Benefit
Comparison Charts
& Rates
1
2
Medical
Benefit Options
This is not the complete Medical Comparison Chart. Refer to the
Medical Summary Plan Description or the Legal Notices on the enclosed CD for full information.
Meritain Health, Mutual Health Services (OH only)
and Piedmont Community Health Plan (VA only)
Out-of-Area OptionBlue Option White Option
In-Network Out-of-Network In-Network Out-of-Network Out-of-Network
You Pay Annual Deductible: Employee Only $2,000 $4,000 $1,750 $3,500 $1,500 Annual Deductible: Employee + Spouse Employee + Child(ren) Employee + Family $4,000 $8,000 $3,5001 $7,0001 $3,000 Annual Out-of-Pocket Maximum: 2 Employee Only $4,000 $8,000 $6,350 $12,700 $3,200 Annual Out-of-Pocket Maximum:2 Employee + Spouse Employee + Child(ren) Employee + Family $8,000 $16,000 $12,7003 $25,4003 $6,400
Lifetime Maximum Unlimited Unlimited Unlimited
Health Reimbursement
Account (HRA) N/A
If you complete the wellness activities:
$750/Employee Only $1,250/Employee + Spouse, Employee + Child(ren), Employee + Family
If you complete the wellness activities: $750/Employee Only $1,250/Employee + Spouse, Employee + Child(ren), Employee + Family Health Savings Account (HSA)4
If you complete the wellness activities: $750/Employee Only $1,250/Employee + Spouse, Employee + Child(ren), Employee + Family
N/A N/A
Preventive
Care Exams Covered at 100%, subject to age/gender guidelines Covered at 100%, subject to age/gender guidelines Covered at 100%, subject to age/gender guidelines
Physician’s
Office Visits 5 20% after deductible 50% after deductible $30 50% after deductible 20% after deductible
Specialist’s
Office Visits5 20% after deductible 50% after deductible $45 50% after deductible 20% after deductible 1One person can meet the individual annual deductible, or a combination of covered family members can meet the annual deductible for these coverage tiers. 2
The out-of-pocket maximum includes the medical deductible. Medical and prescription drug copays and coinsurance also accumulate toward the
out-of-pocket maximum.
3
One person can meet the individual annual out-of-pocket maximum, or a combination of covered family members can meet the annual out-of-pocket
maximum for these coverage tiers.
4 If you are not eligible for a Health Savings Account, your earned company contribution will be deposited into a Health Reimbursement Account. 5 Copay covers the general office visit. You will also pay co-insurance for additional medical services your doctor may prescribe during your visit.
2015 Medical Benefit Option Employee Contributions
(Monthly)
Coverage Tier Blue Option White Option Out-of-Area Option
Employee Only $47 $120 $97
Employee + Spouse $77 $218 $176
Employee + Child(ren) $64 $173 $140
Employee + Family $91 $278 $224
Note: As applicable, the $50 tobacco surcharge and the $50 condition management surcharge will be added to the monthly employee contributions listed above.
Prescription
Drug Coverage
Prescription drug coverage is included as part of
the Medical Benefit.
Blue Option White Option Out-of-Area
In-Network Out-of-Network In-Network Out-of-Network Out-of-Network Prescription Drug Coverage - 30-day Supply RETAIL
Generic 20% after deductible Not covered $10 copay Not covered $10 copay
Preferred Brand 30% after deductible Not covered 25% of cost with $30 min /$75 max Not covered 25% of cost with $30 min /$75 max
Non-Preferred Brand 45% after deductible Not covered 35% of cost with $45 min /$110 max Not covered 35% of cost with $45 min /$110 max
Prescription Drug Coverage - 90-day Supply MAIL ORDER or RETAIL Maintenance at Walgreens Only
Generic 20% after deductible Not covered $25 Not covered $25
Preferred Brand 30% after deductible Not covered $100 Not covered 25% of cost with $75 min /$150 max
Non-Preferred Brand 45% after deductible Not covered $150 Not covered 35% of cost with $125 min /$225 max
Specialty
Vision
Benefit
The Vision Benefit is administered by
UnitedHealthcare Vision, which offers services
through a network of providers at a lower cost.
The benefit provides coverage once every
12 months for routine eye exams and glasses or
contacts. When you visit an in-network provider,
most services will be covered at 100 percent after
you pay a copay. You may go to an out-of-network
provider, but you will incur higher out-of-pocket
costs and you may have to file your own claims.
2015 Vision Benefit Employee Contributions (Monthly)
Coverage Tier Vision CoverageEmployee Only $6.30
Employee + Spouse $12.61
Employee + Child(ren) $13.20
Employee + Family $16.79
Features
In-Network Benefit Pays:
Out-of-Network Benefit Pays:
Eye Exam 100% after $10 copay Up to $45
Glasses - Lenses
Single Vision 100% after $25 copay Up to $30 Lined Bifocal 100% after $25 copay Up to $50 Lined Trifocal 100% after $25 copay Up to $65 Lenticular 100% after $25 copay Up to $100
Glasses - Frames
Covered-in-Full 100% after $25 copay Up to $70 Wholesale Up to $50 Up to $70 Retail Allowance Up to $130 Up to $70
Contact Lenses
Covered-in-Full Elective Contacts* 100% after $25 copay Up to $105 All Other Elective Contacts* Up to $125 Up to $105 Necessary Contacts 100% after $25 copay Up to $210
*If you select elective covered-in-full contact lenses from an in-network provider, the fitting/evaluation fees, contacts and two follow-up visits are covered (after $25 copay). For all other elective contacts, a $125 allowance is applied toward the fitting/evaluation fees and purchase of contact lenses ($25 materials copay does not apply). Toric, gas permeable and bifocal contacts are all examples of contacts that are not considered covered-in-full.
Features
Dental Basic
Dental Plus
Annual Maximum Benefit $1,000/person $1,500/person
Orthodontia Lifetime Maximum Benefit
for children under age 19 Not covered $1,500/person
You Pay You Pay
Deductible $50/person $25/person
$150/family $75/family
Covered Services You Pay You Pay
Preventive and diagnostic care $0, no deductible $0, no deductible Basic and restorative care 20% after deductible 20% after deductible Major care 50% after deductible 40% after deductible Orthodontia
for children under age 19 Not covered 50%, no deductible
2015 Dental Benefit Employee Contributions (Monthly)
Coverage Tier Dental Basic Dental Plus
Employee Only $30 $37
Employee + Spouse $57 $74
Employee + Child(ren) $66 $88
Employee + Family $94 $121
Virginia Residents Only
Your benefits are the same, but you must choose between the Cost-Efficient or Standard Network:
• The discounts are better in the Cost-Efficient network
• MetLife administers the Cost-Efficient network
• Anthem administers the Standard network
VA Only 2015 Dental Benefit Employee Contributions (Monthly)
Coverage TierDental Basic Dental Plus
Cost-Efficient Network Standard Network Cost-Efficient Network Standard Network
Employee Only $30 $31 $37 $38 Employee + Spouse $57 $59 $74 $76 Employee + Child(ren) $66 $68 $88 $90 Employee + Family $94 $97 $121 $125
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Dental
Benefit
The Dental Benefit is designed to help you maintain dental health. You
have two dental options - Dental Basic or Dental Plus. In most states the
Dental Benefit is administered by MetLife.
Benefit
Provider/Administrator
Website
Phone Number
General Questions and
Enrollment FlexChoice Service Center www.babcock.com/enrollment
1-877-222-4015
Outside the U.S.:
1-972-720-3985
Medical and Prescription
Drug Information Care Coordinators www.mybwhealthtools.com 1-888-563-6766
Health Savings Account (HSA) Optum Health Bank www.optumhealthbank.com 1-866-234-8913
Health Reimbursement Account PayFlex ID: 119176 www.healthhub.com 1-800-284-4885
Flexible Spending Accounts PayFlex ID: 119176 www.healthhub.com 1-800-284-4885
Dental Benefit MetLife
Anthem BlueCross BlueShield
www.metlife.com/dental www.anthem.com
1-800-942-0854 1-866-470-7250
Vision Benefit United Healthcare Vision Group # 718582 www.myuhcvision.com 1-800-839-3242
Life Insurance MetLife Group # 145035 www.metlife.com 1-800-638-6420
Long-Term Disability Benefit Cigna Group #FLK-980181 (once a claim is filed)www.mycigna.com 1-800-238-2125
Personal Accident Insurance Chubb Group www.chubb.com 1-877-222-4015
Hospital Income Continental American (Aflac) www.caicworksite.com 1-800-433-3036
Critical Illness American Heritage Life Insurance Company www.allstateatwork.com
Enroll:
1-866-828-1384
Claims:
1-800-348-4489
Group Legal Benefit
Hyatt Legal
Family: 634/0010 Single: 633/0010
www.legalplans.com 1-800-821-6400
Thrift Plan Vanguard www.vanguard.com 1-800-523-1188
Charles Schwab Schwab Participant Services http://eac.schwab.com 1-800-654-2593
Retirement Benefits
(hourly and salaried employees
except NFS) B&W Retirement Service Center N/A 1-877-580-3299
Retirement Benefits
(NFS employees only) B&W Retirement Service Center N/A 1-866-587-4118
Pension Retirement
Planning Resource On-Point www.babcock.hrodb.com 1-877-580-3299
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6
Income Protection
Benefit
B&W offers a variety of income protection benefits you can customize
for your personal needs. No one enjoys thinking about it, but it’s
important to protect your loved ones in case of an accident,
disability or your death.
Benefit
Description
Coverage
Life Insurance Pays your beneficiary if you should die
Basic Life Coverage: $50,000
Provided by company to all eligible full-time and part-time employees
Supplemental Life Coverage:
Full-time employees can elect supplemental coverage in
$50,000 increments, up to the lesser of 10 times per pay or $2,500,000
Part-time employees can elect coverage of $50,000,
$100,000 or $150,000
Spouse Life Coverage:
All employees can elect spouse coverage of $10,000, $25,000, $50,000, $75,000 or $100,000; up to 50% of the employee supplemental life coverage amount
Child(ren) Life Coverage:
All employees can elect $5,000, $10,000 or $15,000 life insurance coverage per child
Long-Term Disability (LTD)
Insurance to work because of an accident or illnessMonthly benefit if you are unable
40% Basic LTD: Provided by company to all eligible
full-time employees at no cost to employee
60% Buy-Up Option: Paid by employee
Minimum monthly benefit of $100; Maximum monthly benefit of $10,000
Personal Accident Insurance Pays a lump-sum benefit if an accidental injury results in a catastrophic loss or death
Pays up to 10 times of base pay:
Employee: $50,000 to $1,000,000
Spouse: 70% of the employee coverage amount without
insured child(ren); 65% with insured child(ren)
Child(ren): 25% of the employee coverage amount without
insured spouse; 20% with insured spouse
Hospital Income* pay your share of hospital expenses, such Flat dollar amount per day to help you as deductibles and coinsurance
Options:
$100 per day $200 per day
Critical Illness*
Supplements your other coverage by paying you a lump-sum benefit–to be used at your discretion– upon the diagnosis of a serious illness, such as stroke, heart attack, organ transplant or paralysis
Options:
$10,000 $15,000 $30,000
Group Legal Easy and low-cost access to a wide variety of personal legal services 11,000 attorneys for a variety of legal needsAccess to a national network of more than
*To enroll in these benefits, contact the providers at the numbers indicated under Contact Information on the next page.
