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2017 Health & Welfare
Benefit Enrollment
Guide for New Exempt
and Non-Exempt Employees
Enroll by phone or online:
1-877-SABIC US
(1-877-722-4287)
www.benefits.sabic-ip.com
Contents of This Guide
Welcome to the SABIC Health and Welfare Benefits Program 2
Enrolling via the SABIC Your Total Rewards Website 4
Medical—Quality Protection for You and Your Family 6
Health Plan Administrators by State 10
Dental Plan Benefits 23
Vision Plan Benefits 24
Flexible Spending Accounts 26
Life Insurance and AD&D 28
Long-Term Disability 29
Salary Continuation Plan 30
Long-Term Care 30
SABIC U.S. Employee Retirement Savings Plan 31
Other Benefits 34
Enrolling via Your SABIC Total Rewards Website 35
Enrolling in Health and Welfare Benefits via the SABIC Benefits Service Center 36
Appendix
Health Care, Dental and Vision Contributions 38
Optional Life Insurance—A Plus Enhanced and Voluntary AD&D 44
Long Term Disability Contribution Rates 45
Long-Term Care Rates 45
HIPAA Privacy Notice 46
Summary of Modification Materials 50
Required Notices 76
2
There are many rewards to working at SABIC, including our comprehensive and affordable
Health & Welfare Benefits Program. This Enrollment Guide provides an overview of your
benefits choices and the information you need to make benefits decisions that best fit your
personal needs.
The SABIC Health & Welfare Benefits Program provides you coverage under the following
benefit plans:
Medical/Prescription Drug*
Employee Assistance Program
Dental
Vision
Life Insurance
Dependent Life Insurance
Accidental Death and Dismemberment
Health Care/Dependent Day Care Flexible Spending Accounts
Long-Term Disability
Salary Continuation
Long-Term Care *Health Savings Account available
Welcome to the SABIC’s Health & Welfare Benefits Program!
You have 63 days including your hire date to enroll in benefits or waive coverage. Once you have missed the 63-day window – you will be placed in
Default Coverage and be responsible for retroactive contributions at the family level. Default Coverage is SABIC Plan for Health Option A, Basic Dental, Basic
Vision, Basic Life Insurance, Basic AD&D Insurance and Long Term Disability at 50% coverage level. Medical, Dental and Vision coverage is at the 3-person coverage level. Default coverage will continue until the end of the current
calendar year. You will be able to make changes to the default coverage during the next annual enrollment window usually held in the October timeframe with a
following January 1 effective date.
You are required to show proof of dependent status. For example to add a
spouse, you must show a valid marriage certificate and proof of current marital status such as a current tax form showing your spouse or some other form of documentation. For children, a birth certificate will be required.
Dependents effective date of coverage is the same as your hire date. However, dependents will not be added to your coverage until this proof is supplied.
Information must be supplied within the 63 days.
3
For More Information
This Enrollment Guide highlights benefits for SABIC employees. It is not an official summary
plan description and is not intended to provide full details of the plans described. Complete
details can be found in the official plan documents, which govern in all cases.
For employees covered by a collective bargaining agreement, participation in programs or
plans described in this document shall only occur upon agreement by the employees’ union
representative. Participation in programs or plans incorporated by reference into the
agreement is only to the extent provided through the incorporation. SABIC reserves the
right to terminate, amend, eliminate or replace any program, plan or benefit at its discretion
and at any time to the extent permitted by law.
Benefits described in this Enrollment Guide apply to eligible employees who are on the
active payroll, unless expressly stated otherwise.
4
You will find a step-by-step guide for enrolling through the SABIC Your Total
Rewards Website and the SABIC Benefits Service Center on pages 35/36.
Ceridian provides payroll, AonHewitt provides health, and welfare benefits administration
services. The AonHewitt hosted Website, referred to as the SABIC Your Total Rewards
Website provides employees with one resource for all of their payroll and health and welfare
questions. The SABIC Your Total Rewards Website and the SABIC Benefits Service Center
are your Health and Welfare benefits information resources.
Before you make your benefit elections, you should access the SABIC Benefits website to
review your options.
Two Ways to Enroll
You have two options for enrolling—online via the SABIC Your Total Rewards Website or by
phone through the SABIC Benefits Service Center. The SABIC Benefits Service Center is
open Monday–Friday from 8 a.m. to 8 p.m. Eastern Time (ET), except Federal holidays.
Please note you can call and enroll through a benefits representative or by using the
Website as early as two days after your new hire date.
When you call the SABIC Benefits Service Center at 1-877-SABIC US, (1-877-722-4287) a
representative can help you through the online enrollment process, or simply take your
elections over the phone.
The SABIC Your Total Rewards Website is open 24 hours a day, seven days a
week. The online system provides a very robust enrollment experience. Go to
www.benefits.sabic-ip.com to enroll and for information about the benefits available to you
and your family.
SABIC Married Employees
If two SABIC employees want to be covered under one medical policy, the higher-paid
employee must cover the lower-paid employee and any dependents. If you are married to
another SABIC employee and you want to be covered under separate Medical Plan policies,
then either employee may cover the dependent children.
Eligible Dependents
Your eligible dependents include:
• Your spouse;
• For Medical, Dental and Vision coverage - Your children:
Up to the end of the month in which they turn age 26.
Enrolling via the SABIC Your Total Rewards Website
5
Appropriate documentation and social security number(s) of dependents will be required
prior to enrollment. Coverage end dates are as of the birthday of the dependent.
In the case of a child who, prior to age 26, is incapable of self-sustaining employment due
to mental or physical disability, dental, vision and dependent life insurance coverage will
continue up to the earlier of the date of recovery or age 65.
Continuation of this coverage requires the employee to submit medical documentation to
the health plan prior to the child turning age 26.
Once a dependent child’s coverage stops after age 26, it cannot begin again. However,
your child may be eligible to continue health care coverage at his or her own expense
through COBRA. For the child to be eligible for this COBRA coverage the parent must have
been working for the Company and covering that dependent child before he or she turns 26.
You will be asked periodically for information about a dependents continuing eligibility
(employment, education, disability or marital status). If the information to support
eligibility is not supplied, the coverage may be terminated. Documentation will be required
to add or maintain dependents based on life status events. This documentation may
include birth certificates, marriage certificates, tax forms and other appropriate
documents.
To qualify for medical, prescription drug, dental or vision coverage, your dependents must:
Not be on the SABIC U.S. payroll in the United States or Puerto Rico as an
employee;
Not be in the armed services of any country; and
Not be covered under any other group medical plan as the employee or subscriber.
6
Medical—Quality Protection for You and Your Family
SABIC is committed to providing access to a variety of high-quality health care coverage
options designed to meet the unique needs of our employees.
When you go to the SABIC Your Total Rewards Website or call the SABIC Benefits Service
Center, you will see or hear the Medical Plan options available to you.
Your Medical Plan Options for 2017
Your Medical Plan benefits help you, and your family, maintain good health. SABIC
employees may choose from three medical plans:
SABIC Health Care Preferred SABIC Plan for Health Option A
SABIC Plan for Health Option B
An important feature of the SABIC Medical Plans Option is that you can use out of network providers, however, this will be at an increased cost to you. In all cases, it
is financially advantageous to you to use in network providers.
SABIC Health Care Preferred
The SABIC Health Care Preferred (HCP) plan provides comprehensive medical coverage
through a network of health care providers. When you see your primary care physician* and
are referred to other providers within the HCP network, your care is covered at 100% after
you pay a co-payment. There is an annual deductible for services obtained in-network and
some services may require a co-pay.
Other HCP network advantages include:
Coordinated care through your primary care physician;
Low out-of-pocket costs for covered services;
Full coverage for preventive care;
Wellness Incentives paid as a reduction to your payroll contribution; and
No claim forms to file.
You always have the option to go out-of-network for care, although you will have to pay
greater out of pocket cost and, in general, file claim forms if you do.
* Not all HCP administrators require that you choose a primary care physician.
SABIC Plans for Health Option A and B
The SABIC Plan for Health combines a health plan with a Health Savings Account (HSA)
funded by you and SABIC with pre- and/or post-tax contributions. An HSA helps you plan,
save and pay for health care. The funds in your HSA can be invested through a bank
associated with your health plan according to the investment options you choose. This
means your money can potentially grow year over year—allowing you to accumulate funds
7
for future medical expenses. Medical plans with HSAs work differently than traditional
medical plans. For example, when you enroll in the SABIC Plan for Health Option A or Option
B, SABIC contributes $500 (individual) or $1,000 (2 or more coverage level) to a HSA when
you open the bank account affiliated with the health plan you are enrolled in. You can earn
an additional contribution of $150 employee/$150 spouse or dependent over the age of 18
when you complete the actions required at the ActiveHealth website
(www.myactivehealth.com/sabic ).
Who Pays for What in the SABIC Plan for Health (Options A and B)?
Here is how the SABIC Plan for Health (Options A and B) and the HSA work together:
Use Your Health Savings Account (HSA) to Pay for Eligible Expenses
HSA dollars you spend on eligible medical, prescription drug and behavioral health services
help satisfy SABIC Plan for Health’s annual deductible. Both in-network and out-of-network
expenses are covered, but in-network services are provided at a discounted rate—so you
save. You may also elect to contribute your own pre-tax dollars to the HSA. 2017 maximum
amounts permitted by the IRS are $3,400 (individual) and $6,750 (2 or more coverage
level). If you are age 55 or over, you may contribute an additional $1,000. Maximum
amounts include your own and the company’s contributions. Your account balance can roll
over to the next plan year.
A Health Savings Account used in conjunction with a high-deductible health insurance policy
allows users to save money tax-free against medical expenses. This incentive and any
payroll contributions can only be deposited if the employee was eligible to open an
account prior to December 1.
A Health Savings Account (HSA) gives you a triple tax break:
• Your contributions are sheltered from income taxes
• The money grows tax-deferred
• The funds can be withdrawn tax-free for medical expenses
It is similar to a flexible spending account that never expires, and it can even serve as an
extra retirement-savings fund. Up to the age of 65 for health care use with no penalty or tax
applied. For any purpose after age 65, no penalty applies, with regular withdrawal taxes
(same as 401k).
Incentives available from SABIC
If the employee enrolls into SABIC Plan for Health and opens the Health Savings Account
with the bank affiliated with the health plan administrator, SABIC will deposit $500
Individual or $1,000 for a Family plan into the HSA. This incentive and any payroll
contributions can only be deposited if the employee was eligible to open an
account prior to December 1.
The annual wellness incentive each active employee who is enrolled in a SABIC Medical Plan Options can earn up to $150 for Plan Year 2017. The $150 would also be available to one enrolled dependent/spouse over the age of 18. For an employee enrolled in a family plan (2 or more enrollees) there is a maximum of $300. This Wellness Incentive is available for both Health Care Preferred and SABIC Plan for Health Option A & B.
http://www.myactivehealth.com/sabic
8
The process to earn the incentive will be contingent on the completion of the Health Assessment at the ActiveHealth website (www.myactivehealth.com/sabic) during the calendar year of January 1 to December 31, 2017. If the Health Assessment is not completed, incentives will not be paid.
The process to earn a $75 incentive will be to complete and report the claim number and date of service for your Annual Physical on the ActiveHealth website (www.myactivehealth.com/sabic).
To earn the additional $75 a participant must complete one of the following options:
Digital coaching on MyActiveHealth.com/sabic – complete 100 heartbeats ($75)
Telephonic coaching – complete 3 calls with ActiveHealth for either Active Lifestyle Coaching or Condition Management ($75)
Note: Members are limited to earning a maximum of 25 heartbeats per week on the Digital Coaching Program.
For participants of the SABIC Plan for Health Option A or B, up to a total of $150 will be deposited in the employee’s Health Savings Account. The account must be open to allow the deposit of the incentive.
For participants of the SABIC Health Care Preferred Plan, up to a total of $150 will be deducted from your payroll contribution once the incentive has been recorded.
All incentive actions for plan year 2017 must be completed by December 31, 2017. Incentives for Plan Year 2017 will be paid out no later than April 15, 2018. This is a voluntary program.
ActiveHealth will report on a monthly basis to SABIC Benefits Team to record all completed actions. It may take up to 2 months to receive your incentive.
In total, you can receive a maximum annual contribution to your HSA of $650 (individual) or
$1,300 (2 or more coverage level).
You use your HSA account to pay eligible expenses before spending your own money.
Under both the SABIC Plan for Health (Options A and B), the plan pays 100% of the cost of
many in-network preventive care services, even before you have satisfied your deductible.
You do not pay for these services, so you save money.
You keep your unused HSA balance and it may grow based on your investment elections. If
you do not use all of your HSA dollars in 2017, the unused balance carries over to 2018 and
you retain these funds in the future if you remain enrolled in this plan. This allows you to
build an account balance and decrease the amount of the deductible you may have to pay
out of your own pocket.
The employee is responsible to open the Health Savings Account as soon as possible after
enrolling. The IRS dictates rules surrounding the HSA and in all cases if an account is not
open by December 1 of the current year, no payroll contributions or incentives can be paid.
Once April 15 of the following year has passed, no payments for the prior year are available
according to IRS regulations.
These incentive payments as well as the employee pre-tax contributions into the Health
Savings Account can only be made into the banks affiliated with the health plans.
If the employee is enrolled in United Healthcare, the bank is Optum Bank. If the employee is
enrolled in Anthem, the bank is BenefitWallet.
http://www.myactivehealth.com/sabichttp://www.myactivehealth.com/sabic
9
Who is eligible for an HSA? Any individual that:
• Is covered by a high deductible health plan
• Is NOT covered by other health insurance
• Is NOT enrolled in Medicare
• Cannot be claimed as a dependent on someone else’s tax return
• Dependent children cannot establish their own HAS
There is no income limits on who may contribute to an HSA.
The employee owns the account. The Health Savings Account is portable – if employee
leaves or retires, the account goes with the employee and money that is in the account
belongs to the employee.
You can withdraw funds for non-healthcare related reason at age 65 with no tax penalty. Tax
applies to funds once withdrawn after age 65. You can continue to use funds to pay health
care expenses past age 65 with no penalty.
For additional information on Taxes and an HSA, you should consult with a Tax Advisor and
review information at the IRS website (www.irs.gov).
How to Open a Health Savings Account (HSA)
Once you have enrolled in the SABIC Plan for Health, you can open your Health Savings
Account. Usually you can enroll within 2 weeks of completing the enrollment actions on the
SABIC Total Rewards website (www.benefits.sabic-ip.com). For information on how to open
a Health Savings Account (HSA), see below.
Anthem and CDPHP affiliated with MyBenefitWallet (formerly Mellon Bank)
• Use link at www.mybenefitwallet.com
• First Name, Last Name, last 4 digits of SSN, date of birth, and zip code
• Must match what is on Enrollment System
UHC affiliated with Optum Bank
• Use link at www.myuhc.com once you have registered; or
• Use link at www.optumbank.com
• Account #729704
Meet Your Annual Deductible
The annual deductible amount varies depending upon whether you elect SABIC Plan for
Health Option A or B, the coverage level you choose and whether you use in-network or out-
of-network providers. You can use your HSA to pay for expenses that count towards
satisfying your deductible.
http://www.irs.gov/http://www.benefits.sabic-ip.com/http://www.mybenefitwallet.com/http://www.optumbank.com/
10
Coinsurance Phase
After meeting the individual (and/or family) deductible, the plan (company) pays 80%, you
pay 20% for in-network services for Option A. For Option B once the deductible has been
met, the plan (company) pays 60%; you pay 40% for in-network services. The plan
(company) pays 60% and you pay 40% for out-of-network services in both Option A and B.
The balance is then billed to you and you can use your HSA funds to pay this amount
Out-of-Pocket Maximum
Once the out-of-pocket maximum is met, SABIC pays 100%. This “safety net” guards you
against high or unexpected medical costs by limiting the amount you pay for medical
services each year. For example, if you chose Individual coverage under SABIC Plan for
Health Option A, and you paid a total of $4,350 on eligible in-network expenses, the
company would begin paying 100% of your eligible expenses for the rest of the year.
Expenses that count toward your deductible and were paid by your HSA count toward
reaching your out-of-pocket maximum so you won’t have to spend $4,350 of your own
money.
In both SABIC Plan for Health Option A and B for family coverage, there is a maximum out
of pocket amount of $6,850 for in network services. Once an individual in a family plan has
paid $6,850 in network services, the company will pay 100% of in network services for that
individual. The remaining family members would pay coinsurance amounts (Option A – 20%,
Option B – 40%) until the total family out of pocket amount was met.
Medical Plan Administration
The Medical Plan is serviced by a group health administrator based on the state in which you
live. Refer to the chart on page 10 for a detailed state-by-state listing.
Health Plan Administrator
The following chart shows the medical plan administrator by the state in which you reside.
State
Health Care
Preferred
SABIC Plan for
Health
(Option A and B) AL and WV United Healthcare (UHC) Anthem
AK, AZ, AR, CA, CO, CT, DE, DC, FL, GA, HI, ID,
IA, KS,KY, LA,ME, MD, MN, MS, MO, MT, NE, NV, NH, NJ, NM, ND, OK, OR, RI, SC, SD, TN, TX,
UT, VT, VA, WA, WI, WY
UHC UHC
IL, IN, MA, MI, NC Anthem Anthem
NY Albany NY area - CDPHP
NYC area - UHC All other NY - Anthem
Albany NY area –
Anthem and CDPHP NYC area - UHC All other NY - Anthem
11
State
Health Care
Preferred
SABIC Plan for
Health
(Option A and B) OH UHC WV Border -
Washington, Athens, Meigs County OH -
Anthem All other OHIO - UHC
PA UHC Anthem or UHC
Please visit the respective plan administrator websites for more information:
www.myuhc.com (Choice Plus Network)
www.anthem.com (National PPO Network)
www.cdphp.com (ASO – Self-insured)
www.express-scripts.com
Enrollment Tip: Use the SABIC Your Total Rewards Website Tools!
Make informed elections—use the tools on the SABIC Your Total Rewards Website to
compare the benefits available under each medical plan. Use the following chart for an overview of your SABIC Medical Plan options.
http://www.myuhc.com/http://www.anthem.com/http://www.cdphp.com/http://www.express-scripts.com/
12
Your SABIC Medical Plan Options at a Glance
Medical Plan Comparison Chart
Following is a comparison of SABIC medical plan options. You may also view a plan comparison on the SABIC Benefits Website at www.benefits.sabic-ip.com.
SABIC Health Care Preferred SABIC Plan for Health with HSA
PPO Consumer Directed
In-Network Out-of-Network In-Network Out-of-Network
Care must be
performed or
authorized by your
primary care
physician or
benefits
administrator, as
required
Benefits are paid
up to reasonable,
necessary and
customary
amounts
Benefits are paid
up to reasonable,
necessary and
customary
amounts
General Information
Medical Plan Annual Deductible
No carryover
deductible
In and Out of
Network Deductible
Amounts are
separate
Individual Annual Deductible on all services except preventive and
pharmacy is $300 Family (2 or more) Annual Deductible
on all services except preventive and pharmacy is
$600
Individual Out of Network Annual Deductible on all services $1,000.
Family (2 or more) Annual Deductible
on all services $2,000.
Option A
Deductible Individual: $1,300 2 or more: $2,600
Medical and Pharmacy combined
Out of Pocket
Individual: $4,350 Individual in a family plan - $6,850, total
family $7,900 2 or more considered
family and OOP Includes deductible
Option A
Deductible Individual: $2,700 2 or more: $4,800
Medical and Pharmacy combined
Out of Pocket
Individual: $8,700 2 or more: $15,800 Includes deductible
Maximum Out-of-Pocket
In and out of Network Out of Pocket Amounts are separate
Medical Annual Out- of- Pocket Individual
$3,700 Family $7,400 (Includes
Deductible and co-pays) Pharmacy
$2,250 per member up to $4,500 per
family
Includes Deductible
Annual Out-of-Pocket Individual $7,500 / Family
$15,000
Other Plan Option Offered
NO Yes, Option B
Option B Components
Does Not Apply Option B all components the same except Deductible and coinsurance
Differences for Option B
Does Not Apply Option B Deductible
Individual: $4,000 - $4,500
2 or more: $6,850 Medical and
Pharmacy combined. Coinsurance would
Option B Deductible
Individual: $4,000 - $4,500
2 or more: $8,000 - $9,000
Medical and
http://www.benefits.sabic-ip.com/
13
SABIC Health Care Preferred SABIC Plan for Health with HSA
PPO Consumer Directed
In-Network Out-of-Network In-Network Out-of-Network
be at 100% after deductible met for an
individual.
Out of Pocket
Individual: $4,000 -$4,500
Individual in a family plan (2 or more):
$6,850. Total family OOP is $8,000 - $9,000. Once 1
individual in family has met deductible,
other family members pay 40% coinsurance until Total OOP is met.
Pharmacy combined
Out of Pocket
Individual: $11,000 2 or more $18,000 Includes deductible
Fee Schedule Contracted rates for network providers/facilities; Out-of-Network
providers/facilities reasonable and customary amounts apply
Contracted rates for network providers/facilities; Out-of-network
providers/facilities reasonable and customary amounts apply
Claims Filing Limit You must submit claims by June 30th for expenses incurred during previous calendar
year
You must submit claims by June 30th for expenses incurred during previous calendar
year
Secondary Coverage Payments
Maintenance of Benefits rules apply HSA rules drive maintenance of benefits
Contributions Higher per pay period contributions based on Wage Band and Family Size
Option A less than HCP – Option B is $0
Option A is according to Wage Band and Family Size Tier
Health Savings Account
Does Not Apply 2017 maximum Amounts permitted by IRS 1 person - $3400
2 or more persons - $6,750 55+ catch up - $1,000
Incentives for well and sick for initial enrollments to total no more than $650
individual and $1,300 family
HSA-eligible expenses will only be applied against available HSA account balance if
employee elects to use account
Incentive amounts apply to over age 18
Health Savings Account Company Contribution Amount
Does Not Apply Automatic $500 Individual to open account, up to $650 with incentives—Individual
Automatic $1,000 to open account, up to $1,300 with incentives—Family
Existing HSA participants will also receive initial $500/$1,000 contribution
Wellness Incentives and Initiatives
Payroll Contribution Reductions - $150 Employee / $150 dependent over the age of
18. Wellness Incentive actions must be
Health Savings Account -- $150 Employee / $150 dependent over the age of 18.
Wellness Incentive actions must be complete
14
SABIC Health Care Preferred SABIC Plan for Health with HSA
PPO Consumer Directed
In-Network Out-of-Network In-Network Out-of-Network
See Incentive details on page 7 & 8
complete to earn reduction in payroll contribution. Incentive payments require
completion of the Health Assessment on the ActiveHealth website
(www.myactivehealth.com/sabic) .Actions must be completed by December 31, 2017. Payments will be made no later than April 1,
2018.
to earn deposit in HSA affiliated with health plan. Incentive payments require completion
of the Health Assessment on the ActiveHealth website
(www.myactivehealth.com/sabic) .Actions must be completed by December 31, 2017. Payments will be made no later than April 1,
2018.
Flexible Spending Account (SPFH Limited Purpose Only)
Up to $2,550 annually to be used for Medical, Pharmacy, Vision, Dental and other OTC as allowed by IRS regulations; Medical Claims automatically fed to vendor for FSA
Limited FSA account up to $2,550 annually to be used for Vision, Dental and other OTC
as allowed by IRS regulations; Not to be used for medical or pharmacy co-pays,
coinsurance or deductibles
Lifetime Maximum N/A N/A
Cancer screenings 100% coverage,
no deductible
80% coverage,
after deductible
100% coverage,
no deductible
60% coverage,
no deductible
Centers of Excellence – For
organ transplants and other highly specialized procedures. Refer to the health plan administrator for specific requirements for Bariatric Surgery and Spine and Back surgeries.
If you accept treatment at a recommended Center of Excellence, the plan covers eligible hospital expenses. It also covers reasonable expenses for lodging, transportation for the patient and one member of the patient’s immediate family, provided the travel is approved in advance by the benefits administrator
Approval by Benefits Administrator
required
100% Coverage, after deductible
T & L guidelines – up to $10,000 lifetime
per covered individual or 12 months from the
surgery date
Not applicable Approval by Benefits Administrator
required
100% coverage, after deductible.
T& L guidelines – up to $10,000 lifetime
per covered individual or 12 months from the
surgery date
Not covered; See hospital, physician
and surgery benefits
Chemotherapy and radiation therapy
100% coverage
after deductible
80% coverage,
after deductible
80% coverage
after deductible*
80% coverage,
after deductible
Spinal Manipulations – up to 15 visits in a
calendar year
100% coverage,
after deductible with a $25 co-pay for
80% coverage,
after deductible
80% coverage
after deductible*
60% coverage,
after deductible
http://www.myactivehealth.com/sabichttp://www.myactivehealth.com/sabic
15
SABIC Health Care Preferred SABIC Plan for Health with HSA
PPO Consumer Directed
In-Network Out-of-Network In-Network Out-of-Network
(network and out-of-network combined), when necessary to treat a medical condition and when performed by a licensed chiropractor
each office visit/treatment
session
Dental Plan Services
Not Covered; Carve Out Vendor METLIFE Not Covered; Carve Out Vendor METLIFE
Diagnostic imaging procedures – such
as X-rays and EKGs used to diagnose an illness or injury
100% coverage
after deductible
80% coverage,
after deductible
80% coverage
after deductible*
60% coverage
after deductible
Diagnostic laboratory procedures – such
as blood and urine tests used to diagnose an illness or injury
100% coverage
after deductible
80% coverage,
after deductible
80% coverage
after deductible*
60% coverage,
after deductible
Dialysis – services
provided for end-stage renal dialysis in your home or at a facility
100% coverage
after deductible
80% coverage,
after deductible Advance approval
is required by benefits
administrator or benefits will not be
paid
80% coverage
after deductible*
60% coverage,
after deductible Advance approval
is required by benefits
administrator or benefits will not be
paid
Extended care facilities –
semiprivate room and board, special services, prescription drugs and medical supplies in a facility that provides 24-hour skilled nursing care, for up to 120 continuous days, when the stay is for convalescent care that requires medical supervision and skilled nursing services and when ordered by a physician
100% coverage,
after deductible
80% coverage,
after deductible Advance approval
is required by benefits
administrator; otherwise, benefits will be reduced by
half, up to a maximum of $1,000
80% coverage
after deductible*
60% coverage,
after your deductible Advance approval
is required by benefits
administrator or benefits will not be
paid
Home health care –
when services are performed by a home health care agency and the treatment
100% coverage
after deductible
80% coverage,
after deductible
Advance approval is required by
80% coverage
after deductible*
60% coverage,
after deductible
Benefits administrator
16
SABIC Health Care Preferred SABIC Plan for Health with HSA
PPO Consumer Directed
In-Network Out-of-Network In-Network Out-of-Network
program is approved in advance by the benefits administrator
benefits administrator or
benefits will not be paid
requires advance approval or
benefits will not be paid.
Office Visits
$15 copay after deductible met for
Primary Care Physician visits and Mental Health visits
$25 visit for OB/GYN, P.T., O.T., other rehab visits at
an office visit
$30 copay after deductible met for Specialists Visits
80% coverage after deductible
80% coverage after deductible
60% coverage after deductible
Inpatient Hospital $300 copay after deductible
80% coverage after deductible
80% coverage after deductible
60% coverage after deductible
Outpatient Hospital $100 copay after deductible
80% coverage after deductible
80% coverage after deductible
60% coverage after deductible
*Option B once deductible is met for an individual plan pays 100% for network-level services. Plan B if total OOP is not met for entire family, after $6,850 paid for 1 individual, plan pays at 60%, member pays 40%.
SABIC Plan for Health Option A and B Mental Health/Substance Abuse – CDPHP, UHC or Anthem
When you enroll in a SABIC Medical Plan, you automatically receive Mental Health/Substance
Abuse coverage. This coverage provides access to a network of psychiatrists, psychologists,
certified addiction counselors, social workers, hospitals and treatment centers to treat the
mental health and substance abuse issues of employees and their families.
For SABIC Plan for Health Option A & B, the health plan administrator – Anthem, CDPHP or
UHC administers the Mental Health/Substance Abuse programs. The participating network
can be found at your medical plan administrator’s website – www.anthem.com,
www.cdphp.com or www.myuhc.com . Authorization for network care is not necessary,
however only medically necessary services will be covered. It is recommended that the
employee /dependent call the health plan administrator at the number on the Medical ID
Card prior to receiving all services. The chart above is also the benefit level for Mental
Health/ Substance Abuse services for inpatient and outpatient services.
http://www.anthem.com/http://www.cdphp.com/http://www.myuhc.com/
17
2017 SABIC Plan for Health Option A & B
Option A Option B
In-Network
Deductible
$1,300 indiv / $2,600
family
$4,000 or $4,500 indiv
$6,850 family
EE Coinsurance 20% 40%
OOP Max (includes
deductible)
$4,350 indiv / $6,850 for
an indiv in a family plan,
Total for family is $7,900
$4,000 or $4,500 indiv
$6,850 maximum OOP for
an indiv in a family plan,
total for family is $8,000 or
$9,000
Preventive Care 100% covered, no ded 100% covered, no ded
Out-of-Network
Deductible
$2,700 indiv / $4,800
family
$4,000 or $4,500 indiv
$8,000 or $9,000 family
EE Coinsurance 40% 40%
OOP Max (includes
deductible)
$8,700 indiv / $15,800
family
$11,000 indiv / $18,000
family
Preventive Care 60% covered, no ded 60% covered, no ded
HSA Maximum Contribution
$3,400 indiv / $6,750 fam
55+ additional $1,000
$3,400 indiv / $6,750 fam
55+ additional $1,000
Incentives for Electing SABIC Plan for Health
When you elect the SABIC Plan for Health, you will receive an incentive in your Health
Savings Account for Plan Year 2017 if your account is active. This money will be
deposited into your Health Savings Account approximately 45 days after you have
enrolled if your account is open. This money is your money to use or save.
You are eligible for Wellness incentives throughout the year, once you (and your
spouse or dependent over the age of 18) have completed the Wellness Incentive
Requirements described earlier in this document.
The Wellness Incentive Actions can be completed on the ActiveHealth website –
www.myactivehealth.com/sabic .
Individual enrollees can earn up to $650 and Families can earn up to $1300 in Plan
Year 2017 to be deposited into their Health Savings Account (HSA).
http://www.myactivehealth.com/sabic
18
Coverage Category Employee Action Incentive Amount to
be Deposited into
Your HSA if eligible
prior to December 1
Single (1) Enroll in SABIC Plan
for Health
$500
Family *(2 or more) Enroll in SABIC Plan
for Health
$1,000
Single (1) Complete Annual
Physical & HA on
ActiveHealth Site
$150
Family *(2 or more) Complete Annual
Physical & HA on
ActiveHealth Site
$300
Total Incentive for
Single (1)
Complete All
Incentives Available
$650
Total Incentive for
Family *(2 or more)
Complete All
Incentives Available
$1,000
*2 or more applies to Adults only over the age of 18. In order to receive the maximum
amount for Family Incentives – 2 Adult members must complete the requirement.
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2017 Health Care Preferred Plan Design
2017 Plan Design Deductible / Co-pay
Amount for In Network
Care
Deductible / Coinsurance
Amount for Out of Network
Care
Deductibles $300 Individual / $600
Family
$1,000 Individual / $2,000
Family
PCP Visit $15 co-pay, after ded 80% Reasonable and Customary
Amount after ded
Mental Health /
Substance Abuse Visit
$15 co-pay, after ded 80% Reasonable and Customary
Amount after ded
OB/GYN Visit $25 co-pay, after ded 80% Reasonable and Customary
Amount after ded
Chiropractic Visit $25 co –pay, after ded 80% Reasonable and Customary
Amount after ded
Urgent Care Visit $30 co-pay, after ded 80% Reasonable and Customary
Amount after ded
Specialist Visit $30 co-pay, after ded 80% Reasonable and Customary
Amount after ded
ER Visit $100 co-pay, after ded 80% Reasonable and Customary
Amount after ded
MRI, CT & PET Scan $100 co-pay, after ded 80% Reasonable and Customary
Amount after ded
Outpatient Surgery $100 co-pay, after ded 80% Reasonable and Customary
Amount after ded
Inpatient Hospital Visit $300 co-pay, after ded 80% Reasonable and Customary
Amount after ded
Preventive Care $0 co-pay 80% Reasonable and Customary
Amount after ded
20
Health Care Preferred Mental Health/Substance Abuse – Beacon Health
When you enroll in a SABIC Medical Plan, you automatically receive Mental Health/Substance
Abuse coverage. This coverage provides access to a network of psychiatrists, psychologists,
certified addiction counselors, social workers, hospitals and treatment centers to treat the
mental health and substance abuse issues of employees and their families.
For Health Care Preferred participants, Beacon Health Options administer Mental
Health/Substance Abuse programs. The participating network can be found at
www.achievesolutions.net/sabic. Authorization for network care is not necessary, however
only medically necessary services will be covered. It is recommended that the employee
/dependent call Beacon Health at 1-877-339-6152 prior to receiving all services. The chart
above is also the copay amounts for Mental Health/ Substance Abuse services for inpatient
and outpatient services.
Wellness Incentive Plan for Health Care Preferred
For all active employees enrolled in Health Care Preferred for plan year 2017, the wellness
incentive plan is available to them. This is a voluntary program.
To receive the reduction in payroll contributions, an employee / dependent, must complete
the Health Assessment on the ActiveHealth website (www.myactivehealth.com/sabic) and
complete the other requirements as described on Page 7 & 8 of this document. Actions
must be complete by December 31, 2017 for any reimbursement to occur. If both actions
are reported to the Benefits Team prior to April 1, 2018, the incentive can be paid out for
plan year 2017. There will be no incentive payments for the prior year after April 15.
Prescription Drug Coverage
You automatically receive prescription drug coverage through Express Scripts, Inc. when you
enroll in a SABIC Medical Plan.
The following chart shows how prescription drugs are paid for if you are enrolled in SABIC
Health Care Preferred.
Express Scripts Network Services ONLY
Retail (up to 30 day supply)
Mail Order (up to 90 day supply)
Out of Pocket Maximum (indiv/family)
Generic $15 $22 $2,250/$4,500
Preferred Brand $30 $65 $2,250/$4,500
Non Preferred Brand $50 $125 $2,250/$4,500
If cost of drug is less than copay then cost is charged, once Out of Pocket is met, coverage is paid at 100%. No out of network coverage available. If lowest cost drug not purchased, employee must pay cost difference plus copay. Routine maintenance drugs are offered exclusively by mail order.
Note: Copay applies for preventive drugs under SABIC Plan for Health – Option A & B. See
next slide for preventive drug list.
http://www.achievesolutions.net/sabichttp://www.myactivehealth.com/sabic
21
Preventive Drug List for SABIC Plan for Health with Examples of drug names
Drug Classification examples where co-pay applies, no deductible
HCP Pharmacy co-pays apply for preventive drugs.
If you are not sure what drug classification you are taking, check with your pharmacy. These
examples are the drug classifications that are considered preventive. In most cases, generic
drugs only are covered at low or no cost copay. Routine maintenance drugs must be
purchased through the mail order program.
Prenatal, Geriatric and Pediatric vitamins
Weight-loss agents
Fluoride preparation
Disulfiram (alcoholism treatment)
Oral contraceptives
Intravaginal/Implantable Contraceptives
Diaphragms/Cervical Caps
Lipid-/cholesterol-lowering agents
Proton pump inhibitors – change to “Anti-Ulcer Medications”
Antihypertensives (high blood pressure)
Agents for osteoporosis
Erythroid and Myeloid stimulants (used to treat certain leukemia cases)
Antiplatelet drugs - Aggrenox, Plavix
Aromatase inhibitors (used to treat some breast and ovarian cancers)
Diabetic Agents
Vaccines
Anti-Malarial Drugs
Identification Cards
You will receive separate Medical Plan and Prescription Drug Identification Cards.
Employee Assistance
All employees have access to the Employee Assistance Program (EAP). These services
include personal, confidential assessments and counseling and referral services to help
employees and their families cope with a variety of concerns, such as stress, marital and
family conflicts and depression. Beacon Health Options administer the EAP and WorkLife
programs. To see what resources are available under Beacon Health Options and to check
for participating providers go to www.achievesolutions.net/sabic (1-877-339-6152). You can
also call the SABIC Benefits Service Center at 1-877-722-4287. Throughout the year, you
can view on line services and webinars on various topics by going to
www.achievesolutions.net/sabic.
My Wellness Program by ActiveHealth
MyWellness Program is available to all employees and their covered dependents. You are
automatically enrolled in the program and have access to the website
(www.myactivehealth.com/sabic ). My Wellness is a benefit offered by SABIC in partnership
with ActiveHealth that helps you identify specific ways to improve your health and live a
healthier lifestyle.
http://www.achievesolutions.net/sabichttp://www.myactivehealth.com/sabic
22
The MyWellness Program by ActiveHealth will alert you and your doctor of possible issues
that may affect your health. In addition, by using the tools offered through this program,
you will be able to track your exercise activity, nutrition intake, and setup reminders of
doctor appointments and annual physicals. We encourage you to take on a greater interest
in your own health and ensure that you are on your way to a healthier lifestyle.
All of the information you share on the MyWellness Program website is completely secure
and confidential. You can choose to share this information with your personal physician, but
SABIC will never see any of your personal health information.
ActiveHealth will call you and eligible dependents directly if you have a condition that is
covered under this program. You are encouraged to participate with this program for your
wellbeing. This program is voluntary.
Take advantage of this tremendous benefit and either get started, or continue taking the
steps towards living a healthy lifestyle. For more information, go to the website
www.myactivehealth.com/sabic .
https://was9.hewitt.com/ytr/US05320/epc/jump_ActiveHealth.htmhttp://www.myactivehealth.com/sabic
23
SABIC Dental Plan Benefits
There are two Dental Plans—the Basic Dental Plan and the Premium Dental Plan. MetLife
administers both plans and employees must either actively select or waive this coverage. To
view participating dentists in your area, you can log onto
www.mybenefits.metlife.com/MyBenefits. You will receive a dental card when you are
enrolled in dental coverage. When using the benefits, inform your dentist to bill MetLife
using your ID number from the ID card.
Dental Plan Design The Basic Dental Plan features a coinsurance design. The coinsurance plan differentiates
between in - and out-of-network benefits. This means that reimbursements are based on a
pre-determined coinsurance level—that is, a percentage of the covered expenses you incur.
Under both Dental Plans, preventive care reimbursement is covered at 100% in-network.
If you or your dependents anticipate needing a higher level of dental care coverage, you
may want to consider purchasing the Premium Dental Plan to obtain a higher level of
coverage for major restorative dental care.
You do not have to select the same coverage category for medical, dental and
vision coverage.
Your SABIC Dental Plan Benefits
Premium Dental Plan Basic Dental Plan
Service In-Network Out-of-Network In-Network Out-of-Network
Basis of Reimbursement
Negotiated PDP** fee
90% of R&C* Negotiated PDP** fee
90% of R&C*
Type A—Preventive (e.g., cleanings)
100% 100% 100% 90%
Type B—Basic (e.g., fillings)
80% 80% 70% 70%
Type C—Major (e.g., crowns, implants)
50% Includes implants
50% Includes implants
40% Includes implants
40% Includes implants
Type D—Orthodontia (child and adult)
50% 50% 40% 40%
Individual Deductible (Annual)
$0 $0 $0 $0
Family Deductible (annual)
$0 $0 $0 $0
Calendar-Year Max $2,500 $2,500 $1,250 $1,250
Lifetime Ortho Max 50% up to $2,500 50% up to $2,500 40% up to $2,500 40% up to $2,500
* Reasonable and customary. **PDP – Preferred Dental Provider.
http://www.mybenefits.metlife.com/MyBenefits
24
SABIC Vision Plan Benefits
You have access to two Vision Plan options—the Basic Vision Plan and the Premium Vision
Plan. Davis Vision administers both Vision Plans. When you enroll in a SABIC Medical Plan,
you will not automatically receive Vision coverage. To view participating providers you can
log on to www.davisvision.com. You will receive an ID card when enrolled in the Vision
plan. Ask your provider to bill Davis Vision using your ID number from your card.
You do not have to select the same coverage category for medical, dental and
vision coverage.
http://www.davisvision.com/
25
The following table provides an overview of some of the covered services and the benefits
provided under both options.
Service Basic Vision Plan Premium Vision Plan
Eye examination, frames and spectacle
lenses, or contact lenses (in lieu of
eyeglasses – regular fashion frames or
safety glasses)
Covered once every
12 months with a $10
copay
Covered once every
12 months
Benefits for Selected Services
Frames
In-network retail allowance:
$110
$150
Benefits are also available for fashion, designer and premier frames.
Laser Eye Surgery
The Laser Eye Surgery $1,000 $1,000
benefit is a total lifetime
benefit per participant
Contact Lenses (in lieu of eyeglasses)
Single vision $130 $200
Bifocal $175 $200
Formulary with Fitting/Follow-Up Care
(in lieu of Elective Allowance):
Standard, soft or daily wear $25 copayment Included
Disposable or planned
replacement (when purchased at
one time)
$65 copayment (4 boxes) Included (up to 8 boxes)
Spectacle Lens Options (selected examples): Your Cost for Network Benefits
Double Segment Lenses $0 $0
Quadrifocals $0 $0
Blended Myodisc $0 $0
Mirror Coating $0 $0
Intermediate Vision Lenses $40 $0
Standard Progressive Lenses (PALs)
Digital Progressive Lenses
$75
$150
$0
$140
Premium PALS (Varilux™, etc.) $90 $25
Polarized Lenses $75 $75
Standard Anti-Reflective Coating (ARC) $35 $0
Premium ARC $48 $13
Value-Added Network Features
One-year Breakage Warranty Included Included
Lens 1-2-3! ® Membership Included Included
Laser Vision Discount Program Included plus allowance Included plus allowance
Vision Value Option Included Included
26
Flexible Spending Accounts
Flexible Spending Accounts (FSAs) can help save you money. You can reduce the amount of
income tax you owe by enrolling in the Health Care and/or the Dependent Day Care Flexible
Spending Account (FSA). The maximum amount you can contribute is $2,550 for plan year
2017. If you participate, you can contribute a portion of your pay from each paycheck into a
spending account before taxes are taken, which reduces your taxable income. You can then
use the money in this account to pay for your out-of-pocket health care as you incur them
and/or dependent day care expenses as your balance accrues If you enroll in the SABIC Plan for Health Option A or Option B, there will be an impact on how the FSA is used. Please
see section titled “Limited FSA” for a description of how to use the FSA plan in combination
with the SABIC Plan for Health.
Limited Purpose FSA
If you elect SABIC Plan for Health Option A or B, there will be an impact on your Health
Care Flexible Spending Account (FSA). First, your SABIC Plan for Health HSA will be used to
pay eligible medical, behavioral health and prescription drug expenses. If you have typically
used your FSA funds for payment of prescription drugs and copays, you should now
consider that your HSA funds would pay these expenses before your FSA funds are used.
You should only contribute enough to your FSA to cover vision and dental expenses, as well
as major medical expenses that cannot be paid with your HSA, such as LASIK surgery.
Tips on How to Use the HSA and FSA Together: If you enroll in SABIC Plan for Health
Option A or B and participate in the Health Care FSA, you can use both accounts to pay for
your eligible expenses. Here are some quick tips on how to use the HSA and FSA together:
Do not put too much in your Limited Purpose Health Care FSA. Only contribute what
you are sure you will use. You may not need to contribute as much to your Limited
Purpose Health Care FSA to cover all of your expected health care expenses. Only
Dental and Vision expenses will be eligible for reimbursement under the Limited
Purpose Health Care FSA.
Use the FSA Calculator on www.benefits.sabic-ip.com to determine how much to
contribute.
The HSA, funded by SABIC (and you if you choose to do so), is the first source of
funds for employees and eligible dependents to pay for all eligible medical,
behavioral health and prescription drug expenses. These are the only types of
expenses the HSA can pay.
The Limited Purpose Health Care FSA can be used to pay medical expenses like
dental, vision hardware and LASIK procedures.
How Dependent Day Care FSAs Help You Save
You can use your Dependent Day Care FSA to reimburse yourself for a number of different
expenses, including:
Child care fees
Day care fees for a handicapped dependent
Day care fees for an elderly dependent
27
Timing of Flexible Spending Account Eligible Expenses
The following chart lists the deadlines for incurring
expenses that can be reimbursed from your 2017 FSA
accounts (This information applies regardless of
whether you participate in the regular or limited
purpose health care FSA).
Type of Flexible Spending Account
If you elect to participate in an
FSA in 2017
Health Care FSA
Maximum amount is $2,550 for Plan Year 2017
You have from January 1, 2017
through December 31, 2017 to incur
eligible expenses for the 2017 plan
year.
Dependent Day Care FSA
Maximum amount is $5,000 unless a highly
compensated individual – limit is $2,500
according to IRS rules
You have from January 1, 2017
through December 31, 2017 to incur
eligible expenses for the 2017 plan
year.
Important FSA Information: If you want to participate in either the Health Care or
Dependent Day Care FSA in 2017, you MUST enroll within 63 days of your hire date. In
2017, you may contribute from $100 to $2,550 in the Health Care FSA. You can contribute
from $100 to $5,000 in the Dependent Day Care FSA if you file a joint tax return or $2,500
if you and your spouse file separate returns. Special rules apply if your spouse is disabled or
a full-time student or if the IRS considers you to be highly compensated. Highly
compensated employees (HCE) may be reduced mid-year due to IRS rules. 2017 HCEs will
be reduced to $2,500.00 at enrollment. Please consult with your tax advisor to determine
how these rules apply to your situation.
Calculate and Estimate Your FSA Deductions and Savings The annual amount you
contribute to one or both FSAs will be deducted from your paycheck in equal installments
during the year. You can estimate your FSA contributions, view your FSA account, and sign
up for direct deposit of your FSA reimbursement checks online at the Your Total Rewards
Website (www.benefits.sabic-ip.com).
Use the tools available on www.benefits.sabic-ip.com to estimate and view potential tax
savings when participating in a Flexible Spending Account. You can find these tools under
the link for Your Flexible Spending Account. Additional information can be found at
http://www.irs.gov.
If you are enrolling or making changes in December, you may be limited to the amount you
are allowed to select due to plan-year elections for remaining payroll checks.
http://www.benefits.sabic-ip.com/
28
SABIC provides Basic Life Insurance and Accidental Death and Dismemberment (AD&D)
coverage administered by MetLife that protects your loved ones financially in the event of
your death. The company pays this coverage in full.
Your Basic Life and AD&D Coverages
Basic Life Insurance
SABIC provides Basic Life Insurance equal to 2.5 X eligible pay. You have the option
to elect only $50,000 of coverage to avoid imputed income. The benefit maximum is
capped at $4.5 million.
MetLife Will Preparation Services- All employees enrolled in the Basic Life Plan will have access to Will Preparation Services. Participating plan attorney’s fees for the
preparation of wills for employees and their spouses are fully covered. Call the Hyatt
Legal Client Service Center at 800-821-6400 Monday through Friday 8 a.m. to 7 p.m.
EST to get started. Please use the following group number for SABIC –
Group#123227.
Basic Accidental Death & Dismemberment (AD&D)
The company-paid AD&D benefit for all employees is 1.5 X eligible pay. The benefit
maximum is capped at $1.5 million.
A Plus Enhanced Supplemental Life
The plans outlined on this page are also administered by MetLife and allow you to purchase
additional financial protection for you and your dependents.
Supplemental Life
The A Plus Enhanced Life Insurance plan is a group term life product with these features:
You can elect coverage of up to 10 X your eligible pay or a total of $6.5 million (when
combined with your Basic Life coverage).
As a new hire (elections must be made within 63 days from your hire date), medical
Evidence of Insurability (MEOI) will be required if you are electing total coverage exceeding
the lesser of 3 X eligible pay or $500,000. Until your MEOI is approved, you will be covered
only at the guaranteed issue amount.
See the next page for a complete definition of MEOI.
Dependent Life
You may elect to purchase coverage for your eligible dependents:
The benefit range is from $5,000 to $250,000 for your spouse—the available coverage
increments are listed on the SABIC Your Total Rewards Website. As a new hire, (elections
must be made within 63 days from your hire date), MEOI is required if you are electing
spouse life coverage greater than $25,000.
Life Insurance and AD&D
29
The benefit range is from $1,000 to $10,000 per child (no MEOI required).
You do not need to choose Supplemental Life Insurance for yourself in order to choose this
coverage for your family members. You can “mix and match” coverage amounts and your
choice for spouse coverage is separate from your choice for child coverage.
Voluntary AD&D
You can elect coverage of up to 5 X eligible pay (up to a $3.5 million maximum) for
yourself:
Under the Voluntary AD&D plan, you may choose coverage for yourself only or extend
coverage to your family (spouse and children). If you elect to extend coverage to your
family, your spouse is automatically covered at 50% of your coverage amount and your
child (ren) automatically is (are) covered at 20% of your coverage amount.
For example, assume your eligible pay is $60,000 and you elect 1 X eligible pay for yourself
and choose family coverage. In this example, your spouse is covered for $30,000 and each
of your children is covered for $12,000. In the event your spouse or child (ren) dies
accidentally, the benefit would be paid to you.
Medical Evidence of Insurability (MEOI) Process
MEOI may be required for some of your elections.
As part of your election process, the MEOI form will be available online. Based on your
response, MetLife may require you to undergo a medical examination.
If MEOI applies to you, the hard-copy Confirmation Statement you receive after you enroll
will also include an MEOI form. Please be sure to complete and return your MEOI form to
the MetLife address shown on the form. Alternatively, you may fax your completed MEOI
form to MetLife at 1-859-225-7909. If you do not return the form within 90 days or if your
form is denied, you will receive the minimum coverage available without providing MEOI.
If you have specific questions related to this process, you may call the SABIC Benefits
Service Center at 1-877-SABIC US (1-877-722-4287).
The Cost of Life and AD&D Coverage
You will find extensive cost and rate tables for both employee and dependent coverages in
the Appendix of this Enrollment Guide.
Long-Term Disability
Long-Term Disability (LTD) provides important income protection in the event you are
unable to work because of an illness, injury or other serious medical condition. LTD is
designed to provide you with income after your Salary Continuation Plan benefits have been
exhausted. You pay the full cost of this coverage on an after-tax basis. Medical Evidence of
Insurability is not required for new elections performed within 63 days of your date of hire.
The LTD plan provides monthly income of 50%, 60% or 70% of your eligible pay. In your
first six months of disability, the Salary Continuation Plan provides income replacement. If
after six months your condition meets the definition of disability under the LTD plan, you
will begin to receive LTD benefits.
30
While on LTD, you may remain eligible for other benefit coverages for up to a
maximum of 12 months from date of disability (up to a maximum of 18 months
from date of disability if a worker’s compensation injury).
Salary Continuation Plan
The Company automatically provides the Salary Continuation Plan for salaried employees.
This plan offers limited financial protection due to an illness, injury or other serious medical
condition. The Salary Continuation Plan has two components:
Personal Illness Payments
You can continue to receive 100% of your pay during a brief illness for up to 20 days in a
rolling 12-month period, subject to your manager’s approval.
Extended Illness Payments
Exempt Employees – May be eligible for payments up to 100% of their pay for 26 weeks.
Non-Exempt Employees – May be eligible for payments up to 100% of their pay for the first
13 weeks, and up to 60% pay for the next 13 weeks.
Long-Term Care
Effective for new participant elections as of 1/1/17:
Under the voluntary SABIC Long-Term Care Plan, you have the following coverage options:
$3,000, $4,500 or $6,000 a month. You also may choose between 2, 3 or 4-year options.
Long-Term Care is available to you and your eligible family members (spouse, parents and
parents-in-law) to help pay expenses in the event of a long-term or chronic illness that
prevents individuals from caring for themselves.
Long-Term Care premiums are determined by the participant’s age at enrollment. Employee
and spouse contributions are paid directly to the administrator—Genworth Life Insurance.
The younger you are when you elect coverage, the lower your cost.
If you elect coverage within 60 days of your hire date, are an actively at work full time
employee and under age 66, you can apply with streamlined short form medical
underwriting. If you are age 66 or older or if you apply any time after your first 60 days,
you will need to go through the long form for medical underwriting.
Long-Term Care options will not be shown on the SABIC Your Total Rewards Website. If you
are interested in learning more about your options or electing to participate, you will need
to contact Genworth Life Insurance directly to request a quote.
Be sure to evaluate your options and follow Genworth’s administrative processes for billing
to ensure you have the coverage you need.
To get more details about this coverage, including sample premiums for you, your spouse
and other family members, go to the Genworth website at www.genworth.com/groupltc.
Enter the Group Name/User ID: SABIC and the Access Code: groupltc. Or, if you prefer, you
can call the Group Long-Term Care Insurance Customer Service Center at 1-800-416-3624.
Anyone already enrolled in Long Term Care coverage prior to 1/1/17 will not be impacted by
the above changes.
http://www.genworth.com/groupltc
31
SABIC U.S. Employee Retirement Savings Plan
Retirement Benefits What do you want to do when you retire? Whatever your goals are, the SABIC U.S.
Employee Retirement Savings Plan, which includes both a contributory and non-contributory
component, is a powerful tool to help you save for the future.
U.S. Employee Retirement Savings Plan (the “Savings Plan”) The Savings Plan can help you save for the future. Valuable tax benefits and two types of
company contributions work together with your own savings to help bring you closer to your
financial goals.
You will be eligible to participate in the Savings Plan immediately when you join the
company. Note that, due to the plan’s automatic enrollment feature, if you do not make an
active election to participate in the Plan within 30 days of your hire date, you will be
automatically enrolled to contribute 8% of your pay to the plan unless you either opt out or
enroll on your own within 30 days. Your contributions will be invested in the Alliance
Bernstein Target Retirement Fund (based on age). For more details on the automatic
enrollment feature, please see your 401(k) Enrollment Guide and the special notice that will
be provided as part of your 401(k) new hire enrollment packet (sent separately). Employees
who are automatically enrolled in the plan may change their contribution and investment
elections prospectively at any time.
You can contribute up to the lesser of 80% of your pay up to the 2017 IRS Limit of
$54,000 in pre-tax, Roth 401(k), and post-tax contributions.
The company matches $0.50 for each $1.00 of the first 8% of eligible pay designated
for pre-tax, Roth 401(k), or after-tax contributions that you make to the plan,
helping you reach your savings goals faster. The match is performed on a per pay
period basis, therefore, the sooner you enroll in the Savings Plan, the sooner you will
begin earning the company match.
Pre-tax contributions are limited to the 2017 IRS Limit of $18,000. You are also
eligible to make Roth 401(k) contributions to the plan. The combined total of your
Roth 401(k) and pre-tax contributions is limited to the 2017 IRS Limit of $18,000.
Roth 401(k) contributions are made on a post-tax basis and grow tax-free. Please
note that once you reach the $18,000 Roth 401(k)/Pre-Tax limit, your contributions
will automatically convert to after-tax, so that you can continue receiving the
Company match.
If you’re age 50 or above (or will turn age 50 in the calendar year), you can also
make a catch-up contribution up to the 2017 IRS Limit of $6,000 of combined pre-
tax and Roth 401(k) catch-up contributions. These catch-up contributions are not
taken into account for purposes of the 2017 $54,000 IRS Limit and there is no
Company match on catch-up contributions.
You vest—or earn ownership of—company matching contributions immediately. You
are always 100% vested in your own contributions and their earnings.
You can borrow money from your account and pay yourself back with interest. You
may also be able to withdraw money if you are facing a financial hardship.
Employer Retirement Contribution Account
Whether or not you participate with your own contributions in the Savings Plan to
receive a Company matching contribution, the Company will automatically set up an
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Employer Retirement Contribution Account equal to 5% of your eligible pay each pay
period.
For this account, you vest—or earn ownership of—100% of the Employer Retirement
Contribution Account after 3 years of service with the Company.
Since these non-contributory Company contributions are meant to assist our
employees attain adequate retirement income, the Company has limited the types of
transactions allowed by employees for this account. For example, you cannot borrow
money from your Employer Retirement Contribution Account. Additionally, you
cannot withdraw money from this account if you are facing a financial hardship.
If you leave the company, you can take your vested balance with you and keep it
growing by rolling it over into an individual retirement account.
Should you wish to change your contributions, please call the SABIC Benefits Service
Center at 877-SABIC US and select Retirement.
You are automatically enrolled in the Savings Plan after 31 days, and you must elect to
waive this benefit if you do not desire to participate. Go to the SABIC Your Total Rewards
Website at www.benefits.sabic-ip.com, click on Retirement, then 401(k). The Website
provides information about the basics of saving and investing and in-depth information on
the plan’s investment funds.
You may also call 1-877-SABIC US (1-877-722-4287) and elect the application option for
Retirement, then follow the prompts to speak to a 401(k) Customer Service Representative.
Customer Service Representatives are available Monday through Friday, between 8 a.m.
and 8 p.m. Eastern Time, except Federal holidays.
Your Investment Choices
The company offers two investment portfolios: Core Funds (9 funds) and Lifecycle
Funds (7 funds). Additionally, a self-directed brokerage window account is also
available for the Savings Plan.
Lifecycle Funds
These portfolios are designed to make investing easy. They are set up for you to put 100%
of your contributions and savings in the professionally designed and monitored portfolio that
most closely matches your retirement age. Lifecycle Funds include:
AB Target Retirement 2010
AB Target Retirement 2015
AB Target Retirement 2020
AB Target Retirement 2025
AB Target Retirement 2030
AB Target Retirement 2040
AB Target Retirement 2050
AB Target Retirement 2060
http://www.benefits.sabic-ip.com/
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Core Funds The Core Funds let you create your own investment mix. Following are the available funds
from most conservative to the most aggressive:
Federated U.S. Treasury Cash Reserves Money Market Fund
BlackRock Inflation Protected Bond Fund
NT Aggregate Bond Index Fund
T. Rowe Price U.S. Value Equity Fund
NT S&P 500 Index Fund
Nuveen Winslow Large Cap Growth Fund
NT Extended Equity Market Index Fund
RS Small Cap Value Equity
Dodge & Cox International Stock Fund
Self-Directed Brokerage Window Account Through this account, you may invest in thousands of different mutual funds using the
money that is already in your Retirement Savings Plan. The self-directed brokerage window
feature is not appropriate for everyone. It is designed for plan participants who have a
strong knowledge of the investment marketplace, want greater flexibility to create a more
customized portfolio, and have the ability, time, and desire to personally research and
evaluate different investments. The self-directed brokerage window investment platform is
provided through Hewitt Financial Services, a broker-dealer subsidiary of Hewitt Associates
LLC and member FINRA/SIPC. The Savings Plan does not play any role in selecting or
limiting the mutual funds that Hewitt Financial Services makes available through the self-
directed brokerage window, and neither Hewitt Financial Services, SABIC nor the Savings
Plan endorses or recommends any particular investment offered through the window.
Should you need more information, please visit www.benefits.sabic-ip.com. You can also
access self-directed brokerage window account reference tools and materials by visiting the
Hewitt Financial Services website at www.hewittfs.com.
If you decide to open a self-directed brokerage account, you may then access it in two
ways:
The Internet—Access the Hewitt Financial Services website directly at www.hewittfs.com
from any computer with internet access.
The Telephone—The automated telephone system is available 24 hours a day. You can
also call 1.800.890.3200 to speak with a licensed representative 9:00 a.m. -7:00 p.m. EST
Monday through Friday.
Shortly after your hire date with the Company, you will receive a 401(k) enrollment kit, that
also includes a Self-Directed Brokerage Account brochure, from our 401(k) Administrator
with additional information on how to enroll in this benefit program. Should you wish to
enroll before receiving your 401(k) new hire guide, you can either go online at
www.benefits.sabic-ip.com and elect Retirement from the 401(k) (Your Savings Resources)
section, or you can call 1-877-SABIC US (1-877-722-4287), elect Retirement, and follow
the prompts to speak to a 401(k) Customer Service Representative. Please note that due to
file feed schedules, it may take up to 7 days for your information to be transmitted to the
various carriers.
http://www.benefits.sabic-ip.com/
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Other Benefits
SABIC provides a number of other benefits (at no cost to you) that add value to your life:
Adoption Assistance
Educational Assistance
Educational Loan Program
Layoff Benefits
Leaves of Absence
Service Award Program
Emergency Aid and Family Aid
Will Preparation Assistance
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Enroll Enroll for your 2017 benefits at the Your SABIC Total Rewards Website.
Remember, you are required to actively enroll. You must make active benefit elections
or you will receive default benefits.
Your SABIC Total Rewards Website You will enroll via the Your SABIC Total Rewards Website. The URL is
www.benefits.sabic-ip.com and the site is a one-stop shop for all of your pay and
benefits needs. In addition to having all benefits information in one location, only one
user ID and password is required. Once you are logged in, you will have a
personalized directory of all your benefits information, including Health and Insurance,
Retirement, Your Total Rewards, & more! Below is a screen shot of the first page to
get started as a new user.
Enroll via the Your SABIC Total Rewards Website
All employees must enroll via the Benefits Website at www.benefits.sabic-ip.com or
if you prefer, through a SABIC Benefits Service Representative at 1-877-SABIC-US
(1.877.722.4287). Usually you may enroll within 2 days of your new hire date.
It is easy to enroll via the Benefits Website:
1. Go to www.benefits.sabic-ip.com.
2. Look for the Register as a New User link on the left side of the page.
3. Then enter the last 4 digits of your SSN, DOB and zip code.
4. The screen after you enter the information above asks you to create a user ID
and a password.
First Time user Web Authorization steps:
5. After you create your password and hint, the next step is the security questions.
6. You will be asked to choose 5 security questions before you can access the site
(you must do all 5 questions). This is to protect your personal information.
http://www.benefits.sabic-ip.com/http://www.benefits.sabic-ip.com/http://www.benefits.sabic-ip.com/
36
7. When answering the security questions, please keep the answers simple. (NOTE: Do
not use special characters in your answers)
8. Last step is to register the computer you are using. Please select Yes. If you select not
to register the device, it will result in the user being challenged for additional
authentication on subsequent logon attempts.
9. After you register your computer, you will then see completed successful and can log
on to the site.
10. Once in the site, click on Health & Insurance to be directed to the Your
Benefits Resources website to complete your New Hire elections. There will be a
Red Message alert button and all you need to do is click “Enroll” to begin the
enrollment process.
11. You will first enter the information for any dependents you would like to cover –
keep in mind; you will need to submit the appropriate documentation before
they are covered in benefits.
12. You will now have access to all of your benefits options.
13. Be sure to click through each option, take advantage of the many calculators,
and plan comparison tools available to help you make the best choices for you
and your family.
14. Pay particular attention to medical, dental and vision—there are three medical
plans to consider; and employees who elect a medical plan will NOT
automatically receive dental and vision coverage. You must make a separate
election for both dental and vision.
15. Do not forget active enrollment is required—be sure to make a positive election
for each benefit plan you want.
16. Once you have completed your enrollment you will receive a confirmation that
you should print for your records.
17. If you chose to cover any dependents in your benefits, you will have to submit
qualifying documentation to be approved before they are covered. Information
will be mailed to your home on what documentation is required. However, you
can also print out the forms online by visiting the Home tab and clicking the
Your Action Needed. The Your Action Needed will be viewable; the next time
you visit the Your Benefit Resources Health and Welfare site.
Enroll via the Benefits Service Center If you prefer, you may also enroll via the SABIC Benefits Service Center by calling 1-877-SABIC-US
(1-877-722-4287). Usually you can enroll within 2 days of your new hire date.
If you are already registered or a current user of the www.benefits.sabic-ip.com
Website - all you do is use your current User ID and password.
If you have any issues with your user ID or password, please call the SABIC Benefits
Service Center, 1-877-SABIC-US (1-877-722-4287).
One User ID and Password The Your SABIC Total Rewards Website also gives you the option to change your User ID and
Password. This includes the flexibility of using your current SABIC single sign-on (single sign-on
User ID and Password synchronization will not be performed automatically since some employees
may choose not to use it). To change your User ID and Password, log into the Your SABIC Total
Rewards Website (www.benefits.sabic-ip.com) and click on the ‘Your Security Profile’ link.
http://www.benefits.sabic-ip.com/
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Questions If you have any questions, you may contact the SABIC Benefits Service Center at 1-877-SABIC US
(1-877-722-4287). Customer Service Representatives are available Monday through Friday,
between 8 a.m. and 8 p.m. Eastern Time, except Federal holidays.
On-Going Benefit Enrollment The 63-day enrollment period for new SABIC employees provides employees the opportunity to
make elections to all available benefits for the current year. Many benefits such as Medical, Dental
and Vision Coverage can only be elected or changed during the 63-day Enrollment Period or if you
experience a qualified change in family status. However, there are a number of benefits that can be
elected anytime during the year by accessing the Your SABIC Total Rewards Website
(www.benefits.sabic-ip.com) or by contacting the SABIC Benefits Service Center at 1-877-
SABIC-US (1-877-722-4287). These benefits include:
SABIC U.S. Employee Retirement Savings Plan
SABIC Roth 401(k) Plan
Long Term Care Insurance*
Long Term Disability Insurance*
A+ Enhanced Supplemental Life Insurance*
Dependent Life Insurance for your Child and Spouse*
Voluntary AD&D Insurance
*Medical evidence of insurability (MEOI) acceptable to the insurance carrier will be required. Coverage becomes effective on the date the insurance carrier approves the application. No MEOI is required for Child Dependent Life Insurance.
Other Benefits
Your SABIC Total Rewards (YSTR)
At SABIC, people are our priority. That is why our Company is committed to providing you with
competitive compensation and benefits. Our comprehensive programs help you manage your
health care, prepare for retirement, provide financial protection for your family and deal with
everyday life. This comprehensive program can be thought of as Your SABIC Total Rewards.
Your SABIC Total Rewards offers an individualized summary of the components of your
compensation and benefits to serve as an ongoing reference for you as you plan your current and
future needs.
Safe and Secure
The Your SABIC Total Rewards Website provides a high level of security. Your personal information
is protected by data encryption and a personal password that only you know.
Check it Out
Log on today to see and print your comprehensive personalized pay and benefits statement and
review the value of the investment that SABIC makes in you. You can access Your SABIC Total
Rewards 24 hours a day, 7 days a week, and 365 days a year via the Your SABIC Total Rewards
website at www.benefits.sabic-ip.com from any computer with Internet access.
For assistance with either your User ID or password, please contact the SABIC Benefits Service
Center by calling 1-877-SABIC US (1-877-722-4287) and electing Retirement, then following the
prompts to speak to a 401(k) Customer Service Representative.
http://www.benefits.sabic-ip.com/
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Appendix This section lists the rates that determine your cost for coverage for each plan that requires
contributions. When you log on to the Your SABIC Total Rewards Website
(www.benefits.sabic-ip.com), you will find personalized contribution amounts that reflect
factors specific to you such as your location (for some medical options), your income (for
medical contributions), your age (for life insurance), your employment status (full-time vs.
part-time), and your pay frequency. If you have any questions about your costs for coverage,
please call the SABIC Benefits Service Center at 1-877-SABIC US (1-877-722-4287).
2017 Health Care Contributions Full-Time Employees Your contributions for medical coverage, as well as for dental and vision coverage if you “buy
up” from the Basic plans depend on the plan you choose and the coverage category you
select. The coverage categories available to you are shown below:
Coverage
Categories Examples
One-Person Employee
Two-Person Employee plus spouse
Employee + 1 child
Three or More Employee plus spouse or Employee + spouse and children
Employee plus 2 or more children
In addition, your contributions depend on your pay and your access to other coverage through
a working spouse. On the following pages, the weekly contribution rates for each of the
medical plan options are shown. If you log onto the Your SABIC Total Rewards Website
www.benefits.sabic-ip.com, you will find only the specific rates for the options you are eligible
to choose. If your pay changes during the year, your contributions could change. The medical
plan contribution rates shown in the following charts are the starting point for calculating your
contributions:
2017 SABIC Health Care Preferred Contribution Rates
Your weekly payroll deductions are:
Annual Pay One-Person Coverage Two-Person Coverage Three or More Coverage
Up to $24,999 $26.43 $58.53 $75.72
$25,000–$37,499 $26.43 $58.53 $75.72
$37,500–$49,999 $32.93 $71.44 $94.07
$50,000–$74,999 $37.62 $80.07 $108.26
$75,000–$99,999 $42.65 $89.69 $