2022 Labster Benefit Guide

2022 Employee Benefit Guide

Benefits for 2022 Table of Contents • Introduction 3 • Overview of Benefits Programs 4 • Medical Benefits 6 • Telemedicine____________________________________________________________________________________ 10 • Dental Benefits__________________________________________________________________________________ 11 • Vision Benefits 12 • Life Insurance & Disability 13 • Health Savings Account (HSA) 14 • Flexible Spending Account (FSA) 15 • Value of Pre-Tax Benefits 16 • Employee Assistance Program 17 • Voluntary Pet Insurance & Digital Clinic 18 • Contact Page 19 • Health Plan Notices 20 Employee Benefit Guide This booklet provides only a summary of your benefits. All services described within are subject to the definitions, limitations, and exclusions set forth in each insurance 2 carrier or provider’s contract.

Benefits for 2022 Introduction Asan employee of Labster enjoying your work and making valuable contributions to business are equally vital. The health, satisfaction and security of you and your family are important, not only to your well-being, but ultimately, in terms of achieving the goals of our organization. For the 2022 plan year, Labster has worked hard to offer a competitive total rewards package that includes valuable and competitive benefits plans. These programs reflect our commitment to keeping our staff healthy and secure. We understand that your situation is unique, and Labster is offering an overall benefits package that can be shaped and molded by you to fit your needs. This benefits booklet is a summary description of your Labster benefit plans. If there is a discrepancy between these summaries and the written legal plan documents, the plan documents shall prevail. This booklet and plan summaries do not constitute a contractof employment. We hope this benefits booklet, along with our additional communication and decision-making tools, will help you make the best health care choices for you and your family. UPDATE ON HEALTH CARE REFORM Effective January 1, 2019 the Tax Cuts and Jobs Act (TJCA) repealed the individual mandate to maintain health insurance or be responsible for a “shared responsibility payment”. We hope to keep offering these benefits as a valuable part of your total compensation in the future. However, because we offer you coverage that satisfies all the health reform requirements, you will not qualify for any federal assistance to purchase an individual or family policy on the open market (the “marketplace”). 2022 Employee Benefit Guide This booklet provides only a summary of your benefits. All services described within are subject to the definitions, limitations, and exclusions set forth in each insurance 3 carrier or provider’s contract.

Benefits for 2022 Overview of Benefits Programs CHANGES AND QUALIFYING EVENTS WhenCoverageBeginsandEnds › Your coverage under the benefits plans will end if you no longer meet the eligibility requirements, your contributionsare discontinued,or the Group InsurancePolicyisterminated. Qualifying Events › Eligible employees may enroll or make changes to their benefits elections during the annual open enrollment period. As with most benefits, once you elect an option you are bound to that choice for the entire plan year unless you experience a “QualifyingEvent”. These may include, but are not limitedto: • Changesinemploymentstatus • Changesinlegalmaritalstatus • Changesinnumberofdependents • Takinganunpaidleaveofabsence • Dependentsatisfiesorceasestosatisfyeligibilityrequirement • FamilyMedical LeaveAct(FMLA)leave. • ACOBRA-qualifyingevent • Entitlementto MedicareorMedicaid • A change in the place of residence of the employee, resulting in the current carrier not being available 2022 Employee Benefit Guide This booklet provides only a summary of your benefits. All services described within are subject to the definitions, limitations, and exclusions set forth in each insurance 4 carrier or provider’s contract.

Benefits for 2022 Overview of Benefits Programs Labster provides an array of benefits that can help you enjoy increased well-being, deal with an unexpected illness or accident, build and protect your financial security, balance your personal and professional lifeand meeteverydayneeds. These benefits are affordable,comprehensiveandcompetitive. The table below summarizes the benefits available to eligible staff and their dependents. These benefits aredescribedingreaterdetailinthisbooklet. BENEFITS AT-A-GLANCE Coverage Carrier Medical United Healthcare Dental Principal Vision Principal with VSP Life & Disability Principal Flexible Spending Account Health Equity Health Savings Account Optum Bank ELIGIBILITY As a Labster employee, you are eligible for benefits if you work at least 30 hours per week. Benefits are effective on your first day of employment. You may enroll your eligible dependents for coverage once you areeligible.Your eligibledependents include: • Your legalspouse • Your domesticpartner • Your children up to the age of 26 (Children will be covered until the last day of the month in which they turn 26) Onceyourbenefitelections become effective, they remainin effect until the end of the year. You may only changewithin30daysofaqualifiedlifeevent. 2022 Employee Benefit Guide This booklet provides only a summary of your benefits. All services described within are subject to the definitions, limitations, and exclusions set forth in each insurance 5 carrier or provider’s contract.

Benefits for 2022 Medical SUMMARY OF COVERAGE Plan Features UHC HSA $2,000 UHC PPO $3,000 IN NETWORK Calendar Year Deductibles $2,000 / $4,000 $3,000 / $6,000 (Individual / Family) Preventive Care $0 $0 Primary Care Visit Deductible, then $0 $25 Specialist Visit Deductible, then $0 $45 Diagnostic Exam Deductible, then $0 Deductible, then $0 X-Rays Deductible, then $0 Deductible, then $0 Complex Images Deductible, then $0 Deductible, then $0 Outpatient Procedure Deductible, then $0 Deductible, then $0 Inpatient Visit Deductible, then $0 Deductible, then $0 Emergency Room Deductible, then $0 $150 after deductible Urgent Care Deductible, then $0 Deductible, then $0 Pharmacy / RX (30 Day Supply) $5 / $40 / $85 $20 / $35 / $60 Pharmacy / RX (90 Day Supply) $12.50 / $100 / $212.50 $40 / $70 / $120 Annual Out-of-Pocket Max $4,000 / $8,000 $5,000 / $10,000 (Individual / Family) OUT OF NETWORK Calendar Year Not Covered $3,000 / $6,000 Deductibles (Indiv / Family) Preventive Care Not Covered 20% coinsurance after deductible Primary Care Visit Not Covered 20% coinsurance after deductible Specialist Visit Not Covered 20% coinsurance after deductible Diagnostic Exam Not Covered 20% coinsurance after deductible X-Rays Not Covered 20% coinsurance after deductible Complex Images Not Covered 20% coinsurance after deductible Outpatient Procedure Not Covered 20% coinsurance after deductible Inpatient Visit Not Covered 20% coinsurance after deductible Emergency Room Not Covered $150 after deductible Urgent Care Not Covered 20% coinsurance after deductible Pharmacy / RX (30 Day Supply) Not Covered Not Covered Pharmacy / RX (90 Day Supply) Not Covered Not Covered Calendar Year Not Covered $5,000 / $10,000 Out-of-Pocket Max (Indiv / Family) EMPLOYEE COST PER PAY PERIOD Employee $0.00 $0.00 Employee + Spouse $129.91 $158.99 Employee + Child(ren) $129.91 $158.99 Employee + Family $194.96 $238.55 * Member may be responsible for any amount over the allowed amount 2022 Employee Benefit Guide This booklet provides only a summary of your benefits. All services described within are subject to the definitions, limitations, and exclusions set forth in each insurance 6 carrier or provider’s contract.

Benefits for 2022 Medical KEY TERMS TO REMEMBER ANNUAL DEDUCTIBLE OUT-OF-POCKET MAXIMUM COPAYS AND PLAN TYPES COINSURANCE 2022 Employee Benefit Guide This booklet provides only a summary of your benefits. All services described within are subject to the definitions, limitations, and exclusions set forth in each insurance 7 carrier or provider’s contract.

Benefits for 2022 Medical Extras FOR UHC MEMBERS LabsteremployeeswhoenrollintheUnitedHealthcaremedicalplanshaveaccesstoseveralextrasthroughUHC: UHCMotion Walking may be one of the easiest ways to maintain an active and healthier lifestyle. With the UnitedHealthcare Motion® incentive program, walking may even help you save on health care costs. So if you’re looking to help boostyourwell-being andloweryourhealthcarecosts,justlaceupyoursneakersandgo. YouandyourenrolledspousecanuseUnitedHealthcareMotiontohelptake greatercontrolofyourhealth while, at the same time, earning credits for meeting specific FIT (frequency, intensive, tenacity) goals. These credits are depositedquarterlyintoyourHRAorHSA. PPOPlanMemberscanearnupto$4perdayinhealthreimbursementaccount(HRA)credits. HSAPlanMemberscanearnupto$3perdayinhealthsavingsaccount(HSA)credits. PPO HSA Frequency $1.50 $1.00 300 steps in 5 minutes 6x/day, at least 1 hour apart Intensity $1.50 $1.00 3,000 steps in 30 minutes Tenacity $1.50 $1.00 10,000+ total daily steps Total $4.00/day; $1,460/year $3/day; $1,095/year UHCMobileApp TheUnitedHealthcare®appputsyourplanatyourfingertips. When you’re out and about, you can do everything from managing your plan to getting convenient care. Just downloadtheappto: • Find nearbycare optionsin yournetwork. • Estimatecosts. • Videochatwithadoctor24/7.* • ViewandshareyourhealthplanIDcard. • Seeyourclaimdetailsandviewprogresstowardyourdeductible. RallyPersonalizedHealthRecommendations Rally is designed to help you make changes to your daily routine, set smart goals and track your progress. You’ll get personalized recommendations to help you move more, eat better and improve your health—and have fun doingit. Get startedat myuhc.com. RealAppeal Real Appeal® is an online weight loss program that provides personal coaching to help you and eligible family membersloseweightandkeepitoff.Onaverage,participantslose10 lbs.afterattendingjust4 onlinesessions. 8 2022 Employee Benefit Guide This booklet provides only a summary of your benefits. All services described within are subject to the definitions, limitations, and exclusions set forth in each insurance carrier or provider’s contract.

Benefits for 2022 Medical Understanding the full value of covered benefits allows you to take responsibility for maintaining good health and incorporating healthy habits into your lifestyle. Some examples include getting regular physical examinations, mammograms and immunizations. Through the plans offered by Labster, all covered individuals and family members are eligible to receive routine wellness services like these, at no cost; all copays,coinsurance,anddeductiblesarewaived. WHICH PREVENTIVE CARE SERVICES ARE COVERED? The US Preventive Services Task Force maintains a regular list of recommended services that all Affordable Care Act (i.e. Health Care Reform) compliant insurance plans should cover at 100% for in-network providers. Below is a list of common services that are included in the plansoffered thisyear: › RoutinePhysicalExam › WellBabyandChildCare › WellWomanVisits › Immunizations › RoutineBoneDensityTest › RoutineBreastExam › RoutineGynecologicalExam › Screeningfor Gestational Diabetes › Obesity ScreeningandCounseling › RoutineDigitalRectal Exam › RoutineColonoscopy › RoutineColorectalCancerScreening › RoutineProstateTest › RoutineLabProcedures › RoutineMammograms › RoutinePapSmear › SmokingCessation “An ounce of › HealthEducation/CounselingServices › HealthCounselingforSTDs andHIV prevention is worth a › Testing for HPVand HIV › ScreeningandCounselingfor DomesticViolence pound of cure” 2022 Employee Benefit Guide This booklet provides only a summary of your benefits. All services described within are subject to the definitions, limitations, and exclusions set forth in each insurance 9 carrier or provider’s contract.

Benefits for 2022 Telemedicine Labster employees enrolled in one of our United Healthcare medical plans have access to around the clock access to a doctor, no matter where they are, through Amwell, Doctor on Demand, or Teladoc. This Telemedicine benefit will connect you to a board-certified doctor by phone or video chat. Examples of illnesses you can have a consultation with are (but not limited to): • Sinus Infections • Pink Eye • Strep Throat • Ear Infections Save over $130 compared to Urgent Care and up to $2,000 in comparison to the ER. Contact Information: You can access Telehealth in several different ways: • Download the Amwell, Doctor on Demand, or Teladoc mobile app • Locate your member ID number on your health plan ID card • Have your credit card ready to cover any costs not covered by your health plan • Choose a pharmacy that's open in case you're given a prescription 2022 Employee Benefit Guide This booklet provides only a summary of your benefits. All services described within are subject to the definitions, limitations, and exclusions set forth in each insurance 10 carrier or provider’s contract.

Benefits for 2022 Dental Coverage SUMMARY OF COVERAGE Plan Features IN NETWORK Annual Deductible (Individual / Family) $50 / $150 Preventive Care 100% Covered – deductible is waived Basic Procedures (Extractions, fillings, etc.) 80% Covered Major Procedures (Crowns, dentures, etc.) 50% Covered Child Orthodontia 50% Covered up to lifetime max of $1,250 Calendar Year Maximum Benefit $1,250 per person OUT OF NETWORK Annual Deductible (Individual / Family) $50 / $150 Preventive Care 100% Covered – deductible is waived Basic Procedures (Extractions, fillings, etc.) 80% Covered Major Procedures (Crowns, dentures, etc.) 50% Covered Child Orthodontia 50% Covered up to lifetime max of $1,250 Calendar Year Maximum Benefit $1,250 per person 2022 Employee Benefit Guide This booklet provides only a summary of your benefits. All services described within are subject to the definitions, limitations, and exclusions set forth in each insurance 11 carrier or provider’s contract.

Benefits for 2022 Vision Coverage SUMMARY OF COVERAGE Plan Features IN NETWORK Vision Exam $10 Lenses Single $25 Bifocal $25 Trifocal $25 Lenticular $25 Frames $150 annual allowance Elective Contact Lenses $150 annual allowance; up to $60 copay for exam Medically Necessary Contact Lenses Covered in Full Frequency (Months) Exam Every calendar year Lenses Every calendar year Frames Every other calendar year Contacts Every calendar year VSP MEMBER DISCOUNTS 40% off a complete second pair of prescription eyeglasses 20% off non-prescription sunglasses 20% off any remaining balance beyond your plan allowances 2022 Employee Benefit Guide This booklet provides only a summary of your benefits. All services described within are subject to the definitions, limitations, and exclusions set forth in each insurance 12 carrier or provider’s contract.

Benefits for 2022 Life Insurance & Disability SUMMARY OF COVERAGE Employer-Paid Basic Life Insurance Disability Insurance Plan Features Short-Term Disability Coverage Amount 60% of your weekly pre-disability Employee Benefit Amount 1x your annual salary earnings Maximum Benefit Amount $2,000 per week Maximum Benefit Amount $150,000 Elimination Period 15 days Guaranteed Issue $150,000 Benefit Duration Up to 24 weeks The following shows how much benefits are reduced at certain Long-Term Disability ages: Coverage Amount 60% of your monthly pre- Age Band Benefit Reduction disability earnings Maximum Benefit Amount $5,000 per month 65 35% Elimination Period 180 days 70 15% Benefit Duration To Normal Social Security Retirement Age 2022 Employee Benefit Guide This booklet provides only a summary of your benefits. All services described within are subject to the definitions, limitations, and exclusions set forth in each insurance 13 carrier or provider’s contract.

Benefits for 2022 Health Savings Account (HSA) LABSTEROFFERS A HEALTH SAVINGS ACCOUNT (HSA) TO EMPLOYEES ENROLLED IN THE UHC BRONZE PLAN. THIS IS HOW AN HSA WORKS: A health savings account (HSA) is a health care account and savings account in one. The main purpose of this account is to offset the cost of a qualifying high deductible health plan (HDHP) and provide savings for your out-of-pocket eligible health care expenses – those you and your tax dependentsmayhavenow,inthefuture,andduringyourretirement. This is a “portable” account. You own your HSA! It’s included in your employee benefits package, butafter yousetup youraccount, it’s yours to keep,evenifyou change jobs or retire. Once your HSA is established, you can contribute up to the IRS annual limit to your account and you can then use your HSA dollars tax-free to pay for eligible health care expenses. You save money on expenses you’re already paying for, like doctors’ office visits, prescription drugs, and muchmore.Bestofall,youdecidehowandwhentouseyourHSAdollars. Individuals: may contributeupto $3,650/year Families: may contributeupto$7,300/year WHY IS IT A GOOD IDEA TO HAVE AN HSA? HSAs benefit everyone who is eligible to have this account – single individuals, families, and soon-to-be retirees. You save moneyon taxesinthree ways: › Tax-free deposits – The money › Tax-free earnings – Your › Tax-free withdrawals – The you contribute to your HSA isn’t interest and any investment money used toward eligible taxed (up to the IRS annual limit) earnings grow tax-free. health care expenses isn’t taxed –now or in the future. › Setting aside pre-tax dollars into your HSA means you pay fewer taxes and increase your take-home pay by your tax savings. You save money on eligible expenses that you are paying for out of your pocket. The amountyousavedependsonyourtax bracket. For example, if you are in the 30 percent tax bracket, you can save$30 onevery$100 spentoneligiblehealthcareexpenses. HSAfundsrolloverfromyeartoyearandaccumulateinyouraccount.Thereisno“use-it-or-lose-it”rulewith HSAs, and you decide how and when to use your HSA funds, which can be used for eligible expenses you have now, in the future, or during retirement. And when you have a certain balance in your HSA, investment opportunitiesare available. Refer to your HSA documentation for more information. 2022 Employee Benefit Guide This booklet provides only a summary of your benefits. All services described within are subject to the definitions, limitations, and exclusions set forth in each insurance 14 carrier or provider’s contract.

Benefits for 2022 Flexible Spending Accounts (FSA) Labster is offering a FlexibleSpendingAccount (FSA) for 2022. This ishow an FSA works: › YousetasidemoneyforyourFSAfromyourpaycheckbeforetaxesaretakenout. › Then use your pre-tax FSA funds throughout the plan year to pay for eligible health care or dependent care expenses. › Yousavemoneyonexpensesyou’realreadypayingfor. Healthcare FSA IRS Annual Contribution Limit: $2,850 Dependent Care FSA IRS Annual Contribution Limit: $5,000 ($2,500 if married & filing separately) You may rollover up to $570 annually of unused Healthcare FSA funds. Unused Dependent Care FSA funds are forfeited at the end of the plan year. HEALTH FSA ELIGIBLE EXPENSES DEPENDENT CARE FSA ELIGIBLE EXPENSES › Medical expenses: co-pays, co-insurance, and › Careforyour childwhoisunderage13 deductibles › Beforeandafter-schoolcare › Dental expenses: exams, cleanings, X-rays, and › Babysittingandnannyexpenses braces › Daycare,nurseryschool, andpreschool › Vision expenses: exams, contact lenses and › Summerdaycamp supplies,eyeglasses,and laser eye surgery › Care for a relative who is physically or mentally › Professional services: physical therapy, incapableof self-careand livesinyour home chiropractor, and acupuncture › Prescriptiondrugsand insulin › Over-the-counter health care items: bandages, pregnancy test kits, blood pressure monitors, etc. Refer to your FSA documentation for more information. 2022 Employee Benefit Guide This booklet provides only a summary of your benefits. All services described within are subject to the definitions, limitations, and exclusions set forth in each insurance 15 carrier or provider’s contract.

Benefits for 2022 Value of Pre-Tax Benefits SECTION 125 PLAN Labster operates a Premium Only Section 125 Plan, which allows you to reduce your total taxable income by your portion of group insurance premiums. In effect, this is just like getting a raise - your withholding taxes are reduced, and your take-homepay increases! Example: Employee earning $30,000 annually, paying $200/month for benefits Without Pre-Tax Benefits With Pre-Tax Benefits Gross Pay $30,000 $30,000 Insurance Deductions/Payments $0 $2,400 Taxable Income $30,000 $27,600 Taxes at 25% $7,500 $6,900 After-Tax Income $22,500 $20,700 After-Tax Payment for Benefits $2,400 $0 Take-home Pay $20,100 $20,700 INCREASEIN TAKE-HOME PAY +$600 2022 Employee Benefit Guide This booklet provides only a summary of your benefits. All services described within are subject to the definitions, limitations, and exclusions set forth in each insurance 16 carrier or provider’s contract.

Benefits for 2022 Employee Assistance Program Labster offers all employees and their household members an Employee Assistance program through MagellanHealth. › The EAP is a no-cost, confidential 24/7 support service you can access when dealing with life’s challenges. › The EAPprovidescoaching,counseling,onlineprograms,andreferrals. › This is provided at no cost to you Get Support Call 1-800-523-5668 24/7/365 Online magellanhealth.com/member WELL-BEING SERVICES OTHER RESOURCES › Coaching – when you have a goal to achieve, › Wellness resources – Want to eat better, move coaches help you create a plan of action and more, be happier and healthier? Bring wellness stay on track habits into your life with interactive tools and › Counseling – for more difficult issues like grief assessments, informative articles, and engaging or stress, counselors can provide support videos. Access information on fitness, proper tailoredto your unique situation eating, weight management, disease and injury › Online programs – Self-guided, interactive prevention,andmore. programs help improve your emotional well- › Legal Assistance, Financial Coaching & Identity beingfor issueslikedepression and anxiety Theft Resolution – Expert consultation to help with your legal, financial, and identity theft needs. Access a free online library with resources for identity theft resolution, budgeting, debt management, family law, wills, andmore. 2022 Employee Benefit Guide This booklet provides only a summary of your benefits. All services described within are subject to the definitions, limitations, and exclusions set forth in each insurance 17 carrier or provider’s contract.

Benefits for 2022 Voluntary Pet Insurance & Digital Clinic PawpPerks Voluntary Pet Emergency Fund Labster employees can choose to enroll in Pawp Perks, which provides an emergency fund amount of $3,000 annually for up to 6 pets. Get instant, unlimited virtual vet visits with an expert anytime, day or night, through text, call, or video chat. Pawpalso gives you a $3,000 safety net in the event of a medical emergency. Plan Requirements The PawpPerks plan is only available for cats and dogs. You must use your Labster email when enrolling to receive the discounted premium of $17/month. Additional Benefits Get personalized vet recommendations and access to veterinarian-backed articles and resources. 2022 Employee Benefit Guide This booklet provides only a summary of your benefits. All services described within are subject to the definitions, limitations, and exclusions set forth in each insurance 18 carrier or provider’s contract.

Benefits for 2022 Contact Information Carrier Name Website Phone Number United Healthcare www.myuhc.com 1-800-842-0204 Principal https://login.principal.com/login 1-800-986-3343 VSP https://vsp.com/login 1-800-877-7195 Health Equity https://healthequity.com/loginhelp 1-877-924-3967 Optum Bank https://www.optumbank.com/sign-in.html 1-877-470-1771 2022 Employee Benefit Guide This booklet provides only a summary of your benefits. All services described within are subject to the definitions, limitations, and exclusions set forth in each insurance 19 carrier or provider’s contract.

Benefits for 2022 Legal Notices Health Insurance Portability and Accountability Act of 1996 (HIPAA) The Health Insurance Portability and Accountability Act of 1996 (HIPAA) is a federal law that addresses the privacy and security of certain individually identifiable health information, called protected health information (or PHI). You have certain rights with respect to your PHI, including a right to see or get a copy of your health and claims records and other health information maintained by a health plan or carrier. For a copy of the Notice of Privacy Practices, describing how your PHI may be used and disclosed and how you get access to the information, contact Human Resources. Women’s Health and Cancer Rights Act Enrollment Notice If you have had or are going to have a mastectomy, you may be entitled to certain benefits under the Women's Health and Cancer Rights Act of 1998 (WHCRA). For individuals receiving mastectomy-related benefits, coverage will be provided in a manner determined in consultation with the attending physician and the patient, for: all stages of reconstruction of the breast on which the mastectomy was performed; surgery and reconstruction of the other breast to produce a symmetrical appearance; prostheses; and treatment of physical complications of the mastectomy, including lymphedema. These benefits will be provided subject to the same deductibles and co- insurance applicable to other medical and surgical benefits provided under the Lykan Bioscience Health Plan. If you would like more information on WHCRA benefits, please call your Plan Administrator Newborns’ and Mothers’ Health Protection Act Disclosure Group health plans and health insurance issuers generally may not, under Federal law, restrict benefits for any hospital length of stay in connection with childbirth for the mother or newborn child to less than 48 hours following a vaginal delivery, or less than 96 hours following a cesarean section. However, Federal law generally does not prohibit the mother’s or newborn’s attending provider, after consulting with the mother, from discharging the mother or her newborn earlier than 48 hours (or 96 hours as applicable). In any case, plans and issuers may not, under Federal law, require that a provider obtain authorization from the plan or the insurance issuer for prescribing a length of stay not in excess of 48 hours (or 96 hours). Patient Protection Notice You have the right to designate any participating primary care provider who is available to accept you or your family members (for children, you may designate a pediatrician as the primary care provider). For information on how to select a primary care provider and for a list of participating primary care providers, contact the Plan Administrator. You do not need prior authorization from the Plan or from any other person, including your primary care provider, in order to obtain access to obstetrical or gynecological care from a health care professional; however, you may be required to comply with certain procedures, including obtaining prior authorization for certain services, following a pre-approved treatment plan, or procedures for making referrals. For a list of participating health care professionals who specialize in obstetrics or gynecology, contact the health plan. 2022 Employee Benefit Guide This booklet provides only a summary of your benefits. All services described within are subject to the definitions, limitations, and exclusions set forth in each insurance 20 carrier or provider’s contract.

Benefits for 2022 Legal Notices HIPAA Special Enrollment Notice If you are declining enrollment for yourself or your dependents (including your spouse) because of other health insurance or group health plan coverage, you may be able to enroll yourself and your dependents in this plan if you or your dependents lose eligibility for that other coverage(or if the employer stops contributing toward your or your dependents’ other coverage). However, you must request enrollment within 30 days after your or your dependents’ other coverage ends (or after the employer stops contributing toward the other coverage). In addition, if you have a new dependent as a result of marriage, birth, adoption, or placement for adoption, you may be able to enroll yourself and your dependents. However, you must request enrollment within 30 days after the marriage, birth, adoption, or placement for adoption. To request special enrollment or obtain more information, contact the Plan Administrator. 2022 Employee Benefit Guide This booklet provides only a summary of your benefits. All services described within are subject to the definitions, limitations, and exclusions set forth in each insurance 21 carrier or provider’s contract.

Benefits for 2022 Legal Notices Premium Assistance Under Medicaid and the Children’s Health Insurance Program (CHIP) If you or your children are eligible for Medicaid or CHIP and you’re eligible for health coverage from your employer, your state may have a premium assistance program that can help pay for coverage, using funds from their Medicaid or CHIP programs. If you or your children aren’t eligible for Medicaid or CHIP, you won’t be eligible for these premium assistance programs but you may be able to buy individual insurance coverage through the Health Insurance Marketplace. For more information, visit www.healthcare.gov. If you or your dependents are already enrolled in Medicaid or CHIP and you live in a State listed below, contact your State Medicaid or CHIP office to find out if premium assistance is available. If you or your dependents are NOT currently enrolled in Medicaid or CHIP, and you think you or any of your dependents might be eligible for either of these programs, contact your State Medicaid or CHIP office or dial 1-877-KIDS NOW or www.insurekidsnow.gov to find out how to apply. If you qualify, ask your state if it has a program that might help you pay the premiums for an employer-sponsored plan. If you or your dependents are eligible for premium assistance under Medicaid or CHIP, as well as eligible under your employer plan, your employer must allow you to enroll in your employer plan if you aren’t already enrolled. This is called a “special enrollment” opportunity, and you must request coverage within 60 days of being determined eligible for premium assistance. If you have questions about enrolling www.askebsa.dol.gov or call 1-866-444-EBSA (3272). in your employer plan, contact the Department of Labor at If you live in one of the following states, you may be eligible for assistance paying your employer health plan premiums. The COLORADO –Health First Colorado (Colorado’s Medicaid following list of states is current as of July 31, 2020. Contact your State for more information on eligibility – ALABAMA –Medicaid Program) & Child Health Plan Plus (CHP+) Website: http://myalhipp.com/ Health First Colorado Website: https://www.healthfirstcolorado.com/ Phone: 1-855-692-5447 Health First Colorado Member Contact Center: 1-800-221-3943/ State Relay 711 CHP+: https://www.colorado.gov/pacific/hcpf/child-health-plan-plus CHP+ Customer Service: 1-800-359-1991/ State Relay 711 Health Insurance Buy-In Program (HIBI): https://www.colorado.gov/pacific/hcpf/health-insurance-buy- program HIBI Customer Service: 1-855-692-6442 ALASKA –Medicaid FLORIDA –Medicaid The AK Health Insurance Premium Payment Program Website: Website: http://myakhipp.com/ https://www.flmedicaidtplrecovery.com/flmedicaidtplrecovery.com/hi Phone: 1-866-251-4861 pp/index.html Email: [email protected] Phone: 1-877-357-3268 Medicaid Eligibility: http://dhss.alaska.gov/dpa/Pages/medicaid/default.aspx ARKANSAS –Medicaid GEORGIA –Medicaid Website: http://myarhipp.com/ Website: https://medicaid.georgia.gov/health-insurance-premium- Phone: 1-855-MyARHIPP (855-692-7447) payment-program-hipp Phone: 678-564-1162 ext 2131 CALIFORNIA –Medicaid INDIANA – Medicaid Website: Healthy Indiana Plan for low-income adults 19-64 https://www.dhcs.ca.gov/services/Pages/TPLRD_CAU_cont.aspx Website: http://www.in.gov/fssa/hip/ Phone: 916-440-5676 Phone: 1-877-438-4479 All other Medicaid Website: https://www.in.gov/medicaid/ Phone 1-800-457-4584 2022 Employee Benefit Guide This booklet provides only a summary of your benefits. All services described within are subject to the definitions, limitations, and exclusions set forth in each insurance 22 carrier or provider’s contract.

Benefits for 2022 Legal Notices IOWA –Medicaid and CHIP (Hawki) MONTANA –Medicaid https://dhs.iowa.gov/ime/members http://dphhs.mt.gov/MontanaHealthcarePrograms/HIPP Medicaid Website: Website: Medicaid Phone: 1-800-338-8366 Phone: 1-800-694-3084 Hawki Website: http://dhs.iowa.gov/Hawki Hawki Phone: 1-800-257-8563 KANSAS –Medicaid NEBRASKA –Medicaid Website: http://www.kdheks.gov/hcf/default.htm Website: http://www.ACCESSNebraska.ne.gov Phone: 1-800-792-4884 Phone: (855) 632-7633 Lincoln: (402) 473-7000 Omaha: (402) 595-1178 KENTUCKY –Medicaid NEVADA –Medicaid Kentucky Integrated Health Insurance Premium Payment Program Medicaid Website: http://dhcfp.nv.gov/ (KI-HIPP) Website: Medicaid Phone: 1-800-992-0900 https://chfs.ky.gov/agencies/dms/member/Pages/kihipp.aspx Phone: 1-855-459-6328 Email: [email protected] KCHIP Website: https://kidshealth.ky.gov/Pages/index.aspx Phone: 1-877-524-4718 Kentucky Medicaid Website: https://chfs.ky.gov LOUISIANA – Medicaid NEW HAMPSHIRE –Medicaid Website: www.medicaid.la.gov or www.ldh.la.gov/lahipp Website: https://www.dhhs.nh.gov/oii/hipp.htm Phone: 1-888-342-6207 (Medicaid hotline) or 1-855-618-5488 Phone: 603-271-5218 (LaHIPP) Toll free number for the HIPP program: 1-800-852-3345, ext 5218 MAINE –Medicaid NEW JERSEY –Medicaid and CHIP Website: http://www.maine.gov/dhhs/ofi/public-assistance/index.html Medicaid Website: Phone: 1-800-442-6003 http://www.state.nj.us/humanservices/dmahs/clients/medicaid/ TTY: Maine relay 711 Medicaid Phone: 609-631-2392 Private Health Insurance Premium Webpage: CHIP Website: http://www.njfamilycare.org/index.html https://www.maine.gov/dhhs/ofi/applications-forms CHIP Phone: 1-800-701-0710 Phone: -800-977-6740. TTY: Maine relay 711 MASSACHUSETTS –Medicaid and CHIP NEW YORK –Medicaid Website: http://www.mass.gov/eohhs/gov/departments/masshealth/ Website: https://www.health.ny.gov/health_care/medicaid/ Phone: 1-800-862-4840 Phone: 1-800-541-2831 MINNESOTA – Medicaid NORTH CAROLINA –Medicaid Website: https://medicaid.ncdhhs.gov/ Website: https://mn.gov/dhs/people-we-serve/children-and-families/health- Phone: 919-855-4100 care/health-care-programs/programs-and-services/other- insurance.jsp Phone: 1-800-657-3739 MISSOURI – Medicaid NORTH DAKOTA –Medicaid Website: http://www.dss.mo.gov/mhd/participants/pages/hipp.htm Website: http://www.nd.gov/dhs/services/medicalserv/medicaid/ Phone: 573-751-2005 Phone: 1-844-854-4825 OKLAHOMA –Medicaid and CHIP UTAH –Medicaid and CHIP Website: http://www.insureoklahoma.org Medicaid Website: https://medicaid.utah.gov/ Phone: 1-888-365-3742 CHIP Website: http://health.utah.gov/chip Phone: 1-877-543-7669 OREGON –Medicaid VERMONT–Medicaid Website: Website: http://www.greenmountaincare.org/ http://healthcare.oregon.gov/Pages/index.aspx Phone: 1-800-250-8427 http://www.oregonhealthcare.gov/index-es.html Phone: 1-800-699-9075 PENNSYLVANIA –Medicaid VIRGINIA – Medicaid and CHIP Website: https://www.dhs.pa.gov/providers/Pages/Medical/HIPP- Website: http://www.coverva.org/hipp/ Program.aspx Medicaid Phone: 1-800-432-5924 Phone: 1-800-692-7462 CHIP Phone: 1-855-242-8282 2022 Employee Benefit Guide This booklet provides only a summary of your benefits. All services described within are subject to the definitions, limitations, and exclusions set forth in each insurance 23 carrier or provider’s contract.

Benefits for 2022 Legal Notices RHODE ISLAND –Medicaid WASHINGTON –Medicaid Website: http://www.eohhs.ri.gov/ Website: https://www.hca.wa.gov/ Phone: 1-855-697-4347, or 401-462-0311 (Direct RIte Share Line) Phone: 1-800-562-3022 SOUTH CAROLINA –Medicaid WEST VIRGINIA – Medicaid Website: http://www.scdhhs.gov Website: http://mywvhipp.com/ Phone: 1-888-549-0820 Toll-free phone: 1-855-MyWVHIPP (1-855-699-8447) SOUTH DAKOTA -Medicaid WISCONSIN –Medicaid and CHIP Website: http://dss.sd.gov Website: Phone: 1-888-828-0059 https://www.dhs.wisconsin.gov/badgercareplus/p-10095.htm Phone: 1-800-362-3002 TEXAS –Medicaid WYOMING –Medicaid Website: http://gethipptexas.com/ Website: https://health.wyo.gov/healthcarefin/medicaid/programs- Phone: 1-800-440-0493 and-eligibility/ Phone: 1-800-251-1269 2022 Employee Benefit Guide This booklet provides only a summary of your benefits. All services described within are subject to the definitions, limitations, and exclusions set forth in each insurance 24 carrier or provider’s contract.

Benefits for 2022 Legal Notices To see if any other states have added a premium assistance program since July 31, 2020, or for more information on special enrollment rights, contact either: U.S. Department of Labor U.S. Department of Health and Human Services Employee Benefits Security Administration Centers for Medicare & Medicaid Services www.dol.gov/agencies/ebsa www.cms.hhs.gov 1-866-444-EBSA (3272) 1-877-267-2323, Menu Option 4, Ext. 61565 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 four 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, 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 1/31/2023) 2022 Employee Benefit Guide This booklet provides only a summary of your benefits. All services described within are subject to the definitions, limitations, and exclusions set forth in each insurance 25 carrier or provider’s contract.

Benefits for 2022 Legal Notices Genetic Information Nondiscrimination Act (GINA) Disclosures Genetic Information Nondiscrimination Act of 2008 The Genetic Information Nondiscrimination Act of 2008 (“GINA”) protects employees against discrimination based on their genetic information. Unless otherwise permitted, your Employer may not request or require any genetic information from you or your family members. The Genetic Information Nondiscrimination Act of 2008 (GINA) prohibits employers and other entities covered by GINA Title II from requesting or requiring genetic information of an individual or family member of the individual, except as specifically allowed by this law. To comply with this law, we are asking that you not provide any genetic information when responding to this request for medical information. “Genetic information,” as defined by GINA, includes an individual’s family medical history, the results of an individual’s or family member’s genetic tests, the fact that an individual or an individual’s family member sought or received genetic services, and genetic information of a fetus carried by an individual or an individual’s family member or an embryo lawfully held by an individual or family member receiving assistive reproductive services. 2022 Employee Benefit Guide This booklet provides only a summary of your benefits. All services described within are subject to the definitions, limitations, and exclusions set forth in each insurance 26 carrier or provider’s contract.

Benefits for 2022 Legal Notices USERRA Notice Your Rights Under USERRA A. The Uniformed Services Employment and Reemployment Rights Act USERRA protects the job rights of individuals who voluntarily or involuntarily leave employment positions to undertake military service or certain types of service in the National Disaster Medical System. USERRA also prohibits employers from discriminating against past and present members of the uniformed services, and applicants to the uniformed services. B. Reemployment Rights You have the right to be reemployed in your civilian job if you leave that job to perform service in the uniformed service and: • You ensure that your employer receives advance written or verbal notice of your service; • You have five years or less of cumulative service in the uniformed services while with that particular employer; • You return to work or apply for reemployment in a timely manner after conclusion of service; and • You have not been separated from service with a disqualifying discharge or under other than honorable conditions. If you are eligible to be reemployed, you must be restored to the job and benefits you would have attained if you had not been absent due to military service or, in some cases, a comparable job. C. Right to Be Free from Discrimination and Retaliation If you: • Are a past or present member of the uniformed service; • Have applied for membership in the uniformed service; or • Are obligated to serve in the uniformed service; then an employer may not deny you o Initial employment; o Reemployment; o Retention in employment; o Promotion; or o Any benefit of employment because of this status. In addition, an employer may not retaliate against anyone assisting in the enforcement of USERRA rights, including testifying or making a statement in connection with a proceeding under USERRA, even if that person has no service connection. D. Health Insurance Protection • If you leave your job to perform military service, you have the right to elect to continue your existing employer-based health plan coverage for you and your dependents for up to 24 months while in the military. • Even if you do not elect to continue coverage during your military service, you have the right to be reinstated in your employer's health plan when you are reemployed, generally without any waiting periods or exclusions (e.g., pre-existing condition exclusions) except for service-connected illnesses or injuries. 2022 Employee Benefit Guide This booklet provides only a summary of your benefits. All services described within are subject to the definitions, limitations, and exclusions set forth in each insurance 27 carrier or provider’s contract.

Benefits for 2022 Legal Notices E. Enforcement • The U.S. Department of Labor, Veterans' Employment and Training Service (VETS) is authorized to investigate and resolve complaints of USERRA violations. For assistance in filing a complaint, or for any other information on USERRA, contact VETS at 1-866-4-USA-DOL or visit its Web site at http://www.dol.gov/vets.An interactive online USERRA Advisor can be viewed at http://www.dol.gov/elaws/userra.htm. • If you file a complaint with VETS and VETS is unable to resolve it, you may request that your case be referred to the Department of Justice or the Office of Special Counsel, as applicable, for representation. • You may also bypass the VETS process and bring a civil action against an employer for violations of USERRA. The rights listed here may vary depending on the circumstances. The text of this notice was prepared by VETS, and may be viewed on the Internet at this address: http://www.dol.gov/vets/programs/userra/poster.htm. Federal law requires employers to notify employees of their rights under USERRA, and employers may meet this requirement by displaying the text of this notice where they customarily place notices for employees. U.S. Department of Labor, Veterans' Employment and Training Service, 1-866-487-2365. 2022 Employee Benefit Guide This booklet provides only a summary of your benefits. All services described within are subject to the definitions, limitations, and exclusions set forth in each insurance 28 carrier or provider’s contract.

2022 Employee Benefit Guide