2013 USX Office SPD.pdf - US Xpress

Description of Benefits
Medical Benefits Medical benefits under the Plan (including prescription drug benefits) are
provided on a self-insured basis by the Company, with claims paid from the general assets of the
Company and by Employees' contributions. Claim payments are paid first from employee
contributions and then, to the extent necessary, from the Company's general assets. The
Company has a contract with Blue Cross Blue Shield of Tennessee, Inc. ("BCBST") to process
claims for medical benefits under the Plan. Two coverage levels are available: standard plan and
premium plan. A detailed description of medical benefits is contained in the "Evidence of
Coverage" document prepared by BCBST, which forms part of this Summary Plan Description.
The Company has delegated to BCBST the exclusive discretionary authority to decide claims for
medical benefits under the Plan, including the right to make final determinations on appeals of
denied claims. BCBST's authority includes the right to make factual determinations with regard to
medical benefits provided under the Plan.
The Company has a contract with Medco/Express Scripts to process claims for prescription drugs
under the Plan under a self-insured arrangement. A detailed evidence of coverage booklet may
be obtained from the Human Resources Department by calling the Benefits Department at (800)
670-1915. The Company has delegated to Medco/Express Scripts the exclusive discretionary
authority to decide claims for prescription drug benefits under the Plan, including the right to
make factual determinations with regard to prescription drug benefits under the Plan.
Dental Benefits Dental benefits under the Plan are provided on a fully-insured basis through an
insurance contract issued by Delta Dental Plan of Tennessee ("Delta Dental"). Premiums for
dental coverage are paid solely by the covered employee. The Company does not contribute
toward the cost of dental benefits. A detailed description of dental benefits is contained in the
benefit description document prepared by Delta Dental, which forms part of this Summary Plan
Description and is attached at the end of this Summary. Delta Dental has exclusive discretionary
authority to determine eligibility for coverage under the terms of the insurance contract, based
upon employee information provided by the Company, and to determine whether benefits are
payable under the contract and the amount of such benefits.
Vision Benefits Vision benefits under the Plan are provided on a fully-insured basis through an
insurance contract issued by Vision Service Plan (“VSP”). Premiums for vision coverage are paid
solely by the covered employee. The Company does not contribute toward the cost of vision
benefits. A description of vision benefits is contained in the benefit description document
prepared by VSP, which forms part of this Summary Plan Description and is attached at the end
of this Summary. VSP has exclusive discretionary authority to determine eligibility for coverage
under the terms of the insurance contract, based upon employee information provided by the
Company, and to determine whether any benefits are payable under the contract and the amount
of such benefits.
Long-Term Disability Benefits Long-term disability ("LTD") benefits under the Plan are
provided on a fully-insured basis through an insurance contract issued by Unum. A detailed
description of the LTD benefits is contained in the separate certificate of insurance document
prepared by Unum, which forms part of this Summary Plan Description. Premiums for LTD
coverage are paid solely by the covered employee. Employee contributions are made on an
after-tax basis. Unum has exclusive discretionary authority to determine eligibility for coverage
under the terms of the insurance contract, based upon employee information provided by the
Company, and to determine whether any benefits are payable under the contract and the amount
of such benefits. A brief summary of the LTD benefits is attached at the end of this Summary. A
copy of the certificate of insurance coverage may be obtained from the Human Resources
department by calling the Benefits Department at (800) 670-1915.
Short-Term Disability Benefits Short-term disability ("STD") benefits under the Plan are
provided on a fully-insured basis through an insurance contract issued by Unum. A detailed
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