Page 21 - 2021 Mid Year Open Enrollment Guide

How We Determine What You Pay for BCBS Medical/Prescription Plan Rates

Medical/Prescription Coverage WEEKLY PAYROLL DEDUCTIONS − CORE PLAN HDHP (HSA ELIGIBLE)

Team member premium deductions for medical/prescription coverage are based on your annual Earnings <$39.9k Earnings $40k-$69.9k Earnings $70k-$99.9k Earnings $100k+
Base Pay Rate. The Base Pay Rate is established for each team member prior to Open Enrollment Employee Only $21.10 $22.21 $27.96 $35.18
and a new hire’s initial coverage effective date. The Base Pay Rate is determined as follows:
Employee + Spouse $65.19 $68.77 $86.26 $114.48
Hourly Non-Variable Team Members – Annualized base hourly rate of pay, not counting overtime. Employee + Children $52.92 $55.70 $64.18 $76.09
Employee + Family $75.25 $83.79 $96.00 $127.16
Salaried Non-Variable Team Members – Base annual rate of pay, not counting bonuses.
BI-WEEKLY PAYROLL DEDUCTIONS − CORE PLAN HDHP (HSA ELIGIBLE)
Variable Pay & Commission-based Team Members – Actual earnings from piecework, weight or zone Earnings <$39.9k Earnings $40k-$69.9k Earnings $70k-$99.9k Earnings $100k+
pay, and/or commission earnings received.
Employee Only $42.19 $44.43 $55.92 $70.35
For purposes of this mid-year enrollment, the earnings period used to determine your Base Pay Rate Employee + Spouse $130.37 $137.54 $172.53 $228.96
is as follows: Employee + Children $105.85 $111.39 $128.35 $152.18
Employee + Family $150.49 $167.58 $192.01 $254.31
Legacy BMC team members – Your earnings received from November 1, 2019 through
October 31, 2020. WEEKLY PAYROLL DEDUCTIONS − STANDARD PPO PLAN

Legacy BFS team members – Your earnings received from September 1, 2019 through Earnings <$39.9k Earnings $40k-$69.9k Earnings $70k-$99.9k Earnings $100k+
August 31, 2020. Employee Only $27.08 $28.19 $33.94 $41.16
Employee + Spouse $77.74 $81.33 $98.82 $127.04
For newly eligible and team members with less than 12 months of Earnings, the Base Pay Rate will
be projected. Employee + Children $64.53 $67.30 $75.78 $87.69
Employee + Family $93.96 $102.51 $114.72 $145.87
Base Plus Team Members – The annualized base hourly rate of pay (if hourly) or base annual rate
of pay (if salaried) plus earnings attributable to piecework, weight or zone pay, and/or commission BI-WEEKLY PAYROLL DEDUCTIONS − STANDARD PPO PLAN
earnings received during the earnings period referenced under the bulleted item ‘Variable Pay Earnings <$39.9k Earnings $40k-$69.9k Earnings $70k-$99.9k Earnings $100k+
& Commission-based Team Members’. For newly eligible and team members with less than 12
months of earnings, the Base Pay Rate will be projected. Employee Only $54.15 $56.39 $67.88 $82.32
Employee + Spouse $155.49 $162.66 $197.64 $254.08
When you log into Dayforce to enroll or to review your current benefits, you will see your costs for all Employee + Children $129.05 $134.59 $151.56 $175.38
coverages as you move through the application.
Employee + Family $187.93 $205.02 $229.44 $291.75
For benefits purposes, your Base Pay Rate is established once for the plan year and will NOT WEEKLY PAYROLL DEDUCTIONS − BUY-UP HDHP (HSA ELIGIBLE)
change until the next plan year.
Earnings <$39.9k Earnings $40k-$69.9k Earnings $70k-$99.9k Earnings $100k+
Did You Know? Employee Only $35.88 $37.00 $42.75 $49.96
The medical/RX plans offered through Builders FirstSource are self-funded. This means we pay Employee + Spouse $96.23 $99.82 $117.31 $145.53
BlueCross BlueShield and CVS/Caremark to administer the plans, pay claims and provide access Employee + Children $81.60 $84.38 $92.86 $104.77
to contracted providers, with whom discounts for services and prescription drugs have been
negotiated. We pay many millions of dollars for these costs each year. As team members, you share Employee + Family $121.52 $130.06 $142.28 $173.43
in the cost of the plan too. As consumers of healthcare services in the plan, you can help hold down
future cost increases by doing things like making sure your medications are generic when possible, BI-WEEKLY PAYROLL DEDUCTIONS − BUY-UP HDHP (HSA ELIGIBLE)
taking preventive steps to avoid larger problems, and make sure to use the most cost effective care Earnings <$39.9k Earnings $40k-$69.9k Earnings $70k-$99.9k Earnings $100k+
options. Employee Only $71.76 $73.99 $85.49 $99.92

Employee + Spouse $192.47 $199.63 $234.62 $291.06
Employee + Children $163.21 $168.75 $185.71 $209.54
Employee + Family $243.04 $260.13 $284.56 $346.86
Refer to prior page for how we determine what you pay for medical coverage.

18 • 2021 BUILDERS FIRSTSOURCE MID-YEAR BENEFITS GUIDE 2021 BUILDERS FIRSTSOURCE MID-YEAR BENEFITS GUIDE • 19