4Refuel Employee Benefits

CHECK OUT THE WIDE RANGE OF SERVICE OPTIONS AVAILABLE TO MEMBERS
CURRENTLY ENROLLED IN ONE OF THE THREE CIGNA PLANS

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ONCE YOU DO, YOU CAN LOG IN ANYTIME, ANYWHERE 

YOUR GUIDE TO UNDERSTANDING WHAT IT IS AND WHAT’S COVERED

KNOW YOUR PLAN.
IN AND OUT.

Pharmacy

VIRTUAL DOCTOR’S VISITS

Employee Assistance Program

Life, AD&D, and Short Term Disability Coverage are paid for 100% by the Employer

$30,000
Basic Life and AD&D

Additional Value Added Services 

Short Term Disability

Voluntary Term Life is 100% paid for by the Employee and is an optional benefit

*Guaranteed issue amounts only apply to new hires when first eligible for benefits.
*Evidence of Insurability Form required for any amounts over the guarantee issue amount.

4Refuel is offering two different Voluntary Supplemental Accident Plans 
Choose the plan that works best for you. This is an optional 100% employee paid benefit.

Supplemental accident insurance provides reimbursement of medical expenses due to an
accidental injury. Payment is made directly to the covered member based on
the scheduled benefit for treatment, injury or services incurred by a covered person.

IMPORTANT PATIENT PROTECTION AND AFFORDABLE CARE ACT NOTICES, ERISA NOTICES AND CONTACTS FOR MORE INFORMATION

4Refuel is providing these important notices to you at no fee. The notices describe important rights that you have under the terms of 4Refuel US, LLC Group Health Plan. If you have any questions or need additional information regarding these notices you can contact:

Your Employer Representative

Julie Li
587-202-8859
julie.li@4refuel.com

or by mail at :
1900 Enchanted Way, Ste 250
Grapevine, TX 76051

Employee Notices

ERISA Summary Plan Description

CAN I MAKE MID-YEAR PLAN CHANGES TO MY GROUP HEALTH INSURANCE?

An employer’s ability to allow employees to cancel or change health plan elections is governed by the Internal Revenue Code. Section 125 of the Internal Revenue Code (IRC) governs how employers provide benefits to employees on a pre-tax basis. After an employee has made an initial enrollment election, Section 125 does not permit changes outside of yearly open enrollment except for certain, specific reasons. The permitted Section 125 changes are the qualified “change-of-status” events described below:

QUALIFYING LIFE EVENT (QLE)

A change in your situation — like getting married, having a baby, or losing health coverage — that can make you eligible for a Special Enrollment Period, allowing you to enroll in health insurance outside the yearly Open Enrollment Period.

There are 4 basic types of qualifying life events. (The following are examples, not a full list.)

• Loss of health coverage

• • Losing existing health coverage, including job-based, individual, and student plans
  • Losing eligibility for Medicare, Medicaid, or CHIP
  • Turning 26 and losing coverage through a parent’s plan

• Changes in household

• • Getting married or divorced
  • Having a baby or adopting a child
  • Death in the family

• Changes in residence

• • Moving to a different ZIP code or county
  • A student moving to or from the place they attend school
  • A seasonal worker moving to or from the place they both live and work
  • Moving to or from a shelter or other transitional housing

• Other qualifying events

• • Changes in your income that affect the coverage you qualify for
  • Gaining membership in a federally recognized tribe or status as an Alaska Native Claims Settlement Act (ANCSA) Corporation shareholder
  • Becoming a U.S. citizen
  • Leaving incarceration (jail or prison)
  • AmeriCorps members starting or ending their service

• See all qualifying life events