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At Halliburton, we work hard to provide you with the benefits you need to be your best — but we can’t do it alone.
It’s up to you to make healthy choices for your life, and to take advantage of the resources and opportunities we
provide. Our history as a company proves that when we work together, we can do great things — so join us on
a journey to better health.
The partnership between you and Halliburton means that you can start working to improve your health today.
Select the right benefits, then make them work for you.
WHEN TO ENROLL:
CURRENT EMPLOYEES NEW HIRES
must enroll in 2018 benefits during Annual must enroll in 2018 benefits within 30 days
Enrollment, November 16 – December 6, 2017. of their date of hire.
Halliburton U.S. Domestic Benefits Guide > Table of Contents 1
Table of Contents
Teladoc 9
How the Consumer Choice Plan Works 10 THE HALLIBURTON RETIREMENT
AND SAVINGS PLAN 24
Health Savings Account (HSA) 11
Flexible Spending Accounts (FSAs) 12 Naming or Updating Your Beneficiaries 24
Tobacco-Free Benefit Requirements 13
Dental 14 COMPLIANCE AND
LEGAL NOTICES 25
Vision 15
Life Insurance 16 The Women’s Health and Cancer
Rights Act of 1998 25
Accidental Death and Dismemberment
(AD&D) 16 IRS Form 1095-c 26
Flex Days 16 Premium Assistance Under Medicaid
and the Children’s Health Insurance
Long-Term Disability (LTD) 17
Program (CHIP) 26
Employee Assistance Program (EAP) 17
2
Halliburton U.S. Domestic Benefits Guide > What’s New for 2018 3
Though freestanding ERs tend to have the Changes to Your Dental Coverage
same look and feel of Urgent Care centers,
many people are unaware that they will pay Using in-network providers for care is less
Emergency Room prices if they receive expensive both for you, and for the Company.
Out-of-Network
That’s why we’re changing the coinsurance you
care there. Coinsurance
pay for basic, out-of-network dental services to
50% effective January 1, 2018.
If you do decide to visit a freestanding ER,
make sure to ask what your costs will be
BEFORE you receive care. Otherwise, you
Changes to Your Purchased Time Off
may be responsible for a much larger price
tag than you expect. If you would like to purchase flex days for 2018, you
Flex Days Must must actively elect them during Annual Enrollment.
be Re-Elected Your previous election will no longer roll over. You
may only elect flex days during Annual Enrollment.
Halliburton offers a choice of medical plans. Eligibility for all plans depends
on your home ZIP code on file with the Halliburton Benefits Center.
The comparison charts below show the differences between each plan.
Always remember that you can save money by using in-network providers.
Log on to www.halliburton.com/totalrewards for more information on
your medical plan options.
Halliburton
Contribution N/A N/A Up to $1,200
to your HSA
Individual
Out-of-Pocket $4,250 $8,500 $4,250 $8,500 $4,750 $9,500
Maximum
Family Out-of-Pocket
$8,500 $17,000 $8,500 $17,000 $9,500 $19,000
Maximum
Routine Office
50% after 50% after 80% after 50% after
Visit (Primary Care/ 70% 80%
deductible deductible deductible deductible
Specialist)
Annual Physical
50% after 50% after
Exam/Preventive 100% 100% 100% 50%
deductible deductible
Care
HEALTH SAVINGS ACCOUNT (HSA) Basic DMP Standard DMP CCP Out-of-Area
Basic and
CCP OOA CCP
Standard PPO/DMP
In-Network Out-of-Network**
Generic 30-Day Supply $15 20% after deductible 50% after deductible
25%
Preferred Brand
Minimum: $25/ 20% after deductible 50% after deductible
30-Day Supply
Maximum: $100
45%
Nonpreferred Brand
Minimum: $45/ 20% after deductible 50% after deductible
30-Day Supply
Maximum: $100
Generic 90-Day Supply $30 20% after deductible 50% after deductible
25%
Preferred Brand
Minimum: $65/ 20% after deductible 50% after deductible
90-Day Supply
Maximum: $200
45%
Nonpreferred Brand
Minimum: $115/ 20% after deductible 50% after deductible
90-Day Supply
Maximum: $250
35%
Specialty Pharmacy**** Minimum: $30/ 20% after deductible 50% after deductible
Maximum: $300
* Refer to the Summary Plan Description (SPD) for information on prescription drug coverage out-of-pocket maximums.
** Out-of-Network subject to allowed amount limits.
*** Maximum of two fills of a maintenance medication at a retail pharmacy; for additional fills, you pay the full cost.
**** Minimum and maximum co-pay amounts depend on number of days supplied.
Halliburton U.S. Domestic Benefits Guide > Benefits for 2018 9
TELADOC
Preventive care is covered at 100% in-network, but that’s not the only reason
to get your annual checkup. Preventive care can catch many conditions early,
sometimes before symptoms begin.
10 Halliburton U.S. Domestic Benefits Guide
THE CONSUMER CHOICE PLAN (CCP) HOW THE CONSUMER CHOICE PLAN WORKS
The Consumer Choice Plan (CCP) provides Phase 1: Deductible Preventive care is covered at 100%
medical coverage for you and your family,
in-network. Certain maintenance
as well as up to $1,200 per year funded
medications are also covered at
by Halliburton and deposited into your
Health Savings Account. The plan has lower 100%, but you pay the full cost of
premiums, a slightly higher deductible, and the remainder of your medical care
allows you full control over the management until you reach your deductible.
of your health care spending. This is offset by the contribution
Halliburton makes to your HSA
and the tax savings you gain by
participating in the account when
you contribute your own funds.
FREE MONEY FROM HALLIBURTON! You may use your Limited Purpose
Health Care FSA for vision and
Halliburton gives you
dental expenses even before
up to $1,200 per you meet your deductible.
year, deposited
into your HSA, Phase 2: Co-insurance Once you meet the annual deductible,
when you enroll you share the cost of services
in the Consumer by paying a percentage (called
Choice Plan (CCP). The co-insurance) for covered health care
money from Halliburton is yours to keep,
expenses and prescription drugs.
and you will never pay taxes on it, the
You can use the funds in your HSA to
interest it earns, or any bills that you pay
with it, as long as you only use it for cover these co-insurance costs or you
qualified medical expenses. may use your Limited Purpose Health
Care FSA for expenses incurred after
the deductible has been met.
The HSA is a special savings account used to pay for qualifying health care
expenses. Anyone enrolled in the Halliburton CCP may take advantage of
the HSA and receive company contributions deposited on a prorated basis
throughout the year.
Any earnings on your account balance are tax-free as long as they are
spent on eligible health care expenses. There is no limit on how much
money you can accumulate and roll over from year to year.
$5,000
$4,000
$3,450
$2,000
$2,850
Any FSA funds not used by December 31, 2018, FSAs help you save money on your taxes by allowing you to use pre-tax
will be forfeited. dollars to pay for eligible medical and dependent day care expenses.
If you can’t certify that you and your spouse are tobacco-free, you may
qualify for an opportunity to earn the same premium discount by identifying
yourself and/or your spouse as a tobacco user during Annual Enrollment,
or upon hire on January 1, 2018 or thereafter, by choosing “Yes” to the
election commitment to enroll in and complete the LiveWell Tobacco
Cessation Program. To complete the program, you and/or your spouse have
the choice to complete either four coaching calls or the online Tobacco Free
Journey through the LiveWell Tobacco Cessation program. Employees hired
prior to January 1, 2018 must complete the program’s requirements by
April 30, 2018; employees hired on 1/1/2018 or thereafter, must complete
the program’s requirements within 4 months of their hire date. Your
receipt of the non-tobacco user incentive is subject to verification of your
completion of the program. Failure to meet any of these requirements
will result in the loss of the non-tobacco user incentive, and your medical
and any optional life insurance payroll contributions will be updated to the
tobacco rate.
Get the RedBrick Health mobile app to access all of the LiveWell Tobacco
Cessation Program tools and resources to help you improve your health —
on the go! Download the app today via Google Play or the App Store.
14 Halliburton U.S. Domestic Benefits Guide
DENTAL
You have two dental coverage options: the Dental Preferred Provider
Organization (DPPO) and the Dental Health Maintenance Organization
(DHMO). To enroll in the DHMO, you must live in an eligible DHMO area.
With the DHMO, you will only receive benefits when you visit in-network
providers. You must choose a primary care dentist — if you do not choose
one, the DHMO will appoint one for you; however, you can contact Cigna
at a later date to choose a primary care dentist.
Dental Plans
In-Network Out-of-Network
Basic Services 80% after deductible 50% after deductible Co-pay structure
Major Services 50% after deductible 50% after deductible Co-pay structure
Co-pay
Orthodontia/Lifetime
50%/$1,500 50%/$1,500 structure/24-month
Maximum
treatment
VISION
Vision coverage helps you manage the cost of routine eye care expenses like
exams, contact lenses and eyeglasses for you and your eligible dependents.
Vision Plan
In-Network Out-of-Network
Up to $170 allowance
Frames after $20 co-pay; 20%
Up to $70 after $20 co-pay
(one per calendar year) discount off amount
over allowance
Medical eyecare
services related to
Diabetic Eyecare Program Type 1 and 2 diabetes; Not covered
$20 co-pay for medical
eyecare exam
* One pair of prescription glasses or contacts every plan year, beginning in January, but not both in the same year.
** Fitting and evaluation to ensure the proper fit of contact lens materials.
*** These conditions include aphakia, anisometropia, high ametropia, nystagmus, keratoconus and correction
of extreme visual acuity problems that are not correctable with glasses, and following cataract surgery.
16 Halliburton U.S. Domestic Benefits Guide
LIFE INSURANCE
The life insurance plan provides financial protection for you and your family
in the event of your death or the death of one of your covered dependents.
Basic coverage is company-paid and is equal to your annual benefit base pay,
up to $50,000. You may choose to purchase extra coverage for yourself and
your family.
Life Insurance
AD&D
FLEX DAYS
Parent/child relations Marriage and family issues Alcohol and drug problems
You can contact the EAP by telephone or in person. You can speak with
a trained professional who will make a preliminary assessment of your needs.
EAP counselors will either help you directly or refer you to the appropriate
resources. Call the EAP at 281-575-3200 or 866-761-4540, or access the EAP
resources online at www.achievesolutions.net/halliburton.
18 Halliburton U.S. Domestic Benefits Guide
WHEN TO ENROLL
If you would like to make changes to your benefits, or make HSA or FSA
contributions for 2018, you must make an election during the enrollment
window below. If you are a new hire, you have 30 days to enroll.
If you take no action, your 2017 elections will carry forward to 2018, with the
exception of Flexible Spending Accounts, Health Savings Account and Flex Days.
If you are a new hire and you do not enroll within 30 days of your hire date,
unless you experience a qualified change in status which you report within
30 days, you will only be provided:
»» Basic Life Insurance of one times your annual benefits base pay,
up to $50,000.
»» Basic Accidental Death and Dismemberment insurance of one times your
annual benefits base pay, up to $200,000.
»» Long-Term Disability insurance of 40% of your annual benefits base pay.
»» LiveWell wellness program.
First, review your benefit options before making changes for 2018. When you’re
ready to enroll, follow the steps below:
»» NEW: Visit the Message Center on the Health and Benefits page at
www.halliburton.com/totalrewards to review copies of any emails or
mailed communications you receive from the Halliburton Benefits Center.
From the home page, click “Menu.” Next, under “My Accounts,” select
“Communications,” and then select “Personal Documents.”
22 Halliburton U.S. Domestic Benefits Guide
Note: Halliburton Total Rewards is available We’re always striving to empower you to use and understand your benefits.
for your use both during Annual Enrollment That’s why we provide the Total Rewards website, and that’s why we’re always
and throughout the year. Take advantage of
expanding the resources available to you online. The site is a streamlined
the convenience of managing your benefits.
source for all of your benefit needs, available from any device, anytime,
See the Forms & Documents page where anywhere. Enroll, change and keep track of your benefits all in one convenient
you can access the Annual Enrollment
location, at www.halliburton.com/totalrewards.
Guide, Summary of Benefits Coverage
and Summary Plan Description.
Learn
Connect Click on the Knowledge
Select Secure Chat to: Center tab to find:
»» Chat privately with »» Health education articles.
a customer service »» Interactive learning tools.
representative. »» Instructional videos.
»» Find answers to
your questions.
Halliburton U.S. Domestic Benefits Guide > Total Rewards Website 23
HALLIBURTON
BASIC CONTRIBUTION
The Halliburton Retirement
and Savings Plan
Generally, if you are an active employee (or on
an approved leave of absence) on December 31,
the Company will make an additional
discretionary contribution, which will be
a percentage of your annual eligible pay. OWN YOUR FUTURE FINANCIAL HEALTH: INVEST IN
The Company will determine in its discretion
whether to make the Halliburton Basic
YOUR HALLIBURTON RETIREMENT & SAVINGS PLAN
Contribution each year and the amount. The
contribution is deposited into your account Haven’t started saving for retirement yet? The Halliburton Retirement
regardless of whether or not you are making
& Savings Plan is a program to help you build your savings for retirement.
contributions to the plan.
By not contributing at least 6% of your earnings into your Halliburton
Retirement & Savings Plan, you’re losing out on money the Company is
offering toward your retirement. The Company matches dollar for dollar
on the first 4% you contribute and 50 cents on the next 2% — for a total
match of 5%. You can enroll in the Halliburton Retirement & Savings Plan
by logging on to the Halliburton Total Rewards website.
Every effort has been made to provide clear and accurate information about
Halliburton’s benefit plans. However, in the event of a discrepancy between
these materials, the Plan’s Summary Plan Description, and the other official
Plan documents, the other official Plan documents will govern. There are
no guarantees that participation under the benefit plans described in this
material will remain unchanged in future years.
If you are enrolled in the Halliburton medical plan, a 1095-c tax form will be
issued to you and, if applicable, your covered dependents.
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 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
August 10, 2017. Contact your state for more information on eligibility.
ALABAMA – Medicaid ALASKA – Medicaid
Website: http://dch.georgia.gov/medicaid
Website: http://flmedicaidtplrecovery.com/hipp/ - Click on Health Insurance Premium
Phone: 1-877-357-3268 Payment (HIPP)
Phone: 404-656-4507
Website: http://mn.gov/dhs/people-we-serve/
Website: http://www.mass.gov/eohhs/gov/
seniors/health-care/health-care-programs/
departments/masshealth/
programs-and-services/medical-assistance.jsp
Phone: 1-800-862-4840
Phone: 1-800-657-3739
Medicaid Website:
http://www.state.nj.us/humanservices/
Website: http://www.dhhs.nh.gov/oii/ dmahs/clients/medicaid/
documents/hippapp.pdf Medicaid Phone: 609-631-2392
Phone: 603-271-5218 CHIP Website: http://www.njfamilycare.org/
index.html
CHIP Phone: 1-800-701-0710
Website: https://www.health.ny.gov/
Website: https://dma.ncdhhs.gov/
health_care/medicaid/
Phone: 919-855-4100
Phone: 1-800-541-2831
Website: http://www.nd.gov/dhs/services/
Website: http://www.insureoklahoma.org
medicalserv/medicaid/
Phone: 1-888-365-3742
Phone: 1-844-854-4825
WYOMING – Medicaid
Website: https://wyequalitycare.acs-inc.com/
Phone: 307-777-7531
Halliburton U.S. Domestic Benefits Guide > Compliance and Legal Notices 29
To see if any other states have added a premium assistance program since
August 10, 2017, or for more information on special enrollment rights, contact:
U.S. Department of Health
U.S. Department of Labor
and Human Services
Employee Benefits Security Administration Centers for Medicare & Medicaid Services
www.dol.gov/agencies/ebsa www.cms.hhs.gov
1-866-444-EBSA (3272) 1-877-267-2323, Menu Option 4, Ext. 61565
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.
www.halliburton.com/totalrewards