Abundant Life Benefit Guide : simplebooklet.com

Eligibility A bundant Life is pleased to provide insurance benefits You may select the insurance that best fits your needs You are eligible for benefits if you are a regular fulltime employee working an average of 30 hours per week Your coverage is effective the first of the month after you have completed 60 days of full time employment Enr ollment must be completed within 31 days of the date of eligibility Once your enrollment is completed no changes will be allowed until the next annual open enrollment period unless you have a Qualifying Life Event or your hours worked per week drop below the minimum The policy year runs from July 1 2024 to June 30 2025 however the company reserves the right to make changes to the policies at anytime as well as the right to require appropriate documentation to prove your dependent relationship status including marriage birth tax returns and other legal documents You may also enroll eligible dependents for benefits coverage The cost to you for dependent coverage will vary depending on the number of dependents you enroll in the plan and the particular plans you choose When covering dependents you must select the same plans for your dependents as you select for yourself Eligible Dependents Include Your legally married spouse Children under the age of 26 regardless of student status dependency or marital status Natural Child Legally Adopted Child Step child Child for who you or your spouse are the legal guardian as long as you have the sole legal right and obligation to provide support and medical care Children who are fully dependent on you for support due to a mental or physical disability and who are indicated as such on your federal tax return coverage may continue past age 26 2 Qualifying Life Events Once you elect your benefit options they will remain in effect for the entire plan year until the following Open Enrollment You may only change coverage during the plan year if you have a Qualifying Life Event and you must do so within 30 days of the event Qualifying Life Events Include Marriage divorce legal separation or annulment Birth adoption or placement for adoption of an eligible child Death of a spouse or child Change in your spouse s employment that affects benefits eligibility Change in your child s eligibility for benefits reaching the age limit Change in residence that affects your eligibility for coverage Significant change in coverage or cost in your your spouse s or child s benefit plans FMLA Leave COBRA event Court Judgement or Decree If you have a Qualifying Life Event and want to request a mid year change you must notify Human Resources and complete your election changes within 30 days following the event Be prepared to provide documentation to support the Qualifying Life Event

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ENROLL IN YOUR BENEFITS One step at a time Step 1 Log In Go to www employeenavigator com and click Login Returning users Log in with the username and password you selected If you have forgotten your password Click Reset a forgotten password First time users Click on your Registration Link in the email sent to you by your admin or Register as a new user Create an account and create your own username and password Company Identifier Abundant Life HSC Company Step 2 Welcome After you login click Let s Begin to complete your required tasks Step 3 Onboarding For first time users if applicable Complete any assigned onboarding tasks before enrolling in your benefits Once you ve completed your tasks click Start Enrollment to begin your enrollments T I P if you hit Dismiss complete later you ll be taken to your Home Page You ll still be able to start enrollments again by clicking Start Enrollments Step 4 Start Enrollments After clicking Start Enrollment you ll need to complete some personal dependent information before moving to your benefit elections T I P Have dependent details handy To enroll a dependent in coverage you will need their date of birth and Social Security number 3 Enrollment Instructions

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Step 5 Benefit Elections To enroll dependents in a benefit click the checkbox next to the dependent s name under Who am I enrolling Below your dependents you can view your available plans and the cost per pay To elect a benefit click Select Plan underneath the plan cost Click Save Continue at the bottom of each screen to save your elections If you do not want a benefit click Don t want this benefit at the bottom of the screen and select a reason from the drop down menu Step 6 Forms If you have elected benefits that require a beneficiary designation Primary Care Physician or completion of an Evidence of Insurability form you will be prompted to add in those details Step 7 Review Confirm Elections Review the benefits you selected on the enrollment summary page to make sure they are correct then click Sign Agree to complete your enrollment You can either print a summary of your elections for your records or login at any point during the year to view your summary online T I P If you miss a step you ll see Enrollment Not Complete in the progress bar with the incomplete steps highlighted Click on any incomplete steps to complete them Step 8 HR Tasks if applicable To complete any required HR tasks click Start Tasks If your HR department has not assigned any tasks you re finished You can login to review your benefits 24 7 4 Enrollment Instructions

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M in im u m Essen t ial Coverag e M EC Plan s The coverage you want wit h some addit ional perks M in im u m Essen t ial Coverag e M EC p lan s cover t h e req u ired ACA Preven t ive Care p rescrip t ion s an d services Th is m ean s you h ave t h e b asics covered an d exp erien ce low er p rem iu m cost s We ll t h row in a few ext ras for you as w ell M EC Ju st t h e b asics Preven t ive services TeleM ed d iscou n t vision M EC Plu s Th e b asics g en eric Rx p rim ary care off ice visit s M EC En h an ced M ore com p reh en sive coverag e Bet t er Rx D iscou n t d en t al In clu d ed w it h all EM I Heal t h M EC Plan s Pair an y M EC Plan alon g sid e m ajor m ed ical p rod u ct s Fin d secu rit y w it h a 3 rat e cap for on e ad d it ion al year Rat es st ay t h e sam e for volu n t ar y or con t rib u t or y TeleM ed w it h n o con su l t at ion f ee D iscou n t Vision w it h access t o t h e VSP n et w ork 5 Netw orks Nat ionwide Ut ah First Health Limited Benefit Network EMI Health MEC Network EM I Healt h 510 1Sou t h Com m erce D rive M u rray Ut ah 84107 Get m ore f rom you r M EC Lin d say Joh n son 80 1 891 134 0 ljoh n son em ih ealt h com Toll Free 80 0 662 5850 W eb em ih ealt h com

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EM I Heal t h M EC Plan s Plan Com p arison s M EC Prescript ion Drug Benefit s You Pay M EC Plu s Prescript ion Drug Benefit s You Pay M EC En h an ced Prescript ion Drug Benefit s You Pay Participating Pharmacy 30 day supply ACA Preventive Care Covered 100 Generic Discount Only Preferred Discount Only Non Preferred Discount Only Participating Pharmacy 30 day supply ACA Preventive Care Covered 100 Generic 50 Preferred Discount Only Non Preferred Not Covered Participating Pharmacy 30 day supply ACA Preventive Care Covered 100 Generic 10 Preferred 50 Non Preferred Not Covered Non Participating Pharmacy Mail Order 90 day supply Not Covered ACA Preventive Care Covered 100 Generic Discount Only Preferred Discount Only Non Preferred Discount Only Non Participating Pharmacy Mail Order 90 day supply Not Covered ACA Preventive Care Covered 100 Generic 50 Preferred Discount Only Non Preferred Not Covered Non Participating Pharmacy Mail Order 90 day supply Not Covered ACA Preventive Care Covered 100 Generic 10 Preferred 50 Non Preferred Not Covered Specialty Pharmacy Prevent ive Services Not Covered You Pay Specialty Pharmacy Prevent ive Services Not Covered You Pay Specialty Pharmacy Prevent ive Services Not Covered You Pay Routine Physical Gynecological Pap Smear Mammogram Well Baby Vision and Hearing Exams 1 visit per year Covered 100 Routine Physical Gynecological Pap Smear Mammogram Well Baby Vision and Hearing Exams 1 visit per year Covered 100 Routine Physical Gynecological Pap Smear Mammogram Well Baby Vision and Hearing Exams 1 visit per year Covered 100 Covered Immunizations Eligible Preventive Facility Services Covered 100 Covered 100 Covered Immunizations Eligible Preventive Facility Services Covered 100 Covered 100 Covered Immunizations Eligible Preventive Facility Services Covered 100 Covered 100 6 Rat es Physician Professional Services Physician Office Visits primary care Max 3 per year Bi Weekly Payroll Deduction Coverag e M EC M EC Plu s Single 1 85 952 30 0709 Employee Spouse 3 28 757 4 8 14169 Employee Child ren 3 99 293 5 7 16399 Family 531 2089 7 41 3715 3 rate cap for one additional year M EC En h an ced 5 31 0289 831 9084 9 62 0202 1 2217 378 TeleMed Included W it h All Plans You Pay 0 You Pay 10 EM I M KTG M EC TX 0 119 1123 Legal Stuff Long term maintenance medications must be purchased through mail order or Walgreens to receive coverage PLEASE NOTE These are summaries only and do not guarantee benefits All benefits are subject to the terms limitations and exclusions set forth in the Plan document and in the Summary Plan Description SPD handbook of the Plan Any discrepancies between this summary the SPD handbook and the Plan document are resolved in favor of the Plan document For more information refer to the SPD handbook or the Plan document or contact EMI Health Customer Service All services are subject to the EMI Health Table of Allowances There will be no benefit when using a Non participating Provider THIS IS A MINIMUM ESSENTIAL COVERAGE PLAN BENEFITS ARE NOT INTENDED TO COVER ALL MEDICAL EXPENSES Read your plan document carefully Administered by Educators Health Plans Life Accident and Health Inc Physician Professional Services Physician Office Visits primary care Max 3 per year Physician Office Visits secondary care Max 3 visits per year Convenience Clinic Max 3 visits per year Major Diagnostic Test CT Scan MRI NMR office M ax 1 per year Minor Diagnostic Test Radiology Lab office or outpatient Max 3 per year Injections office Max 3 per year Surgery office Max 1 per year Anesthesiology office Max 3 per year Urgent Care Clinic Urgent Care Clinic Max 3 visits per year Medical Supplies Equipment Diabetic Testing Supplies 90 day supply Medical Supplies office Max 3 per year You Pay 20 50 20 250 50 Covered 100 Covered 100 Covered 100 You Pay 50 You Pay 30 Covered 100 Discount Dent al 15 75 savings on dental services procedures To Find a Provider Phone 800 662 5851 Website www EMIHealth com

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MEC Provider Search The First Health Limited Network provider search ensures that you are going to an in network provider and preventing unnecessary costs How to find a provider Go to emihealth com Medical Under the Plans section select MEC and choose your state from the State drop down menu Click Find a Provider I Dental Under the Plans section select Value and choose your state from the State drop down menu Vision Under the Plans section select VSP Choice and choose your state from the State drop down menu A pop up window will appear after you ve selected your state Click the First Health Limited Network logo You will be taken to the First Health website Click Start now A pop up window will appear after you ve selected your state Click Search A pop up window will appear Click Continue You will be taken to the Careington website Customize your search by marking what you d like to search physician hospital urgent care center etc Customize your search by marking what you d like to search Hit Search for Providers Hit Search Now to find your providers Questions As always we are here to help Call customer service at 800 662 5851 7 Click Search EMI MKTG MEC PROV SRCH 0119 1133

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Preventive Care Detect potential problems early The Affordable Care Act ACA provides for certain preventive services to be covered 100 percent when received by participating providers Preventive services are those provided when no symptoms or diagnosed medical conditions exist For services to be covered as preventive your doctor must bill claims with preventive codes If a preventive service identifies a condition that needs further testing or treatment regular copayments coinsurance or deductibles may apply Here are some some preventive services covered with no patient cost Routine physical exam Routine vision exam Routine hearing exam Routine gynecological exam Routine Pap smear Screening mammogram Screening colonoscopy or Cologuard FDA approved contraception Immunizations recommended by the Advisory Committee on Immunizations Practices of the Center for Disease Controls and Prevention CDC are covered 100 percent if received from a participating provider As of June 2021 those recommendations are as follows Children Rotavirus Diphtheria Tetanus Pertussis RV RV DTaP DTaP DTaP DTaP DTaP DTaP Catch Up DTaP DTaP Catch Up Haemophilus lnfluenzae Type b Hib Hib Hib Hib Inactivated Poliovirus Measles Mumps Rubella Varicella Pneumococcal Influenza Hepatitis A Meningococcal Human Papillomavirus IPV IPV PCV PCV PCV IPV MMR Varicella PCV HepA 2 Doses IPV MMR Varicella Poliovirus Catch Up MMR Catch Up Varicella Catch Up Influenza Yearly HepA Catch Up MenACWY MenACWY HPV HPV Catch Up VACCINE Diphtheria Tetanus Pertussis Td Tdap Influenza Pneumococcal 19 26 Yrs Adults 27 49 Yrs 50 59 Yrs 60 64 Yrs One dose of Tdap then boost with Td every 10 years One dose annually 1 or 2 doses 65 Yrs 1 dose Zoster Shingles 2 doses after age SO Measles Mumps Rubella Varicella IF NOT RECEIVED AS A CHILD HPV Varicella 8

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Diabetes Management Enhanced Plan Only Your medical plan covers diabetic equipment and supplies under the major medical benefit and or Prescription Drug Pharmacy Benefit Contact customer service for the specifics of your plan Here are some common coverages Diabetic Testing Supplies Diabetic testing supplies such as blood sugar glucose test strips and lancets may be covered through your Major Medical or Prescription Drug Benefit Major Medical Benefits Coverage falls under the Medical Supplies Equipment benefit Refer to the Diabetic Testing Supplies line item of your Schedule of Benefits for your member cost share The following suppliers are participating providers on EMI Health plans If you obtain supplies through any other medical provider or facility benefits are subject to your Non Participating Provider benefit option if any Byram Healthcare 800 775 4372 Edgepark Cardinal 877 21 5 2568 JQ Medical Supply 801 942 8582 Prescription Drug Pharmacy Benefit Refer to the Prescription Drug section of your Schedule of Benefits for your member cost share The 2020 formulary includes OneTouch and Freestyle All other brands are excluded from coverage Continuous Glucose Monitoring Systems CGMS and Sensors CGMS and sensors may be covered through your Major Medical or Prescription Drug Benefit subject to preauthorization criteria and plan review Refer to the Durable Medical Equipment and Prescription Drug sections of your Schedule of Benefits for your member cost share EMI MKT G DIABETES0921 0175 9

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Insulin Pump and Insulin Pump Supplies Enhanced Plan Only Insulin pumps are covered through your Major Medical Benefit subject to preauthorization criteria and plan review Refer to the Durable Medical Equipment section of your Schedule of Benefits for your member cost share Insulin pump supplies cartridges and infusion sets may be covered through your Major Medical or Prescription Drug Benefit Refer to the Durable Medical Equipment and Prescription Drug sections of your Schedule of Benefits for your member cost share Insulin Insulin is covered under the Prescription Drug Benefit You may receive up to a 30 day supply per retail copayment or up to a 90 day supply per mail order copayment Refer to the Prescription Drug section of your Schedule of Benefits for member cost share Preferred insulin copayments will be capped at 25 per 30 day supply and 75 per 90 day supply through the Cigna Express Scripts Patient Assurance Program Preferred insulins are Humalog Humulin and Lantus Prescription Drugs Prescription drugs are covered under the Prescription Drug Benefit This includes Glucagon GLPI agents e g Byetta Bydureon and Tradjenta and oral agents for Type 2 diabetes e g Glucophage Avandia and Amaryl Refer to the Prescription Drug section of your Schedule of Benefits for member cost share Blood sugar testing monitors glucose control solutions and weight loss medications are NOT covered under the Major Medical or Prescription Drug Benefits Questions As always we are here to help Call customer service at 800 662 5851 10

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TeleMedicine EM1f H EALTH Reach a doctor 24 7 365 70 of doctor visits can be handled over the phone and 40 of urgent care visits can be managed using TeleMedicine Save time and money while still getting the treatment you need through EMI Health TeleMed offered through Recuro When to Use TeleMed Recuro doctors diagnose acute non emergent medical conditions and prescribe medications when clinically appropriate Speak with a doctor anytime and pay no consultation fee rather than paying the high costs associated with office visits urgent care visits and emergency room visits Just call 855 6RECURO Video consultations are available as well from 7 AM 7 PM Common Conditions Acid Reflux Allergies Ear Pain Fever Pink Eye Rashes Asthma Gout Sinus Conditions Bladder Infection Headache Sore Throat Bronchitis Hemorrhoids Stomach Virus Cold Flu High Blood Pressure Thyroid Conditions Constipation Joint Pain Urinary Tract Infections Cough Nausea Yeast Infections In accordance with telemedicine guidelines ear infections are only diagnosed for patients that are 18 years of age or older Common Medications Albuterol Allegra Flonase Ibuprofen 800 mg Lipitor Nasonex Asthma Levaquin Many Others m RECURO H E A L T H 855 6RECURO m r m Download the m Recuro mobile app z 0 co bfj EMI Health 5101 South Commerce Drive Murray Utah 84107 To1ll1Free 800 662 5851 Web emihealth com

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Your ID Card back Card Back This card does not guarantee coverage Please confirm eligibility and benefits prior to services To confirm eligibility verify benefits check the status of a claim or provider search please contact our customer service This is a Minimum EsseJ verage MEG Plan and pays 100 of ive services as defined by Centers For Medicare Medicaid Services CMS In Utah Dental Networks In Utah CARE POS C ircington Advantage Outside Utah This is the claims submission address for Utah medical claims and all dental claims In most cases your provider will submit claims directly to EMI Health This is the telephone number to call for customer service inquiries e These are your participating provider medical networks for Utah and nationally To verify a provider s status visit emihealth com or call 800 662 5851 This is the telephone number to call for preauthorizations 0 These are your participating provider dental networks outside of Utah To verify a provider s status visit emihealth com or call 800 662 5851 If this section is not on your card you do not have dental coverage through EMI Health 13

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5101 SOUTH COMMERCE DRIVE MURRAY UT 84107 Corporate 801 262 7475 Customer Service 800 662 5851 EMIHealth com Group Plan Underwritten Administered by Plan Type Effective Date Benefit Year Abundant Life HCS Plan 8685 Summit Plus Indemnity Educators Health Plans Life Accident and Health Inc Voluntary Fully Insured 7 1 2024 Calendar Type 1 Preventive Oral Exams Cleanings X rays Fluoride Type 2 Basic Fillings Oral Surgery Type 3 Major Crowns Bridges Prosthodontics Type 4 Orthodontics Dependent children ages 7 through 18 Adults Endodontics Periodontics Sealants Space Maintainers In Network 100 80 60 Discount Only Discount Only Type 2 Basic Type 2 Basic Type 2 Basic Type 2 Basic Out of Network 100 up to R C 80 up to R C 60 up to R C No Coverage No Coverage Type 2 Basic Type 2 Basic Type 2 Basic Type 2 Basic Waiting periods Type 2 Basic Type 3 Major Type 4 Orthodontics Deductible Per Person Family Max Deductible Applies To Annual Maximum Per Person Orthodontic Lifetime Maximum None None N A In and Out of Network Deductibles are Combined 50 00 50 00 150 00 150 00 Type 2 Type 3 Type 2 Type 3 1 500 00 N A Network Utah Premier EMI Health N A Network Texas Outside Utah Summit Plus Cigna N A Fee Schedule Summit Plus R C 90th Bi Weekly Rates Employee Employee Spouse Employee Child ren Employee Spouse Child ren 16 66 34 71 35 91 55 29 Provisions Limitations Exclusions Exams including Periodontal Cleanings and Fluoride 2 per year Fluoride Up to age 16 Sealants Up to age 16 Space Maintainers Up to age 16 Bitewing X Rays Up to 4 twice per year Periapical X Rays 6 per year Panoramic X Ray 1 every 3 years Impacted Teeth Covered in Type 2 Basic Anesthesia Age 8 and over for the extraction of impacted teeth only Covered in Type 3 Major Anesthesia For children age 7 and under once per year Covered in Type 3 Major Implants Implant Abutments Covered in Type 3 Major Crowns Pontics Abutments Onlays and Dentures 1 every 5 years per tooth Fillings on the same surface 1 every 18 months Benefits illustrated are in summary only Refer to your certificate for a complete description of benefits limitations and exclusions When using a Non participating Provider the insured is responsible for all fees in excess of the Reasonable and Customary Charges R C Anesthesia is not subject to waiting periods 14

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Corporate 801 262 7475 Customer Service 800 662 5851 EMIHealth com Group Plan Effective Date Plan Type Abundant Life HCS Plan 8685 VSP Plus 10 130 7 1 2024 Voluntary In Network Out of Network Network VSP Choice Plus WellVision Exam 10 Co pay Up to 65 Lenses Glass or Plastic Single Vision Lined Bifocal Lined Trifocal Lenticular Lens Options Progressive Standard no line Premium Progressive Options Custom Progressive Options Plastic Gradient Dye Solid Plastic Dye Photochromic Lenses Polycarbonate for Adults Polycarbonate for Children under 18 Coatings Scratch Resistant Coating Anti Reflective Coating UV Protection Additional lens enhancements Frames Allowance Based on Retail Pricing Additional Pairs of Glasses Elective Contact Lenses In Lieu of Frame Lenses Elective contact lens fitting evaluation services and prescription contact lenses are covered up to plan allowance 15 discount given off contact lens fitting and evaluation services excluding materials 10 Co pay 10 Co pay 10 Co pay 10 Co pay 0 Co pay 95 105 Co pay 150 175 Co pay 17 Co pay 15 Co pay 75 Co pay 31 Co pay SV 35 Co Pay Multifocal 0 Copay 17 Co pay 41 Co pay 16 Co pay Up to 25 Discount 130 Allowance at any VSP doctor or 70 at Costco Sam s Club or Walmart Up to 20 Off Retail 130 Allowance Up to 30 Up to 50 Up to 65 Up to 100 The reimbursement outlined under the Lenses section is a total reimbursement for lenses and any lens enhancements elected The reimbursement outlined under the Lenses section is a total reimbursement for lenses and any lens enhancements elected Up to 80 N A Up to 115 Frequency Exam Lenses Frame or Contacts Every 12 Months Refractive Surgery LASIK Bi Weekly Rates Employee Employee Spouse Employee Child ren Employee Spouse Child ren Up to 500 in Savings Voluntary 3 65 7 85 8 45 12 09 Not Covered Notes This is a summary of plan benefits The actual Policy will detail all plan limitations and exclusions 20 discount off unlimited additional pairs of glasses offered through any VSP Choice Providers within 12 months of last covered eye exam Discounts average 15 20 off or 5 off a promotional offer for laser surgery including PRK LASIK Custom LASIK and IntraLase3 Underwritten by Educators Health Plans Life Accident Health EHPL TX V VSP SCH D 15

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Extra savings with your vision plan Here are some perks on your vision benefits All non covered lens options are cost controlled averaging 20 25 off retail prices Most popular lens options have fixed co pay for upgrades like light reactive impact resistant scratch resistant anti glare coating UV coatings and more 20 savings on frame cost over the frame allowance 20 savings on complete pairs within the last 12 months of exam 15 savings on contact lens evaluation fitting fees Laser vision correction Average 15 off the regular price or 5 off the promotional prices only available from contracted facilities After surgery use your frame allowance if eligible for sunglasses from any VSP doctor Out of Network OON Claim Submittal Options If you do visit an out of network provider you have options 1 Provider Level Assignment of Benefit Option AoB Provider bills VSP for OON reimbursement Member pays overage at the time of service 2 Member Level Submitting for Reimbursement ALL CLAIMS BY MAIL MUST BE SUBMIT T ED ON A VSP MEMBER REIMBURSEMENT FORM To submit a claim you will need a copy of the itemized receipts or service statements To submit a claim by mail contact VSP Member Services at 800 877 7195 to request a VSP Member Reimbursement Form T he form can be sent to a preferred address or emailed to you You must complete the form and mail it to the address below VSP Attention Claims Services PO Box 385018 Birmingham AL 35239 5018 3 Online Submission VSP com Member signs in and completes online form and submits electronically 17

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Looking for dental and vision providers It s easy to find in network dental and vision providers near you using the EMI Health Provider Search tool 0 Go to emihealth com Click on Find a Provider along the upper part of the home page 0 0 Select the type of provider Select dental or vision Enter your plan name found on your ID card These are the plan options you will see Dental Summit Plus Vision VSPChoice Plus If you have the Summit or Summit Plus dental plans you will be redirected to Cigna s dental provider search 0 Enter your location information and click Search You can also select Use My Location This feature will automatically populate the state and zip code where you are searching 0 Filter and sort your results Now you can filter your results for locations specialties facilities languages and more Click Search each time you adjust a filter to refresh the results list That s all there is to it You will see a list of participating providers along with contact information address and the ability to map the location of their offices You can also download the results as a PDF to keep or take with you 6 EOBs View explanation of benefits Member ID Card View Member ID Card Ii Plan Documents View current plan documents 0 Express Scripts Go to Express Scripts 0 Smart Cost Calculator Go to Change Healthcare 0 EMI TeleMed Go to EMI TeleMed by WellVia Profile Information View profile information Search on the go In addition to being another convenient way to search for providers and facilities the EMI Health mobile app allows you to do even more Access your ID Card View and download your plan grids so you always know the benefits you have View your EOBs and search by person service date and more Update your profile information like email address password or security questions 18

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My EMI Health Account All your benefit answers in one place Getting Started Find everything related to your benefits from general plan documents to detailed claims information Go to emihealth com Click Sign In and select My EMI Health Select Register and choose Member as the type of account Enter the data to identify yourself and click Continue You will need your Member ID found on your Efv11 Health ID card Also for your security your password must be at least six characters and include a special character e g etc Please note that you will only make an Efv11 Health account for your family through the plan subscriber Dependents and spouses will not have their own account Sign In n p s r 1o Qs rm What you can do View your plan documents View and sort your claims Download and print your ID cards View all your EOBs See at a glance progress towards your accumulators Review eligibility enrollment status 20

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The EMI Health Mobile App Your benefits Anytime Anywhere Provider Search Find in network providers and facilities Customer Service Need to talk to a person No problem Call us from the app Other Features Access current and past issues of the Hope Health newsletter Update your profile information like email address password or security questions ANDROID APP ON Google play ID Card Access your ID Card from anywhere at any time EOBs View your EOBs and search by person service date and more Plan Information View and download your plan grids so you always know the benefits you have Log in Register Download the opp and log in using your My EMI Health username and password If you haven t registered your account you can do so in the opp or online at emihealth com Scan this QR code 9r i r t i r with your phone to download 21

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Accident Plan Colonial Life pays these benefits once per covered person for each covered accident unless otherwise noted Accident Benefits Accident Emergency Treatment Doctor s office urgent care facility or emergency room One visit per person per accident Four visits per person per calendar year Accident Follow Up Doctor Visit Doctor s office urgent care facility or emergency room Accidental Death Accidental Death Common Carrier Accidental Dismemberment Loss or Loss of use of Hand Foot Sight 1 Hand Foot Sight 2 Finger Toe 1 Loss of Finger Toe 2 Ambulance Air Ambulance Ground Appliances such as wheelchair crutches Blood Plasma Platelets Burns based on size in square inches or percent of body and degree 2nd Degree 36 of body 3rd Degree 9sq 18sq 3rd Degree 18sq 35sq 3rd Degree Over 35 sq Burns Skin Graft Catastrophic Accident Accidental total and irrecoverable loss or loss of use of any combination of hand s arm s foot feet leg s sight of eye s or loss of hearing of both ears or loss of the ability to speak Payable once per covered person Coma duration of at least 14 consecutive days Concussion Dislocation Based on joint and if repaired by open or closed reduction Preferred 150 visit 50 visit 4 visits per covered accident 16 visits per calendar year 50 000 employee 50 000 spouse 10 000 child 200 000 employee 200 000 spouse 40 000 child 9 000 18 000 1 050 2 100 1 500 300 100 400 1 000 2 000 7 000 15 000 50 of burn benefit 50 000 employee 50 000 spouse 25 000 child 10 000 375 200 6 000 Premier 200 visit 50 visit 6 visits per covered accident 24 visits per calendar year 50 000 employee 50 000 spouse 10 000 child 200 000 employee 200 000 spouse 40 000 child 15 000 30 000 1 500 3 000 2 000 400 200 500 1 500 3 000 10 000 21 000 50 of burn benefit 100 000 employee 100 000 spouse 50 000 child 20 000 500 280 8 000 23

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Cancer Plan Benefits are payable for each covered person under the policy Benefits are payable only when charges are incurred Benefits Air Ambulance per trip Maximum trips per confinement Ambulance per trip Maximum trips per confinement Anesthesia General Anesthesia Local per procedure Anti Nausea Medication per day Maximum per month Blood Plasma Platelets Immunoglobulins per day Maximum per calendar year Bone Marrow or Peripheral Stem Cell Donation per donation maximum one per lifetime Bone Marrow Stem Cell Transplant per transplant Peripheral Stem Cell Transplant per transplant Maximum transplants per lifetime Companion Transportation per mile Maximum per round trip Egg s Extraction or Harvesting or Sperm Collection one per lifetime Egg s or Sperm Storage one per lifetime Experimental Treatment per day Maximum per lifetime Family Care per day Maximum per calendar year Hair External Breast Voice Box Prosthesis per calendar year Home Health Care Services per day Maximum per calendar year Examples include physical therapy occupational therapy speech therapy and audiology prosthesis and orthopedic appliances and rental or purchase of medical equipment Hospice Initial Hospice Daily Maximum combined Initial and Daily per lifetime Hospital Confinement 30 days or less per day Hospital Confinement 31 days or more per day Level 2 Level 3 2 000 2 000 2 2 250 250 2 2 25 of Surgical Procedures Benefit 30 40 40 50 160 200 150 175 10 000 10 000 500 750 4 000 4 000 2 0 50 1 000 7 000 7 000 2 0 50 1 200 700 1 000 200 350 250 300 12 500 15 000 40 50 2 000 2 500 200 350 75 100 30 days or twice the days confined 1 000 50 15 000 150 300 1 000 50 15 000 250 500 24

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Lodging per day Maximum days per calendar year Medical Imaging Studies per study Maximum per calendar year Outpatient Surgical Center per day Maximum per calendar year Private Full time Nursing Services per day Prosthetic Device Artificial Limb per device or limb Maximum per lifetime Radiation Chemotherapy Injected chemotherapy by medical personnel one per week Radiation delivered by medical personnel one per week Self Injected Chemotherapy one per month Pump Chemotherapy one per month Topical Chemotherapy one per month Oral Hormonal Chemotherapy 1 24 months one per month Oral Hormonal Chemotherapy 25 months one per month Oral Non Hormonal Chemotherapy one per month Reconstructive Surgery per surgical unit Maximum per procedure including 25 for general anesthesia Second Medical Opinion one per lifetime Skilled Nursing Care Facility Per day up to the number of days for hospital confinement Skin Cancer Initial Diagnosis one per lifetime Supportive Protective Care Drugs Colony Stimulating Factors per day Maximum per calendar year Surgical Procedures per unit Maximum per procedure Transportation per mile Maximum per round trip Additional Benefits Bone Marrow Donor Screening Maximum of one per lifetime Cancer Vaccine Benefit Maximum of one per lifetime Waiver of Premium 50 70 125 250 200 600 75 1 500 3 000 500 500 200 200 200 200 100 200 40 2 500 200 100 300 100 800 50 3 000 0 50 1 000 Level 2 50 50 Yes 75 70 175 350 300 900 125 2 000 4 000 750 750 300 300 300 300 150 300 60 3 000 300 100 400 150 1 200 60 5 000 0 50 1 200 Level 3 50 50 Yes 25

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Wellness Benefit Employer Option Part 1 Cancer Wellness Health Screening As the employer you will choose whether to include the Cancer Wellness Health Screening Benefit If selected you will also choose one of four benefit amounts 25 50 75 or 100 We will pay a benefit if any covered person incurs a charge and has one of the following tests listed below performed after the waiting period and while the policy is in force This benefit is payable once per covered person per calendar year The covered tests include Cancer Wellness tests Bone marrow testing Breast ultrasound CA 15 3 blood test for breast cancer CA 125 blood test for ovarian cancer CEA blood test for colon cancer Chest x ray Colonoscopy Flexible sigmoidoscopy Hemoccult stool analysis Mammography Pap smear PSA blood test for prostate cancer Serum protein electrophoresis blood test for myeloma Skin biopsy Thermography ThinPrep pap test Virtual colonoscopy Health Screening tests Blood test for triglycerides Fasting blood glucose test Carotid Doppler Echocardiogram ECHO Electrocardiogram EKG ECG Serum cholesterol test to determine level of HDL and LDL Stress test on a bicycle or treadmill Part 2 Cancer Wellness Additional Invasive Diagnostic Test or Surgical Procedure We will pay an additional benefit if any covered person incurs a charge for an additional invasive diagnostic test or surgical procedure performed by a physician after the waiting period This benefit matches the Part 1 benefit amount We will pay this benefit only after an abnormal result from one of the covered Cancer Wellness tests in Part 1 has determined that an additional invasive diagnostic test or surgical procedure is necessary We will pay a Part 2 benefit regardless of the results of the test s This benefit is payable once per covered person per calendar year Cancer Plan Bi weekly Rates 26

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Accident Benefits Preferred Premier Emergency Dental Work Crown Implant or Denture 300 600 Extraction 100 200 Eye Injury with surgical repair 300 400 Fracture Based on bone and if repaired by 200 7 500 200 10 000 open or closed reduction Hospital Admission1 1 000 1 500 Hospital Confinement2 up to 365 days 250 day 350 day Hospital ICU Admission1 1 750 2 500 Hospital ICU Confinement2 up to 15 days 400 day 600 day Knee Cartilage Torn 750 1 250 Laceration No Stitches 50 75 With stitches less than 2 150 150 With stitches 2 6 300 600 With stitches greater than 6 600 1 200 Lodging Companion per day up to 30 days 200 250 Medical Imaging Study Limit one per covered person per 200 400 calendar year Pain Management Epidural Anesthesia 150 150 Prosthetic Device Artificial Limb 1 250 1 2 500 2 1 750 1 3 500 2 Rehabilitation Unit Confinement3 up to 15 days per covered 150 day 200 day accident and up to 30 days per calendar year Ruptured Disc with Surgical Repair 900 1 200 Surgery Cranial Open Abdominal Thoracic 1 500 2 000 Surgery Hernia 300 400 Surgery Exploratory and Arthroscopic 225 275 Tendon Ligament Rotator Cuff 900 1 1 800 2 1 200 1 2 400 2 Therapy Occupational and Physical Therapy 45 day 55 day up to 10 days Transportation up to 3 trips per accident 600 trip 700 trip X Ray Benefit 60 60 1We will not pay the hospital admission benefit and the hospital ICU admission benefit simultaneously 2We will not pay the hospital confinement benefit and the hospital ICU confinement benefit simultaneously 3We will not pay the hospital confinement benefit and the rehabilitation unit confinement benefit simultaneously Accident Plan Bi weekly Rates 27

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Critical Care Plan Includes lump sum for covered critical illnesses and Benefit Payable Upon Subsequent Diagnosis of a Critical Illness Coverage Heart Attack Stroke End Stage Renal Kidney Failure Major Organ Failure Coma Blindness Occupational Infectious HIV or Occupational Infectious Hepatitis B C D Permanent paralysis due to a covered accident Coronary Artery Bypass Surgery Disease Face Amount 5 000 100 000 face amount in 1 000 increments Guarantee Issue Coverage Types available Up to 30 000 during initial enrollment and ongoing for new hires Named Insured Employee Named insured and Spouse One Parent Family Two Parent Family Subsequent Diagnosis Benefit Included Health Screening Benefit 50 Optional Employer Choice Critical Care Bi weekly Rates 28

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Notes ______________________________________ ______________________________________ ______________________________________ ______________________________________ ______________________________________ ______________________________________ ______________________________________ ______________________________________ ______________________________________ ______________________________________ ______________________________________ ______________________________________ ______________________________________ ______________________________________ ______________________________________ ______________________________________ ______________________________________ ______________________________________ ______________________________________ ______________________________________ 30

Abundant Life Benefit Guide

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