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MANAGERS BENEFITSGUIDE2024An overview of the wide array of benefits provided byRaleigh Pediatric Associates to help you enjoy increased well-being and financial security.

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's or provider's contract.Managers Benefits Guide2024 Raleigh Pediatric AssociatesAs an employee of Raleigh Pediatric Associates, 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 2024 plan year, Raleigh Pediatric Associates has worked hard to offer a competitive total rewards package that includes valuable and competitive benefit plans. These programs reflect our commitment to keeping our staff healthy and secure. We understand that your situation is unique, and Raleigh Pediatric Associates 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 Raleigh Pediatric Associates 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 contract of 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.INTRODUCTIONEligibility & EnrollmentAs a full-time manager working 30+ hours/week you are eligible for benefits. You can enroll or make changes during our annual enrollment period or within 30 days if you experience a qualifying life event during the year. A Qualifying Life Event includes changes in marital status, employment status, birth or adoption of a child, death of a dependent, entitlement to Medicaid or Medicare, loss of other coverage or eligibility of dependents.Benefits Begin 1st of the month following 60 days of full-time employmentBenefits End End of the month following terminationDependents Legal spouse, dependent children up to age 26Domestic Partner Same and Opposite Sex

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's or provider's contract.Managers Benefits Guide2024 Raleigh Pediatric AssociatesComparison of PlansCoverage Provided by NCMS Employee Benefit PlanIn-Network PPO 5000-70 HDHP 7000-100Benefit Period Calendar Year: 1/1 – 12/31 Calendar Year: 1/1 – 12/31Deductibles (Individual / Family)$5,000 / $10,000 $7,000 / $14,000Preventive Care Covered in full Covered in fullPrimary Care Visit$40 CopayRegister your PCP on www.BlueConnect.com and 1st three visits copay waved0% after deductibleSpecialist Visit $120 Copay 0% after deductibleTelehealth via Teladoc $40 Copay 0% after deductibleUrgent Care $120 Copay 0% after deductibleEmergency Room $1,000 Copay 0% after deductibleOutpatient Procedure 30% after deductible 0% after deductibleInpatient Visit 30% after deductible 0% after deductiblePharmacy / RX (30 Day Supply)Tiers 1-5$15 / $35 / $45 / $90 / 25% ($50 min, $200 max)0% after deductibleLens and Frames Coverage $130 at 100%, 90% thereafterEnhanced Preventive: 0%, no deductibleAll Others: 0% after deductibleOut-of-Pocket Max (Individual / Family)$8,550 / $17,100 $7,000 / $14,000MEDICALThe chart below is an overview of the In-Network benefits. Out-of-Network benefits are available; please review your NCMS plan documents for additional details.

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's or provider's contract.Managers Benefits Guide2024 Raleigh Pediatric AssociatesWellness and Health ManagementUnderstanding 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 Raleigh Pediatric Associates, all covered individuals and family members are eligible to receive routine wellness services like these, at no cost; all copays, coinsurance, and deductibles are waived.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 plans offered this year:• Routine physical exam• Well baby and childcare• Well women visits• Immunizations• Routine bone density test• Routine breast exam• Routine gynecological exam• Screening for Gestational diabetes• Obesity screening and counseling• Routine digital rectal exam• Routine colonoscopy• Routine colorectal cancer screening• Routine prostate test• Routine lab procedures• Routine mammograms• Routine pap smear• Smoking cessation• Health education/counseling services• Health counseling for STDs and HIV • Testing for HPV and HIV• Screening/counseling for domestic violencePREVENTIVE CAREPricing Per Pay Period PPO 5000-70 HDHP 7000-100Employee$56.99 $25.64Employee + Spouse$412.80 $349.16Employee + Child$170.99 $129.29Employee + Children$322.98 $267.49Employee + Family$671.89 $584.73Your Cost

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's or provider's contract.Managers Benefits Guide2024 Raleigh Pediatric AssociatesEmployees and dependents enrolled in our medical have access to telemedicine through Teladoc. Telehealth provides acute and behavioral care 24 hours a day via phone or video by board-certified doctors and behavioral health specialist. Telehealth is a good option for minor health problems when you can’t see your regular doctor. It is also a convenient choice when you want to speak to a counselor or therapist. Some providers will also offer telehealth appointments. Check with your provider on the availability and cost.How Does Telehealth Work?Your virtual visit will take place via phone, video call on a laptop, tablet or cellphone; or through an app. The provider will ask you the same questions you'd be asked at an in-person visit and may recommend treatment based on their findings.What Can’t Telehealth Be Used For?• Life-threatening or emergency situations • Situations in which diagnostic care (e.g., blood work, imaging or lab tests) are required• Situations of severe illness or complex conditionsHow Do I Access Telehealth?There are 3 ways to access Teladoc:• Download the Teladoc mobile app• Go to Teladoc.com and click “Log in/Register”• Call 1-800-835-2362Refer to your plan documentation for more information.TELEHEALTHWhat Can Telemedicine Be Used For?General, non-life-threatening doctor's visits or consultations for acute care, such as:• Allergies• Cough, cold and flu• Diarrhea, nausea and vomiting• Ear problems• Insect bites• Sinus problems• Urinary problems• And moreBehavioral health issues such as:• Addictions• Anxiety• Depression• Grief and loss• Relationship issues• And more

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's or provider's contract.Managers Benefits Guide2024 Raleigh Pediatric AssociatesAmazon PharmacyBlue Cross NC now offers access to Amazon Pharmacy for your mail order needs. This includes Meds Your Way, a discount card that provides additional savings through Amazon Pharmacy. At check out you’ll see the lowest cost available for your prescription. Sign up and learn more at www.amazon.com/bluecrossnc. Mail Order Pharmacy ProgramWeight Loss Prescription DrugsEffective November 1, 2023, coverage for anti-obesity “weight loss” drugs will be discontinued. These drugs will no longer be covered due to safety concerns, as well as the lack of data supporting long-term use of these drugs. The following products will be excluded as covered medications:Wegovy LomairaSaxenda PhendimetrazineAdipex-P ContraveBenzphetamine QsymiaDiethylpropion

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's or provider's contract.Managers Benefits Guide2024 Raleigh Pediatric AssociatesThrough our partnership with NCMS, enrolled members have access to several additional programs to help support you in achieving a healthy balanced life.Nurse Support Program Condition CareManaging a chronic condition can be complicated. This BCBSNC program connects you to additional tools, resources and care if you have a condition such as:• Asthma• Chronic Obstructive Pulmonary Disease• Congestive Heart Failure• Coronary Artery Disease• Diabetes• HypertensionA Nurse Advocate may call you to provide one-on-one support. If you have not already been contacted by the Nurse Advocate, you can call 1-888-229-8510, Monday through Friday, between 9:00 a.m. and 7:00 p.m.Eat Smart, Move More, Weigh LessEat Smart, Move More, Weigh Less is an online weight management program that uses strategies proven to work for weight loss and maintenance. Each lesson informs, empowers and motivates participants to live mindfully as they make choices about eating and physical activity.To register visit: https://esmmweighless.com/howitwork/enroll-choose-a-class/ and enter the employer code: ASONCMSRaleighPeds. For questions, please contact Administrator@ESMMWeighLess.com.Nutrition Counseling Total Nutrition Technology provides members with a custom-built nutrition plan and exercise guidelines to fit each member’s lifestyle and dietary objectives. To get started on your wellness journey, complete and submit this form: https://www.totalnutritiontechnologycharlotte.com/curi-member-form/. MEDICAL SUPPORT PROGRAMS

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's or provider's contract.Managers Benefits Guide2024 Raleigh Pediatric AssociatesA health savings account (HSA) is a health care account and savings account in one. HSA helps offset the cost of a HDHP while saving for your out-of-pocket eligible health care expenses. The HSA is your personal bank account and can be used for you and your dependents now and in the future.Who is Eligible?You are eligible to contribute to an HSA if:• You are enrolled in a qualified HDHP• You are not enrolled in a copay plan such as a spouse’s non-HDHP, Medicare, Medicaid or Tri-Care• You or your spouse is not enrolled in a full purpose Health Care Flexible Spending AccountWhy Is It A Good Idea To Have An HSA?HSAs benefit everyone who is eligible to have this account, including single individuals, families and soon-to-be retirees. You save money on taxes in three ways:• Tax-Free Deposits: The money you contribute to your HSA isn't taxed (up to the IRS annual limit)• Tax-Free Earnings: Your interest and any investment earnings grow tax-free• Tax-Free Withdrawals: The money used toward eligible health care expenses isn't taxed now or in the futureSetting 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 amount you save depends on your tax bracket. For example, if you are in the 30% tax bracket, you can save $30 on every $100 spent on eligible health care expenses.HSA funds roll over from year to year and accumulate in your account. There is no "use-it-or-lose-it" rule with 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. Also, when you have a certain balance in your HSA, investment opportunities are available.Refer to your HSA documentation for more information.HSA Contribution LimitsYou can contribute to your HealthEquity HSA on a pre-tax basis through payroll deductions up to the IRS statutory maximums. These maximums include your employer’s contribution of $500/year. The IRS has established the following maximum HSA contributions:2024 Tax Year$4,150 Individual / $8,300 FamilyIf you are age 55 and over, you may contribute an extra $1,000 catch-up contribution. HEALTH SAVINGS ACCOUNT (HSA)HealthEquity will automatically open an account for you if you don’t already have one.

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's or provider's contract.Managers Benefits Guide2024 Raleigh Pediatric AssociatesThis Is How An FSA Works:• You set aside money for your FSA from your paycheck before taxes are taken out.• You then use your pre-tax FSA funds throughout the plan year to pay for eligible health care or dependent care expenses.• You save money on expenses you're already paying for.Our plan through Flores, offers a carry over up to $640 of unused funds to the following year. OR If you don’t use it, you lose it. Refer to your FSA documentation for more details.Health FSA Eligible Expenses• Medical expenses: copays, coinsurance and deductibles• Dental expenses: exams, cleanings, X-rays and braces• Vision expenses: exams, contact lenses, eyeglasses and laser eye surgery• Professional services: physical therapy, chiropractic and acupuncture• Prescription drugs and insulin• Over-the-counter health care items such as bandages, pregnancy tests and blood pressure monitorsDependent Care FSA Eligible Expenses• Care for your child who is under the age of 13• Before-school and after-school care• Babysitting and nanny expenses• Day care, nursery school and preschool• Summer day camp• Care for a relative who is physically or mentally incapable of self-care and lives in your homeRefer to your FSA documentation for more information. FLEXIBLE SPENDING ACCOUNT (FSA)

2024 FSA Enrollment Information*EMPLOYEES ENROLLING IN A HDHP PLAN SHOULD NOT ENROLL IN FSA*1. FSA – Enrollment for an FSA account is done on the Proliant website• A Health Care Flexible Spending Account provides payroll deducted tax-exempt funds you can use to pay for eligible healthcare expenses that are not covered, or only partially covered, by your medical, dental, and vision insurance plans. (Co-pays, deductibles, insurance differentials, and various OTC medications and supplies.• A Dependent Care Flexible Spending Account provides payroll deducted tax-exempt funds that you can use to pay for eligible expenses related to daycare or elderly dependent care. It cannot be used for private school tuition.2. Use it or Lose it – Per IRS guidelines, monies in a FSA account have to be used by the end of the benefit year or they are lost. The IRS does allow up to $640 to be rolled over to the next year. However, when deciding on your contribution amount, be careful not to over-estimate how much you will need.3. Annual Maximum Contribution Limits – Healthcare FSA - $3,200/ Dependent Care FSA - $2,500 for those married and filing separately OR $5,000 for those single or married filing jointly4. Dependents – Children may be covered under their parent’s Healthcare FSA account until age 26 as long as they are a taxable dependent. However, if your child will turn 27 anytime in 2024, they cannot be covered under your FSA in 2024 at all.5. Pay Periods - 26 pay periods for 2024. Employees should take the annual election amount that you choose and divide by the # of pay periods (26) to figure the contribution amount per pay period. The Proliant website will calculate this for you if you enter a yearly contribution amount.6. Using FSA for Over-the-Counter Drugs SEE MEMO FROM FLORES TO SEE ALLOWABLE OVER-THE-COUNTER EXPENSESPlease note: In 2011, prescriptions started being required for many types of Over-The-Counter medications (pills, syrups, sprays, etc.).7. Having both a Flexible Spending Account (FSA) AND a Health Savings Account (HSA) – Per IRS guidelines, a person can have both types of accounts but they cannot use them for the same “type” of expenses. For example, if someone has a HSA to pay for medical expenses, they can still have a FSA but could only use the FSA for dental and/or covered over-the-counter supplies/products. This is called a “Limited FSA”. RPA does not offer a limited FSA. Therefore, if you are enrolling into a HDHP, you cannot enroll in FSA because you will have a HSA.

2024 FSA Enrollment Information*EMPLOYEES ENROLLING IN A HDHP PLAN SHOULD NOT ENROLL IN FSA*8. Online Registration: Employees are encouraged to register at www.flores247.com once your FSA account is active. It allows you to manage your FSA, submit receipts and substantiation forms online, view your balance, and check the status of claims on your FSA account. You can then also download the Flores Mobile app to your smartphone and connect your FSA account to it.9. Submitting Substantiation – The easiest way to submit substantiation for a FSA purchase is through the Flores mobile app. You can simply take a photo of your receipt and bill and upload it through the mobile app to your FSA account. Flores Mobile is available through the Apple store or Google Play. Substantiation can also be submitted through the Flores website.10. Your Debit Card is good for 3 years. If you are currently enrolled in the plan, you will not be issued a new card unless your card is expiring.11. New enrollees should receive their Debit Cards by Jan. 1, 2024.12. If you pay out of pocket for a FSA purchase (instead of using your FSA debit card) and submit for reimbursement, you will use the reimbursement forms found on the Flores website. If you wish to have your monies deposited directly into your bank account versus waiting for a check, you may submit a direct deposit form to Flores to set this up. This form is also found on their website.13. Current elections: For anyone who enrolled Jan. 1, 2023, you will have until December 31, 2023 to use your 2023 contributions. Substantiation forms for purchases/claims prior to December 31, 2023 must be submitted no later than February 28, 2024. At the end of the year, up to $640 of unused 2023 monies may be rolled over into 2024. Once the 2023 contributions are exhausted, Flores will begin to use your 2024 contributions.14.Future elections: Will be effective January 1, 2024. Monies for 2024 must be used by December 31, 2024. At the end of the year, up to $640 of unused monies may be rolled over into the following year’s FSA account.

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's or provider's contract.Managers Benefits Guide2024 Raleigh Pediatric AssociatesSummary of CoverageCoverage Provided by Delta Dental In-NetworkAnnual Deductibles(Individual / Family)$50 / $150Preventive Care Covered in fullBasic Procedures (extractions, fillings, etc.)20% coinsuranceMajor Procedures(crowns, dentures, etc.)50% coinsuranceChild Orthodontics 50% coinsurance for children through age 18Lifetime Orthodontics Benefit $1,200Calendar Year Maximum Benefit $1,200DENTALBelow is a high-level summary of our dental benefits. While Out-of-Network coverage is available, using an In-Network provider will result in less out of pocket expenses. In-Network dentist cannot balance bill you for the amount over the allowable charges. Please review your plan documents for additional details.Pricing Per Pay PeriodEmployee$0.00Employee + Spouse$18.88Employee + Children$34.29Employee + Family$53.66Your Cost

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's or provider's contract.Managers Benefits Guide2024 Raleigh Pediatric AssociatesSummary of CoverageCoverage provided by DeltaVision/VSP. In-NetworkVision Exam (Once per plan year) $10Lenses (once per plan year)Single $10Bifocal $10Trifocal $10Frames (Once per plan year) Up to $150Elective Contact Lenses (Once per plan year) Up to $150Medically Necessary Contact Lenses Covered in full after copayVISIONOur vision coverage is provided by DeltaVision/VSP. Please review your plan documents for additional details.Pricing Per Pay PeriodEmployee$0.00Employee + Spouse$3.76Employee + Children$4.29Employee + Family$9.10Your Cost

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's or provider's contract.Managers Benefits Guide2024 Raleigh Pediatric AssociatesSummary of CoverageCoverage provided by Sun LifePlan FeaturesCoverage Paid By Raleigh Pediatric AssociatesEmployee Benefit Amount1 x annual earnings rounded to the next higher $1,000Maximum Benefit Amount $150,000AD&D Benefit $150,000Benefit Reductions begin at age 65Group life insurance coverage is an employer-sponsored safety net in case the worst happens, with no out-of-pocket costs to you. If you believe you need additional coverage, you may wish to enroll in voluntary life insurance as well. GROUP LIFE and AD&D INSURANCE

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's or provider's contract.Managers Benefits Guide2024 Raleigh Pediatric AssociatesVoluntary life insurance is paid for by you. Employees must fill out an EOI form if they exceed the guaranteed issue amount or wait to enroll until after they are first eligible.VOLUNTARY LIFE and AD&D INSURANCESummary of CoverageLife Benefit EmployeeAmountIncrements of $10,000 up to the lesser of 5 x annual earnings or $500,000Minimum Amount $50,000Maximum Amount $500,000AD&D Amount Matches life amountGuarantee Issue (Newly Eligible Employees) $100,000Benefits Will Reduce By35% at age 6550% at age 70*A dependent is defined as unmarried dependent children from birth to age 21 or to age 25 if a full-time student.For summary of rate sheet, please see carrier summary. Cost is age-banded and based on employee’s age.Life Benefit Spouse Dependent*AmountIncrements of $5,000 up to the lesser of 50% of employee amount or $250,000Increments of $2,000 up to the lesser of 100% of employee amount or $10,000Minimum Amount $5,000 $2,000Maximum Amount $250,000 $10,000AD&D Amount Matches life amount Matches life amountGuarantee Issue (Newly Eligible)$25,000 $10,000

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's or provider's contract.Managers Benefits Guide2024 Raleigh Pediatric AssociatesSummary of CoverageCoverage provided by Sun LifePlan FeaturesCoverage Paid By Raleigh Pediatric AssociatesEmployee Benefit Amount 60% of weekly earningsMaximum Benefit Amount $1,000 per weekElimination Period (Accident) 14 daysElimination Period (Sickness) 14 daysBenefit Duration 11 weeksDisability insurance is coverage that provides you with income protection should you be unable to work due to an injury or illness. With disability coverage, you are compensated for a portion of your lost income. SHORT-TERM DISABILITY INSURANCE

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's or provider's contract.Managers Benefits Guide2024 Raleigh Pediatric AssociatesVoluntary Benefits are offered through Colonial Life to assist employee's personal insurance needs. These programs are designed to fill the gaps in coverage such as your deductibles and co-insurance under your major medical.Worksite BenefitsGAPWe offer two group medical bridge plans:Plan 1 - HDHP HSA Compliant• Hospital Confinement benefit• Wellness/ Health screening benefit Plan 2 - Traditional PPO (Non-HSA)• Hospital Confinement benefit• Complex Diagnostic procedures• Outpatient Surgical procedures• Wellness/ Health screening benefit• Medical Treatment PackageAccidentPays a lump sum benefit if you or a covered family member experience an accident. Coverage can be purchased for employee and dependents.Critical IllnessPays a lump sum benefit should a covered family member experience a heart attack, stroke or other covered serious illnesses.Individual Term Life InsuranceCoverage is available in 10-year, 15-year, 20-year, or 30-year options.Individual Disability Income ProtectionProtects your paycheck and financial security if you are out of work longer than 90 days.• Helps to pay mortgage or rent, utility bills & other household expenses, food, clothing, and other necessities.• Provides disability benefits if you are involved in an accident or suffer an illness that results in a covered disability.Cancer InsurancePays lump-sum benefits that can help you protect yourself and your loved ones through the diagnosis, treatment, and recovery journey. The plan also pays a $100 Health Screening benefit (per covered person per calendar year) to encourage annual screenings – improving your chances of early detection and survival.

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's or provider's contract.Managers Benefits Guide2024 Raleigh Pediatric AssociatesOur EAP through VITAL WorkLife offers free, confidential assistance at no cost to you.• Unlimited phone support 24/7• Face-to-Face or Virtual Counseling sessions• Coaching Sessions• Online Resources• Articles• Website• Online Seminars• Guided Education ModulesOur EAP Provides Support For:• Grief• Anxiety/Stress• Problems with your children• Substance Abuse• Financial Counseling• Legal advice and referrals• And moreEMPLOYEE ASSISTANCE PROGRAM (EAP)Call: 800.383.1908 Or visit: VITALWorkLife.com Username: ncmsplan Password: ncmsplan

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's or provider's contract.Managers Benefits Guide2024 Raleigh Pediatric AssociatesCarrier ResourcesBENEFIT CARRIER GROUP # PHONE NUMBER WEBSITEMedicalNCMS Plan/BCBSNC14171957 888-206-4697www.bluecrossnc.comDental Delta Dental 1245 800-662-8856 www.deltadentalnc.com LifeDisabilitySun Life 20274254 800-786-5433www.sunlife.com EAP Vital WorklifeUsername & Password:ncmsplan800-383-1908 www.vitalworklife.com Healthcare FSADependent Care FSAFlores N/A 800-532-3327 www.flores247.com HSA HealthEquity N/A 866-346-5800www.healthequity.com Worksite Benefits Colonial Life N/A 800-325-4368www.coloniallife.com How to access ID CardsBENEFIT CARRIER HOW TO ACCESSMedical NCMS/BCBSNCHard copy ID cards are issued and mailed to your home address. Electronic copies can be accessed here: https://member.bcbsnc.com/blueconnect/web/registrationDental Delta DentalNo ID card is issued. Electronic copies can be accessed here: www.memberportal.com Vision Delta Vision No ID card is issued. FSA FloresHard copy ID cards are issued and mailed to your home address. If you’d like to request an additional card for a spouse or dependent, please request through the Flores portal: www.flores247.com Dependent Care FSAFloresNo ID card is issued. Flores will issue you a Participant ID number to help you manage your account on the Flores mobile app or website: www.flores247.com

Know Your BenefitsBrought to you by: Sentinel Risk Advisors, LLCMedical Insurance InformationDeductible: A deductible is the amount of money you or your dependents must pay toward a health claim before your organization’s health plan makes any payments for health care services rendered. For example, a plan participant with a $100 deductible would be required to pay the first $100, in total, of any claims during a plan year.Copayment (Copay): A copay is a flat fee you pay upfront for doctor visits, prescriptions, and other healthcare services. It does not count toward your deductible. Coinsurance: On top of your deductible, coinsurance is a provision in your health plan that shows what percentage of a medical bill you pay and the percentage a health plan pays.Out-of-pocket Maximum (OOPM): An OOPM is the maximum amount (deductible and coinsurance) that you will have to pay for covered expenses under a plan. Once the OOPM is reached the plan will cover eligible expenses at 100 percent.Explanation of Benefits (EOB): An EOB is a description your insurance carrier sends to you explaining the health care benefits that you received and the services for which your health care provider has requested payment.Preferred Provider Organization (PPO): A PPO is a group of hospitals and physicians that contract on a fee-for-service basis with insurance companies to provide comprehensive medical service. If you have a PPO, your out-of-pocket costs may be lower than in a non-PPO plan.High Deductible Health Plan (HDHP): An HDHP is a type of insurance plan that offers a low premium offset by a high deductible. Because of the low cost of the plan, the insurer will not cover most medical expenses until the deductible is met. As an exception, preventive care services are typically covered before the deductible is met. HDHPs are often designed to be compatible with heath savings accounts (HSAs), which are tax-advantaged accounts that can be used to pay for qualified out-of-pocket medical expenses before the HDHP’s deductible is met.This Know Your Benefits article is provided by Sentinel Risk Advisors, LLC and is to be used for informational purposes only and is not intended to replace the advice of an insurance professional. © 2005, 2011, 2013-2014, 2020 Zywave, Inc. All rights reserved.

Know Your BenefitsBrought to you by: Sentinel Risk Advisors, LLCDental Insurance InformationAnnual Maximum: The total dollar amount that a plan will pay for dental care for an individual member or family member (under a family plan) for a specified benefit period, typically a calendar year.Assignment of Benefits: When a member authorizes the dental plan to forward payment for a covered procedure directly to a member’s dentist.Balance Billing: When a participating dentist bills a member for amounts indicated as not billable to the patient by Delta Dental. Participating dentists agree to accept the fee approved by Delta Dental as payment in full and cannot bill a member for any difference.Benefit Year: The 12-month period a member’s dental plan covers, which is not always a calendar year.Contracted Fee: The fee for each single procedure that a dentist has agreed to accept as payment in full for covered services provided to a member.Covered Service: A dental treatment for which payment is provided under the terms of a member’s dental plan.In-Network Dentist: A dentist who has agreed to be a part of Delta Dental’s network and accept pre-established fees for his or her professional dental services.Lifetime Maximum: The maximum amount a plan will pay over the course of a lifetime. It may apply to an individual or a family and typically applies to specific treatments such as orthodontic treatment.Maximum Plan Allowance (MPA): The amount set by Delta Dental that a Delta Dental Premier dentist has agreed to charge for a service. For Premier dentists, Delta Dental will pay at the MPA or the actual billed amount-whichever is less.Waiting Period: A period of time before a member is eligible to receive benefits for all or certain treatments. It typically applies to expensive services such as dentures or crowns.This Know Your Benefits article is provided by Sentinel Risk Advisors, LLC and is to be used for informational purposes only and is not intended to replace the advice of an insurance professional. © 2005, 2011, 2013-2014, 2020 Zywave, Inc. All rights reserved.

Know Your BenefitsBrought to you by: Sentinel Risk Advisors, LLCVision Insurance InformationFrames Allowance: Your allowance is the amount DeltaVision/VSP will cover for your frames or for lens enhancements. For frames, a typical allowance is $150. In that case if you choose frames that cost less than $150, you pay nothing. If you choose frames that cost more than $150, you’ll pay the difference. So, for frames that cost $170, you’ll pay $20 at the doctor’s office.Frequency: How often you can get an exam or eyewear with your VSP network doctor.Lens Enhancement: A lens enhancement or lens option is an elective feature for your prescription lenses designed to improve your overall experience with your glasses. They often improve your vision and/or comfort. Here’s a list of some common lens enhancements:• Scratch-resistant coatings - Reduces normal scratching and pitting on plastic lenses.• Impact-resistant, also referred to as polycarbonate lenses - A lens material that is impact and scratch resistant, light, thin and gives UV protection.• Anti-glare coating, also referred to as anti-reflective coating - Combats eyestrain from glare, reflections and in some cases blue light from digital devices. Protects lenses from scratches.• No-line multifocal, also referred to as progressive lenses - Lenses with multiple prescription zones for near, mid and long-range vision and no visible line separating these zones as you would see on a bi-focal.This Know Your Benefits article is provided by Sentinel Risk Advisors, LLC and is to be used for informational purposes only and is not intended to replace the advice of an insurance professional. © 2005, 2011, 2013-2014, 2020 Zywave, Inc. All rights reserved.

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's or provider's contract.Managers Benefits Guide2024 Raleigh Pediatric AssociatesThis page is intentionally blank

MANAGERS BENEFITS GUIDEPrepared By Sentinel Benefits Consulting | sentinelra.com2024Raleigh Pediatric Associates