Employee Benefits Guide for Plan Year: January 1, 2019 - December 31, 2019

X-FAB takes great pride in offering an excellent selection of benefits to

all full-time employees. This guide provides quick access to information

about your employee benefit program, which is an important part

of your total compensation package. Please take a few moments to

familiarize yourself with the benefit programs available to you as part

of the X-FAB family.

Eligibility & Enrollment Guidelines 3

check Enroll in Your Benefits 3

Payroll & Deduction Options 3

www.myXFABbenefits.com 3

Medical Plans 4

user-shield Blue Cross & Blue Shield of Texas 5

mobile-alt X-FAB App 5

building X-FAB + 6

Connect your Care FSA 7

Teladoc 8

tooth Dental Plans 9

Vision Plans 10

Basic Term Life and AD&D 11

Voluntary Term Life and AD&D 11

Short & Long Term Disability 12

Cancer & Rare Disease Insurance 12

shield-alt Legal Shield 13

401(k) 14

X-FAB Wellness | NEST 14

Contacts 15

building Carrier Contacts 15

What’s Inside

DISCLAIMER: The information in this Enrollment Guide is intended for illustrative and informational purposes only. The information contained herein

was taken from various summary plan descriptions, certificates of coverage and benefit information. Every effort was taken to accurately report

your benefits however discrepancies and errors are always possible. It is not intended to alter or expand rights or liabilities set forth in the official

plan documents or contracts. It is not an offer to contract nor are there any express or implied guarantees. In case of a discrepancy between this

information and the actual plan documents, the actual plan documents will prevail. If you have any questions about this summary, please contact

Human Resources. © 2019 Marsh& McLennan Agency. All Rights Reserved.

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Eligibility & Enrollment Guidelines

Employees are eligible on the first date of hire. If you choose not to enroll during initial eligibility, the employee must wait to enroll during the next Open Enrollment, unless there is a qualifying event.

Open enrollment takes place in November and it is the one opportunity during the year to make changes to benefit elections. Qualifying events allow an employee to make coverage election changes within 30 days of the event. These include: marriage, divorce, court order, birth or adoption of a child, loss of a dependent, loss of other coverage or significant change in employee’s or spouse’s employment status

The benefit elections you make during open enrollment will be effective January 1, 2019 - December 31, 2019.

check Enroll in Your Benefits

You will enroll online through Paycom. Go to www.paycomonline.com

◗ Before your start date, you will be sent an email with a temporary password.

◗ X-FAB’s client code is 0I677 and your default user name is 0I677+your employee number.

◗ If you’re having problems enrolling online, call the Benefits Administrator at 806-747-4400 extension 2849.

If you’re hired in October, November or December

If you’re hired or become eligible for benefits during October, November or December you’ll be asked to enroll twice:

1. The first time will be to select benefits for the remainder of the plan year through December 31.

2. The second time you enroll will be for the plan year beginning January 1. Your benefits elections will not roll forward from year to year.

Payroll & Deduction Options

Access employee self-service, review your benefits, check your latest pay stub and more with Paycom’s mobile application or online at paycomonline.com.

X-FAB has a Section 125 Cafeteria Plan. Participation allows you to pay for health, dental and vision premiums on a pre-tax basis. Employees enrolled in these benefit plans are automatically enrolled in the Cafeteria plan. Employees can opt out in writing to Human Resources prior to the start of coverage each plan year.

www.myXFABbenefits.com

Visit your Employee Benefit Website to access your benefit information and relevant documents such as: benefit summaries, plan documents, claim forms, contact information

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Medical Plans

Your medical plans are administered by BlueCross BlueShield of Texas.

IN-NETWORK BENEFITSCopays

Primary Care Physician 20% coinsurance, after deductible

Specialist 20% coinsurance, after deductible

Urgent Care 20% coinsurance, after deductible

Prescription Drugs

Generic Drugs 5% coinsurance, for generics filled at WalMart or Sam’s Club 25% coinsurance, if filled elsewhere

Single Source Brand Name Drugs 40% coinsurance

Multi-source Brand Name Drugs 50% coinsurance

Specialty Drugs

40% coinsurance (retail & mail) not to exceed $10

0.00, deductible does not apply

$25 copay for insulin

Calendar Year Deductible

Individual $500

Family $1,000

Out of Pocket Limit (Includes Deductible)

Individual $3,000

Family $6,000

Member Coinsurance

Preventive Care Covered at 100%

Lab and X-ray 20% coinsurance, after deductible

Diagnostic Imaging

(MRI, Pet Scans, CT Scans, etc.) 20% coinsurance, after deductible

Hospital Services 20% coinsurance, after deductible

Emergency Services 20% coinsurance, after deductible

Per Pay Period Employee Contributions Effective 1/1/2019

Wellness Status No Wellness With Wellness*

Employee Only $21.88 $12.50

Employee + Children $85.63 $48.93

Employee + Spouse $123.78 $70.73

Employee + Family $187.53 $107.16

Covered Member Tobacco Use Fee $15.00 per user covered by the medical plan

*New hires must complete HRA, and existing employees must meet Wellness requirements to receive the premium discount.

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user-shield Blue Cross & Blue Shield of Texas

Go Mobile with the BCBSTX App

Looking for an easy way to have access to information about your health care on the go? With our BCBSTX App, you can stay connected with us and access your important health plan information wherever you are, whenever you need!

mobile-alt X-FAB App

Providing You Better Access to YOUR Benefits

X-FAB utilizes the inGAGED platform to better communicate with its employees. This app provides real time communication, personalized content, and access to all of your benefits in one place! If you haven’t downloaded the App, please be sure and visit the Apple Store or Google Play to download it today!

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building X-FAB +

X-FAB has partnered with Physician Network Services (PNS) to give you access to a special discount on medical services provided at UMC PNS clinics. X-FAB employees and dependents that are covered on the medical plan will have a $5 copay per visit at the following locations:

United Express Clinic | 50th & Q 1701 50th | 9 am - 7 pm

United Express Clinic | 82nd & Boston 2703 82nd | 9 am - 7 pm

Express Care Clinic | South Plains Mall 6002 Slide Road | 9 am - 8 pm

Express Care Clinic | Wolfforth 502 E. Highway 62/82 | 9 am - 6 pm

UMC Urgent Care Center 808 Joliet Ave, Suite 110 | 9 am - 6 pm

Services available at PNS Express Care Clinics ◗ Ordinary and routine office visits

◗ Chronic illness evaluation

◗ Diagnosis of diabetes and referral to PCP for treatment

◗ High cholesterol

◗ Asthma

◗ Acute conditions – sore throats, ear, headache, fever, body aches

◗ Allergies, cough, sinus

◗ Rashes

◗ Stomach aches

◗ Strains, sprains, musculoskeletal problems

Laboratory services including:

◗ Urine pregnancy tests – included in visit fee

◗ Glucose Test (finger stick) – included in visit fee

◗ Urine Analysis – included in visit fee

◗ Bloodwork (South Plains Mall location only) – charged separately at standard rates

Services NOT available at PNS Express Care Clinics ◗ Preventive Care

◗ Well Checks

◗ Radiology

◗ Wellness Screenings

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Connect your Care Flexible Spending Account

What is a Flexible Spending Account?

A Flexible Spending Account (FSA) allows you to use pre-tax dollars to pay for qualified health or dependent day care expenses.

There are hundreds of eligible expenses for your FSA funds, including prescriptions, doctor office copays, health insurance deductibles and coinsurance for you, your spouse or eligible dependents, and much more.

1. Health FSA

You may contribute up to $2,700 a year to your Health FSA.

2. Dependent Care FSA

You may contribute up to $5,000 a year, or up to $2,550 a year if married and filing separately, to the Dependent Care FSA.

24/7 Online/Mobile Access & Support

CYC Mobile, our secure mobile app, saves you time by delivering important account information on the go. Download it today!

◗ View account balances & payments

◗ Request a payment

◗ View FAQs or tap to call Customer Service

◗ Receive important account alerts

◗ Cut the time needed to submit a receipt - take a photo of your receipt and upload it directly to the system

◗ Available for Android, iOS & Windows devices

ConnectYourCare.com | 877-292-4040

Enjoy savings that really add up.

You can also access your account details online at ConnectYourCare.com.

Save time with CYC Mobile.

Because FSA contributions are set aside before taxes are taken from your paycheck, the amount of income you pay taxes on is reduced and you save money.

A typical FSA participant can save $490* a year!

How it works: Assume “Samantha” earns $35,000 a year and has $1,500 in eligible expenses.

With FSA

No FSA

Annual pay $35,000 $35,000

Pre-tax FSA contribution –$1,500 –$0

Taxable income =$33,500 =$35,000

Federal income and Social Security taxes

–$7,362 –$7,852

After-tax dollars spent on eligible expenses

–$0 –$1,500

Spendable income =$26,138 =$25,648

Samantha’s Tax Savings with FSA

$490 $0

CYC Mobile, our secure mobile app, saves you time by delivering important account information on the go. Download it today!

• View account balances & payments

• Request a payment

• View FAQs or tap to call Customer Service

• Receive important account alerts

• Cut the time needed to submit a receipt - take a photo of your receipt and upload it directly to the system

• Available for Android, iOS & Windows devices

“I absolutely LOVE the mobile app!

Being able to take a picture of my

receipt from my smartphone & upload

it with my claim is very efficient!”

- Jennifer, FSA Participant *Sample tax savings for a single taxpayer with no dependents; actual savings will vary based on your individual tax situation. Consult a tax professional for more information.

The average FSA participant saves

hundreds annually!

Learn more about FSA tax savings with a short video. Use the QR code or visit ConnectYourCare.com/FSAsavings

...because you don’t have money to throw away.

FSAs are the smart choice...

Flexible Spending Accounts

Enroll in an FSA Save on health and dependent day care!

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0914

With your consent, Teladoc is happy to provide information about your Teladoc consult to your primary care physician.

STEP 1 SET UP YOUR

ACCOUNT

We've made it quick and easy to set up your account online. Simply visit the website and

click "Set up account".

STEP 2UPDATE YOUR

MEDICAL HISTORY

Make sure the "My Medical History" tab is updated so the

doctor has the information needed to provide an accurate diagnosis.

STEP 3 REQUEST A CONSULT

10E-141A

Facebook.com/Teladoc Teladoc.com/mobile

© 2016 Teladoc, Inc. All rights reserved. Teladoc and the Teladoc logo are trademarks of Teladoc, Inc. and may not be used without written permission. Teladoc does not replace the primary care physician. Teladoc does not guarantee that a prescription will be written. Teladoc operates subject to state regulation and may not be available in certain states. Teladoc does not prescribe DEA controlled substances, non-therapeutic drugs and certain other drugs which may be harmful because of their potential for abuse. Teladoc physicians reserve the right to deny care for potential misuse of services. © 2016 Teladoc, Inc. Todos los derechos reservados. Teladoc y el logotipo de Teladoc son marcas de Teladoc, Inc. y no pueden ser utilizados sin permiso por escrito. Teladoc no sustituye al médico de atención primaria. Teladoc no garantiza que una receta se escribe. Teladoc opera sujeta a la regulación estatal y pueden no estar disponibles en ciertos estados. Teladoc no prescribir sustancias controladas DEA, las drogas no terapéuticas y algunos otros medicamentos que pueden ser perjudiciales debido a su potencial de abuso. Médicos Teladoc reservamos el derecho de negar la atención por el mal uso potencial de los servicios.

Teladoc doctors are available when you need

care now. Request a consult anytime online or by phone.

Teladoc® gives you 24/7/365 access to U.S. board-certif ed doctors throughi phone or video consults. It does not replace your primary care physician but is an affordable option for quality care.

Teladoc

X-FAB offers Teladoc services to all employees enrolled in the medical plan. Teladoc gives you access to a doctor through the convenience of phone 24 hours a day, 7 days a week, 365 days a year, at no cost to you!

Use company code: xft1101

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tooth Dental Plans

Your dental plans are administered by BlueCross BlueShield of Texas.

Dental Plan Highlights

Receive two routine cleanings/year at no cost when visiting network providers.

You may choose any dentist. However, if you elect to see an out-of-network provider, you may be balance billed for anything over the usual and customary amount allowed by BlueCross. Find in-network dentists at www.bcbstx.com.

BCBSTX DENTAL PLANCalendar Year Deductible Individual $50 | Family $150

Preventive Care (i.e. cleanings)

100%, Deductible waived

Basic Care (e.g. fillings)

80%, After deductible

Major Care (e.g. crowns, inlays/onlays)

50%, After deductible

Orthodontia (children only)

50%, Deductible Waived

Annual Maximum Benefit $3,000 per covered person

Orthodontia Lifetime Maximum Benefits $3,000 per child under 19 years old

Per Pay Period Employee Contributions

Employee Only $13.00

Employee + Child(ren) $43.55

Employee + Spouse $41.55

Employee + Family $45.64

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SUPERIOR VISION IN-NETWORK OUT-OF-NETWORKAnnual deductibles

Eye Exam $10 $10

Materials $25 $25

LensesSingle Vision Covered at 100% Up to $25 retail

Bifocal Covered at 100% Up to $40 retail

Trifocal Covered at 100% Up to $45 retail

Lenticular Covered at 100% Up to $80 retail

FramesFrames Up to $150 Up to $70 retail

Contact Lenses (in lieu of Glasses)Exam and fitting Included in allowance Up to $80 retail

Medically Necessary Covered at 100% Up to $150 retail

Elective Up to $150

FrequenciesExams Once every 12 months

Once every 12 months

Once every 12 months

Lenses

Frames

Per Pay Period Employee Contributions

Employee Only $3.42

Employee + Family $8.55

Vision Plans

Your vision plan is administered by Superior Vision.

Vision Plan Highlights

Locate an in-network vision provider at www.superiorvision.com or call 800-507-3800. If you use an out-of-network provider the benefits will be reduced and you will be required to submit a reimbursement to Superior Vision along with the receipt for your related expenses.

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Basic Term Life and AD&D

Your Basic Term Life and Accidental Death & Dismemberment coverage is through Mutual of Omaha. All Active Full-Time Employees are Eligible for the following benefits, at no cost:

Voluntary Term Life and AD&D

Your Term Life Insurance coverage is through Mutual of Omaha. All active Full-Time Employees are Eligible for the following benefits

Please be sure you have a current beneficiary form on file!

MUTUAL OF OMAHA AMOUNTLife Benefit $30,000

AD&D Benefit $30,000

Accelerated Death Benefit 50% of benefit amount

Age Reduction Schedule: 65 Benefits reduce to 65%

70 Benefits reduce to 50%

MUTUAL OF OMAHA EMPLOYEE SPOUSE* CHILD/RENBenefit Amount 5x Annual Earning, Maximum

of $500,00050% of EE Amount, Maximum

of $250,00050% of EE Amount, Maximum

of $10,000

Increments $10,000 $5,000 $2,000

Guarantee Issue $150,000** $25,000** $10,000**

Accelerated 50% of benefit amount up applicable maximums n/a

*Spouse benefit not to exceed 50% of employee’s coverage

Age Reduction Schedule: 65 Benefits reduce to 65%

70 Benefits reduce to 50%

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Short & Long Term Disability

Your short and long term disability coverage is provided through Mutual of Omaha, and is paid for by X-FAB. All Active Full-Time Employees are Eligible for the following benefits, at no cost:

MUTUAL OF OMAHA SHORT TERM DISABILITY LONG TERM DISABILITY

Benefit Amount 60% of Weekly Earnings 60% of Monthly Earnings

Maximum Benefit $1,200/week $6,000/month

Elimination Period 14 Days Injury or Illness 90 Days Injury or Illness

Benefit Duration 11 weeks To age 65

Please see carrier plan documents for additional details, limitations, and exclusions.

Cancer & Rare Disease Insurance

Your cancer & rare disease insurance is provided through Allstate. Group Cancer Insurance supplements existing coverage and can help provide cash to cover medical and living expenses.

Group Voluntary Cancer coverage from Allstate Benefits pays cash benefits for cancer and 29 specified diseases to help with the costs of treatments and expenses as they happen.

Some of these additional diseases are Muscular Dystrophy, Lou Gehrig’s Disease, Multiple Sclerosis, Encephalitis, Bacterial Meningitis, Lyme Disease, Cystic Fibrosis, Primary Biliary Cirrhosis, and more.

Refer to your benefit summary for detail on coverage amounts for initial diagnosis, hospitalization, radiation/chemotherapy, surgery, transportation and lodging, and more.

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shield-alt Legal Shield

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401(k)

The X-FAB 401(k) Plan allows you to save for retirement with either pre-tax or post-tax dollars. You may choose between a traditional 401(k) or a Roth 401(k). (Roth 401(k) deferrals are made post-tax.)

Eligibility

You are eligible to enroll in the 401(k) if you are at least 18 years old and have completed 3 months of continuous service.

Enrollment

As a new hire, you will be automatically enrolled in the 401(k) plan at the beginning of the quarter following 3 months of continuous employment. This contribution will be 5% of your compensation per pay period, unless you opt out of participation in the plan, and this amount will increase by 1% each year up to 10%.

You will have the opportunity to make changes to your contribution amounts, or opt out of participation at the beginning of any quarter as follows:

◗ January 1

◗ April 1

◗ July 1

◗ October 1

Employer Contributions

X-FAB will match 100% of the first 3% and 50% of the next 2% of your contributions. X-FAB’s matching contributions are NOT subject to the vesting schedule and are 100% vested.

For complete plan details, visit your EBC or refer to your plan documents.

X-FAB Wellness | NEST

We are excited to continue to partner with iaWellness to bring you a best in class wellness program! Some of the features include:

◗ Interactive points system to achieve your insurance premium incentive

◗ Team & individual challenges

◗ Education opportunities

◗ Free health coaching with Registered Nurses, Registered Dietitians, and Certified Personal Trainers

800-343-3548 | netbenefits.com

Visit the NEST website for more information! xfabwellness.com

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Contacts

X-FABAmy Hymel,

Benefits & Wellness ManagerAmy.Hymel@xfab.com

806-747-4400 ext. 2849

Marsh & McLennan AgencyJulie Lawson,

Senior Account Managerjulie.lawson@marshmma.com

806-765-7264

866-765-7264 (toll free)

building Carrier ContactsMEDICAL/DENTAL BENEFITSBlueCross BlueShield of Texas800-521-2227 | bcbstx.com

FLEXIBLE SPENDING ACCOUNTConnect Your Care877-292-4040 | connectyourcare.com

TELEMEDICINETeladoc800-Teladoc | teladoc.com

VISION BENEFITSSuperior Vision800-507-3800 | superiorvision.com

LIFE & DISABILITY BENEFITSMutual of Omaha800-877-5176 | mutualofomaha.com

CANCER & RARE DISEASE POLICYAllstate877-810-2920 | allstate.com

401(k)Fidelity800-343-3548 | netbenefits.com

X-FAB Mixed Signal Foundry Experts 2301 N. University Avenue | Lubbock, TX 79415 | 806-747-4400