2022 Benefits Guide

Welcome to Your FET Benefits Guide

Whether at work or at home, we want you to live your best life. Your hard work and dedication are the key to our success
as a worldwide provider of mission-critical products, services and solutions for the global energy industry. This is why FET
is proud to offer a quality, comprehensive benefits program to you and your family.

This overview is designed to assist you in making your benefit enrollment choices and will also serve as a handy reference
throughout the year. We encourage you to take the time to review this guide to educate yourself about your benefit options
so you can choose the best coverage for your needs.

— Michael D. Danford, Senior Vice President, Human Resources

What’s Inside
Enrolling in Coverage 3
Who is Eligible? 3
How to Enroll 4
Medical Coverage 5
Medical Summary 6
Dental Coverage 7
Vision Coverage 7
Your Cost for Coverage 7
Flexible Spending Accounts (FSA) 8
Life and AD&D Insurance 9
Disability Coverage 9
Employee Assistance Program (EAP) 10
401(k) Savings Plan 10
Other FET Benefits 11
BCBSTX Resources 11
Time Off 12
Important Notices 13
Important Contacts 15

2 FET // Benefits Guide 2022

Enrolling in Coverage Who Is Eligible?
The choices you make when you first become eligible are You are eligible to participate in FET’s benefit plans if you are
in effect for the remainder of the plan year unless you a regular, full-time employee scheduled to work at least 30
experience a Qualifying Life Event. It’s important to review hours per week.
your benefit options and choose the best coverage for you
and your family. Your eligible dependents have access to many of the benefits
we offer. Documentation, such as a marriage license or birth
As a new hire, you have 30 days from your date of hire to certificate, is required to prove dependent eligibility. Eligible
enroll in benefits. If you do not enroll within 30 days, your dependents include:
next opportunity to elect benefits will be during Annual • Your legal spouse.
Enrollment for a benefits effective date of January 1, 2023. • Your children (e.g., natural child, stepchild, foster
child, adopted child) who are:
Use this chart to determine when your benefits are effective: ° Up to age 26 for medical, dental, vision, life
and AD&D insurance.
° Any age for unmarried dependent children
Benefit Effective Date who are mentally or physically handicapped
Health & Welfare Benefits Date of hire and meet certain requirements.

Short Term Disability 30 days You must provide accurate Social Security numbers and
1st of month following dates of birth for all enrolled dependents during enrollment.
401(k)
30 days

Qualifying Life Event

If you experience a Qualifying Life Event during the plan year,
you will have the opportunity to make changes to your
benefits up to 30 days after the event date, via UKG.
Examples of a Qualifying Life Event include, but are not
limited to, the following:
• Marriage, divorce, legal separation, or annulment.
• Birth or adoption of a child.
• Change in employment for you or your spouse that
affects your benefit eligibility.
• Loss of other health coverage.

It is your responsibility to notify the FET Benefits Team within

30 days of the qualifying event. You will need to provide
documentation of the event, such as a marriage license or
proof of birth. Any benefit changes must be directly related
to the Qualifying Life Event.

FIND OUT MORE

More detailed information on all the benefit plans
can be accessed when you log in to UKG.

• Summary Plan Descriptions (SPDs)

• Summary of Benefits and Coverage (SBCs)
• Detailed Enrollment Instructions

2022 Benefits Guide // FET 3

How to Enroll
Enrolling via the UKG online enrollment system
is fast and convenient. To start, log in to UKG at
https://ew13.ultipro.com. Next, enter your user name
and password.

If this is your first time accessing the UKG system, your

user name will be your FET ID number preceded by the
letters FET and your default password is your date of birth
in MMDDYYYY format.

If you have logged in before but forgotten your password,

click “Forgot your password?” on the login screen and
follow the instructions to set up a new password.

Once you have logged in, follow these easy steps to

complete your online benefit enrollment:

1. On the UKG home page under FET Benefit Quick

Links, click the New Hire/Rehire Benefit Elections
link and choose the New Hire/Rehire session to begin.

2. Enter your beneficiary and dependent information.

You must have a valid SSN and date of birth for
dependents that you wish to cover.

3. Select each benefit plan by clicking the icon next to

the plan and then choosing which dependents you
would like to cover.

4. Review the Benefits Summary page to confirm your

benefit selections. If you need to make any changes,
you can use the menu items listed on the left side to
return to a specific benefit.

5. Once you are satisfied with your elections, click

“Submit” and keep a copy of your confirmation
statement that is generated.

More detailed instructions are available on the UKG

homepage, if needed.

If at any time you would like assistance,

please see your HR Representative or email
the FET Benefits Team at [email protected].

4 FET // Benefits Guide 2022

Medical Coverage Health Savings Account (HSA)
• With an HSA, you can save tax dollars while saving
We offer two medical plan options that utilize the Blue Cross for medical expenses.*
Blue Shield of Texas (BCBSTX) network. To help you decide • Your contributions are deducted on a pre-tax basis and
which plan is best for you and your family, refer to the plan deposited into your HSA.
comparison chart provided on Page 6. • Unused HSA dollars roll over year after year. There is
no “use it or lose it” provision.
PPO Plan • You take the HSA funds with you if you leave FET.
With the PPO Plan, you can receive medical care from any • Premiums are lower for the HDHP plan. You can put
physician or facility you choose. You do not need to choose a this savings toward funding your account.
primary care doctor, nor do you need referrals for specialists. • You can modify the amount of money you are
Keep in mind that benefits are higher when you choose a contributing to your account at any time.
network provider.

High Deductible Health Plan (HDHP) 2022 HSA Contribution Limit

Like the PPO plan, the High Deductible Health Plan allows
you to receive care from any provider. If you select this plan, Single $3,650
you will automatically have a Health Savings Account (HSA) Two-Party/Family $7,300
set up on your behalf that you will be required to activate. Age 55 + (Single) $4,650
Age 55 + (Two-Party/Family) $8,300
Each year you participate in the HDHP, FET will make a
FET’s contributions count toward the IRS limit.
contribution to your account, prorated on a bi-weekly basis,
according to your level of coverage. See below for details:
• Employee only coverage: $500 per year. HSA Eligibility Requirements
• Employee/Spouse, Employee/Child(ren), or • You must be enrolled in a High Deductible Health
Employee/Family: $1,000 per year. plan and have no other health coverage (unless it
is a HDHP).
Prescription Drugs • Your covered spouse may not participate in a Health
Both the PPO and HDHP plans utilize the Advantage Care Flexible Spending Account.
Pharmacy Network and the Performance Drug Formulary. • You cannot be enrolled in Medicare.
Members can access a list of network pharmacies online • You cannot be claimed as a dependent on someone
by visiting www.MyPrime.com and clicking on “Find a else’s tax return.
Pharmacy.”
*More information and a list of eligible expenses can be found in IRS
The formulary (list of covered drugs) can be found by visiting Publication 969 at www.irs.gov/pub/irs-prior/p969--2018.pdf and IRS
Publication 502 at www.irs.gov/pub/irs-pdf/p502.pdf.
https://www.bcbstx.com/rx-drugs/drug-lists/drug-lists.
Choose the Drug list for large groups and select the
Performance Drug List.

2022 Benefits Guide // FET 5

2022 Medical Summary
Blue Cross Blue Shield
PPO Plan HDHP Plan
In-Network Out-of-Network In-Network Out-of-Network

Calendar Year Deductible

(Individual / Family) $1,400 / $2,800 $2,800 / $5,600 $2,800 / $5,600 $5,200 / $10,400

Coinsurance 20% 50% 0% 50%

Out-of-Pocket Maximum
(Individual / Family) $4,000 / $8,000(1) $8,000 / $16,000(1) $2,800 / $5,600 $5,200 / $10,400

Preventative Care No Charge 50% No Charge 50%

Office Visits
• Virtual Visits $30 copay N/A $44(2) N/A
• Primary Care $30 copay 50% after 0% after 50% after
• Specialist $60 copay deductible deductible deductible
20% after $250 copay 0% after 50% after
Inpatient Hospital Services
deductible then 50% deductible deductible

20% after 50% after 0% after 50% after

Outpatient Hospital Services
deductible deductible deductible deductible

Emergency Room $150 copay, then 20% 0% after deductible

50% after 0% after 50% after

Urgent Care
$60 copay deductible deductible deductible

Lab & X-ray

(when provided in conjunction $0 copay 50% after 0% after 50% after
with an office visit) deductible deductible deductible

20% after 50% after 0% after 50% after

MRI, CT, PET Scans
deductible deductible deductible deductible

Ambulance
(Emergency Only) 20% after deductible 0% after deductible

Prescription Drugs – Retail (up to a 30-day supply)

Generic
$10 copay

50% of 0% after
Brand-Name Formulary 20%, $30 allowable deductible
min/$100 max 0% after
amount deductible
Non-Formulary 20%, $50
min/$150 max

Specialty 20%, $200 max Not covered Not covered

Prescription Drugs – Mail Order (up to a 90-day supply)

Generic
$30 copay

Brand-Name Formulary 20%, $90 min/$300 max 0% after deductible

Non-Formulary 20%, $150 min/$450 max

Out-of-Pocket Maximums include deductibles.

(1)

If deductible has been met, cost of virtual visit is $0. Charges for mental health services may be higher.
(2)

To find a Blue Cross Blue Shield of Texas provider near you, go to www.bcbstx.com or call 800.521.2227.

6 FET // Benefits Guide 2022

Dental Coverage
The plan offers a wide network of providers for your dental needs and allows you to seek care from any licensed dentist.
However, your out-of-pocket cost will generally be lower by selecting a network provider. To find a Blue Cross Blue Shield of
Texas Dental provider near you, visit www.bcbstx.com or call 800.521.2227.

Dental Plan Features

Annual Deductible $50 individual/$150 family

Maximum Annual Benefit $1,500 per member

Preventive Services (Exams, X-rays, Cleanings) No charge, deductible waived

Basic Services (Periodontal Maintenance, Fillings, Extractions) 20% after deductible

Major Services (Root Canals, Crowns, Bridges) 50% after deductible

Orthodontia Child only: 50%, up to $1,500 lifetime benefit

Vision Coverage
The vision plan includes benefits for eye exams, eyeglasses, and contact lenses through the VSP network. You may visit a
doctor within the VSP network and take advantage of higher benefits coverage, or visit an out-of-network provider of your
choice for a reduced benefit. To find a provider, visit www.vsp.com or call 800.877.7195. VSP does not provide ID cards.
At the time of service, simply provide your Social Security number.

Vision Plan Features

Benefit Description Copay Frequency

WellVision Exam Overall eye wellness $10 Every calendar year

Prescription Glasses $25 Every calendar year

• $130 - $150 allowance Included in

Frames • 20% savings on amount over prescription glasses Every other
allowance copay calendar year

• Single vision, lined bifocal, & lined

Lenses trifocal lenses Included in
• Polycarbonate lenses for dependent prescription glasses Every calendar year
children copay

• Premium progressive $95 - $105

Lens Enhancements • Custom progressives $150 - $175 Every calendar year

Contacts • $130 allowance, copay does not apply

(instead of glasses) • Contact lens exam (fitting & evaluation) Up to $60 Every calendar year

Your Cost for Coverage

Rates per pay period for each plan and coverage category are shown in the table below.

Medical Dental Vision

PPO Plan HDHP Plan DPPO VSP

Employee $76.61 $25.39 $8.23 $1.70

Employee + Spouse $142.26 $63.49 $18.11 $2.87

Employee + Child(ren) $120.37 $40.63 $14.81 $2.93

Employee + Family $218.87 $71.10 $23.86 $4.63

2022 Benefits Guide // FET 7

Flexible Spending Accounts (FSAs)
FET offers three types of Flexible Spending Accounts How FSAs Work
to help you stretch your benefit dollars and receive real When you enroll in a Flexible Spending Account, you will
tax savings: receive a Flexible Employee Benefits Debit Card to use
when you receive services. You may also pay for services
1. The Health Care Spending Account: You can contribute out-of-pocket and submit a claim for reimbursement.
up to $2,600 per year on a pre-tax basis to pay for eligible • You must save your receipts! The IRS requires that
out-of-pocket medical, dental, and vision expenses.* you must be able to provide supporting documentation
2. The Limited Purpose FSA: HDHP plan participants can for your expenses, such as an itemized bill or
enroll in the Limited FSA. This type of FSA allows you Explanation of Benefits.
to be reimbursed for eligible out-of-pocket dental and • Claims incurred during 2022 must be submitted
vision expenses. Medical expenses* are not eligible for for reimbursement by March 31, 2023.
reimbursement from your Limited FSA until you have
met your health insurance plan’s deductible. Important FSA Rules to Keep in Mind
3. Dependent Care Spending Account: You can contribute FSAs offer sizable tax advantages, but they are also subject to
up to $5,000 per household per year on a pre-tax basis strict IRS regulations, including the following:
to cover the cost of care for children up to age 13. If • Use it or lose it. If you do not use the full amount in
married, both you and your spouse must work in order your FSA(s) by the end of the calendar year
to be eligible to participate. (December 31), you will lose any remaining funds.
• You cannot transfer funds from one FSA to another.
• You cannot stop or change your FSA contribution
amount during the year unless you have a Qualifying
Life Event.
*A list of eligible health care expenses can be found in IRS Publication
502 at www.irs.gov/pub/irs-pdf/p502.pdf. Information regarding eligible
dependent care expenses can be found in IRS Publication 503 at
www.irs.gov/pub/irs-pdf/p503.pdf.

8 FET // Benefits Guide 2022

Life and AD&D Insurance
Basic Life and AD&D Insurance
FET provides you with basic employee life and accidental death and dismemberment (AD&D) insurance coverage through
The Hartford at no cost to you. You automatically receive life and AD&D coverage in the amount of $50,000.

Additional Life and AD&D Insurance

You also have the opportunity to purchase additional life and AD&D insurance for yourself, your spouse, and your children at
group rates. The chart below describes the amounts of additional voluntary insurance you may purchase. Keep in mind that
you must be enrolled in coverage in order to enroll your spouse or children. Evidence of Insurability (EOI) will be required if
you elect more than the guaranteed issue amount.

Voluntary Life and AD&D

Employee Spouse Children*

Up to $250,000 in
Up to $500,000 in $5,000 increments, not to Children between
Amount of Coverage $10,000 increments, not to 6 months and 25
exceed 50% of employee’s
exceed 5X base salary voluntary coverage years: $10,000

Guaranteed Issue
(Available during initial $150,000 $50,000 No EOI required
enrollment, no EOI)

35% reduction at age 65 Same reduction schedule Coverage available

Age Reductions 50% reduction at age 70 (based on employee age) until age 26

*Coverage for children between 14 days and 6 months of age is limited to $500.

Disability Coverage
The FET-provided Short-Term Disability (STD) Plan and Long-Term Disability (LTD) Plan are intended to replace a portion of
your income in the event of an illness or injury. Coverage is provided through The Hartford. Keep in mind that LTD benefits are
offset by other sources of income, such as Social Security and workers’ compensation.

Filing a Claim and Reporting your

STD LTD Leave of Absence
Earnings Replaced 60% 60% The Hartford administers FET’s Leave of Absence
policy and provides you with information and
$1,500 $20,000 assistance with your disability claim. Any time you
Maximum Benefit per week per month
are missing work for three business days or more
Length of due to your own serious medical condition, the
disability up to medical condition of a family member, or any other
Up to the normal reason, please contact:
Benefit Duration
11 weeks retirement age
as defined in • Your supervisor or HR representative, and
the policy • The Hartford at
www.thehartford.com/groupbenefits
15th day of or by calling 800.549.6514. You can also
Benefit Start Date illness or injury 90 days
visit the MY BENEFITS employee portal at
www.thehartford.com/mybenefits to begin a
claim, check your claim status, or view/upload
Maternity Benefit documents.
If your STD leave is due to maternity, you will receive an additional
benefit that ensures a 100% income replacement for the first four The Hartford will notify you and the FET Benefits Team
weeks of postnatal care. of the status of your claim once it has been processed.

2022 Benefits Guide // FET 9

Employee Assistance Program 401(k) Savings Plan
We are all confronted with life or work difficulties from time You are automatically enrolled in the 401(k) plan at 3% of pay
to time and need assistance to manage these challenges. In on the first of the month following 30 days of employment.
order to help resolve such issues, FET offers a confidential FET matches 100% of the first 3% of your contribution plus
Employee Assistance Program (EAP) through ComPsych to 50% of your contribution that exceeds 3% up to 5% of
help you and your family members at no charge. your salary.

For confidential assistance with nearly any personal mat- If you do not make an investment election, your contributions
ter you may be experiencing, browse the online tools and will be invested in an age-appropriate target date fund based
resources, or call the EAP 24 hours a day, 7 days a week at on your date of birth and an estimated retirement age. You
800.327.1850. may contribute from 1% up to 75% of your pay up to the IRS
This program offers the following services: limits ($19,500 plus $6,500 in catch-up contributions if you
• Face-to-face individual counseling: Up to 3 counseling are at least age 50 before the end of the year).
sessions, per family member per year.
• Professional assessment and referrals. Your contributions can either be pre-tax contributions, Roth
• Assistance with legal advice, financial consultation, 401(k) after-tax contributions or a combination of both. You
parenting and family services, and elder care and may change your contribution amount and investments at
child care resources. any time. You are 100% vested in your own contributions
and all earnings on those monies.

The 401(k) plan is administered by Fidelity Investments. You

can modify your contribution percentage and your investment
elections any time by visiting www.netbenefits.com or on
the NetBenefits app.

It is your responsibility to log in to your account and

designate a beneficiary.

10 FET // Benefits Guide 2022

Other FET Benefits
Legal Insurance Benefits Value Advisor (BVA)
ARAG is a comprehensive group legal plan that provides you You can speak to a BCBSTX Benefits Value Advisor who
with affordable, flexible legal coverage and award winning can help you get benefits information and find in-network
service. It is specifically designed to cover legal situations providers for a number of health care services such as:
associated with high-cost attorney fees. It offers smart and MRIs, knee surgery, hip or joint replacement surgery. Benefit
trusted resources to help you plan for, prevent and resolve Value Advisors can also help you plan for your health care by:
legal and financial matters that impact your everyday life. • Giving you a cost estimate for health care services.
Please see below for bi-weekly rates: • Scheduling a doctor or procedure appointment.
• Individual coverage: $7.02 • Helping you get general health information about
• Family coverage: $9.27 your condition.
To reach a Benefits Value Advisor, call the Customer
FET Advantage Service number on the back of your BCBSTX ID card.
The FET Advantage program offers exclusive corporate
discounts on popular products and services – everything from Virtual Visits
computers to theme park tickets. For information about the
Virtual Visits, powered by MDLIVE, allow you to have a
programs offered and convenient links that make shopping
live consultation with an independently contracted,
easy, visit FET Advantage by logging in to UKG and clicking
board-certified MDLIVE doctor or therapist. Available
on the FET Advantage link. New products, seasonal sales and
24/7, MDLIVE doctors and therapists can treat many
special promotions are added frequently.
non-emergency medical and behavioral health conditions
and even write and send prescriptions to a nearby
BCBSTX Resources pharmacy when appropriate. Examples of non-emergency
conditions include, but are not limited to:
Blue Access for Members (BAM) & • Allergies.
BCBSTX App • Asthma.
Get information about your health benefits, anytime, • Sinus Infections.
anywhere. Use your computer, phone or tablet to access • Cold/flu.
the Blue Cross and Blue Shield of Texas (BCBSTX) secure • Ear infections.
member website. With BAM, you can: • Stress management.
• Check the status or history of a claim.
• View or print Explanation of Benefits statements. 24/7 Nurseline
• Locate a doctor or hospital in your plan’s network. Get answers to your health questions when you need them
• Find Spanish-speaking providers. – 24 hours a day, 7 days a week. The Nurseline can help
• Request a new ID card – or print a temporary one. determine the severity of a medical condition and advise
• Estimate and compare costs of services and accordingly. Plus you can learn about more than 1,000 health
procedures. topics over the phone with their audio library system.

Well OnTarget
IT'S EASY TO GET STARTED Get the tools and support you need, plus rewards for making
healthy choices. Gain access to a convenient, members-only

1. Go to bcbstx.com/member website that includes a health assessment, interactive tools

and educational information and tips, as well as a points
2. Click Register Now reward program. Points can be redeemed for various items,
including electronics, clothing, and cookware.
3. Use the information on your BCBSTX ID card
to complete the registration process.
Text* BCBSTX to 33633 to get the BCBSTX App that lets
you use BAM while you're on the go.
*Messaging and data rates may apply

2022 Benefits Guide // FET 11

Paid Time Off (PTO)
You receive an annual PTO allowance to be used for a variety of reasons, such as vacation, personal or family illness, or other
personal needs. Your PTO allowance is based on your years of service:

Completed Years 12 Month

of Employment PTO Allowance

0 to 4 Years 15 days (120 hours)

5 to 9 Years 20 days (160 hours)

10+ Years 25 days (200 hours)

2022 Holiday Schedule

FET provides twelve paid holidays each year:

Holiday Actual Date(s)

New Years Monday, January 3, 2022
Good Friday Friday, April 15, 2022
Memorial Day Monday, May 30, 2022
Independence Day Monday, July 4, 2022
Labor Day Monday, September 5, 2022
Thursday, November 24, 2022
Thanksgiving
Friday, November 25, 2022
Friday, December 23, 2022
Christmas
Monday, December 26, 2022
Dates mutually agreed upon between
Floating Holidays (3)
employee and supervisor

Parental Leave Bereavement Leave

New parents are provided up to three paid days of FET provides three paid days of bereavement leave to
Parental Leave to care for a new addition to the family. full-time employees for the death of an immediate family
Eligible employees include: member. Immediate family members include:
• An employee who is the father of a new born child; or • Spouse; or
• An employee who is the mother or father of a newly • Child; or
adopted child; or • Father/Mother of the employee or spouse; or
• An employee who is the legal spouse of a person • Grandparents of the employee or spouse; or
who has given birth to a child. • Sister/Brother; or
• Brother-in-law/Sister-in-law; or
Eligible employees must coordinate with their supervisor • Any relative who lives with the employee.
and supply proper documentation (e.g. birth certificate,
birth facts) in order for their parental leave to be approved. Jury Duty
If you are unable to work due to mandatory jury duty,
FET will pay you for up to 20 days when you provide
your supervisor with a valid summons and signed release
form as evidence of having served.

12 FET // Benefits Guide 2022

Important Notices
Women’s Health and Cancer Rights Act
On October 21, 1998 Congress passed the Women’s Health and Cancer Rights Act. This law requires group health plans that
provide coverage for mastectomies to provide coverage for certain reconstructive services, including:
• all stages of reconstruction of the breast on which a mastectomy has been performed,
• surgery and reconstruction of the other breast to produce symmetrical appearance,
• breast prostheses, and
• treatment of physical complications of the mastectomy, including lymphedemas.

In addition, the plan may not:

• interfere with a woman’s right under the plan to avoid these requirements, or
• offer inducements to the health provider, or assess penalties against the health provider, in an attempt to interfere with
the requirements of the law.

Newborns’ and Mothers’ Health Protection Act

In compliance with the Newborns’ and Mothers’ Health Protection Act of 1996, the plan also provides that:
• hospital stays will be covered for at least 48 hours following a normal vaginal delivery, or at least 96 hours following a
Cesarean section,
• the attending physician does not need to obtain authorization from the plan to provide the mother and newborn with
this length of hospital stay, and
• shorter hospital stays are permitted if the attending health care provider, in consultation with the mother, determines
that this is the best course of action.

Benefits are subject to deductibles, copays, and coinsurance consistent with other coverage provided by the plan. If you have
questions about the current plan coverage please contact your HR Representative.

Employee Rights Under the Family and Medical Leave Act

Leave Entitlements
Eligible employees who work for a covered employer can take up to 12 weeks of unpaid, job-protected leave in a 12-month
period for the following reasons:
• The birth of a child or placement of a child for adoption or foster care;
• To bond with a child (leave must be taken within one year of the child’s birth or placement);
• To care for the employee’s spouse, child, or parent who has a qualifying serious health condition;
• For the employee’s own qualifying serious health condition that makes the employee unable to perform the
employee’s job;
• For qualifying exigencies related to the foreign deployment of a military member who is the employee’s spouse,
child, or parent.

An eligible employee who is a covered servicemember’s spouse, child, parent, or next of kin may also take up to 26 weeks
of FMLA leave in a single 12-month period to care for the servicemember with a serious injury or illness.

An employee does not need to use leave in one block. When it is medically necessary or otherwise permitted, employees
may take leave intermittently or on a reduced schedule.

Employees may choose, or an employer may require, use of accrued paid leave while taking FMLA leave. If an employee
substitutes accrued paid leave for FMLA leave, the employee must comply with the employer’s normal paid leave policies.

Benefits and Protections

While employees are on FMLA leave, employers must continue health insurance coverage as if the employees were not
on leave.

Upon return from FMLA leave, most employees must be restored to the same job or one nearly identical to it with equivalent
pay, benefits, and other employment terms and conditions.

An employer may not interfere with an individual’s FMLA rights or retaliate against someone for using or trying to use FMLA
leave, opposing any practice made unlawful by the FMLA, or being involved in any proceeding under or related to the FMLA.

2022 Benefits Guide // FET 13

Eligibility Requirements
An employee who works for a covered employer must meet three criteria in order to be eligible for FMLA leave.
The employee must:
• Have worked for the employer for at least 12 months;
• Have at least 1,250 hours of service in the 12 months before taking leave;* and
• Work at a location where the employer has at least 50 employees within 75 miles of the employee’s worksite.
*Special “hours of service” requirements apply to airline flight crew employees.

Requesting Leave
Generally, employees must give 30-days’ advance notice of the need for FMLA leave. If it is not possible to give 30-days’
notice, an employee must notify the employer as soon as possible and, generally, follow the employer’s usual procedures.

Employees do not have to share a medical diagnosis, but must provide enough information to the employer so it can
determine if the leave qualifies for FMLA protection. Sufficient information could include informing an employer that the
employee is or will be unable to perform his or her job functions, that a family member cannot perform daily activities, or that
hospitalization or continuing medical treatment is necessary. Employees must inform the employer if the need for leave is for
a reason for which FMLA leave was previously taken or certified.

Employers can require a certification or periodic recertification supporting the need for leave. If the employer determines that
the certification is incomplete, it must provide a written notice indicating what additional information is required.

Employer Responsibilities
Once an employer becomes aware that an employee’s need for leave is for a reason that may qualify under the FMLA, the
employer must notify the employee if he or she is eligible for FMLA leave and, if eligible, must also provide a notice of rights
and responsibilities under the FMLA. If the employee is not eligible, the employer must provide a reason for ineligibility.

Employers must notify its employees if leave will be designated as FMLA leave, and if so, how much leave will be designated
as FMLA leave.

Enforcement
Employees may file a complaint with the U.S. Department of Labor, Wage and Hour Division, or may bring a private lawsuit
against an employer.

The FMLA does not affect any federal or state law prohibiting discrimination or supersede any state or local law or collective
bargaining agreement that provides greater family or medical leave rights.

For additional information or to file a complaint:

1.866.4.USWAGE
(1.866.487.9243) TTY: 1.877.889.5627
www.dol.gov/whd
U.S. Department of Labor | Wage and Hour Division

Paperwork Reduction Act Statement

According to the Paperwork Reduction Act of 1995 (Pub. L. 104-13) (PRA), no persons are required to respond to a collection of information
unless such collection displays a valid Office of Management and Budget (OMB) control number. The Department notes that a Federal
agency cannot conduct or sponsor a collection of information unless it is approved by OMB under the PRA, and displays a currently valid
OMB control number, and the public is not required to respond to a collection of information unless it displays a currently valid OMB control
number. See 44 U.S.C. 3507. Also, notwithstanding any other provisions of law, no person shall be subject to penalty for failing to comply
with a collection of information if the collection of information does not display a currently valid OMB control number. See 44 U.S.C. 3512.

The public reporting burden for this collection of information is estimated to average approximately seven minutes per respondent.
Interested parties are encouraged to send comments regarding the burden estimate or any other aspect of this collection of information,
including suggestions for reducing this burden, to the U.S. Department of Labor, Employee Benefits Security Administration, Office of
Policy and Research, Attention: PRA Clearance Officer, 200 Constitution Avenue, N.W., Room N-5718, Washington, DC 20210 or email
[email protected] and reference the OMB Control Number 1210-0137.

OMB Control Number 1210-0137 (expires 12/31/2019)

14 FET // Benefits Guide 2022

Important Contacts
If You Have A Question About... Contact Telephone Website/App

Medical Insurance Blue Cross Blue Shield 800.521.2227 www.bcbstx.com

PPO Group # 075553 of Texas Mobile App: BCBSTX
HDHP Group # 075554

Health Savings Account (HSA) Fidelity Investments 800.835.5095 www.netbenefits.com

Mobile App: NetBenefits

Prescription Prime Therapeutics 877.357.7463 Register at

www.myprime.com
then log on to
www.bcbstx.com

BCBS 24/7 Nurseline Blue Cross Blue Shield 800.581.0368

of Texas

BCBS Virtual Visits Blue Cross Blue Shield 800.680.8646 www.mdlive/bcbstx

(telehealth) powered by MDLIVE of Texas Mobile App: MDLIVE

Dental Insurance Blue Cross Blue Shield 800.521.2227 www.bcbstx.com

Group # 247627 of Texas Mobile App: BCBSTX

Vision Insurance VSP Network 800.877.7195 www.vsp.com

Group # 30085185 Mobile App:VSP Vision Care On the Go

Life and AD&D Insurance The Hartford 888.563.1124 www.TheHartford.com/groupbenefits

Group/Plan ID # 681116

Leave of Absence Management The Hartford 800.549.6514 www.TheHartford.com/groupbenefits

(FMLA, STD, LTD)

Flexible Spending Accounts (FSA) WEX 866.451.3399 www.wexinc.com

Group # 19006 Mobile App: Benefits by WEX

Employee Assistance Program (EAP) ComPsych 800.327.1850 www.guidanceresources.com

401(K) Retirement Savings Plan Fidelity Investments 800.835.5095 www.netbenefits.com
Mobile App: NetBenefits

Employee Stock Purchase Plan (ESPP) Computershare 855.338.7851 www.computershare.com

Legal Insurance ARAG 800.247.4184 www.ARAGLegalCenter.com

Access Code: 17881 fet
Mobile App: ARAG Legal

FET Advantage Beneplace 800.683.2886 www.beneplace.com/fet

All Other Issues Contact Your Human Resources Representative

2022 Benefits Guide // FET 15

 Forum Energy Technologies, Inc.
10344 Sam Houston Park Dr., Suite 300
Houston, TX 77064