Employee Benefits Guide 2017

2017
E MP L O Y E E B E N E F I T S

2
T A B L E O F C O N T E N T S
In this Guide, we use the term Company to refer to your company.
requirements, enrollment procedures and coverage effective dates for the benefits offered by the Company. It is not a legal plan
document and does not imply a guarantee of employment or a continuation of benefits. While this Guide is a tool to answer most
of your questions, full details of the plans are contained in the Summary Plan Descriptions (SPDs), which govern each plan’s
operation. Whenever an interpretation of a plan benefit is necessary, the actual plan documents will be used.
This Guide is intended to describe the eligibility
y the Company. It is not a legal plan
4 Welcome
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Survivor Benefits
Income Protection
Retirement Planning
Additional Benefits
Glossary
Required Notices
Important Contacts & Mobile Apps
Eligibility & Enrollment
Medical Benefits
Pharmacy Benefits
Dental Benefits
Vision Benefits
Health Savings Account (HSA)
Flexible Spending Account (FSA)
7
9
1
See page for important
information concerning
Medicare Part D coverage.
31
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Employee Wellness
Changes in 2017
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15
17
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24
25
27
29
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C H A N G E S I N 2 0 1 7
It's no secret that change is inevitable. It's a way of life. Accept it.
The Company wants you to be aware of the following changes going forward in 2017:
Visit Aetna's DocFind® at
https://www.aetna.com/individuals-
families/find-a-doctor.html
Selected Plan:
What does all this mean to you and your family?
YOUR DOCTOR’S OFFICE
IS CLOSED. DO YOU
KNOW WHERE TO GO?
Freestanding ER vs.
Urgent Care Centers
What to look for
Hours
Wait time
Who you'll see
Capabilities
Patient load
Cost
■
■
■
■
■
■■
3
Aetna Open Access
Managed Choice POS
®
®
The Keystyle Portal extends the Vista by Viewpoint
processes with an easy to use web-based interface for
accelerated review and approval. Reviewers can login to
the portal on any device that supports web viewing to
complete the review process (iPhone/iPad, Android,
PC,etc.)
The portal provides an accessible interface for
employees to simplify common business tasks,
including the following:
■ Update Personal Info
■ Open Enrollment/Benefits
■ Submit Timecards
■ Request Time Off
Streamline Processes
*Dynamic Systems, Inc. (DSI) ONLY*
Research the options in your area and determine which ones
are covered by your insurance plan's network; note that
balance billing may apply.
Be sure you know which facilities in your area are urgent care
and which are freestanding ERs. Lastly, when you need
medical care, determine what level of care you actually
require. Choosing an urgent care center for everyday health
concerns could save you hundreds of dollars.
*Reminder: Just because a hospital is in your plan's network,
doesn't mean that its associated freestanding ER is.

From the App Store on your
mobile device, search for
"QR Reader" and install the
tool needed to scan QR codes
seen throughout the guide.
Have a Smartphone?
This Benefit Guide is equipped with
mobile-friendly barcodes. These barcodes are
more commonly referred to as QR Codes, or
"Quick Response" codes.
Scanning these codes allows you to instantly
navigate to separate sites on your phone in a
matter of seconds. The content of the sites
might be a website, video, article, or App
download. A QR Code can essentially take you
anywhere - you just have to scan them first.
How Do I Scan Them?
1. Get one of the FREE QR Reader Apps
2. Once downloaded, open the App on
your smartphone & follow the directions
for scanning QR Codes
3. The App reads the codes automatically,
then immediately takes you to that
code's content
WELCOME
health and well-being. We are proud to provide
you and your family with valuable information
and significant benefits. This Guide is an
overview of the benefits available to you
and their impact on your compensation
as a whole. Please read it carefully in order
to make the best choices for you and your
family in the 2017 Plan Year.
We are committed to our employees and their
4
WE L C O ME

ELIGIBILITY & ENROLLMENT
You and your family have unique needs, which is why benefit plans from which you
may choose. Consider your spouse's benefits eemplmployment and
eligibility when weighing each option.
If you are a 30 hours
per week, you are
Dental, Vision, Life and Disability Plans, along with the
Flexible Spending Account (FSAs), Health Savings Account
(HSA) and additional benefits.
When Does Coverage Begin?
Eligible Dependents
Dependents eligible for coverage in
Your spouse in states
which recognize common-law marriages).
5
benefits plan include:full-time employee who works at least
eligible to participate in the Medical,
we offer a variety of
through his or her place of employment and your dependent's
legal spouse (or common-law
The elections you make for benefits are effective the first (1st)
day of the month following the date of hire. Field personnel are
eligible for benefits the first (1st) day of the month following
60 days from the date of hire. Due to IRS regulations, once you
have made your choices for the 2017 Plan Year, you won't be
able to change your benefits until the next enrollment period
■ Children up to age 26 (includes birth children,
stepchildren, legally adopted children, children placed
for adoption, foster children, and children for whom
legal guardianship has been awarded to you or your
■
spouse.)
■ Dependent children, regardless of age, provided he or she
is incapable of self-support due to a mental or physical
disability, is fully dependent on you for support as
indicated on your federal tax return, and is approved
by your Medical Plan to continue coverage past age 26.
Verification of dependent eligibility will be required
upon enrollment.
unless you experience a Qualifying Life event.
The choices you made during Open Enrollment will become
effective on January 1, 2017.
You CANNOT change your beneit
selections during the Plan Year
unless you have a Qualifying
Life Event, such as the birth or
adoption of a child.
E L I G I B I L I T Y
& E N R O L L ME N T
Eligibility
5
■
CURIOUS
ABOUT
Qualifying Life
Events and how
they may
afect your
coverage?

Qualifying Life Events
When one of the following events occurs, you
from the date of the event
request changes to your coverage.
■ Change in your legal marital status (marriage, divorce or
legal separation)
■ Change in the number of your dependents (for example,
through birth or adoption, or if a child is no longer an
eligible dependent)
■ Change in your
in a loss or gain of coverage)
■ Change in your employment status from full time to
part time, or part time to full time, resulting in a gain or
loss of coverage
■ Entitlement to Medicare or Medicaid
■ Eligibility for coverage through the Marketplace
■ Change in your address or location that may affect the
coverage for which you are eligible
Your change in coverage must be consistent with your change
in status. Please direct questions regarding specific life events
and your ability to request changes
Preparing to Enroll
to Human Resources.
spouse's employment status (resulting
absorbing a significant amount of the costs.
e sure to have the Social S
As a committed partner in your health, the Company will be
have 30 days
Please note that employee contributions for Medical, Dental
and Vision depending on the level of coverage
you select. In general, the more coverage you have, the higher
your employee contribution will be.
coverage vary
that you may select any combination of Medical,
Dental and Vision plan coverage categories. For example, you
could select Medical coverage for you and your entire family,
but select Dental and Vision coverage only for yourself.
The only requirement is that you must elect coverage for
yourself in order to elect any dependent have
the option to select coverage from the following categories:
coverage. You
■
■
Employee Only
■ Employee + Spouse
■
■
Employee + Child(ren)
■ Employee + Family
Keep in mind
Be sure to have the Social Security numbers and birthdates
for any eligible dependent(s) that you plan to enroll. You
cannot enroll your dependent(s) without this information.
contributions for Medical, Dental, Vision, FSA or HSA benefits
is deducted on a pre-tax basis, which lessens your tax liability.
How to Enroll
1. Understand Your Choices
This Guide contains very useful reference
material to help you prepare for Annual
Enrollment. Keep it handy so you can refer
to it throughout the year.
2. Review Your Options
with Your Family
Make sure you include any other individuals
who will be affected by your elections in the
decision-making process.
5. Conirm Your Personal
and Dependent Information
6. Review Your Existing Coverage
or Select New Coverage
3.
4.
Things to Consider
Take the following situations into account before you enroll to
make sure you have the right coverage.
■ Does your benefit coverage
available through another employer?
■ Did you get married, divorced or have a baby recently?
If so, do you need to add or remove any dependent(s)
and/or update your beneficiary designation?
■ Did any of your covered children reach their
birthday this year? If so, they are no longer eligible for
benefits unless they meet specific criteria. Additional
details can be found in the Eligible Dependents section of
this Guide.
spouse or dependents have
26th
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to notify Human Resources to
Your share of the

WELLNESS
From time to time, we all need a little extra advice from a health professional or a gentle nudge
toward wellness. This is why we offer a health management program to all benefits-eligible employees
called Health Management Programs through Aetna. This benefit is provided to you at no cost and is
completely confidential.
Visit www.myaetna.com todayVisit www.myaetna.com today
■ Informative Webinars, Programs, Challenges & Discounts
■ Personalized Coaching and Chronic Condition
Management Tools
■ Convenient and Secure Storage of Medical Records
■ Helpful Reminders About Upcoming or Needed
Preventive Exams
■ BMI and Weight Management Tools
■ Talk to a Nurse
■ Tele-doc
It serves as a customized guide, much like a road map, to
help you on your journey to wellness. The Health and
Wellness Program is full of helpful tools such as: We want to reward you for taking steps toward good
health. The first step is to know your blood work numbers.
We provide on-site Biometric Wellness Screenings for
employees and their spouses on a voluntary basis. The
Biometric Screenings will consist of the following
measurements: blood pressure, blood lipids (total
cholesterol, HDL cholesterol), glucose, height, weight,
body mass index, and waist circumference. Individual
test results will remain confidential; The Company will
not have access to such private health information.
Wellness Discount
If you are not able to participate in the onsite Biometric
Screenings, there are additional options available to
you. Contact your Human Resources department to
learn more.
Visit Quest Diagnostics online at
the website below for more
information on your voluntary
Wellness Screening:
www.my.questforhealth.com
Registration Key: FGI
Unique ID: Last Name & Last 4 #'s of SSN
SWAP
SUGARY
drinks for water.
Find more tips
here on leading a
healthy lifestyle.
E MP L O Y E E
WE L L N E S S
7

90% of lung cancer cases
are linked to smoking. Visit
www.smokefree.gov to learn
how to kick the habit for good.
90% of Lung Cancer cases
are linked to smoking.
Visit www.smokefree.gov to learn
how to kick the habit for GOOD!
N O T E S
__________________________________________
__________________________________________
Tobacco User
In order to help control employee Medical premium
costs, the Company has implemented a Tobacco User
Discount. This Discount is applicable to employees
and eligible household dependents enrolled in the
Medical Plan. You must sign a Tobacco Affidavit as
part of your enrollment for you and your household
If you make the decision to eliminate tobacco use, the
Company offers a variety of programs and information
to support you to quit. Aetna gives you access to a
variety of services, including personal coaching, online
tools, an audio health library, and discounts to wellness
-related products and services. Once a Tobacco
Program is successfully completed, you will be eligible
for the Tobacco User Discount with your plan.
If it is unreasonably difficult for you or your spouse to
complete a Biometric Screening due to a Medical
please call Human Resources to discuss alternatives.
Privacy Reminder: The Company does not have
access to individual health information. The statistics
reference in this communication are aggregate.
Personal health information is always treated
privately and we take this very seriously.
__________________________________________
__________________________________________
Discount
dependents to receive the Discount.
Please contact Human Resources to complete or enroll
in a tobacco cessation program or to submit
confirmation of being under a physician's care for
tobacco or nicotine use.
Cessation
8
condition,

Our Medical coverage helps you maintain your well-being through preventive care and access to an
extensive network of providers, as well as affordable prescription medication. It is up to you to choose the
Plan that best option you elect will be in place for all of
the 2017 Plan Year, unless you have a Qualifying Life Event.
Medical Premiums
Premium contributions for Medical will be deducted from your paycheck on a pre-tax basis. Your level of coverage will determine
How to Find a Provider
SCAN HERE
TO LEARN ABOUT
A VARIETY OF
TOPICS, INCLUDING
HEART HEALTH.
MEDICAL BENEFITS
10
matches your needs. Please keep in mind that the
your semi-monthly contributions.
EMPLOYEE
ONLY
EMPLOYEE +
SPOUSE
EMPLOYEE +
CHILD(REN)
EMPLOYEE +
FAMILY
$1,500 MEDICAL PLAN $5,000 MEDICAL PLAN HSA MEDICAL PLAN
8
To see a current list of Medical providers online, go to The provider
directory, DocFind, allows you to search for medical professionals within the network.
If you do not have internet access, please call Member Services at 1-888-416-2277.
The phone number is also provided on the back of your Aetna ID card.
If you do not have an ID card or internet access, call Aetna's Corporate Contact Center at
1-800-US-AETNA (1-800-872-3862). This is not a Member Services phone number. You will
be transferred to the Member Services group that handles your Aetna coverage. The Corporate
Contact Center is staffed Mon-Fri, 7 a.m. to 7 p.m. ET.
SEMI-MONTHLY DEDUCTIONS
NON-
SMOKER
NON-
SMOKER
NON-
SMOKER
SMOKER SMOKER SMOKER
NON-SMOKER
W/SPOUSE
SURCHARGE
NON-SMOKER
W/SPOUSE
SURCHARGE
NON-SMOKER
W/SPOUSE
SURCHARGE
SMOKER
W/SPOUSE
SURCHARGE
SMOKER
W/SPOUSE
SURCHARGE
SMOKER
W/SPOUSE
SURCHARGE
WITH CREDIT
APPLIED
WITH CREDIT
APPLIED
WITH CREDIT
APPLIED
WITHOUT CREDIT
APPLIED
WITHOUT CREDIT
APPLIED
WITHOUT CREDIT
APPLIED
$ 65.63
$ 279.51
$ 165.69
$ 393.75
$ 120.63
$ 334.51
$ 220.69
$ 448.75
$ 22.24
$ 192.58
$ 87.45
$ 245.81
$ 77.24
$ 247.58
$ 300.81
$ 65.63
$ 279.51
$ 165.69
$ 393.75
$ 120.63
$ 334.51
$ 220.69
$ 448.75
$ 142.45
www.myaetna.com.
ME D I C A L B E N E F I T S
9

119
Each covered individual is not required to meet the individual deductible. The HSA has an aggregate deductible, meaning the
family deductible amount will include all combined eligible expenses that you and your covered dependents incur. The family
deductible amount may be satisfied by one member or a combination of two or more members covered under your medical plan.
Health Care Cost Transparency
Urgent Care Centers vs. Freestanding Emergency Rooms
Freestanding emergency rooms look a lot like the urgent care centers you are likely used to, but the costs and services are
drastically different. In general, consider an urgent care center as an extension of your primary care physician, while freestanding
emergency rooms should be used for health conditions that require a high level of care. Research the options in your area and
determine which ones are covered by your insurance plan's network; note that balance billing may apply. Choosing an urgent care
center for everyday health concerns could save you hundreds of dollars.
Save Money by Seeing In Network
Physicians and Taking Advantage
of Preventive Care Services
Ofered by Your Plan.
FAMILY
IN-NETWORK OUT-OF-NETWORK OUT-OF-NETWORK OUT-OF-NETWORKIN-NETWORK IN-NETWORKIN-NETWORK IN-NETWORKOUT-OF-NETWORK
INDIVIDUAL
ANNUAL DEDUCTIBLE
ANNUAL OUT-OF-POCKET MAXIMUM (Includes Deductible and ALL Medical Copays)
$1,500
$3,000
$3,000
$6,000
$5,000
$10,000
$10,000
$20,000
$4,000
$8,000
$8,000
$16,000
$6,350
$12,700
$12,500
$25,000
80% 80%50% 50%
$2,600 *
$5,200 *
100%
$5,000
$10,000
N/A
N/A
N/A
N/A
N/A
$5,000*
$10,000*
70%
$10,000
$20,000
LIFETIME MAXIMUM Unlimited Unlimited Unlimited
PREVENTIVE CARE
URGENT CARE
EMERGENCY ROOM
COPAYS / COINSURANCE
SPECIALIST
PRIMARY CARE $25 copay 50% after deductible $30 copay 50% after deductible 100% after deductible
50% after deductible 50% after deductible$50 copay $60 copay
50% after deductible 50% after deductible
$50 copay 50% after deductible $75 copay 50% after deductible
$250 copay $250 copay $250 copay $250 copay
100% after deductible
N/A
N/A
N/A
N/A
N/A70% after deductible
Medical Plan Summary
The chart below gives a summary of Medical coverage provided
necessity as determined by the Plan. Please be aware that all out-of-network services are subject to Reasonable and Customary
(R&C) limitations.
the 2017 by Aetna. All covered services are subject to Medical
No Charge No Charge No Charge
Consumer-Driven Health Plans and tools, such as Flexible Spending Accounts and Health Savings Accounts, have helped put
the power of health care spending in consumers' hands. This means you have control over how your health care dollars are
spent. But with the cost of services varying widely even within the same network and geographic area, how can you be sure
you're getting the most bang for your health care buck? Health Care Cost Transparency tools are available through Aetna.
These online tools allow consumers to compare costs for everything from prescription drugs to major surgeries. For more
information, visit www.myaetna.com.
10
$250 copay after deductible$250 copay after deductible$250 copay
AFTER deductible
$250 copay
AFTER deductible
$250 copay
AFTER deductible
$250 copay
AFTER deductible
100% after deductible 70% after deductible
* The Company has elected to fund the HSA Account in 2017 for the employee $500
or $1,000 for family. This is a discretionary amount that will be reviewed annually.
INDIVIDUAL
FAMILY
COINSURANCE
(PLAN PAYS)

Prescription Drug Coverage for Medical Plans
PHARMACY BENEFITS
12
Our Prescription Drug Program is coordinated through Aetna.
You may find information on your benefits coverage and search for network pharmacies by logging on to www.myaetna.com
or by calling the Customer Care number on your ID Card.
Your cost is determined by the tier assigned to the prescription drug product. All products on the list are assigned as Generic,
Preferred, Non-Preferred or Specialty.
IN-NETWORK
OUT-OF-
NETWORK
IN-NETWORK
OUT-OF-
NETWORK
IN-NETWORK
OUT-OF-
NETWORK
RETAIL RX
$10 copay $15 copay
80% after
applicable copay
$30 copay $35 copay
$50 copay $60 copay
80% after
applicable copay
80% after
applicable copay
80% after
applicable copay
80% after
applicable copay
(30-DAY SUPPLY)
MAIL ORDER RX (90-DAY SUPPLY)
$25 copay
$75 copay
$125 copay
In-Network
coverage only
In-Network
coverage only
$37.50 copay
$87.50 copay
$150 copay
In-Network
coverage only
In-Network
coverage only
In-Network
coverage only
?
?
80% after
applicable
copay
80% after
applicable
copay
In-Network
coverage
only
RETAIL PHARMACY (30-day supply)
(90-day supply)
In-Network
coverage
only
10
(Tier 1)GENERIC
PREFERRED
NON-PREFERRED
(Tier 2)
(Tier 3)
(Tier 1)GENERIC
PREFERRED
NON-PREFERRED
(Tier 2)
(Tier 3)
70% after
applicable
copay
In-Network
coverage
only
In-Network
coverage
only
$30 copay
after deductible
$50 copay
after deductible
$10 copay
after deductible
$60 copay
after deductible
$100 copay
after deductible
$20 copay
after deductible
P H A R MA C Y B E N E F I T S
Individual spending on prescription drugs is skyrocketing, especially for those requiring specialty medications - those that treat
complex conditions such as cancer and rheumatoid arthritis. Go to GoodRX.com to compare costs at local and mail-order
pharmacies and find coupons for your prescription drug needs.
You should also take advantage of tax breaks, such as withdrawing money tax-free from a Health Savings Account or Flexible
Spending Account when paying for medications.
Raising Prescription Drug Costs
11
Premier RX with Step Therapy will require Pre-certification.

NEED
ADDITIONAL
GENERIC DRUG FACTS?
Q&A:
GENERIC DRUGS
What is a generic drug?
When a new, FDA-approved drug goes on the market,
it may have patent or exclusivity protection that enables the
manufacturer to sell the drug exclusively for a period of time.
When those expire or no longer serve as a barrier to approval,
other companies can make it in generic form.
Are generic drugs as efective
as brand-name drugs?
Yes. A generic drug is the same as a brand-name drug in
dosage, safety, strength, quality, the way it works, the way
it is taken and the way it should be used. he FDA requires
generic drugs have the same high quality, strength, purity
and stability as brand-name drugs.
Are generic drugs as safe
as brand-name drugs?
Yes. he FDA must approve the generic drug before
it can be marketed.
Are generic drugs that
much cheaper than
brand-name medications?
Yes. On average, the cost of a generic drug is 80%
to 85% lower than the brand-name equivalent.
Is there a generic equivalent
for my brand-name drug?
To ind out if there is a generic equivalent for your
brand-name drug, visit www.fda.gov to view a catalog
of FDA-approved drug products, as well as drug labeling
information.
131112

DENTAL BENEFITS
Routine preventive care such as regular Dental checkups can help lower your risk of stroke and heart
disease. coverage will provide you and your family affordable options for
overall health. Coverage is available from
1414
United HealthCare.
The Company's Dental
12
Dental Premiums
Premium contributions for Dental will be deducted from your paycheck on a pre-tax basis. Your tier of coverage will determine
your semi-monthly
DENTAL PLAN - United Health Care (UHC)
EMPLOYEE ONLY
EMPLOYEE + SPOUSE
EMPLOYEE + CHILD
EMPLOYEE + FAMILY
Company-Paid
$9.08
$26.06
$33.88
ELECTION OPTIONS:
(UHC).
To find a network dentist,
visit www.myuhc.com.
BRUSH UP
ON CARING
FOR YOUR TEETH.
Network Dentists
Your Plan's In-Network dentists have agreed to charge lower
fees, which helps keep money in your pocket. If you choose to
use a dentist who doesn't participate in your Plan's network,
your out-of-pocket costs will be higher, and you are subject to
any charges beyond the Reasonable and Customary (R&C).
premium.
D E N T A L B E N E F I T S
13

1513
Flossing isn’t fun,
but it can go a long way toward
preventing gum disease.
14
Dental Plan benefits are available to you as a Company benefit. The chart
below gives a summary of the 2017 Dental coverage provided by United
HealthCare (UHC). All out-of-network services are subject to Reasonable
and Customary (R&C) limitations.
Dental Plan Summary
IN-NETWO F-NETWORK
INDIVIDUAL $25 $35
FAMILY $50 $65
ANNUAL DEDUCTIBLE
$50
$150
$1,500 $1,000$1,500
$50
$150
CALENDAR YEAR MAXIMUM
COVERED SERVICES
MAJOR SERVICES
85%* 79%*
ORTHODONTICS
85%* N/A
ORTHODONTIC
LIFETIME MAXIMUM
$1,000
Crowns
Dentures
Bridges
Dependent Child(ren) (up to age 19)
50%
DENTAL PLAN
(UHC)
50% after
deductible
100% 85%*
Amalgam Filling
Root Canal Therapy
Periodontal Scaling
Routine Extractions
BASIC SERVICES
80% after
deductible
95%* 80%*Cleanings
X-Rays
PREVENTIVE SERVICES
100%

Vision Premiums
Premium contributions for Vision will be deducted from your paycheck on a pre-tax basis. Your tier of coverage will determine
VISION BENEFITS
1616
your
If you wear glasses or contacts, chances are you already have a steady appointment with an eye doctor.
But even those with perfect eyesight should have their Vision checked on a regular basis. To ensure that
you and your family have access to quality Vision care, The Company offers a comprehensive Vision
benefit provided by United HealthCare (UHC).
14
SET YOUR
EYES ON A FEW
WAYS TO MAINTAIN
YOUR VISION.
vision
semi-monthly premium.
V I S I O N B E N E F I T S
15
- United Health Care (UHC)
EMPLOYEE ONLY
EMPLOYEE + SPOUSE
EMPLOYEE + CHILD
EMPLOYEE + FAMILY
Company-Paid
VISION PLAN
ELECTION OPTIONS:
$2.32
$2.48
$4.96

1715
According to the Centers for
Disease Control and Prevention,
approximately 14 million
Americans 12 and older have
self-reported visual impairment
(deined as 20/50 or worse).
VISION PLAN (UHC)
COVERED MATERIALS
LENSES
IN-NETWORK OUT-OF-NETWORK
LENTICULAR
SINGLE VISION
BIFOCAL
TRIFOCAL
$25 copay
$25 copay
$25 copay
$25 copay
Up to $40
Up to $60
Up to $80
Up to $80
FRAMES
RETAIL FRAME EQUIVALENT
CONTACT LENSES
NECESSARY
ELECTIVE
COPAYS
*
BENEFIT FREQUENCY
EXAMINATION
LENSES
FRAMES
CONTACTS
(in lieu of Lenses and Frames)
Once every 12 months
* Allows for 4 boxes of disposable contact lenses from a network provider
$130 allowance
$25 copay
$105 allowance
$10 copay
Up to $45
Up to $210
Up to $105
Up to $40EXAMINATION / SCREENING
VISION PLAN - (UHC)
Vision Plan Summary
)
16
Vision Plan benefits are available to you as a Company benefit. Premium contributions for Vision will be deducted from
your paycheck on a pre-tax basis. Your tier of coverage will determine your semi-monthly premium.

HEALTH SAVINGS ACCOUNT
Take charge of your health care spending with a Health Savings Account (HSA). Contributions to an
HSA are tax-free, and no matter what, the money in the account is yours. Use the account to pay for eligible
Medical expenses when you are enrolled in a qualified consumer-driven health plan with HSA.
Your HSA can be used for qualified expenses, including those
of your spouse or dependent(s), even if they are not covered
by your Plan.
a debit card, giving you direct access
to your account balance. When you have a qualified medical
expense, you can use your debit card to pay. You must have a
balance to use your debit card. There are no receipts to submit
for reimbursement.
Eligibility
You are eligible to open and fund an HSA if:
■ You are enrolled in an HSA-eligible Consumer-Driven
Health Plan.
■ You are not covered by
care flexible spending account or health reimbursement
account.
■ You are not eligible to be claimed as a dependent on
someone else’s tax return.
■ You are not enrolled in Medicare, Medicaid
or TRICARE for Life insurance.
■ You have not received Department of Veterans Affairs
Medical benefits in the past 90 days.
Individually Owned Account
You own and manage your
Health Savings Account. You
determine how much you'll
contribute to the account, when
to use the money to pay for
qualified medical expenses,
and when to reimburse yourself.
HSAs allow you save and roll
over money if you do not spend
it in the calendar year. The money
in this account is portable, even
if you change plans or jobs. There
are no vesting requirements or
forfeiture provisions.
18
CALCULATE
YOUR TAX SAVINGS
FROM AN HSA.
18
HSA Bank will issue you
your spouse's health plan, health
Eligible expenses include doctors' office visits, eye exams,
prescription expenses and LASIK surgery. IRS Publication 502
provides a complete list of eligible expenses and can be found
on www.irs.gov.
16
H E A L T H
S A V I N G S A C C O U N T
17

1917
Funds in your HSA will roll over
from year to year, allowing you
to save money for future
Medical expenses.
N O T E S
__________________________________________
__________________________________________
__________________________________________
__________________________________________
__________________________________________
__________________________________________
__________________________________________
__________________________________________
18
How to Enroll
You must elect HSA. You will all HSA
enrollment materials and designate the amount to contribute on
a pre-tax basis. The Company will establish an HSA account
need to complete
in your name and send in your contribution once bank account
information has been provided and verified.
Maximize Your Tax Savings
Contributions to an HSA are
through payroll deduction on a pre-tax basis when you open
an account with in this account
(including interest and investment earnings) grows
As long as the funds are used to pay for qualified
medical expenses, they are spent
HSA Bank. The money
TAX-FREE.
TAX-FREE.
TAX-FREE
HSA Funding Limits
Each year, the IRS places a limit on the maximum amount that
can be contributed to HSA accounts.
HSA FUNDING LIMITS
EMPLOYEE
FAMILY
$3,400
$6,$6,750
HSA FUNDING LIMITS
$3,400
HSA CATCH-UP CONTRIBUTIONS
HSA FUNDING LIMITS
AGE 55 OR OLDER $1,000
an HSA employer contribution
that will be deposited on a quarterly basis.
EMPLOYER HSA CONTRIBUTION
EMPLOYEE
FAMILY
The Company also
$500
$1,000
provides
EMPLOYER HSA CONTRIBUTION
The Company HSA Plan is established with HSA Bank.
You may be able to roll over funds from another HSA.
For more enrollment information, visit online at
www.hsabank.com.
, so they can be made
that include any employer contribution are limited to the
following:
For 2017, contributions

FLEXIBLE SPENDING ACCOUNT
222218
Flexible Spending Accounts (FSAs) allow you to set aside pre-tax payroll deductions to pay for
out-of-pocket health care expenses such as deductibles, copays and coinsurance, as well as dependent
care expense.
You can contribute up to $2,600 for qualified medical
expenses with pre-tax dollars, which will reduce the
amount of your taxable income and increase your
take-home pay.
Please note: Over-the-Counter (OTC) drugs are not
eligible for reimbursement through an FSA without a
doctor's prescription.
Please note: If you elect for a Health Savings Account
(HSA) for medical, you are NOT eligible for a Health
Care FSA.
Health Care
Flexible Spending Account
Please note: ALL employees are eligible for a Dependent Care
FSA, regardless of which medical plan you are enrolled in.
In addition to the Health Care FSA, you may opt to participate
in the Dependent Care FSA as well - whether or not you elect
any other benefits. The Dependent Care FSA allows you to set
aside pre-tax funds to help pay for expenses associated with
caring for elder or child dependents. Unlike the Health Care
FSA, reimbursement from your Dependent Care FSA is
limited to the total amount that is deposited in your account at
that time.
Dependent Care
Flexible Spending Account
With the Dependent Care FSA, you are allowed to
set aside up to $5,000 to pay for child or elder care
expenses on a pre-tax basis.
Eligible dependents include children younger than
the age of 13 and dependents of any age who are
incapable of caring for themselves.
Expenses are reimbursable as long as the provider is
not anyone considered your dependent for income
tax purposes.
In order to be reimbursed, you must provide the tax
identification number or Social Security number of
the party providing care.
■
■
■
■
F L E X I B L E
S P E N D I N G A C C O U N T
19

2319
You cannot use FSA funds
to pay for insurance premiums.
Once you incur an eligible expense, submit a claim form
along with the required documentation. If you have a
question about a reimbursement, contact P&A Group.
Should you need to submit a receipt, P&A Group will
mail or email you a receipt notification. You should
always retain a receipt for your records.
How to Use the Account
Please check with your tax advisor to determine if any
exceptions apply to you.
This account covers dependent day care expenses that are
necessary for you and your spouse to work or attend school
full time. The dependent must be a child younger than the age
of 13 and claimed as a dependent on your federal income tax
return or a disabled dependent who spends at least eight hours
a day in your home.
Eligible Dependent Care Flexible
Spending Account Expenses
Examples of eligible dependent care expenses include:
In-Home Baby-Sitting Services■
Care of a Preschool Child by a Licensed Nursery■
(not by an individual you claim as a dependent)
Before and After-School Care■
Day Camp■
In-House Dependent Day Care■
or Day Care Provider
General Rules and Restrictions
■
Your expenses must be incurred during■
the 2017 Plan Year.
Your dollars cannot be transferred from■
one FSA to another.
You cannot participate in Dependent Care FSA■
and claim a dependent care tax deduction
at the same time.
In exchange for the tax advantages that FSAs offer, the IRS
has imposed the following rules and restrictions for both
Health Care and Dependent Care FSAs:
G
I
H
LEARN
MORE ABOUT
FSA LIMITS, GRACE
PERIODS AND
ROLLOVERS.
exceptions apply to you.
20
Health Care FSAs.
Up to may be rolled over to the next■ $250
You cannot change your FSA election
in the middle of the Plan Year unless
■
a Qualifying Life Event occurs, such as
marriage, birth of a child, or divorce.
Please note that failure to provide proof that an expense
was valid can result in your expense being deemed
taxable.
Plan Year at the end of 2017 for

For example:
SURVIVOR BENEFITS
242420
Discussing what might happen to your family if you were not around to provide for them isn't always the
easiest conversation, but it is necessary. Survivor benefits provide financial assistance in an absence, and
can help you plan for the unexpected. If you have life insurance now, chances are you can take comfort
in knowing that those who depend on you will be provided for.
Dependents who are eligible must be listed on the benefit forms
turned into Human Resources for processing.
Beneficiary Designation
A beneficiary is the person you designate to receive your life
insurance benefits in the event of your death. This includes any
benefits payable under Group Term Life offered by The Company.
Benefits payable for a dependent’s death under the
insurance are payable to you.
It is important that your beneficiary designation is clear so there
is no question as to your intentions. It is also important that you
name a primary and contingent beneficiary. When naming your
beneficiary(ies), please indicate their full name, address, Social
Security number, relationship, date of birth and distribution
percentage. If the beneficiary is not legally related, insert the
words “Not Related” in the relationship field.
If you name more than one beneficiary with unequal shares,
please show the amount of insurance to be paid to each
beneficiary in percentages.
Life Provider Co.
Basic Term Life and
Accidental Death & Dismemberment
(AD&D) Insurance
Life and AD&D benefits are essential to the financial security of
you and your family. As such, it is important to understand how
your Plan works and what benefits you will receive.
Dependents who are elig
NEED HELP
CHOOSING THE RIGHT
LIFE INSURANCE PLAN?
Basic Term Life and AD&D benefits are provided to you as a
part of your basic coverage. The Company provides employees
with Life and AD&D insurance through Aetna, which
guarantees that loved ones, such as a spouse or other designated
survivor(s), continue to receive part of an employee's benefits
after death.
automatically receive life insurance even if you elect to waive
other medical, dental, or vision coverage. Your Basic AD&D
benefit is and is also provided by this Company at no
cost to you.
Your Basic Life benefit is
Company at no cost to you. If you are a full-time employee, you
$150,000,
For just $1 per month, you may elect
life insurance for your dependent(s) as
follows:
Supplemental
Dependent Life
$5,000 for spouse
$100 for children (14 days - 6 mo.)
$2,000 for children (6 mo. - 19) OR
age 25 if a full-time student.
■
■
■
and is provided by this
e a full-time employee, y
$50,000
PRIMARY CONTINGENT
Mary J. Doe,
Wife (34%)
Jane Doe,
Daughter (33%)
John Doe,
Son (33%)
Joseph W. Doe,
Son (50%)
Jane Doe,
Daughter (50%)
OR
Estate of the Insured
(100%)
If there is insufficient space for your beneficiary designations,
leave it blank and attach a separate sheet of paper indicating
your designations and share percentages. If you need assistance,
contact or your own legal counsel.Human Resources
S U R V I V O R
B E N E F I T S
21

2521
BASIC LIFE
COVERAGE AMOUNT
WHO PAYS Sample Company
BENEFITS PAYABLE Upon employee’s death
MAXIMUM BENEFIT $5,000
EVIDENCE OF INSURABILITY (EOI) REQUIRED N/A
BASIC DEPENDENT LIFE
COVERAGE AMOUNT
WHO PAYS Sample Company
BENEFITS PAYABLE Upon dependent’s death
MAXIMUM BENEFIT $1,000 per family
EVIDENCE OF INSURABILITY (EOI) REQUIRED
COVERAGE AMOUNT Increments of $1,000
WHO PAYS Employee
BENEFITS PAYABLE Upon your death
MAXIMUM BENEFIT The lesser of ﬁve times your annual salary or $500,000
EVIDENCE OF INSURABILITY (EOI) REQUIRED When making elections greater than $100,000
COVERAGE AMOUNT Increments of $5,000
WHO PAYS Employee
BENEFITS PAYABLE Upon dependent’s death
MAXIMUM BENEFIT The lesser of two times employee’s annual salary or $250,000 fo spouse; $25,000 per child
SUPPLEMENTAL DEPENDENT LIFE
SUPPLEMENTAL EMPLOYEE LIFE
$150,000
FGI Services, LLC. (the Company)
Upon employees death
$150,000
N/A
$5,000 $100 $2,000
Employee - $1.00 per month
$5,000 $100 $2,000
Upon dependent's death
Subject to EOI
Subject to EOI
$100,000
Upon employee's death
$100,000
increments of $5,000
must be less than
50% of the
employee's amount
or $250,000
must be less than
50% of the
employees amount
or $10,000
increments of $2,000
$100
$100
Upon dependent's death
* You must purchase Supplemental Life insurance for yourself if you wish to
purchase Supplemental Life insurance for your spouse and/or children
EVIDENCE OF INSURABILITY (EOI) REQUIRED When making elections greater than $50,000Subject to EOI
Employee
Employee
*
*
Life Insurance
may Life insurance for themselves and their families. Premiums are paid through
post-tax payroll deductions.
Eligible employees purchase Supplemental
Guarantee Issue
Employees are allowed $100,000 of Supplemental Term Life insurance without providing proof of good health, which is also
known as Evidence of Insurability (EOI). Spouses are allowed $25,000 of Supplemental Term Life insurance without providing
proof of good health.
The Guarantee Issue is available to those new hires, employees, and their dependents who enroll
mu
when they are first eligible for
coverage.
,
You st also ciary t. must also designate a beneficiary to receive payment.
22

262622
AGE
(AS OF JANUARY 1)
SP STIC
Younger than 20 Younger than 25
21-23 26-28
24-26 29-31
27-29 32-34
30-33 35-37
34-36 38-41
37-39 42-44
40-43 45-47
44-46 48-50
47-50 51-53
51-55 54-57
SUPPLEMENTAL LIFE INSURANCE
AGE
(as of January 1st)
EMPLOYEEEMPLOYEE
POUSE/DOMES
PARTNERSPOUSE
(per $5k)(Non-Tobacco per $10k) (Tobacco per $10k)
EMPLOYEE
$0.86
$1.00
$1.31
$1.84
$3.02
$5.08
$7.78
$10.52
$20.66
$38.59
$76.42
$1.39
$1.76
$2.65
$4.43
$7.57
$12.23
$17.07
$21.03
$37.10
$61.66
$99.43
Under 30
30-34
35-39
40-44
45-49
50-54
55-59
60-64
65-69
70-74
75+
$0.54
$0.59
$0.75
$1.18
$2.11
$3.46
$5.01
$7.68
$14.16
$23.39
$47.39
M O N T L Y R A T E S
Be sure to check state-speciic
rules if you designate someone
other than your spouse as your
Life insurance beneiciary.
M O N T H L Y R A T E S
l
SUPPLEMENTAL CHILD(REN) LIFE INSURANCE
One or more Children $0.49
PREMIUM RATES - PER $2,000 MONTLYMONTHLY
$ ÷ 1,000 = $ x Age Based Rate = $
Beneﬁt Elected Monthly Premium
TO CALCULATE HOW MUCH YOUR SUPPLEMENTAL LIFE COVERAGE WILL COST :
23

Disability insurance can replace
up to of your income
if you are unable to work.
Sample Company ofers disability coverage to protect you against an unfortunate or debilitating
injury. This insurance protects a portion of your income until you can return t u reach
retirement age.
INCOME PROTECTION
Short Term Disability (STD)
Insurance
Long Term Disability (LTD)
Insurance
27
for deta
Short Term Disability (STD) benefits are available to you as
a company benefit. STD insurance protects a portion of your
income if you become partially or totally disabled for a short
period of time. It replaces 60% of your income, up to a
maximum weekly benefit of $2,250, depending on your
current annual earnings. You must be sick or disabled for at
least 30 days before you can receive a benefit payment.
Payments may last up to 180 days. Certain exclusions and
any pre-existing condition limitations may apply. Please refer
to your Summary Plan Description for details or contact
Human Resources for specifics.
23
Your Company offers disability coverage to protect you against an unfortunate or debilitating
injury. This insurance protects a portion of your income until you can return to
reach retirement age.
60%
work or until you
DISCOVER
FREE RESOURCES,
TIPS AND DATA ON
DISABILITIES HERE.
I N C O ME
P R O T E C T I O N
24
Long Term Disability (LTD) benefits are available to you
as a company benefit. LTD insurance protects a portion of
your income if you become partially or totally disabled for
an extended period of time. This insurance replaces 60%
of your income, up to a maximum of $9,750 per month,
depending on your current annual earnings. You must be
sick or disabled for at least 902 days before you can
receive a benefit payment. Payments will last for as long
as you are disabled or until you reach your Social Security
Normal Retirement Age, whichever is sooner. Certain
exclusions and any pre-existing condition limitations may
apply. Please refer to your Summary Plan Description for
details or contact Human Resources for specifics.

RETIREMENT PLANNING
N O T E S
__________________________________________
__________________________________________
__________________________________________
__________________________________________
__________________________________________
__________________________________________
__________________________________________
__________________________________________
__________________________________________
2924
Don’t forget to account for future
health care costs when you are
considering how much money you
will need during retirement.
Contributing to the Plan
Deferred contributions are based on a
to exceed Plan limits set by the IRS. The limit for 2017
Catch-up Contributions
If you are or will be age 50 or older during
and you already contribute the maximum allowed to your
401(k) account, you may also make a catch-up contribution.
This additional deposit of funds accelerates your progress toward
your retirement goals. The maximum catch-up contribution is
$6,000 for 2017.
It's never too early - or too late - to start planning for your retirement. Making contributions to a 401(k)
account is the first step toward achieving financial security later in life. The FGI Group 401(k) Plan provides
you with the tools and flexibility you will need to retire comfortably and securely.
flat dollar amount not
2017 calendar year
can invest for retirement while receiving
certain tax advantages. The Company will match 25% of your
contribution with no cap.
Eligible employees
, in 2017.
All employees are eligible for 401k benefits the first of the month,
following or coinciding with date of hire and will be enrolled
automatically with a deferral rate of 6%. Instructions on how to
change your contributions/opting-out will be mailed to you
directly from Fidelity.
Eligibility
You may start mak
R E T I R E ME N T
P L A N N I N G
25
is $18,000.

303025
N O T E S
__________________________________________
__________________________________________
__________________________________________
__________________________________________
__________________________________________
__________________________________________
SET
RETIREMENT GOALS.
NEED MORE ADVICE?
26
Consolidating Your Retirement
Savings
If you have an existing qualified retirement plan (pre-tax
or post-tax) with a previous employer, you may transfer
or rollover that account in to the Plan at any time. To
initiate a rollover into your Plan, please refer to the
Summary Plan Description or contact Human Resources
for further instruction.
You may change the amount of your contributions any time.
All changes will become effective as soon as administratively
feasible and will remain in effect until you modify them. You
may also discontinue your contributions any time. Once you
stop making contributions, you may start again at any time.
Ask Fidelity about their Fidelity Advisory Service that can
assist you in managing your accounts. Fees for this service is
required.
Changing or Stopping Your
Contributions
VESTING SCHEDULE
YEARS OF SERVICE PERCENTAGE VESTED
0-2 years 20%
45%
6 years 100%
3-5 years
less than 2 years
2 years
0%
20%
3 years 40%
60%4 years
5 years 80%
6 years or more 100%
Investing in the Plan
You decide how to invest the assets in your account.
for you to choose from. This includes the traditional (pre-tax)
401(k) and the Roth (post-tax) 401(k). You may change your
investment choices any time. For more information, please
refer to your 401(k) Enrollment Guide.
The FGI 401(k) Plan offers a selection of investment options
You ma

ADDITIONAL BENEFITS
31
Emotional Health and Well-Being
■ Alcohol or Drug Dependency
■ Marriage or Family Relationship Problems
■ Job Pressures
■ Stress, Anxiety, Depression
■ Grief and Loss
■ Financial or Legal Advice
EAP provides referrals to help with:
■ Unlimited phone contact for grief counseling, financial
planning and legal advice up to one year from the date
of your claim’s approval
■ Assessment and action planning to help you develop
an individualized course of action
■ Up to three sessions per problem per member
with the appropriate EAP counselor for any combination
of emotional, legal, or financial advising
■ Referrals to additional resources outside of the Beneficiary
Assist Program to support specific situations like long-term
grief counseling or complex probate and estate planning
Services Include:
The Company cares about you and your family's total health management - mental, emotional and physical. For that reason, the
Company provides an Employee Assistance Program (EAP) to all staff members at no co
This service connects you with the best mental health and counseling services. Whether you are interested in work/life resources,
mental health assistance, or legal and financial advice, the EAP service can connect you and members of your household with a
variety of professionals. With just one phone call, at any hour of the day or night, you have access to helpful resources. The EAP
benefit includes three counseling sessions per problem per member with a qualified licensed professional. All services are 100%
confidential and will not be shared with the Company.
For more information, visit online at www.aetnaeap.com/login.aspx or by calling 1-800-492-4357.
26
■
Employee Assistance Program (EAP)
Your Company knows the value of having healthy, well-rounded, and balanced employees, which is why
we offer additional benefits to help you manage your life.
(EAP) at no cost to you.
A D D I T I O N A L
B E N E F I T S
27
Username: FGI Group Password: 8004924357

33
Talk to a Nurse
The "Ask a Nurse" program offered through Aetna can give
you a peace of mind knowing that there is a medical
professional available by phone or email 24-hours a day.
Registered nurses can help you:
Understand medical procedures and treatment options
Medication counseling and side effect explainations
Improve how you talk with your doctor/medical provider
Describe your symptoms better
Ask the right questions
Avoid trips to the doctor's office or hospital
■
■
■
■
■
■
Do you prefer to read? Healthwise solutions shares it's tools
and illustrations to help you make more informed health care
decisions. Find information about health conditions, tests and
procedures, and treatment options. Insights provided include
Healthwise Blogs, Patient Responses, health care news and
events, and more.
Visit the program online at:
https://www.healthwise.net/aetna/Content/CustDocument.
aspx?XML=STUB.XML&XSL=CD.FRONTPAGE.XSL
Healthwise Knowledgebase
27
Travel Assistance
With Aetna's Travel Assistance Program, toll-free emergency
assistance is available to you and any dependent(s) 24 hours
a day, seven days a week, when traveling 100 or more miles
from your primary home for 90 days or less.
Paid Time Of
The purpose of Paid Time Off (PTO) is to
with flexible, paid time off from work that can be used for
needs such as vacation, personal or family illness, doctor
appointments, school, volunteering and other activities of the
choice. The Company's goal is to reduce unscheduled
absences and the need for supervisory oversight.
The PTO days you acquire replace all existing vacation, sick time
and personal business days that you have been allotted under
prior policies.
provide employees
employee's
Tuition Assistance
to helping its full-time
pursue professional growth and development
by offering tuition assistance for eligible courses at the
undergraduate level.
The Company is committed
employees
Courses must be work related.
Telemedicine
Telemedicine through
on-demand access to board-certified doctors and pediatricians by
online video, phone, or secure email. For a copay of
consultation, you can be treated for various health and general
pediatric care issues without leaving the comfort of your home.
This service can be utilized for after-hours non-emergency care,
when your primary care physician is not available, make requests
TelaDoc is an additional benefit available
to employees and their dependents. With TelaDoc, you have
for prescriptions or refills, or if you are traveling and need
general medical care. Examples of items that can be treated
include allergies, asthma, headache, pink eye, respiratory
infections, ear infections, and much more. Please note that
some states do not allow physicians to prescribe medications
via telemedicine.
To access a board certified physician via phone or online
video consultation, please visit www.teladoc.com/aetna
or call 855-835-2362.
$40 per
AVISO: El programa tambien esta disponible en espanol.
To speak with a nurse at anytime
call 1-800-556-1555
28

GLOSSARY
Coinsurance – Your share of the cost of a covered health
care service, calculated as a percent (for example, 20%) of the
allowed amount for the service, typically after you meet your
deductible. For instance, if your plan’s allowed amount for an
office visit is $100 and you’ve met your deductible (but haven't
yet met your out-of-pocket maximum), your coinsurance
payment of 20% would be $20. Your plan sponsor or employer
would pay the rest of the allowed amount.
Flexible Spending Accounts (FSAs) – An option
that allows participants to set aside pre-tax dollars to pay for
certain qualified expenses during a specific time period (usually a
12-month period). There are two types of FSAs: the Health Care
FSA and the Dependent Care FSA.
■ Health Care FSA – With the Health Care
FSA, participants can use their accounts to cover
eligible medical expenses such as copays, eye exams,
prescriptions and more. All expenses must be qualified
as defined in Section 213(d) of the Internal Revenue
Code. Please note that over-the-counter medications
are not eligible for reimbursement without a doctor’s
prescription with the Health Care FSA.
343428
Health Care Cost Transparency – Also known as
Market Transparency or Medical Transparency. Health care
provider costs can vary widely, even within the same geographic
area. To make it easier for you to get the most cost-effective
health care products and services, online cost transparency
tools, which are typically available through health insurance
carriers, allow you to search an extensive national database
to compare costs for everything from prescription drugs and
office visits to MRIs and major surgeries.
cription
Explanation of Beneits (EOB)– A statement sent
by your insurance carrier that explains which procedures and
services were provided, how much they cost, what portion of the
claim was paid by the plan, and what portion is your liability,
in addition to how you can appeal the insurer’s decision. These
statements are also posted on the carrier's website.
Employee Contribution – The amount
you pay for your insurance coverage.
semi-monthly
Deductible – The amount you owe for health care services
before your health insurance or plan sponsor (employer) begins
to pay its portion. For example, if your deductible is $1,000,
your plan does not pay anything until you’ve met your $1,000
deductible for covered health care services. This deductible
may not apply to all services, including preventive care.
Copay – The fixed amount, as determined by your insurance
plan, you pay for health care services received.
Consumer-Driven Health Plan
that provides choice, flexibility and control when it comes to
spending money on health care. Preventive care is covered at
100% with in network providers, there are no copays, and all
qualified employee-paid Medical expenses count toward your
deductible and your out-of-pocket maximum.
(HSA) - Plan option
G L O S S A R Y
29
Both accounts are "use it or lose it" -
meaning that funds that are NOT used by
the end of the plan year will be lost.
Up to $250.00 may be rolled over to
the next Plan Year at the end of
2017 for Health Care FSAs.
■ Dependent Care FSA– A Dependent Care FSA –
helps to reimburse participants for eligible expenses associated
with caring for a qualified dependent, such as a dependent
younger than age 13 or another dependent that may be
incapable of self-care. For additional information on eligible
expenses, refer to Publication 503 on the IRS website.

Prescription Medications – Medications prescribed
to you by a doctor. Cost of these medications is determined
by their assigned
■ Drugs – Drugs approved by the U.S. Food
and Drug Administration (FDA) to be chemically
identical to
■ Drugs – Brand-name drugs on your
provider’s list of approved drugs. You can check online
with your provider to see this list.
■ Drugs – Brand-name drugs not on
your provider’s list of approved drugs. These drugs are
typically newer and have higher co-payments.
■ Drugs – Prescription medications used to
treat complex, chronic and often costly conditions such as
multiple sclerosis, rheumatoid arthritis, hepatitis C, and
hemophilia. Because of the high cost of these specialty
drugs, many insurers require that specific criteria be
met before a drug is covered. These requirements often
include:
• Performing a prior authorization to request coverage
of the medication
• Having a specific disease that the drug is FDA-approved
to treat
• Having a history of trying and failing cheaper
medications
• Creating high out-of-pocket costs when purchasing
the medication
• Restricting what pharmacy can dispense these
medications
Reasonable and Customary Allowance (R&C) –
Also known as an eligible expense or the Usual and Customary
(U&C). The amount your insurance company will pay for
a Medical service in a geographic region based on what
providers in the area usually charge for the same or similar
Medical service.
Summary of Beneits and Coverage (SBC) –
Mandated by health care reform, your insurance carrier or
plan sponsor will provide you with a clear and easy to follow
summary of your benefits and plan coverage.
35
tier: Generic, Preferred, Non-Preferred or
Specialty.
corresponding Preferred or Non-Preferred
Generic
Preferred
Non-Preferred
Specialty
cription
N O T E S
Health Savings Account (HSA) – A personal health
care bank account funded by you or your employer’s tax-free
dollars to pay for qualified medical expenses. You must be
enrolled in a CDHP to open an HSA. Funds contributed to an
HSA roll over from year to year and the account is portable,
meaning if you change jobs your account goes with you.
Out-of-Network – Out-of-network providers are doctors,
hospitals and other providers that are not contracted with your
insurance company. If you choose an out-of-network doctor,
services will not be provided at a discounted rate.
Out-of-Pocket Maximum – The most you pay during
a policy period (usually a 12-month period) before your health
insurance or plan begins to pay 100% of the allowed amount.
This limit does not include your premium, charges beyond
the Reasonable & Customary, or health care your plan doesn’t
cover. Check with your health insurance carrier to confirm what
payments apply to the out-of-pocket maximum.
Over-the-Counter (OTC) Medications – Medications
typically made available without a prescription.
29
versions. The color or flavor of a Generic medicine may be
different, but the active ingredient in the drugs are usually
the most cost-effective version of any medication.
__________________________________________
__________________________________________
__________________________________________
30

Required Notices
Important Notice from FGI Services, LLC About Your
Prescription Drug Coverage and Medicare under the
AetnaPlan(s)
Please read this notice carefully and keep it where you can ind it. This
notice has information about your current prescription drug coverage with
FGI Services, LLC and about your options under Medicare’s prescription drug
coverage. This information can help you decide whether or not you want to
join a Medicare drug plan. If you are considering joining, you should compare
your current coverage, including which drugs are covered at what cost, with
the coverage and costs of the plans offering Medicare prescription drug
coverage in your area. Information about where you can get help to make
decisions about your prescription drug coverage is at the end of this notice.
There are two important things you need to know about your current coverage
and Medicare’s prescription drug coverage:
1. Medicare prescription drug coverage became available in 2006
to everyone with Medicare. You can get this coverage if you join a
Medicare Prescription Drug Plan or join a Medicare Advantage Plan
(like an HMO or PPO) that offers prescription drug coverage. All
Medicare drug plans provide at least a standard level of coverage set
by Medicare. Some plans may also offer more coverage for a higher
monthly premium.
2. FGI Services, LLC has determined that the prescription drug coverage
offered by the Aetna plan(s) is, on average for all plan participants,
expected to pay out as much as standard Medicare prescription drug
coverage pays and is therefore considered Creditable Coverage.
Because your existing coverage is Creditable Coverage, you can keep
this coverage and not pay a higher premium (a penalty) if you later
decide to join a Medicare drug plan.
When Can You Join A Medicare Drug Plan?
You can join a Medicare drug plan when you irst become eligible for Medicare
during a seven-month initial enrollment period. That period begins three
months prior to your 65th birthday, includes the month you turn 65, and
continues for the ensuing three months. You may also enroll each year from
October 15th through December 7th.
However, if you lose your current creditable prescription drug coverage,
through no fault of your own, you will also be eligible for a two (2) month
Special Enrollment Period (SEP) to join a Medicare drug plan.
What Happens To Your Current Coverage If You Decide to
Join A Medicare Drug Plan?
If you decide to join a Medicare drug plan, your current FGI Services, LLC
coverage will not be affected. For most persons covered under the Plan, the
Plan will pay prescription drug beneits irst, and Medicare will determine its
payments second. For more information about this issue of what program
pays irst and what program pays second, see the Plan’s summary plan
description or contact Medicare at the telephone number or web address
listed herein.
If you do decide to join a Medicare drug plan and drop your current
FGI Services, LLC coverage, be aware that you and your dependents will not
be able to get this coverage back.
When Will You Pay A Higher Premium (Penalty) To Join A
Medicare Drug Plan?
You should also know that if you drop or lose your current coverage with
FGI Services, LLC and don’t join a Medicare drug plan within 63 continuous
days after your current coverage ends, you may pay a higher premium (a
penalty) to join a Medicare drug plan later.
If you go 63 continuous days or longer without creditable prescription drug
coverage, your monthly premium may go up by at least 1% of the Medicare
base beneiciary premium per month for every month that you did not have that
coverage. For example, if you go nineteen months without creditable coverage,
your premium may consistently be at least 19% higher than the Medicare base
beneiciary premium.You may have to pay this higher premium (a penalty) as
long as you have Medicare prescription drug coverage. In addition, you may
have to wait until the following October to join.
For More Information about This Notice or Your Current
Prescription Drug Coverage…
Contact the person listed at the end of these notices for further information.
NOTE: You’ll get this notice each year. You will also get it before the next
period you can join a Medicare drug plan, and if this coverage through
FGI Services, LLC changes. You also may request a copy of this notice at any
time.
For More Information about Your Options under Medicare
Prescription Drug Coverage…
More detailed information about Medicare plans that offer prescription drug
coverage is in the “Medicare & You” handbook.You’ll get a copy of the
handbook in the mail every year from Medicare.You may also be contacted
directly by Medicare drug plans.
For more information about Medicare prescription drug coverage:
» Visit www.medicare.gov
» Call your State Health Insurance Assistance Program (see the inside
back cover of your copy of the “Medicare & You” handbook for their
telephone number) for personalized help
» Call 1-800-MEDICARE (1-800-633-4227).
TTY users should call 1-877-486-2048
If you have limited income and resources, extra help paying for Medicare
prescription drug coverage is available. For information about this extra help,
visit Social Security on the web at www.socialsecurity.gov, or call them at
1-800-772-1213 (TTY 1-800-325-0778).
Remember: Keep this Medicare Part D notice. If you decide to join one
of the Medicare drug plans, you may be required to provide a copy of
this notice when you join to show whether or not you have maintained
creditable coverage and, therefore, whether or not you are required to
pay a higher premium (a penalty).
Date: January 1, 2017
Name of Entity/Sender: FGI Services, LLC
Contact—Position/Ofice: Human Resources
Address: P.O. Box 585
Austin, TX 78767
Phone Number: 512-443-4848
31

Women’s Health and Cancer Rights Act
The Women’s Health and Cancer Rights Act of 1998 was signed into law
on October 21, 1998. The Act requires that all group health plans providing
medical and surgical beneits with respect to a mastectomy must provide
coverage for all of the following:
» Reconstruction of the breast on which a mastectomy has been
performed
» Surgery and reconstruction of the other breast to produce a
symmetrical appearance
» Prostheses
» Treatment of physical complications of all stages of mastectomy,
including lymphedema
This coverage will be provided in consultation with the attending physician
and the patient, and will be subject to the same annual deductibles and
coinsurance provisions which apply for the mastectomy. For deductibles and
coinsurance information applicable to the plan in which you enroll, please
refer to the summary plan description or contact Human Resources at
512-443-4848.
HIPAA Privacy and Security
The Health Insurance Portability and Accountability Act of 1996 deals with how
an employer can enforce eligibility and enrollment for health care beneits, as
well as ensuring that protected health information which identiies you is kept
private. You have the right to inspect and copy protected health information
that is maintained by and for the plan for enrollment, payment, claims and
case management. If you feel that protected health information about you is
incorrect or incomplete, you may ask your beneits administrator to amend
the information. The Notice of Privacy Practices has been recently updated.
For a full copy of the Notice of Privacy Practices, describing how protected
health information about you may be used and disclosed and how you can get
access to the information, contact Human Resources at 512-443-4848.
HIPAA Special Enrollment Rights
If you are declining enrollment for yourself or your dependents (including your
spouse) because of other health insurance or group health plan coverage, you
may be able to later enroll yourself and your dependents in this plan if you
or your dependents lose eligibility for that other coverage (or if the employer
stops contributing towards your or your dependents’ other coverage).
Loss of eligibility includes but is not limited to:
» Loss of eligibility for coverage as a result of ceasing to meet the plan’s
eligibility requirements (i.e. legal separation, divorce, cessation of
dependent status, death of an employee, termination of employment,
reduction in the number of hours of employment);
» Loss of HMO coverage because the person no longer resides or works
in the HMO service area and no other coverage option is available
through the HMO plan sponsor;
» Elimination of the coverage option a person was enrolled in, and
another option is not offered in its place;
» Failing to return from an FMLA leave of absence; and
» Loss of coverage under Medicaid or the Children’s Health Insurance
Program (CHIP).
Unless the event giving rise to your special enrollment right is a loss of
coverage under Medicaid or CHIP, you must request enrollment within 30 days
after your or your dependent’s(s’) other coverage ends (or after the employer
that sponsors that coverage stops contributing toward the coverage).
If the event giving rise to your special enrollment right is a loss of coverage
under Medicaid or the CHIP, you may request enrollment under this plan
within 60 days of the date you or your dependent(s) lose such coverage under
Medicaid or CHIP. Similarly, if you or your dependent(s) become eligible for a
state-granted premium subsidy towards this plan, you may request enrollment
under this plan within 60 days after the date Medicaid or CHIP determine that
you or the dependent(s) qualify for the subsidy.
In addition, if you have a new dependent as a result of marriage, birth,
adoption, or placement for adoption, you may be able to enroll yourself and
your dependents. However, you must request enrollment within 30 days after
the marriage, birth, adoption, or placement for adoption.
To request special enrollment or obtain more information, contact Human
Resources at 512-443-4848.
32

Premium Assistance Under Medicaid and the
Children’s Health Insurance Program (CHIP)
If you or your children are eligible for Medicaid or CHIP and you’re eligible
for health coverage from your employer, your state may have a premium
assistance program that can help pay for coverage, using funds from their
Medicaid or CHIP programs. If you or your children aren’t eligible for Medicaid
or CHIP, you won’t be eligible for these premium assistance programs but
you may be able to buy individual insurance coverage through the Health
Insurance Marketplace. For more information, visit www.healthcare.gov.
If you or your dependents are already enrolled in Medicaid or CHIP and you
live in a State listed below, contact your State Medicaid or CHIP office to find
out if premium assistance is available.
If you or your dependents are NOT currently enrolled in Medicaid or CHIP, and
you think you or any of your dependents might be eligible for either of these
programs, contact your State Medicaid or CHIP office or dial
1-877-KIDS NOW or www.insurekidsnow.gov to find out how to apply. If
you qualify, ask your state if it has a program that might help you pay the
premiums for an employer-sponsored plan.
If you or your dependents are eligible for premium assistance under Medicaid
or CHIP, as well as eligible under your employer plan, your employer must
allow you to enroll in your employer plan if you aren’t already enrolled. This
is called a “special enrollment” opportunity, and you must request coverage
within 60 days of being determined eligible for premium assistance.
If you have questions about enrolling in your employer plan, contact the
Department of Labor at www.askebsa.dol.gov or call
1-866-444-EBSA (3272).
If you live in one of the following states, you may be
eligible for assistance paying your employer health plan
premiums. The following list of states is current as of
July 31, 2016. Contact your State for more information
on eligibility –
ALABAMA – Medicaid
WEBSITE http://myalhipp.com/
PHONE 1-855-692-5447
ALASKA – Medicaid
WEBSITE The AK Health Insurance Premium Payment Program
http://myakhipp.com/
PHONE 1-866-251-4861
EMAIL CustomerService@MyAKHIPP.com
MEDICAID
ELIGIBILITY:
http://dhss.alaska.gov/dpa/Pages/medicaid/default.aspx
ARKANSAS – Medicaid
WEBSITE http://myarhipp.com/
PHONE 1-855-MyARHIPP (855-692-7447)
COLORADO – Medicaid
WEBSITE http://www.colorado.gov/hcpf
PHONE Medicaid Customer Contact Center: 1-800-221-3943
FLORIDA – Medicaid
WEBSITE http://flmedicaidtplrecovery.com/hipp/
PHONE 1-877-357-3268
GEORGIA – Medicaid
WEBSITE http://dch.georgia.gov/medicaid
- Click on Health Insurance Premium Payment (HIPP)
PHONE 404-656-4507
INDIANA – Medicaid
WEBSITE Healthy Indiana Plan for low-income adults 19-64
http://www.hip.in.gov
PHONE 1-877-438-4479
WEBSITE All other Medicaid
http://www.indianamedicaid.com
PHONE 1-800-403-0864
IOWA – Medicaid
WEBSITE http://www.dhs.state.ia.us/hipp/
PHONE 1-888-346-9562
KANSAS – Medicaid
WEBSITE http://www.kdheks.gov/hcf/
PHONE 1-785-296-3512
KENTUCKY – Medicaid
WEBSITE http://chfs.ky.gov/dms/default.htm
PHONE 1-800-635-2570
LOUISIANA – Medicaid
WEBSITE http://dhh.louisiana.gov/index.cfm/subhome/1/n/331
PHONE 1-888-695-2447
MAINE – Medicaid
WEBSITE http://www.maine.gov/dhhs/ofi/public-assistance/index.html
PHONE 1-800-442-6003
TTY: Maine relay 711
MASSACHUSETTS – Medicaid and CHIP
WEBSITE http://www.mass.gov/MassHealth
PHONE 1-800-462-1120
MINNESOTA – Medicaid
WEBSITE http://mn.gov/dhs/ma/
PHONE 1-800-657-3739
MISSOURI – Medicaid
WEBSITE http://www.dss.mo.gov/mhd/participants/pages/hipp.htm
PHONE 573-751-2005
MONTANA – Medicaid
WEBSITE http://dphhs.mt.gov/MontanaHealthcarePrograms/HIPP
PHONE 1-800-694-3084
NEBRASKA – Medicaid
WEBSITE http://dhhs.ne.gov/Children_Family_Services/AccessNebraska/Pages/
accessnebraska_index.aspx
PHONE 1-855-632-7633
NEVADA – Medicaid
WEBSITE Medicaid Website: http://dwss.nv.gov/
PHONE Medicaid Phone: 1-800-992-0900
NEW HAMPSHIRE – Medicaid
WEBSITE http://www.dhhs.nh.gov/oii/documents/hippapp.pdf
PHONE 603-271-5218
33

NEW JERSEY – Medicaid and CHIP
WEBSITE Medicaid Website:
http://www.state.nj.us/humanservices/
dmahs/clients/medicaid/
PHONE Medicaid Phone: 609-631-2392
WEBSITE CHIP Website: http://www.njfamilycare.org/index.html
PHONE CHIP Phone: 1-800-701-0710
NEW YORK – Medicaid
WEBSITE http://www.nyhealth.gov/health_care/medicaid/
PHONE 1-800-541-2831
NORTH CAROLINA – Medicaid
WEBSITE http://www.ncdhhs.gov/dma
PHONE 919-855-4100
NORTH DAKOTA – Medicaid
WEBSITE http://www.nd.gov/dhs/services/medicalserv/medicaid/
PHONE 1-844-854-4825
OKLAHOMA – Medicaid and CHIP
WEBSITE http://www.insureoklahoma.org
PHONE 1-888-365-3742
OREGON – Medicaid
WEBSITE http://healthcare.oregon.gov/Pages/index.aspx
http://www.oregonhealthcare.gov/index-es.html
PHONE 1-800-699-9075
PENNSYLVANIA – Medicaid
WEBSITE http://www.dhs.pa.gov/hipp
PHONE 1-800-692-7462
RHODE ISLAND – Medicaid
WEBSITE http://www.eohhs.ri.gov/
PHONE 401-462-5300
SOUTH CAROLINA – Medicaid
WEBSITE http://www.scdhhs.gov
PHONE 1-888-549-0820
SOUTH DAKOTA - Medicaid
WEBSITE http://dss.sd.gov
PHONE 1-888-828-0059
TEXAS – Medicaid
WEBSITE http://gethipptexas.com/
PHONE 1-800-440-0493
UTAH – Medicaid and CHIP
WEBSITE Medicaid: http://health.utah.gov/medicaid
CHIP: http://health.utah.gov/chip
PHONE 1-877-543-7669
VERMONT– Medicaid
WEBSITE http://www.greenmountaincare.org/
PHONE 1-800-250-8427
VIRGINIA – MEDICAID AND CHIP
WEBSITE Medicaid Website: http://www.coverva.org/programs_premium_
assistance.cfm
PHONE Medicaid Phone: 1-800-432-5924
WEBSITE CHIP Website: http://www.coverva.org/programs_premium_
assistance.cfm
PHONE CHIP Phone: 1-855-242-8282
WASHINGTON – Medicaid
WEBSITE http://www.hca.wa.gov/free-or-low-cost-health-care/program-
administration/premium-payment-program
PHONE 1-800-562-3022 ext. 15473
WEST VIRGINIA – Medicaid
WEBSITE http://www.dhhr.wv.gov/bms/Medicaid%20Expansion/Pages/default.aspx
PHONE 1-877-598-5820, HMS Third Party Liability
WISCONSIN – Medicaid and CHIP
WEBSITE https://www.dhs.wisconsin.gov/publications/p1/p10095.pdf
PHONE 1-800-362-3002
WYOMING – Medicaid
WEBSITE https://wyequalitycare.acs-inc.com/
PHONE 307-777-7531
To see if any other states have added a premium assistance program since
July 31, 2016, or for more information on special enrollment rights, contact
either:
U.S. Department of Labor
Employee Beneﬁts Security Administration
www.dol.gov/ebsa
1-866-444-EBSA (3272)
U.S. Department of Health and Human Services
Centers for Medicare & Medicaid Services
www.cms.hhs.gov
1-877-267-2323, Menu Option 4, Ext. 61565
OMB Control Number 1210-0137 (expires 10/31/2016)
34

N O T E S
____ ___
____ ___
__________
___________________________________
___________________________________
___________________________________
_______________________ _
____________________
___
_____
_____
_____ _
___________________________________
___________________________________
Directly benefit
information with the Lockton BeneftLink
Mobile App.You’ll be immediately connected to
provider websites and phone numbers.You can
even capture and
store important
information like ID
cards, your group
numbers, doctors’
names and more!
BeneftLink
Username: fgi
Password: benefits
IMPORTANT CONTACTS
COVERAGE CONTACT
MEDICAL
PHARMACY
WELLNESS
DENTAL
VISION
LIFE AND AD&D
DISABILITY
EMPLOYEE
ASSISTANCE
PROGRAM
BENEFICIARY
ASSISTANCE
401(K) PLAN
HEALTH SAVINGS
ACCOUNT
FLEXIBLE SPENDING
ACCOUNTS
P&A Group
800-688-2611
Claims Fax: 716-855-7105 or 877-855-7105
www.padin.com
Aetna
888-416-2277
Lockton
access, FGI Services, LLC.
34
Aetna
Plan #835875
888-416-2277
www.aetna.com/individuals-families/ pharmacy.html
Aetna
Plan #835875
888-416-2277 or 1-800-US-AETNA
www.aetna.com
United HealthCare (UHC)
Plan #743533
877-816-3596
www.myuhc.com/member/prewelcome
United HealthCare (UHC)
Plan #743533
800-638-3120
www.myuhc.com/member/prewelcom
Human Resources
512-443-4848
Aetna Resources for Living
800-492-4357
www.mylifevalues.com
Fidelity Investments
Plan #487074
800-835-5097
www.401k.com or www.netbenefits.com
Aetna
Plan #835875
866-326-1380
www.aetna.com
HSA Bank
Client Assistance Center
800-357-6246
www.hsabank.com
Aetna
Plan #835875
866-326-1380
www.aetna.com
www.aetna.com/insurance-producer/health-wellness
-programs.html
______________________________
______________________________
______________________________
____________________________
____________________________
______
______________
______________
#80840
www.aetna.com/individuals-families/pharmacy.html
www.aetna.com/insurance-producer/health-wellness-
tools.html
www.myuhc.com/member/
www.myuhc.com/member/
https://www.padmin.com/employee-participants/
account-login/index.php3
P&A Group
800-688-2611
Claims Fax: 716-855-7105 or 877-855-7105
www.hsabank.com/hsabank/members
https://www.aetna.com/individuals-families/member-
plans-benefits/disability-insurance.html
https://www.aetna.com/insurance-producer/life-
insurance.html
I MP O R T A N T C O N T A C T S
35

IMPORTANT CONTACTS
CONTINUED
404040
_
_
_
_
_
35
___
__ _
_______________
HSA Bank
Mobile
______________________ __
_____________
______________
_____________
______________
_
__
__ __
_ _
______________
__
https://itunes.apple.com/us/app/hsa-
bank-mobile/id867117986?mt=8
https://play.google.com/store/apps/
details?id=com.lighthouse1.mobilebe
nefits.hbkbp&hl=en
Get Away Inc.
214-632-9988
www.getaway.com
Aetna
AXA Assistance USA's Alert Center
312-935-3704 (direct) or 877-935-3704 (toll-free)
If outside the U.S., call 312-935-3704.
All collect calls are accepted.
TRAVEL
ASSISTANCE
TELEMEDICINE
TelaDoc
855-835-2362
www.teladoc.com/aetna
HUMAN
RESOURCES
512-443-4848
3901 S. Lamar
Suite 100
Austin, TX 78704
HUMAN
RESOURCES
512-443-4848
3901 S. Lamar
Suite 100
Austin, TX 78704
WELLNESS
SCREENING
Quest Diagnostics
FGI Group Plan Specialist: Katie Birkenfeld
913-895-2536
www.my.questforhealth.com
____________________________
____________________________
______
Scan the codes below
now to access apps that
save you time & money
_
__
__
_
__ ___
______________ __
____________________________
______________
______________
United
HealthCare
(UHC)
__
_______________ ___
_______________ __
____________________________
______________
______________
Aetna
Medical
__ __
______________ _
___________________________
______________
______________
Fidelity
Net Benefits
__ __
______________ __
____________________________
______________
______________
iTriage
_
_
Medwatcher
______________________ __
_____________
______________
_____________
______________
_
__
__ __
_ _
______________
__
_
__________________________________________
______________________ __
_____________
______________
_____________
______________
_
__
__ __
_ _
______________
__
https://itunes.apple.com/us/app/tela
doc-member-24-7-access/id65687260
7?mt=8&ign-mpt=uo%3D4
https://play.google.com/store/apps/
details?id=com.teladoc.members
_
_
__ ___
__
__________________________________________
__ ___
______________ __
____________________________
______________
______________
Instant
Heart Rate
https://itunes.apple.com/us/app/med
watcher-for-drugs-vaccines/id3917670
48?mt=8
https://play.google.com/store/apps/d
etails?id=org.medwatcher&hl=en
_
I MP O R T A N T C O N T A C T S
36

In today’s uncertain economic times, it’s more
important than ever to ensure your retirement
plan is on track—and The Clift Group at Morgan
Stanley is here to help. As a participant in the FGI
Group Inc 401(k) Plan, you can receive one-on-one
financial planning. And best of all, this service is
available at no additional cost to you.
Take charge of
your retirement
planning
We can help you:
• Build a Customized Financial Plan for
you and your family
• Understand your plan’s features and
investment options
• Review the importance of
diversification and other asset
allocation strategies
• Discuss Non-Qualified and Self-Directed
Brokerage Accounts
• Complete a Pre-Retirement Checklist
• Assist retiring employees with
retirement plan distribution strategies
Meet your retirement
plan consulting team:
Kevin Clift, CIMA
Financial Advisor
214-661-7101
Kevin.l.clift@ms.com
31 years of experience
Matt Sheldahl, CFA
Consulting Group Analyst
214-661-7103
matthew.sheldahl@ms.com
Kyle Clift, CRPS
Financial Advisor
214-661-7102
Kyle.clift@ms.com
http://www.morganstanleyfa.com
/thecliftgroup/
200 Crescent Court, Suite 900
Dallas, TX 75201
Planning for retirement is important. To reach your goals, you need to know how much
to save and which investment options are right for you. We’re here to help. The Clift
Group has over 50 years of experience serving 401(k) Plans like yours.
Tax laws are complex and subject to change. Morgan Stanley Smith Barney LLC (“Morgan Stanley”) , its affiliates and Morgan Stanley
Financial Advisors and Private Wealth Advisors do not provide tax or legal advice and are not “fiduciaries” (under ERISA, the Internal
Revenue Code or otherwise) with respect to the services or activities described herein except as otherwise agreed to in writing by Morgan
Stanley. Individuals are encouraged to consult their tax and legal advisors (a) before establishing a retirement plan or account, and (b)
regarding any potential tax, ERISA and related consequences of any investments made under such plan or account.
Investments and services offered through Morgan Stanley Smith Barney LLC. Member SIPC.

2017
PAYROLL DEDUCTION AUTHORIZATION FORM
PRE-TAXABLE BENEFITS
F
O
R
P
A
Y
R
O
L
L
U
S
E
O
N
L
Y
DEPENDENT (DAY CARE) SPENDING ACCOUNT: MAXIMUM $5,000.00
ANNUAL (CALENDAR YEAR) CONTRIBUTION AMOUNT: $ DECLINE
FLEXIBLE SPENDING ACCOUNT: MAXIMUM
ANNUAL (CALENDAR YEAR) CONTRIBUTION AMOUNT: $ DECLINE
HEALTH PLAN COVERAGE OPTIONS – CHOOSE ONE
Aetna Deductible Options: $1,500 (Standard) OR $5,000 (HDHP) OR Health Savings Account (HSA)
Employee Only Employee & Spouse
Employee & Children Employee & Family DECLINE
DENTAL COVERAGE
Employee Only (Company Pays) Employee & Spouse
VISION COVERAGE
Employee Only (Company Pays) Employee & Spouse
VOLUNTARY BENEFITS
DEPENDENT LIFE ($1.00 A MONTH) EMPLOYEE PAYS DECLINE
SUPPLEMENTAL LIFE INS. (Aetna APPLICATION REQUIRED) EMPLOYEE PAYS DECLINE
If you are electing to participate in FSA Medical and/or Dependent Day Care, please complete the requested information below
Spouse Name Date of Birth Dependent Name Date of Birth
Dependent Name Date of Birth Dependent Name Date of Birth
I hereby elect the benefits indicated above. I have read and understand the enrollment materials contained within the employee benefit guide and I authorize
my employer to adjust my pay as required by my election(s). I understand that this election is binding and cannot be revoked or modified until the next plan
year, except under the limited circumstances that are described in detail in the SPD that I have received from my employer (i.e. marriage, divorce, birth). I also
understand if participating in an FSA account (Health/Dependent Day Care) any funds not used for eligible expenses incurred during the period of coverage will
be forfeited in accordance with the current plan provisions and tax laws.
I hereby, elect to make a CHANGE to my current "pre-tax" benefits (as allowed by my employer’s plan do u e t), due to the followi g “family status change"
which was effective on / / 2017
Marriage Divorce Legal Separation Birth/Adoption of child Change in job status
Death in immediate family My depe de t’s eligi ility for e efits has ha ged My (spousal) eligibility for benefits has changed
EMPLOYEE SIGNATURE___________________________________________ DATE________________________________
FOR HR USE ONLY
EFFECTIVE DATE:
EMPLOYER/DIVISION
FGI Services, LLC Dynamic Systems, Inc. Dynamic Manufacturing Solutions, LLC TAB Technologies, Inc.
EMPLOYEE LAST NAME FIRST NAME, MIDDLE INITIAL DATE OF BIRTH MARITAL STATUS
Single Married
EMPLOYEE MAILING ADDRESS CITY, STATE & ZIP
CONTACT PHONE NUMBER PRIMARY EMAIL BACKUP EMAIL
$2,600.00

HR 2017
ENROLLMENT / CHANGE / CANCELLATION FORM
฀ ENROLL ฀ CHANGE
A. Employee Information
FIRST NAME M.I. LAST NAME SOCIAL SECURITY NO.
MAILING ADDRESS CITY STATE ZIP
B. Dependents
(If additional space is needed, attach separate sheet)
ACTION NAME/SOCIAL SECURITY NUMBER SEX DATE OF BIRTH RELATIONSHIP FULL-TIME
STUDENT
COVERAGE
฀ Enroll
฀ Change
฀ Cancel
Spouse:
฀ M
฀ F
฀ Yes
฀ No
฀ Medical
฀ Dental
฀ VisionSS#
฀ Enroll
฀ Change
฀ Cancel
Dependent:
฀ M
฀ F
฀ Yes
฀ No
฀ Medical
฀ Dental
฀ Vision
SS#
฀ Enroll
฀ Change
฀ Cancel
Dependent:
฀ M
฀ F
฀ Yes
฀ No
฀ Medical
฀ Dental
฀ Vision
SS#
฀ Enroll
฀ Change
฀ Cancel
Dependent:
฀ M
฀ F
฀ Yes
฀ No
฀ Medical
฀ Dental
฀ VisionSS#
฀ Enroll
฀ Change
฀ Cancel
Dependent:
฀ M
฀ F
฀ Yes
฀ No
฀ Medical
฀ Dental
฀ Vision
SS#
aa
C. Other Insurance
On the day your coverage begins, will you, your spouse, or dependents be covered under any other
insurance? If yes, complete the following section: (Use a separate sheet if necessary)
Insurance Company Name
฀ Medicare ฀ Medicaid ฀ Other Insurance Carrier
Name of Person Insured Social Security Number Coverage Start Date Coverage End Date
C. Other Insurance
SIGNATURE: _________________________________________ DATE: __________________________

Health Savings Account (HSA) Application and Eligibility Form
Instructions: Complete all fields below. Mail or fax your application to: HSA Bank, P.O. Box 939, Sheboygan, WI 53082, Fax: 920-803-4184
For assistance, call 800-357-6246, Monday - Friday, 7 a.m. - 9 p.m., or Saturday, 9 a.m. -1 p.m., CT. Para ayuda en Español, por favor llamar 866-357-6232.
PART 1: GENERAL INFORMATION FOR PRIMARY ACCOUNTHOLDER
First Name: MI: Last Name: Date of Birth (must be 18): (mm/dd/yyyy) Social Security Number (Required):
Physical Street Address: (Required) City: State: ZIP Code:
Preferred Mailing Address: Physical Street Address P.O. Box
Email:
P.O. Box: City: State: ZIP Code:
Home Phone: Business Phone:
Citizenship Status: U.S. Citizen Resident Alien Non-resident Alien If not a U.S. Citizen, enter Country of Citizenship:
Employment: Employed Not Employed Self-Employed Retired
Employer: Title/Profession:
Health Plan Insurance: Single Family Effective Date of your Health Insurance: Deductible Amount: $
PART 2: AUTHORIZED SIGNER OPTIONAL: (SUCH AS A SPOUSE OR ANOTHER THIRD PARTY)
By completing all of the fields below, you are authorizing the person designated as “Authorized Signer” to access and initiate transactions on your account as your agent.
HSA Bank will rely upon this designation until HSA Bank receives your written revocation of this authorization and has had a reasonable time to act upon it. You hold harmless
and indemnify HSA Bank against any claims against or losses arising out of HSA Bank’s reliance on this authorization, and release HSA Bank from any liability arising from
such reliance, unless otherwise prohibited by law. You remain solely responsible for any tax consequences that result from any actions taken by the authorized signer
regarding your account.
First Name: MI: Last Name: Date of Birth: (mm/dd/yyyy) Social Security Number:
Address same as accountholder
Street Address:
City: State: ZIP Code: Phone Number:
If you would like to designate a beneficiary for your account, please complete our Designation of Beneficiaries form which is available on our website at:
http://www.hsabank.com/beneficiary.
PART 3: ACCOUNT SELECTIONS
Please select the account options and enter an amount where appropriate.
Primary Accountholder debit card (No Charge)
Authorized Signer debit card (if applicable) (No Charge)
Checks ($7.95 – check must be included to process order) $______________
Initial Contribution $______________ Contribution Year_______________
Transfer: Yes No (If yes, please attach the HSA transfer/rolloverform or IRA form)
PART 4: ACCOUNT AUTHORIZATION
By signing below, I certify that:
• I am, or will be covered by a qualified High Deductible Health Plan (HDHP), I am not enrolled in Medicare or covered under other health insurance that is not compatible with an HSA, and I may
not be claimed as a dependent on another person’s tax return (excluding spouses per the IRS).
• HSA Bank is hereby appointed to serve as custodian of my Health Savings Account.
• To help the government fight the funding of terrorism and money laundering activities, Federal Law requires that all financial institutions obtain, verify and record information that identifies each
person who opens an account. What this means to you: when you open an account we will need you and your authorized signer to provide name, street address, date of birth and other
information that will allow us to identify you and your authorized signer. We may also ask to see your driver’s license or other identifying documents.
After your application is processed, you will receive a Welcome Kit by mail in 7-10 business days. The Welcome Kit contains your account number and our disclosures. It also outlines our
services and provides details on how to manage your account. If you don’t receive your Welcome Kit, please contact us.
Accountholder Signature: Date:
For Tracking Purposes (to be completed by employer or insurance/financial representative) Internal Use Only:
Health Plan Code Broker Dealer AIN# SVC Software MGA Marketing Employer Fed ID #
FGI Group Inc
1036743 1036742 1015084 742333173

Health Savings Account (HSA)
Contribution Options & Salary Reduction Arrangement
FORM_Contributions_Options_EE_to_ER_030915
By my signature below, I certify that I have enrolled, or plan to enroll, in an HSA-qualified High Deductible Health Plan (HDHP) and
am not covered under any other plan that would disqualify me from opening or contributing to my Health Savings Account. I
understand that this form is provided for convenience purposes and that HSA Bank will not initiate any contributions to my HSA,
but will allow my employer or their authorized agent to initiate contributions to my account.
OPTION ONE
I elect to make contributions to my HSA through a pre-tax salary reduction through my employer’s Section 125 Cafeteria Plan
and authorize my employer deduct the amounts as indicated from my salary and forward the funds to HSA Bank to be deposited
in my HSA.
Deduction Option: Frequency of Pay Period:
$50.00 per pay period Weekly (52 per/year)
$75.00 per pay period Bi-Weekly (26 per/year)
$100.00 per pay period Semi-Monthly (24 per/year)
Maximum Single Contribution
(less employer contribution)
Monthly (12 per/year)
Maximum Family Contribution
(less employer contribution)
Other $_______.____
Total Annual Employee Election: $_______.____
Total Annual Employer Election (if applicable): $_______.____
Note: Your Total Annual Employee Election along with contributions from any other sources, including your employer, may not
exceed the Annual Maximum Contribution amount set by the IRS. Contribution limits for the current tax year can be found at:
www.hsabank.com or by visiting the IRS site at: www.irs.gov. Additionally, investment accounts are not FDIC insured, may lose
value and are not a deposit or other obligation of, or guarantee by the bank.
Date of first HSA contribution: _____________
(Date must be on or after the first day of your HDHP coverage or the first day of opening your HSA, whichever is later. Leaving the
date blank will authorize your employer to determine the date on your behalf.)
OPTION TWO
I do not want to make contributions to my HSA through a pre-tax salary reduction. I understand that I may make contributions
to my HSA on an after-tax basis by sending contribution(s) directly to HSA Bank.
EMPLOYEE INFORMATION
Employee Name: SSN:
Employee Address:
City: State: Zip Code:
Employee Signature: Date:
Please return form to your employer.

FGI Group, Inc. Enrollment/Change Request
Aetna Life Insurance Company
BASIC LIFE INSURANCE
A. Transaction Information
1. Enrollment
 New Employee
-Tobacco
Requested Employee Coverage
Voluntary Life/AD&D
Requested Dependent
Coverage
Yes
No
Tobacco
Non-Tobacco
2. Termination (Cancel)
 Employee*
*Employee must be
enrolled for dependent(s)
to have coverage.
3. Change (*Provide explanation in Section
D, Special Remarks.)
 Add Dependent(s)
 Remove Dependent(s)
 Plan Change
 Increase/Decrease Benefit Amount*
 Other*
B. Employer Information
1. Employer Name – Full Name of Business or Organization
FGI Group, Inc.
2. Control No.
835875
Suffix Account 3. Plan Number 4. SFO
Dallas
5. Employer Address (Street, City, State, ZIP Code) Location of Business or Organization
3901 S. LAMAR BLVD, SUITE 100 AUSTIN TX 78704
6. Claim Office Code
Hartford, CT #174
7. Customer Code (Optional)
N/A
C. Employee Information – Please Print all Information.
1. Employee Social Security No. 2. Employee Name (Last, First, Middle Initial) 3. Birthdate
(MM/DD/YYYY)
4. Sex 5. Telephone Numbers
Home ( )
Work ( )
6. Employee Home Address (Number, Street, Apt. No., City, State, ZIP Code) 7. Employee Annual Earnings
$
8. Occupation/Title
9. Employee Coverage Amounts (Based on the requirements of your Plan, you may have to submit evidence of good health.)
Employee Annual Earnings
$
Basic Life Amount
$150,000
Supplemental Life Amount
$
Basic AD&D Amount
$50,000
10. Beneficiary Designation – If more than one beneficiary, use Special Remarks. Dependent coverage Beneficiary is always the Employee.
Full Beneficiary Name (First, Middle, Last) Social Security Number of Beneficiary Relationship to Employee
D. Covered Dependents
Complete only if Dependent Coverage is offered under your Plan.  Check this box if you are refusing coverage for your dependents.
(A)dd/New
(C)hange
(R)emove
Dependent Name (First,
Middle Initial, Last)
Social Security
Number
(If dependent has no
SSN, write “None”)
Relat.
Code
Birthdate
MM/DD/YYYY
Student
Age 19
or Older
Yes No
Supplemental
Dependent
Life Amount
Supplemental
Dependent
AD&D
Amount
  $ $
  $ $
  $ $
  $ $
Special Remarks
E. Certification – Signatures Required Employee E-mail Address:
My signature below signifies my agreement with the statements and authorization under Certification and Authorization on the back of this form.
1. Employee Signature
X _______________________________________________________
Date 2. Employer Signature
X _____________________________________________________
Date
Visit us at www.aetna.com Make a copy for your records. (3-02) B-POD

TOBACCO AFFIDAVIT
To be eligible for the Non-Tobacco Credit, you must select one of the following “Tobacco Free”
requirements:
1. My household and I are “tobacco free”; or
2. My household dependents and I must complete a Tobacco Cessation Program and submit a
Tobacco Cessation Certificate of Completion to the HR Department; or
TOBACCO IS DEFINED AS CIGARETTES, E-CIGARETTES (VAPING), PIPES,
CIGARS, OR CHEWING TOBACCO
Please make your selection below:
□ I and my household dependents are Tobacco Free and will be eligible for the Non-Tobacco Credit
3. I and my household dependents must submit documentation to the HR Department that I/we
are under a physician's care for tobacco cessation or are unable to complete the tobacco
cessation program due to a medical condition.
□
□ I and my household dependents must submit documentation to the HR Department that I/we
are under a physician's care for tobacco cessation or are unable to complete the tobacco
cessation program due to a medical condition.
□
I and my household dependents are in the process of completing a Tobacco Cessation Program.
I understand that I need to complete an submit proof of completion to HR to receive the Tobacco
Discount.
I and/or my household dependents are NOT Tobacco Free and will not receive The
Tobacco Discount.
Providing inaccurate or false information to receive the Non-Tobacco credit may lead to
disciplinary action up to and including separation.
Employee Signature: __________________________________ Date: __________________
Employee Name (Print): _________________________________
Tobacco Discount.
If you and your eligible household dependents elect to participate in one of FGI's medical plans,
you must complete and sign this Tobacco Affidavit Statement before your Enrollment can be
processed by the HR Department.

Employee Benefits Guide 2017

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