory guidelines of your state.
When you need it
Teladoc has a national network of doctors ready to
answer your call. With an average call back time of
only eight minutes, you can forget about spending
hours in the waiting room. Now, you can quickly and
easily consult with an experienced doctor from the
comfort of your home.
It’s easy to get started
Grab your insurance card and go to
www.Teladoc.com or call 866-789-8155 to set up
your account. Once you have an account, simply log
in with your username and password whenever you
need to consult with a Teladoc physician.
Want to know more? Please visit the website to
learn more about using Teladoc.
Medical Benefits
Using Preventive Care
Covered under your medical plans and free when
you visit a network provider, your once a year annual
preventive care visit is an accessible and affordable
option to help you stay healthy. Preventive health
screenings can help detect a condition in the early
stages, when it is most treatable.
Your doctor can help you determine what types of
preventive care and health screenings are right for
you and your family, such as:
•B  lood pressure, diabetes and cholesterol tests
• Mammograms, colonoscopies and other
cancer screenings
• Well baby and well child visits
• Routine vaccinations
• Healthy pregnancy screenings and vaccines
Make sure to avoid unexpected costs by clearly
stating when you make your appointment that your
visit is for an annual preventive care service. If
your doctor diagnoses or treats an illness during
a preventive care visit, those services will not be
covered at 100%.
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Urgent Care vs. Emergency Room
Choosing an urgent care center instead of an
emergency room for non-life threatening care can
save you time and money. Urgent care centers
usually offer shorter waits, walk-in services and
sometimes even online check-in. They handle
conditions that require immediate attention, but
are not equipped to handle life-threatening injuries
or illnesses.
Consider an urgent care center for:
• Ear infections
•U  rinary tract infections or respiratory infections
• Sprains
• Flu-like symptoms (sore throat/fever)
• Vomiting
• Rashes, insect bites or sunburns
• Cuts or wounds when bleeding is controlled
• Mild or moderate asthma attacks
Head to the nearest hospital emergency room if you
experience a potentially life-threatening condition
such as:
• Chest pain or shortness of breath
• Broken bones
• Serious burns, cuts, infections
• Uncontrollable bleeding
• Head trauma and/or loss of consciousness
• Severe pain or severe allergic reaction
Medical Benefits
Important Terms You Should Know
There are several terms associated with benefit programs and insurance used in this guide. Learn the
basics below.
Coinsurance: The portion of covered expenses
that you must pay for care after first meeting your
deductible amount. This is shared between you and
the plan. With the $1700 Plan or the $2800 Plan,
your share is 20%. With the $4800 Plan, your share
is 30%.
Deductible: The amount you pay toward covered
services each plan year. The accumulation of the
deductible (for tiers other than Employee Only) is
different with the $1700 Plan or the $2800 Plan and
the $4800 Plan After you have paid your deductible,
additional expenses are covered at the coinsurance
amount.
In-Network Providers: The group of healthcare
professionals who provide care at a predetermined
rate. Staying in the network to receive care is an
effective way for you to control your insurance
costs.
Out-of-Pocket Maximum: The most you will spend,
each plan year, for the annual deductible and
coinsurance. The accumulation of the Out-of-Pocket
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Maximum (for tiers other than Employee Only) is
different with the $1700 Plan or $2800 Plan and the
$4800 Plan.
Generic Prescription Drug: A generic contains
the same active ingredient as the name brand
counterpart, but may have different inactive
ingredients or a different appearance. A generic is
generally less expensive than the reference name
brand product.
Preferred Brand Prescription Drug: A preferred
brand is a non-generic that receives preferential
treatment on the formulary as compared to a
non-preferred brand. Generally a preferred brand
may not have generic copies available in the
market place, but this is not always the case.
Non-Preferred Brand Prescription Drug:
A non-preferred brand are brand name products
where other, less expensive generic or preferred
brand alternatives are available. They are subject to
a higher copay or, in some cases, not covered.
 Health Savings Account (HSA)
When you enroll in any of the TC Transcontinental medical plans, you may be eligible to open a Health
Savings Account (HSA) through HSA Bank. An HSA allows you to set aside tax-free dollars to pay out-of-
pocket medical, prescription drug, dental and vision expenses. It’s like a savings plan for your current and
future health care needs.
HSA Eligibility
To be eligible for an HSA, you must be enrolled in
a high deductible health plan. In order to make
contributions to an HSA, you must not be:
• Covered by any other health plan, Medicare, Tri-
Care, Spouse’s medical plan, individual plan, etc.
• Receiving Medicare benefits (Parts A, B or D) or
any other Medicare coverage
• Claimed as a dependent on another person’s
tax return
• Participating in a regular Medical Flexible Spending
Account (FSA) or Health Reimbursement
Account (HRA)
Note: If you do not meet these guidelines, you
are not eligible to open an HSA and contributions
cannot be made without IRS tax penalty. You are
eligible to enroll in the TC Transcontinental medical
plans, but cannot open and contribute to an HSA.
Tax penalties will apply. Please discuss your HSA
individual contributions with a qualified tax advisor.
Visit irs.gov for additional guidance.
HSA Contributions
Both you and TC Transcontinental can make
contributions to your HSA account. If you enroll
in any of the TC Transcontinental medical plans,
TC Transcontinental will make the following one-
time contribution to your HSA account:
$1700 Plan
• $300 if you are enrolled in Employee-Only coverage
• $600 if you are enrolled in Employee + Spouseor
Employee + Child(ren) coverage
• $750 if you are enrolled in Family coverage
GO MOBILE!
BCBSF HSA Bank Accounts Mobile is all about giving you the tools to
take control and better manage your health accounts.
To get started, follow these three simple steps:
• Create Your Username and Password Register on the Member
Website.
• Download BCBSF HSA Bank Accounts Mobile At Google Play or the
App Store
• Log in to BCBSF HSA Bank Accounts Start managing your account
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on the go.
$2800 Plan
• $400 if you are enrolled in Employee-Only coverage
• $700 if you are enrolled in Employee + Spouse or
Employee + Child(ren) coverage
• $900 if you are enrolled in Family coverage
$4800 Plan
• $500 if you are enrolled in Employee-Only coverage
• $800 if you are enrolled in Employee + Spouse,
Employee + Child(ren)
• $1,000 if you are enrolled in Family coverage
HSA funds will be deposited within the first 60
days of the 2020 plan year, or for new hires, upon
notification from HSA Bank of account opening.
You are not required to contribute to your HSA to
receive the TC Transcontinental contribution.
Per IRS guidelines, the maximum amount you
can contribute to an HSA for 2020 (including both
your contributions and TC Transcontinental’s
contributions) is:
• $3,550 if you are enrolled in Employee-Only
coverage
• $7,100 if you are enrolled in Employee +1 or Family
coverage
• If you are 55 or older, you can make an additional
$1,000 catch-up contribution
HSA Features
Here’s what you can do with the flexibility your HSA
offers:
• Carry forward your balance each year since there is
no “use-it-or-lose-it” rule
• Withdraw money from your account to pay eligible
expenses
• Continue to spend the funds in your account
even if you are no longer enrolled in a TC
Transcontinental medical plan
• Take your HSA balance with you when you leave
TC Transcontinental and continue to use your
balance to pay for eligible expenses
• Invest a portion of your HSA balance when
allowed — and grow your
health care savings
Dental Benefits
Not only is regular dental care essential to good health, it can also prevent serious illnesses and
surgeries. TC Transcontinental offers the PPO dental plan through MetLife that includes both in-
network and out-of-network coverage.

MetLife PPO Plan

Under this plan, you can go to any dentist you want, but you will maximize your benefits when you receive
care from a MetLife PDP Plus network dentist. That’s because MetLife’s network dentists have agreed
to reduced, pre-negotiated fees for their services, which helps reduce your out-of-pocket costs. Non-
network dentists have not agreed to accept reduced fees, so they may bill you for any charges over
allowed amounts.

To find a network dentist near you, go to the MetLife website, MetLife.com, and click on I want to find a
MetLife dentist, enter your zip code and choose the PDP Plus Network,. You can also register on the site
to have access to real time benefit information about your plan, check claim status, sign up for electronic
Explanation of Benefits, print an ID card and more. You can also call MetLife at 1.800.438.6388 for more
information.

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Dental Benefits At-A-Glance
MetLife PDP Plus
Non-Network Dentist
Network Dentist

Annual Deductible $50/person; $75/person;

(applies to Basic and Major Services Only) $150/family $225/family
Annual Maximum $1,750/person
Orthodontia Lifetime Maximum $1,500/person
Preventive/Diagnostic Services
•R  outine exams (three per benefit year)
•C  leanings (two per benefit year)
• X -rays (bitewings – once per benefit year; full
mouth – every three years) 100% 100%
• F luoride treatments (once per benefit year to
age 16)
• S pace maintainers (to age 14)
• S ealants (to age 16)
Basic Services
• E mergency exams & palliative (pain relief)
treatment
• F ilings (silver (amalgam) and tooth colored
(composite) on front teeth)
•G
 eneral Anesthesia (in conjunction with oral
surgery)
80% 80%
•P  eriodontics
•O  ral surgery
• E ndodontics
• I V sedation
• L ocal chemotherapeutic agents
• I njection of antibiotic drugs
Major Services
• I mplants
•C  rowns, onlays, and other ceramic
restorations to permanent teeth
•P  artial/full dentures
•D  enture (reline,rebase) 50% 50%
• F ixed removable bridges
• L abial veneers
•O  cclusal adjustments
•R  epair and adjustments to dentures
Orthodontia (to age 26) and Adults
Treatment necessary for proper alignment of 50% 50%
Teeth

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Vision Benefits
TC Transcontinental offers two vision plans through EyeMed; a Base Plan (at no cost to you if you enroll in
one of the medical plans) and a Buy-Up Plan (paid for by you if you choose to enroll). EyeMed has a large
network of providers who have agreed to discounts on covered exams and eyewear. There are over 69,000
EyeMed providers nationwide, including a mix of independent and retail outlets like LensCrafters, Pearle
Vision, Sears Optical, Target Optical and JCPenney Optical.

You can go to any vision provider, but you will get the best value from your plan benefits when you receive
care from an EyeMed network provider.

Vision Benefits At-A-Glance

If you go to a network provider, copays will apply. If you see an out-of-network provider, you are required
to pay in full and then submit the claim and your receipts to EyeMed for reimbursement based on the
out-of-network allowance.

To Find An EyeMed Provider Near You, Visit eyemedvisioncare.com.

BASE PLAN BUY UP PLAN

OUT-OF- OUT-OF-
EYEMED BENEFIT PLAN IN-NETWORK IN-NETWORK
NETWORK NETWORK

Exams $20 Up to $40 $20 Up to $40

Standard Plastic Lenses

• Single Vision $50 $20 Up to $30
• Bifocal $70 N/A $20 Up to $50
• Trifocal $105 $20 Up to $70
• Lenticular $105 $20 Up to $70
• Standard Progressive $135 $85 Up to $70
Frames $0 Co-pay, $150 Allowance,
35% off retail price N/A Up to $91
20% off balance over $150
Contact Lenses
•C
 onventional 15% off retail N/A $0 copay, $150 allowance, $130
15% off balance over $150
• Disposable N/A $0 copay, $150 allowance, $130
plus balance over $150
Laser Correction Surgery 15% off regular
15% off regular price or
price or 5% off N/A N/A
5% off promotional price
promotional price

Frequency of Benefits
• Exam Once every 12 months Once every 12 months
• Lenses/contacts Unlimited Once every 12 months
• Frame Unlimited Once every 24 months

Additional benefits include:

• Fixed pricing on premium lens options
• Sun Perks savings on non-prescription sunglasses at Sunglass Hut ($20 off any purchase/$50 off $200)
• Additional Pairs Benefit – members receive a 40% discount off complete pair eyeglass purchase
and a 15% discount off conventional contact lenses once the funded benefit has been used

15
Life, AD&D and Disability Insurance
TC Transcontinental covers all eligible employees with Group Life, Accidental Death and Dismemberment
(AD&D) and Core Short-Term Disability benefit plans administered by Lincoln Financial Group. Premiums
are fully paid for by TC Transcontinental.

You need to name a beneficiary for your Group Life Insurance. You can change, or update, your beneficiary
information, anytime, through the TC Transcontinental Enrollment Portal.

Life/AD&D Insurance
Your Group Life Insurance and AD&D Insurance benefit is $20,000. If you are injured in an accident,
the AD&D insurance pays all or a portion of the benefit based on on Lincoln Financial Group’s benefit
schedule.
Note: Your life insurance benefit and AD&D principal sum will begin to reduce at age 65.
This insurance is portable — you can take it with you if you leave TC Transcontinental. For more
information, call 800.487.1485.

Short-Term Disability Insurance

If you are unable to work due to a qualified short-term disability — including maternity leave,
TC Transcontinental offers a plan that can help replace a portion of your income for up to 26 weeks.
There is no cost to you for this coverage.
You receive a benefit amount equal to 50% of your base salary, up to $500, for 26 weeks.
You can choose to purchase additional STD Insurance that will bring your benefit up to 60% of your salary,
up to $1,000 per week.

Long-Term Disability Insurance

Voluntary LTD Insurance is designed to replace a portion of your monthly income and help you meet your
financial obligations if you are unable to work for an extended period of time due to an illness or injury.

The plan replaces 60% of your salary, up to $3,000 per month, after you have been disabled for 180 days.
LTD benefits will not extend beyond the time you reach Social Security normal retirement age.

16
Accident, Critical Illness and Hospital
Indemnity Insurance
MetLife offers benefits to supplement your medical plan benefits:
• Accident Insurance
• Critical Illness Insurance
• Hospitality Indemnity Insurance
Available to all employees, these plans provide you with lump-sum payments that you can use to help pay
for out-of-pocket expenses not covered by your medical plan, giving you added protection. You choose
how you use your benefit, whether to help pay your deductible, coinsurance, transportation to/from
medical facilities, household bills, child care, or to help cover any other expenses. These benefits can also
help make up for lost wages.

Accident Insurance Hospital Indemnity Insurance

If you enroll in the MetLife Accident Insurance
plan, you will receive a lump-sum benefit if you are
involved in a covered accident outside of work and
require medical services. Benefit payments vary
based on the type of injury and medical treatments
you receive.
You may elect coverage during Open Enrollment or
as a New Hire.
Critical Illness Insurance
Critical illness insurance pays a lump-sum benefit
directly to you if you are diagnosed with a serious
illness or condition covered under the plan, such as
a heart attack or stroke.
Hospital indemnity insurance is a type of plan that
pays a set amount — per day, per week, per month,
or per visit — if you’re confined in a hospital.
Payments from Hospital Indemnity Insurance
are made directly to you if you are admitted to a
hospital for a covered sickness or injury. Payments
are made even if you did not actually incur any out-
of-pocket expenses.
And the money you receive can be used for any
purpose, such as:
•D
 eductibles and copays
•T
 ravel to and from the hospital for treatment
•C
 hild care services while recovering

You can elect coverage for yourself in the amount of

$15,000 or $30,000. Coverage is guaranteed if you
Health Screening Benefit
are an active, full-time employee. Want to earn $100? If you have one of the
covered screenings or tests, your Critical
When you cover yourself, you can also choose to Illness or Accident Insurance policy will pay
cover your spouse and children at 50% of your you $100.
coverage amount. Examples of Covered Screenings:
•A  nnual Physical Exam
The cost of this benefit depends on the coverage
• Breast Mammogram
level you choose, your age, whether you are a • Colonoscopy
tobacco user and whether you choose to cover • Endoscopy
other family members. •S  kin Cancer Screening
For a complete list of services and how to
submit proof, please see the Accident and
Critical Illness Health Benefit Flier in the
enrollment portal Library.

17
Rally Wellness
We’re all in different places in our health and wellness journey. It’s a lifelong journey with many paths
and unique obstacles. TC Transcontinental wants to help you choose a path that leads you to a healthier
lifestyle.
In 2020 we will be introducing Rally, a program offered through BCBS. You do not need to be enrolled in
the medical plan to participate in the Rally program.
Rally is a digital health platform that uses clinical data, customized recommendations and continual
rewards to help you make positive lifestyle choices.
Each day, Rally encourages you to take small steps that result in meaningful, lasting improvements to
your overall health and well-being. And through integration with mobile devices, Rally stays connected
with you wherever you go.

Rally will include:

Health Survey Communities

Answer a series of simple questions which will
allow the system to make recommendations to
guide your experience. You will even receive your
estimated “Rally Age” which could be higher or
lower than your physical age based on risk factors
and healthy behaviors.
Missions
Allows you to build a digital action plan consisting
of small Mission recommendations or based on
options you select. Missions encourage small steps
in multiple areas to improve overall health and
well-being.
Challenges
Various online fitness Challenges on a rotating
basis for you to track your progress and compete
against others.
Virtual health and wellness Communities to foster
social interaction throughout your journey. You
can join a Community to start discussions, ask
questions or simply connect with others who have
similar concerns or interests.
Health Coaching
Link with a health coach and they can recommend
Missions, Challenges and Communities. They can
also track your activity to monitor your progress.
You can communicate with your coach regularly
using the Rally private messaging feature.
More information to come in early 2020!

18
Tobacco Cessation Program
The Optum Quit for Life Tobacco Cessation Program is a free program available to all employees and their
dependents. Simply enroll in the program via phone or web to get started.
• 1.866.QUIT.4.LIFE (1.866.784.8454)
• www.quitnow.net
• You will work with a Quit Coach® staff member who specializes in helping people quit tobacco to create a
plan that fits you. You will have a series of calls with them to get you to your end goal.
A number of other resources are also available through the program:
•T
 ext2QuitSM – connect with your Quit Coach or interact with a Web Coach via text message
• Web Coach® – access a private online community with others in the program where you can complete
activities, watch videos, track your progress and join in discussions
•Q
 uitting Aids – you can receive FREE nicotine patches or gum if nicotine replacement therapy is part of
your quitting plan
•U
 nlimited Inbound Support – call anytime to talk to a Quit Coach
•Q
 uit Guide – you’ll receive a workbook that you can reference to help you stick with your plan

19
Dependent Care Flexible Spending
Account (DCFSA)
Dependent Care Flexible Spending Account (DCFSA)
TC Transcontinental offers a Dependent Care
Flexible Spending Account (DCFSA) administered
by PayFlex. A DCFSA lets you set aside money
from your paycheck — pre-tax — to pay for eligible
dependent care expenses, such as day care costs,
day camp costs and preschool tuition. Both you and
your spouse must work or attend school full-time
to take advantage of this benefit.
Eligible Dependents
Services may not be provided by someone you
claim as a dependent on your tax return. Your day
care expenses must be for:
• Your dependent under age 13 who lives with you
for more than half the year and for whom you can
claim a tax exemption
• A child under age 13 for whom you have custody if
you are divorced or legally separated
• Your spouse who is physically or mentally incapable
of self-care
• A dependent of any age, such as an elderly parent
or other adult dependent, who meets all of the
following criteria:
• Is physically or mentally incapable of caring for
himself or herself
• Receives over half of his or her support from you
• Lives with you for more than half the year
• Shares your residence as a member of the
household
You can contribute up to:
• $5,000 per year if you are married and file a joint
tax return
•$
 2,500 if you are married and file separate
tax returns
20
Your contributions will be deducted from your
paychecks in equal amounts during the plan
year. As you pay for your eligible expenses out
of your own pocket, you can be reimbursed from
your account. Be sure to estimate your expenses
carefully because you will forfeit any unused funds
at the end of the plan year.
The IRS requires you to provide the following
information on your income tax return when you
use a DCFSA:
• The name, address and Employer Identification
Number (EIN) or Social Security Number of your
day care provider
• Information about your qualifying dependents
who are age 2 and older, including their names,
birth dates and Social Security numbers
For a list of eligible Dependent Care expenses,
refer to IRS Publications 502 and 503 available
at irs.gov. To request reimbursement from your
DCFSA or for more information on how the account
works, go to:
• www.payflex.com: 24-hour access to account
information, claim forms, substantiation forms,
FAQs and more
• 1.888.678.8242: help with online account
registration, website navigation, account balance
information and transaction history
Health Advocate
TC Transcontinental provides two programs
through Health Advocate: The Advocacy Program
and Employee Assistance Program. Both are
no-cost, confidential programs.
Who is eligible to use the Health Advocate
Programs?
• You
• Your Spouse and Dependent Children
• Your Parents and Parents-in-laws
Advocacy Program
The Advocacy Program is designed to provide one-
on-one help to resolve clinical, administrative and
insurance-related issues.
Health Advocate is a team of independent and
objective healthcare professionals who are experts
at solving medical, clinical and administrative
issues on your behalf. You do not need to be
enrolled in one of the TC Transcontinental Medical
Plans to be eligible for this benefit.
Health Advocate does not replace your health
insurance coverage, provide medical care or
recommend treatment. It does, however, help you
to meet your healthcare needs by working through
issues with healthcare professionals and insurance
companies.
Your Personal Health Advocate is a highly trained
professional. They will help you to:
• Schedule appointments with hard to reach
specialists
• Help resolve eligibility, benefit and claims issues
• Assist with eldercare issues
• Help negotiate with providers on your behalf
• Assist with correcting billing mistakes
• Assist with locating and  scheduling appropriate
doctor appointments
• and more
To contact Health Advocate’s Advocacy
Program or EAP:
1.866.799.2728 or healthadvocate.com
21
Health Cost Estimator
Health Cost Estimator empowers your
Personal Health Advocates to educate you about
common treatment and procedure costs, prior to
receiving service.
Medical Bill Saver
Medical Bill Saver provides you with a valuable
resource to help manage post-service costs.
After you have received bills for services received,
Health Advocate’s professional staff can negotiate
with providers on your behalf, in an attempt to
lower costs and establish payment plans. Health
Advocate’s experienced claims negotiators are
skilled at working cooperatively and productively
with providers, who benefit from these services by
receiving prompt payment for services billed.
Key Benefits:
•E  nhanced level of service
•H  elp empower consumers
•H  elp lower healthcare costs
• Make your medical plan more effective
(if applicable)
Employee Assistance Program (EAP)
The EAP program is a program designed to
help address the personal issues you and your
dependents are facing. This service, staffed by
experienced clinicians at Health Advocate, is
available by phone 24 hours a day, seven days a
week. A guidance Consultant will refer you to a
local consultant or to resources in your community.
You do not need to be enrolled in the Medical Plan
to be eligible for this benefit. You can call any time
with personal concerns including but not limited to:
•R
 elationships
•P
 roblems with your children
•S
 ubstance Abuse
•M
 arital conflicts
Additional services include legal information and
resources, information and resources for work-life
needs, financial information and on-line information.
Additional Benefits
ID Sanctuary
Thieves want to steal your identity. Don’t let them get away with it! ID Sanctuary provides the proactive
tools and recovery assistance you need to quickly respond to an identity or fraud crisis. With ID Sanctuary,
you can rely on immediate, personalized attention from a fraud specialist whenever you need it. Fraud
specialists are armed with the knowledge to help reduce the risk of identity theft and provide unlimited
resolution assistance should you fall victim—giving you emotional support and peace of mind. Includes
the employee and up to the three legal dependents over the age of 18.

Roadside Assistance
Stranded? Car trouble is no trouble. Roadside Assistance is there for you and your immediate family to
help with a flat tire, lock-out, battery, collision and even towing—with coverage up to $50. They will even
bring you fuel, oil, fluid and water 24/7!

Pharmacy
Save 10% to 85% on most prescriptions at 60,000 pharmacies nationwide including CVS, Walgreens,
Target and more. Compare your prescription prices and see for yourself at MyRxPrice.com.

Global Travel Assistance

Got a trip planned? Protect yourself and your loved ones. When traveling 100 miles or more from home,
you can rest easy knowing you have a global network of doctors, assistance personnel and emergency
benefits. Get medical help around the world with emergency medical evacuation, monitoring of
treatment, replacement of lost or stolen travel documents and more.

Global Travel Assistance not available to FL, NY, OR or WA residents

Interested in these benefits?

You can sign up through the
enrollment portal. The cost is
$9.10 per month.

22
401(k) Retirement Savings Plan
The TC Transcontinental Savings Plan, administered by Transamerica Retirement Solutions, gives you the
opportunity to save for your future with pre-tax dollars. You are eligible to participate in the plan 31 days
after your date of hire if you meet eligibility requirements.

You decide whether and how much to save through payroll deductions. For 2019, the maximum
contribution amount allowed by the IRS is $19,000. If you are age 50 or older, you are eligible to make
an additional “catch-up” contribution of $6,000, for a total of $25,000. At the time of printing, the 2020
contribution limits were not yet available.

TC Transcontinental matches your contributions at 50% on the first 6% of pay you contribute.

Benefits of the plan are that you can:

• Contribute a percentage of your pay up to the IRS limits pre or post tax.
• Choose between a broad range of investment options and change the mix of your investments at any time
• Change your contribution amount at any time
• Rollover contributions from other eligible plans

New hires, 30 days from date of hire, will automatically be enrolled in the TC Transcontinental Savings
Plan at a deferral rate of 6%. You have the ability to “opt out” of participating or change your rate of
participation through Transamerica.

If you have questions, call Transamerica at 1.800.755.5801, visit www.transamerica.com/portal/home/ or

download the My TRSRetire App for your mobile device.

My TRSRetire App
Download the My TRSRetire app to connect
with your retirement benefits on your tablet or
mobile device. The app offers easy access to:
• View your account balance and rate of return
• Know Your Retirement Outlook
• Model ways to improve your forecast
•T
 ake action right from your device

23

Value Added Benefits
LifeKeys services, included at no additional cost with all Lincoln Term Life and Accidental Death and
Dismemberment Insurance policies, provide assistance to you, your family and your beneficiaries.
EstateGuidance® will preparation
Create your will online — easily and economically.
Follow a step-by-step guide through the entire
process, and then use online instructions to execute
your will. You can:
• Name an executor to manage your estate
• Choose a guardian for your children
• Specify wishes for your property
• Provide funeral and burial instructions
GuidanceResources® Online
GuidanceResources® Online is the place to go for
articles, tutorials, streaming videos and “Ask the
Expert” personal responses on topics such as:
•L aw and regulations
• Money and investments
•F amily and relationships
•H ealth and wellness
•W ork and education
•L eisure and home
Identity theft
Identity theft is one of the fastest-growing crimes in
the U.S. Be sure you have the information you need
to recognize and prevent it. Our online resource
helps you:
• Spot the warning signs
• Take steps to protect your cell phone, computer
and tax records from fraud
• Lessen the damage and repair your credit if
identity theft occurs
• Link to essential resources such as credit reporting
bureaus, the FBI Internet Crime Complaint Center,
ID Theft Resource Center, and more
For Your Beneficiaries
• Support for your loved ones
• Financial Services
• Legal Support
• Support with day-to-day concerns
24
To access LifeKeys services:
Call 1-855-891-3684 or visit
GuidanceResources.com
(First-time user: Web ID = LifeKeys)
Employee Assistance Program
When you’re faced with a challenge, Lincoln
Financial Group’s EAP is ready to help you and your
family find a solution through voluntary counseling.
To use this program call 888.628.4824 or go to
www.guidanceresources.com
(username: LFGsupport password: LFGsupport1)
TravelConnect
The Travel Connect program provides a wealth
of travel, medical and safety-related services
you can access while traveling. Comprehensive
coverage includes:
• Medical Emergency evacuation and transportation:
Includes arrangement and payment for
transportation of the patient to the nearest medical
facility able to treat the injury or illness. Once the
patient can travel home, includes arrangement and
payment for the trip.
• Dependent child transportation: If a medical
emergency leaves no covered parents available,
includes arrangement and payment for a dependent
child’s trip home or arrangement and payment for a
family member to travel to and care for the child.
• Travel treatment monitoring: Includes care
management when a traveler has a medical
emergency; services are available until the traveler
is released or sent to a hometown hospital. Services
vary from case to case but can include: medical
record requests and reviews to ensure treatment
is appropriate; intermediary services; medical
translation services for the patient and/or the
family; and communication between the patient and
family back home.
A program description is available at
www.Lincoln4Benefits.com. To use TravelConnect
services, call UnitedHealthcare Global at
1-800-527-0218 or 1-410-453-6330, and provide
them with ID number 322541.
Frequently Asked Questions (FAQs)
Understanding your benefits and how they work
for you and your family can be confusing, so we’ve
compiled some of the most frequently asked
questions here for your reference.
What Will My Benefits Cost In
2020?
Please refer to the 2020 Rate Sheet for contribution
information for medical, dental and vision benefits.
All other rates are available as you move through
the enrollment portal.
How Do I Enroll For Benefits?
Access the TC Transcontinental Enrollment
Portal at tctranscontinental.bswift.com and
log in with:
Username: The first initial of your first name and
your full last name. For example, John Smith’s
user name will be ‘jsmith’.
Password: The last 4 digits of your Social Security
Number.
All enrollments for open enrollment are to be
completed by November 15, 2019.
Will I Receive New Insurance
Cards For 2020?
Medical/Prescription Drug - all employees
enrolling in medical/prescription drug for the
2020 plan year will receive new ID cards. You
will receive 2 cards; one for medical and one
for prescription drug.New cards will be mailed
at the end of December to your home address.
Please allow ten business days for delivery. If you
need a replacement medical card, or additional
insurance cards, you can request them by calling
BCBSFL or on myhealthtoolkitfl.com. If you need a
replacement prescription card, or additional
cards you can request them by calling ESI or on
express-scripts.com.
25
Dental - with the move to MetLife for 2020 you will
not receive a dental ID card. Your dentist will verify
eligibility by using your social security number.
However, a supply of generic MetLife dental ID
cards will be made available at each location. You
can also print an ID card on the MetLife portal.
Vision - all employees enrolling in vision for the
2020 plan year will receive new vision ID cards.
EyeMed will mail out your ID card in mid-January
2020 to your home address, ID cards are accessible
starting January 1st on their mobile app.
Do I Have To Re-Elect To
Participate In My HSA In 2020?
Yes. HSA requires an annual enrollment even if you
want to participate at the same contribution rate
from 2019.
Do I Have To Re-Elect To
Participate In My DCFSA In 2020?
Yes. DFSA requires an annual enrollment even if
you want to participate at the same contribution
rate from 2019.
What If I Don’t Want To Change
Any Of My Benefits?
You must actively enroll in your medical, dental,
vision, HSA and DFSA benefits for coverage in 2020.
All other benefits will carry-over from 2019.
What Is The Vesting Schedule For
My 401K Match?
You are 100% vested from the first day you begin
participating in the TC Transcontinental Savings Plan.
Important Contacts
Please contact the company/provider listed here to learn more about a specific benefit plan. We also
invite you to speak with your HR Representative when you have questions.

WHEN YOU HAVE QUESTIONS ABOUT CONTACT PHONE NUMBER WEBSITE

Medical Insurance Blue Cross Blue Shield 888.233.3197 www.myhealthtoolkitfl.com

Pharmacy Coverage Express Scripts 800.711.0917 www.express-scripts.com

Health Savings Account (HSA) HSA Bank 800.357.6246 www.hsabank.com

Dental Insurance MetLife 800.438.6388 www.metlife.com

Vision Insurance EyeMed 866.939.3633 www.eyemedvisioncare.com

Group Life and AD&D Lincoln Financial Group 800.487.1485 www.lfg.com

Disability Insurance Lincoln Financial Group 800.487.1485 www.lfg.com

FMLA Reporting Cigna 888.842.4462 www.mycigna.com

Employee Assistance Program (EAP) Health Advocate 866.799.2728 www.healthadvocate.com

Dependent Care Flexible

PayFlex 888.678.8242 www.payflex.com
Spending Account (DCFSA)

Advocacy Program Health Advocate 866.799.2728 www.healthadvocate.com

ID Sanctuary New Benefits 800.800.7616

www.transamerica.com/portal/
401(k) Transamerica 800.755.5801
home/
866.QUIT.4.LIFE
Tobacco Cessation Program Optum www.quitnow.net
866.784.8454
Accident, Critical Illness and
MetLife 800.438.6388
Hospital Indemnity
www.GuidanceResources.com
LifeKeys Lincoln Financial Group 855.891.3684 (First-time user:
Web ID = LifeKeys)
www.Lincoln4Benefits.com
TravelConnect Lincoln Financial Group 800.527.0218
(ID 322541)

26
Important Notices
HIPAA with CHIP Special
Enrollment Notice
If you decline enrollment for Medical benefits
for yourself or your eligible dependents because
of other health insurance or group health plan
coverage, you may be able to enroll yourself and
your eligible dependents in the Medical benefits
provided under this Plan if you or your eligible
dependents lose eligibility for that other coverage
(or if the other employer stops contributing
toward your or your dependents other coverage).
However, you must request enrollment within 30
days after your or your eligible dependents other
coverage ends (or after the other employer stops
contributing toward the other coverage).
In addition, if you have a new dependent as a result
of marriage, birth, adoption or placement for
adoption, you may be able to enroll yourself, your
spouse and your new eligible dependent children.
However, you must request enrollment within
30 days after the marriage, birth, adoption, or
placement for adoption.
If you request a change due to a special enrollment
event within the 30-day timeframe, coverage will be
effective the date of birth, adoption or placement
for adoption. For all other events coverage will
be effective the first of the month following your
request for enrollment.
Effective April 1, 2009, the Plan must allow a HIPAA
special enrollment for employees and dependents
who are eligible, but not enrolled, if they lose
Medicaid or CHIP coverage because they’re no
longer eligible, or they become eligible for a state’s
premium assistance program. Employees have 60
days from the date of the Medicaid/CHIP event to
request enrollment under the Plan. If you request
this change, coverage will be effective the first of
the month following your request for enrollment.
Specific restrictions may apply depending on
federal and state law.
To request a special enrollment or obtain more
information, contact your HR Representative.
27
Women’s Health and Cancer
Rights Act of 1998 (WHCRA)
If you have had or are going to have a mastectomy,
you may be entitled to certain benefits under the
Women’s Health and Cancer Rights Act of 1998
(WHCRA). For individuals receiving mastectomy-
related benefits, coverage will be provided in
a manner determined in consultation with the
attending physician and the patient, for:
• all stages of reconstruction of the breast on which
the mastectomy was performed;
• surgery and reconstruction of the other breast to
produce a symmetrical appearance;
• prostheses; and
• treatment of physical complications of the
mastectomy, including lymphedema.
These benefits will be provided subject to the same
deductibles and coinsurance that are applicable to
other medical and surgical benefits provided under
the plan in which the individual is enrolled. If you
would like more information on WHCRA benefits,
please contact Human Resources.
The Newborn and Mothers Health
Protection Act
Group health plans and health insurance
issuers generally may not, under federal law,
restrict benefits for any hospital length of stay
in connection with childbirth for the mother or
newborn child to less than 48 hours following a
vaginal delivery, or less than 96 hours following a
cesarean delivery. However, federal law generally
does not prohibit the mother’s or newborn’s
attending provider, after consulting with the
mother, from discharging the mother or her
newborn earlier than 48 hours (or 96 hours as
applicable). In any case, plans and issuers may
not, under Federal law, require that a provider
obtain authorization from the plan or the issuer
for prescribing a length of stay not in excess of 48
hours (or 96 hours).
Notice of Privacy Practices
Available Upon Request
This serves as a reminder that our Notice of
Privacy Practices for protected health information
is available, and under the HIPAA privacy rule, you
are entitled to request and receive a copy of it.
The Notice of Privacy Practices informs you about
the ways in which we may use and disclose your
protected health information. This notice also
describes your rights and certain obligations. You
may request a copy of this notice at any time by
contacting Human Resources.
Important Notice from TC
Transcontinental about Your
Prescription Drug Coverage and
Medicare
Please read this notice carefully and keep it
where you can find it. This notice has information
about your current prescription drug coverage
with TC Transcontinental and about your options
under Medicare’s prescription drug coverage.
This information can help you decide whether
or not you want to join a Medicare drug plan. If
you are considering joining, you should compare
your current coverage, including which drugs are
covered at what cost, with the coverage and costs
of the plans offering Medicare prescription drug
coverage in your area. Information about where
you can get help to make decisions about your
prescription drug coverage is at the end of this
notice. There are two important things you need to
know about your current coverage and Medicare’s
prescription drug coverage:
1. M
 edicare prescription drug coverage became
available in 2006 to everyone with Medicare.
You can get this coverage if you join a Medicare
Prescription Drug Plan or join a Medicare
Advantage Plan (like an HMO or PPO) that
offers prescription drug coverage. All Medicare
drug plans provide at least a standard level of
coverage set by Medicare. Some plans may
also offer more coverage for a higher monthly
premium.
2. T
 C Transcontinental has determined that the
prescription drug coverage offered by the TC
28
Transcontinental CDHP plans is, on average for
all plan participants, expected to pay out as much
as standard Medicare prescription drug coverage
pays and is therefore considered Creditable
Coverage. Because your existing coverage is
Creditable Coverage, you can keep this coverage
and not pay a higher 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 each year from
October 15th to December 7th.
However, if you lose your current creditable
prescription drug coverage, through no fault of your
own, you will also be eligible for a two (2) month
Special Enrollment Period (SEP) to join a Medicare
drug plan.
What Happens To Your Current
Coverage If You Decide to Join A
Medicare Drug Plan?
If you decide to join a Medicare drug plan, your
current TC Transcontinental coverage will not
be affected.
If you do decide to join a Medicare drug plan and
drop your current TC Transcontinental coverage, be
aware that you and your dependents will be able to
get this coverage back.
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 TC Transcontinental and don’t
join a Medicare drug plan within 63 continuous days
after your current coverage 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, your
monthly premium may go up by at least 1% of the
Medicare base beneficiary premium per month for
every month that you did not have that coverage.
For example, if you go nineteen months without
creditable coverage, your premium may consistently
be at least 19% higher than the Medicare base
beneficiary premium. You may have to pay this higher
premium (a penalty) as long as you have Medicare
prescription drug coverage. In addition, you may have
to wait until the following October to join.
For More Information About
This Notice Or Your Current
Prescription Drug Coverage…
Contact the person listed below for further
information. NOTE: You’ll get this notice each year.
You will also get it before the next period you can join
a Medicare drug plan, and if this coverage through TC
Transcontinental changes. You also may request a
copy of this notice at any time.
For More Information About
Your Options Under Medicare
Prescription Drug Coverage…
More detailed information about Medicare plans
that offer prescription drug coverage is in the
“Medicare & You” handbook. You’ll get a copy of the
handbook in the mail every year from Medicare.
You may also be contacted 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 drug
coverage is available. For information about this extra
help, visit Social Security on the web at
www.socialsecurity.gov, or call them at
1-800-772-1213 (TTY 1-800-325-0778).
Remember: Keep this Creditable Coverage notice.
If you decide to join one of the Medicare drug plans,
you may be required to provide a copy of this notice
when you join to show whether or not you have
maintained creditable coverage and, therefore,
whether or not you are required to pay a higher
premium (a penalty).
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Date: January 1, 2020 Name of Entity: TC
Transcontinental Contact: Alina Dziekonski
Address: 8600 West Bryn Mawr Avenue, Suite 800N
Chicago, Illinois 60631
Phone Number: 773.756.5916
Premium Assistance Under
Medicaid and the Children’s
Health Insurance Program (CHIP)
If you or your children are eligible for Medicaid or
CHIP and you’re eligible for health coverage from
your employer, your state may have a premium
assistance program that can help pay for coverage,
using funds from their Medicaid or CHIP programs.
If you or your children aren’t eligible for Medicaid
or CHIP, you won’t be eligible for these premium
assistance programs but you may be able to buy
individual insurance coverage through the Health
Insurance Marketplace. For more information, visit
www.healthcare.gov.
If you or your dependents are already enrolled
in Medicaid or CHIP and you live in a State listed
below, contact your State Medicaid or CHIP office to
find out if premium assistance is available.
If you or your dependents are NOT currently
enrolled in Medicaid or CHIP, and you think you or
any of your dependents might be eligible for either
of these programs, contact your State Medicaid or
CHIP office or dial 1-877-KIDS NOW or
www.insurekidsnow.gov to find out how to apply. If
you qualify, ask your state if it has a program that
might help you pay the premiums for an employer-
sponsored plan.
If you or your dependents are eligible for premium
assistance under Medicaid or CHIP, as well as
eligible under your employer plan, your employer
must allow you to enroll in your employer plan if
you aren’t already enrolled. This is called a “special
enrollment” opportunity, and you must request
coverage within 60 days of being determined
eligible for premium assistance. If you have
questions about enrolling in your employer plan,
contact the Department of Labor at
www.askebsa.dol.gov or call
1-866-444-EBSA (3272).
If you live in one of the following states, you may be eligible for assistance paying your employer health plan premiums. The following list of states is
current as of July 31, 2019. Contact your State for more information on eligibility.

ALABAMA – Medicaid MAINE – Medicaid

Website: http://myalhipp.com/ Website: http://www.maine.gov/dhhs/ofi/public-assistance/index.html
Phone: 1-855-692-5447 Phone: 1-800-442-6003
TTY: Maine relay 711
ALASKA – Medicaid
The AK Health Insurance Premium Payment Program MASSACHUSETTS – Medicaid and CHIP
Website: http://myakhipp.com/ Website:
Phone: 1-866-251-4861 http://www.mass.gov/eohhs/gov/departments/masshealth/
Email: CustomerService@MyAKHIPP.com Phone: 1-800-862-4840
Medicaid Eligibility:
http://dhss.alaska.gov/dpa/Pages/medicaid/default.aspx MINNESOTA – Medicaid
Website:
ARKANSAS – Medicaid https://mn.gov/dhs/people-we-serve/seniors/health-care/health-care-
Website: http://myarhipp.com/ programs/programs-and-services/other-insurance.jsp
Phone: 1-855-MyARHIPP (855-692-7447) Phone: 1-800-657-3739

COLORADO – Health First Colorado (Colorado’s Medicaid Program) & Child MISSOURI – Medicaid
Health Plan Plus (CHP+) Website: http://www.dss.mo.gov/mhd/participants/pages/hipp.htm
Health First Colorado Website: https://www.healthfirstcolorado.com/ Phone: 573-751-2005
Health First Colorado Member Contact Center:
1-800-221-3943/ State Relay 711 MONTANA – Medicaid
CHP+: https://www.colorado.gov/pacific/hcpf/child-health-plan-plus Website: http://dphhs.mt.gov/MontanaHealthcarePrograms/HIPP
CHP+ Customer Service: 1-800-359-1991/ State Relay 711 Phone: 1-800-694-3084

FLORIDA – Medicaid NEBRASKA – Medicaid

Website: http://flmedicaidtplrecovery.com/hipp/ Website: http://www.ACCESSNebraska.ne.gov
Phone: 1-877-357-3268 Phone: (855) 632-7633
Lincoln: (402) 473-7000
GEORGIA – Medicaid Omaha: (402) 595-1178
Website: https://medicaid.georgia.gov/health-insurance-premium-
payment-program-hipp NEW HAMPSHIRE – Medicaid
Phone: 678-564-1162 ext 2131 Website: https://www.dhhs.nh.gov/oii/hipp.htm
Phone: 603-271-5218
INDIANA – Medicaid Toll free number for the HIPP program: 1-800-852-3345, ext 5218
Healthy Indiana Plan for low-income adults 19-64
Website: http://www.in.gov/fssa/hip/ NEW JERSEY – Medicaid and CHIP
Phone: 1-877-438-4479 Medicaid Website:
All other Medicaid http://www.state.nj.us/humanservices/
Website: http://www.indianamedicaid.com dmahs/clients/medicaid/
Phone 1-800-403-0864 Medicaid Phone: 609-631-2392
CHIP Website: http://www.njfamilycare.org/index.html
IOWA – Medicaid CHIP Phone: 1-800-701-0710
Website: http://dhs.iowa.gov/Hawki
Phone: 1-800-257-8563 NEW YORK – Medicaid
Website: https://www.health.ny.gov/health_care/medicaid/
KANSAS – Medicaid Phone: 1-800-541-2831
Website: http://www.kdheks.gov/hcf/
Phone: 1-785-296-3512 NORTH CAROLINA – Medicaid
Website: https://medicaid.ncdhhs.gov/
KENTUCKY – Medicaid Phone: 919-855-4100
Website: https://chfs.ky.gov
Phone: 1-800-635-2570 NORTH DAKOTA – Medicaid
Website: http://www.nd.gov/dhs/services/medicalserv/medicaid/
LOUISIANA – Medicaid Phone: 1-844-854-4825
Website: http://dhh.louisiana.gov/index.cfm/subhome/1/n/331
Phone: 1-888-695-2447 OKLAHOMA – Medicaid and CHIP
Website: http://www.insureoklahoma.org
Phone: 1-888-365-3742

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OREGON – Medicaid VERMONT– Medicaid
Website: http://healthcare.oregon.gov/Pages/index.aspx Website: http://www.greenmountaincare.org/
http://www.oregonhealthcare.gov/index-es.html Phone: 1-800-250-8427
Phone: 1-800-699-9075
VIRGINIA – Medicaid and CHIP
PENNSYLVANIA – Medicaid Medicaid Website:
Website: http://www.dhs.pa.gov/provider/medicalassistance/ http://www.coverva.org/programs_premium_assistance.cfm
healthinsurancepremiumpaymenthippprogram/index.htm Medicaid Phone: 1-800-432-5924
Phone: 1-800-692-7462 CHIP Website: http://www.coverva.org/programs_premium_assistance.cfm
CHIP Phone: 1-855-242-8282
RHODE ISLAND – Medicaid and CHIP
Website: http://www.eohhs.ri.gov/ SOUTH CAROLINA – Medicaid
Phone: 855-697-4347, or 401-462-0311 (Direct RIte Share Line) Website: https://www.scdhhs.gov
Phone: 1-888-549-0820
NEVADA – Medicaid
Medicaid Website: https://dhcfp.nv.gov WASHINGTON – Medicaid
Medicaid Phone: 1-800-992-0900 Website: https://www.hca.wa.gov/
Phone: 1-800-562-3022 ext. 15473
SOUTH DAKOTA - Medicaid
Website: http://dss.sd.gov WEST VIRGINIA – Medicaid
Phone: 1-888-828-0059 Website: http://mywvhipp.com/
Toll-free phone: 1-855-MyWVHIPP (1-855-699-8447)
TEXAS – Medicaid
Website: http://gethipptexas.com/ WISCONSIN – Medicaid and CHIP
Phone: 1-800-440-0493 Website: https://www.dhs.wisconsin.gov/publications/p1/p10095.pdf
Phone: 1-800-362-3002
UTAH – Medicaid and CHIP
Medicaid Website: https://medicaid.utah.gov/ WYOMING – Medicaid
CHIP Website: http://health.utah.gov/chip Website: https://wyequalitycare.acs-inc.com/
Phone: 1-877-543-7669 Phone: 307-777-7531

To see if any other states have added a premium assistance program since July 31, 2019, or for more information on special enrollment rights, contact either:

U.S. Department of Labor

Employee Benefits Security Administration
www.dol.gov/agencies/ebsa
1-866-444-EBSA (3272)

Paperwork Reduction Act Statement

According to the Paperwork Reduction Act of 1995 (Pub. L. 104-13) (PRA), no persons are required to respond to a collection of information
unless such collection displays a valid Office of Management and Budget (OMB) control number. The Department notes that a Federal agency
cannot conduct or sponsor a collection of information unless it is approved by OMB under the PRA, and displays a currently valid OMB control
number, and the public is not required to respond to a collection of information unless it displays a currently valid OMB control number. See
44 U.S.C. 3507. Also, notwithstanding any other provisions of law, no person shall be subject to penalty for failing to comply with a collection of
information if the collection of information does not display a currently valid OMB control number. See 44 U.S.C. 3512.
The public reporting burden for this collection of information is estimated to average approximately seven minutes per respondent. Interested
parties are encouraged to send comments regarding the burden estimate or any other aspect of this collection of information, including
suggestions for reducing this burden, to the U.S. Department of Labor, Employee Benefits Security Administration, Office of Policy and
Research, Attention: PRA Clearance Officer, 200 Constitution Avenue, N.W., Room N-5718, Washington, DC 20210 or email ebsa.opr@dol.gov
and reference the OMB Control Number 1210-0137.

OMB Control Number 1210-0137 (expires 12/31/2019)

About This Guide

This guide describes the benefit plans and policies available to you as an employee of TC Transcontinental. The details of these
plans and policies are contained in the official plan and policy documents, including some insurance contracts. This guide is
meant only to cover the major points of each plan or policy. It doesn’t contain all of the details that are included in your Summary
Plan Descriptions (as required by ERISA). If there’s ever a question about one of these plans and policies, or if there is a conflict
between the information in this guide and the formal language of the plan or policy documents, the formal wording in the plan or
policy documents will govern.

Note: The benefits highlighted and described in this guide may be changed at any time and do not represent
a contractual obligation — either implied or expressed — on the part of TC Transcontinental.

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