U.S. Xpress Enterprises, Inc.
Plan Information Worksheet
Flex STD
Latest revision – 12.1712 FINAL bwe REVISED
Please note that your contract will be based on your approval and sign off of this plan document
These provisions are governed by the state and cannot be altered, unless otherwise stated
Client Information
Legal Name: U.S. Xpress Enterprises, Inc.
Legal Address: 4080 Jenkins Road; Chattanooga, Tennessee 37421
Situs:
Tennessee
Type of Business (SIC Code):
4213 – Trucking, except Local
Effective Date: 1-1-2013
Policy Number: 294727–001 Flex STD
Other Lines of Coverage/Policy Number(s):
294727-002 Flex LTD
294728-Flex Life
294729–Exec Trad. LTD
Prior
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Plan:
Prior Carrier: Reliance Standard
Effective Date: 1/1/2004
Termination Date: 12/31/2012 as per contract doc
STD Information
Eligible Groups: (note claim divisions will match group numbering)
US Xpress Enterprises, Inc.
Group 1: All full-time Office Employees of US Xpress Enterprises, Inc, except drivers and except for any person employed
on a temporary or seasonal basis, in active employment in the United States with the Employer.
Group 2: All full-time Drivers of US Xpress Enterprises, Inc., except for any person employed on a temporary or seasonal
basis, in active employment in the United States with the Employer.
Total Transportation of Mississippi, LLC
Group 3: All full-time Office Employees of Total Transportation of Mississippi, LLC except drivers and for any person
employed on a temporary or seasonal basis, in active employment in the United States with the Employer.
Group 4: All full-time Drivers of Total Transportation of Mississippi, LLC except for any person employed on a temporary or
seasonal basis, in active employment in the United States with the Employer.
Arnold Transportation Services, Inc.
Group 5: All full-time Office Employees of Arnold Transportation Services, Inc, except drivers for any person employed on a
temporary or seasonal basis, in active employment in the United States with the Employer.
Group 6: All full-time Drivers of Arnold Transportation Services, Inc except for any person employed on a temporary or
seasonal basis, in active employment in the United States with the Employer.
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Xpress Global Systems
Group 5: All full-time Office Employees of Xpress Global Systems, except drivers for any
person employed on a temporary or seasonal basis, in active employment in the United States with the Employer.
Group 6: All full-time Drivers Xpress Global Systems, except for any person employed on a temporary or seasonal basis, in
active employment in the United States with the Employer.
Foreign Nationals: none
Minimum # of Hours:
Group 1,3, 5, : 33 hours per week
Group 2,4, 6, : Drivers who are considered active in the US Xpress system named Infinium.
Waiting Period Present & New: 1st of the month coinciding with or following 90 days of continuous active
employment
Waiver of the Waiting Period OR Credit Prior Service Y/N: Yes, Credit prior service
Rehire: 30 days
Buy-up Employee Contributions: Shared
Group 1,3,5 Office Employees
Option 1: n/a since Non-contrib.
Option 2-20: Shared contrib
Group 2,4 Truck Drivers
All options are contrib.100%
Group 6 Truck Drivers (XGS)
Option 1: n/a since Non-contrib.
Option 2-6: Shared contrib
Participation Requirement: 25%
Section 125 Plan (Y/N): N
Benefit Taxability (Pre/Post):
Group 1,3, 5, Options 2 thru 20 post tax
Group 2, 4, , All options are post tax
Group 6 Options 2 thru 6 post tax
Percentage Employees Contribute:
Group 1,3, 5,: Options 2 thru 20: Shared, Employer pays premium for first $200
Group 2, 4, : 100% Employee contrib. for all options
Group 6 Options 2 thru 6: Shared, Employer pays premium for first $200
Elimination Period: 14 consecutive days
Are Employees required to Exhaust Salary Continuation or Accumulated Sick Leave Plan (Y/N): N
Weekly Benefit
Group 1,3, 5, Office Employees (Max Benefit not to exceed 60% of earnings)
Option 1: $200 – non contrib
Option 2: $250
Option 3: $300
Option 4: $350
Option 5: $400
Option 6: $450
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Option
Option
Option
Option
Option
Option
Option
Option
Option
Option
Option
Option
Option
Option
7: $500
8: $550
9: $600
10: $650
11: $700
12: $750
13: $800
14: $850
15: $900
16: $950
17: $1000
18: $1050
19: $1100
20: $1150
Group 2,4, Truck Drivers (Max Benefit not to exceed 60% of earnings)
Option 1: no coverage
Option 2: $50
Option 3: $100
Option 4: $150
Option 5: $200
Option 6: $250
Option 7: $300
Option 8: $350
Option 9: $400
Option 10: $450
Group 6 Truck Drivers for XGS (Max Benefit not to exceed 60% of earnings)
Option 1: $200 non contrib
Option 2: $250
Option 3: $300
Option 4: $350
Option 5: $400
Option 6: $450
Does the plan have a opt out/no coverage option? Yes
Weekly Earnings Definition:
Shift Differential (Y/N):
No for all groups
Unum Prior Plan
WHAT ARE YOUR WEEKLY EARNINGS?
Office Employees
"Weekly Earnings" means your gross weekly income from your Employer in effect
just prior to your date of disability. It includes your total income before taxes. It is
prior to any deductions made for pre-tax contributions to a qualified deferred
compensation plan, Section 125 plan, or flexible spending account. It does not
include income received from commissions, bonuses, overtime pay, any other extra
compensation, or income received from sources other than your Employer.
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Drivers
"Weekly Earnings" means your gross weekly income from the Employer based on
the average of the 12 weeks just prior to the date of your disability. It includes your
total income before taxes. It is prior to any deductions made for pre-tax
contributions to a qualified deferred compensation plan, Section 125 plan, or flexible
spending account. It includes income actually received from per diem wages but
does not include income received from commissions, bonuses, overtime pay or any
other extra compensation, or income received from sources other than your
Employer.
Maximum Period of Payment (Benefit Duration): All groups: 13 weeks
Benefit Payment Basis: 1/7th
8/31 Willis confirmed
2012 Initial Enrollment
 Groups 1-8: One level buy up with no EOI for someone currently enrolled
Ongoing EnrollmentsWhen are employees allowed to make changes in coverage:
 Annual Enrollment
 Change in Status NO EOI Required to increase to max if already in plan
What changes are allowed: .
 Annual Enrollment Unum will allow one level buy up with no EOI for someone currently enrolled
 Change in Status : NO EOI Required to increase to max if already in plan
Evidence of Insurability:
When can an employee enroll as a Late Entrant:
 Annual Enrollment
 Change in Status – all amounts of insurance including enter into plan
When is EOI required for employee Late Entrant:
 Annual Enrollment All amounts of insurance
 Change in Status – all amounts of insurance including enter into plan
EOI form #: 1143-01 (check State for applicable form number)
Effective Date of Coverage that requires EOI: Date of approval
ALL GROUPS
Coverage during Temporary Layoff: End of the month following the month in which the temporary layoff begins.
Coverage during Approved Leave of Absence: End of the month following the month in which the leave of
absence begins.
Extension of Coverage for Massachusetts Residents (Y/N): Y
Definition of Disability: Residual
Social Security Offset (if STD duration is over 26 weeks): n/a
Deductible Sources of Income: Unum Standard
Optional Deductible Sources of Income (Offsets) (Y/N): Y salary continuation
USX confirmed on Friday 8/31
Exclusions: Unum Standard.
Pre-Ex Condition: None
Continuity of Coverage (Y/N): not necessary since no pre-ex
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Unum is a registered trademark and marketing brand of Unum Group and its insuring subsidiaries
Recurrent Disability: 14 consecutive days or less from the end of the prior claim
Rehabilitation/Return to Work Program: Additional benefit of 10% of their gross disability payment to a
maximum benefit of $250 per week
Delayed Effective Date: Your coverage will begin on the date you return to active employment.
Divisions, Subsidiaries & Affiliates (Company(ies) Y/N: Y
 If yes, need Name & Address(es) (City & State):
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Total Transportation of Mississippi, LLC; Chattanooga, TN
Arnold Transportation Services, Inc.; Chattanooga, TN
Xpress Global Systems; Chattanooga, TN
ERISA Plan #, Year End, Plan Name, EIN # and Phone #:
Group Short Term Disability Insurance
U.S. Xpress Enterprises, Inc.
4080 Jenkins Road
Chattanooga, TN 37421
(423)-510-3757
EIN 62-1378182
Plan Number 501
Employee Booklet – Are separate booklets by eligibility group needed?: YES
Email: athompson@usxpress.com
Eligibility: By group number
Group Number: By group number
Other STD Information
Transport Layer Security (TLS) (Y/N): N
STD Telephonic Claims Intake (Y/N): Y
*Employer FICA Match (Y/N): Y – however not billed back to ER. Ok’d by UW on 9/10/12 M.Brown
*Services that require Agreements (Agreements must be executed prior to the policy effective date)
Rate and Administration Information
Eligible Lives: 6234
Monthly Premium Rates:
Group 1,3,5,6:
Basic Rate: $0.49 per $10
Buy-up Rate:
Monthly Rate of ($STEP) per $10 of weekly
benefit
AGE
STD (per $10)
Less than 25
$0.49
25-29
$0.49
30-34
$0.49
35-39
$0.49
40-44
$0.49
45-49
$0.49
50-54
$0.72
55-59
$0.72
60-64
$1.10
65-69
$1.10
70 and over
$1.10
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Group 2,4,: Drivers
Monthly Rate of ($STEP) per $10 of weekly
benefit
AGE
STD (per $10)
Less than 25
$0.49
25-29
$0.49
30-34
$0.49
35-39
$0.49
40-44
$0.49
45-49
$0.49
50-54
$0.72
55-59
$0.72
60-64
$1.10
65-69
$1.10
70 and over
$1.10
If Step Rates, how is the employee age calculated for premium purposes:
 Based on employee’s age as of the policy anniversary
Flex Billing Method:
 Rated separately (all employees reported in base)
Plan Anniversary Date: each January 1st.
Rate Guarantee: 3 year
Is your annual re-enrollment coverage effective date the same as your anniversary date (Y/N): Y
Typically, what month(s) do you hold your enrollment period: Oct. 29- Nov. 18
Premium Grace Period: 31 days
Notice of Rate Action: 31 days
Customer Contact Information
Decision Maker:
Amanda Thompson
Director, Human Resources
4080 Jenkins Road
Chattanooga, TN 37421
Ph: 423-510-3491
Cell: 423-413-0570
Fax: 423-510-6114
athompson@usxpress.com
Number of Billing Divisions: By company name and group of EE’s
Is the Billing Contact the same for each Billing Division if there are multiple (Y/N) : Y
Billing Contact(s):
Tina Wilkes
Benefits Supervisor
4080 Jenkins Road,
Chattanooga, TN 37421
Ph: 423- 510-3823
Fax: 423- 510- 6017
twilkes@usxpress.com
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Number of Claims Divisions: By company name and group of EE’s
Is the Claims Contact the same for each Claim Division if there are multiple (Y/N): Y
Tina Wilkes
Benefits Supervisor
4080 Jenkins Road,
Chattanooga, TN 37421
Ph: 423- 510-3823
Fax: 423- 510- 6017
twilkes@usxpress.com
Back up – AMANDA Delk to put this in SH
Tammie Vineyard
Benefits Supervisor, Human Resources
4080 Jenkins Road,
Chattanooga, TN 37421
Ph: 423-510-3426
Fax: 423-510-5801
tvineyard@usxpress.com
NOTE: If Policyholder needs loss ratio experience (premium vs. claims) for any group it will need to be identified through
separate billing and claim divisions
US Xpress Approval & Comments
Name: Amanda Thomspon
Date Basic Information Sheet is approved: 11/7 after multiple reviews
Comments:
Underwriter(s) Approval & Comments
Name: Matt Brown
Date Basic Information Sheet is approved: 9/18/2012
Final Debrief on 11/7/12
Comments:
9/18 – update termination date to 12/31/2012. Otherwise, ok to approve the document. MFB
9/19/12 – updated BWE
NOTE: Sister policy language with 294730—001, OK’d by Matt Brown on 12/18/12 at 7:51am
WHO CAN CANCEL OR MODIFY THIS POLICY, SUMMARY OF BENEFITS OR ANY PLAN?
This policy, summary of benefits, or any plan under the policy or summary of benefits can be cancelled:
–
–
by Unum; or
by the Employer.
Unum may cancel or modify any policy, summary of benefits, or any plan under this policy or summary of benefits issued to any
participant on the listing contained in the contract files for [XYZ Corporation], if:
– the Employer fails to perform any of its obligations
– Unum determines that there is a significant change, in the size, occupation or age of
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the eligible group under any of the [XYZ Corporation] policies or summaries of benefits as a
result of a corporate transaction such as a merger divestiture, acquisition, sale, or
reorganization of the employer and/or its employees; or
If Unum cancels or modifies any policy, summary of benefits, or any plan under a policy or summary of benefits for reasons
other than the Employer's failure to pay premium, a written notice will be delivered to the Employer at least 31 days prior to the
cancellation date or modification date. The Employer may cancel any policy, summary of benefits, or any plan under a policy or
summary of benefits if the modifications are unacceptable.
If any portion of the premium is not paid during the grace period, Unum will either cancel the policy, summary of benefits, or any
plan under the policy or summary of benefits automatically at the end of the grace period. The Employer is liable premium for
coverage during the grace period. The Employer must pay Unum all premiums due for the full period the coverage is inforce.
The Employer may cancel any policy, summary of benefits, or any plan under a policy or summary of benefits by written notice
delivered to Unum at least 31 days prior to the cancellation date. When both the Employer and Unum agree, this policy,
summary of benefits or any plan under this policy or summary of benefits can be cancelled on an earlier date. If Unum or the
Employer cancels any policy, summary of benefits, or any plan under a policy or summary of benefits, coverage will end at 12:00
midnight on the last day of coverage.
If a policy, summary of benefits, or any plan under a policy or summary of benefits is cancelled, the cancellation will not affect a
payable claim.
RATE GUARANTEE AND RATE CHANGES
A change in premium rate will not take effect before [xxxxx]. However, Unum may change premium rates at any time for
reasons which affect the risk assumed, including those reasons shown below:
-
a change occurs in the [XYZ Corporation] plan design;
a division, subsidiary, or affiliated company is added or deleted;
the number of insureds changes by 25% or more;
a new law or a change in any existing law is enacted which applies to the [XYZ Corporation] plans, policies, summaries of
benefits, or any plan under a policy or a summary of benefits; or
any of the [XYZ Corporation] plans, policies, or summaries of benefits are cancelled or modified.
Unum will notify the Employer in writing at least 31 days before a premium rate is changed. A change may take effect on an
earlier date when both Unum and the Employer agree.
Unum Information
Sales Office: Nashville
Sales Rep Name:Tom Coyne
Service Office: Nashville
NAM Name: Kathy McCarter
Benefits Operational Consultant Name: Amanda Delk
Benefits Location: Chattanooga
Underwriter(s) Name: Matt Brown
Implementation Manager: Becky Ewton
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