2013 USX Office SPD.pdf - US Xpress

Plan is also an Internal Revenue Code section 125 plan and an Internal Revenue Code section
129 plan.
Funding: Except for medical benefits, benefits are fully insured. Medical benefits are self-insured
with claims paid from the general assets of the Company and employee contributions. Premiums
for fully insured benefits are paid in whole or part by the Company out of its general assets and in
part by the Employee’s pre-tax or post-tax payroll deductions. The Plan Administrator provides a
schedule of the applicable premiums during the initial and subsequent annual enrollment periods
and on request for each of the component benefit programs, as applicable.
Claims Administrators and Insurance Carriers:
1. Blue Cross Blue Shield of Tennessee, Inc.
1 Cameron Hill Circle
Chattanooga, TN 37402-2555
(800) 565-9140
2. PayFlex Systems USA, Inc.
P.O. Box 3039
Omaha, NE 68103-3039
(800) 284-4885
3. Delta Dental Plan of Tennessee
240 Venture Circle
Nashville, TN 37228
(800) 223-3104
4. Medco/Express Scripts
N 19 W24130 Riverwood Drive
Waukesha, WI 53188
800-721-3501
5. VSP
3091 Governors Lake Drive, Suite 240
Norcross, GA 30071
(800) 877-7195
6. Unum
1 Fountain Square
Chattanooga, TN 37402
(877) 281-1746
7. Allstate Workplace Division
1776 American Heritage Life Drive
Jacksonville, FL 32224
1-800-521-3535
1291550_2 18