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2023ABC COMPANY or LOGOBENEFITS ENROLLMENT GUIDE

CONTENTS01Benefits OverviewXXMedical InsuranceXXHealth Savings Account (HSA)XXFlexible Spending AccountsXXFlexible Spending Account vs. Health Savings AccountXXDental InsuranceXXVision InsuranceXXBasic Life and Accidental Death & Dismemberment InsuranceXXDisability InsuranceXX401(k) Retirement Savings Plan XXEmployee Assistance ProgramXXOpen Enrollment InstructionsXXImportant ContactsXXGlossary

INTERNAL NOTE:The following two pages are specific pages for open enrollment and new hires that have been built into the benefit guide template.Please try to include any specific open enrollment information onto the “Welcome to Open Enrollment” page. Once open enrollment is completed, this one page can be replaced with the new hire welcome page, thus allowing Client Care to quickly provide the revision.

As an employee of ABC Company you are eligible to participate in a variety of employee benefit plans. ABC Company knows how important it is to provide quality employee benefits to our employees and their dependents. We always strive to provide a total benefit package that meets your needs as well as the needs of the company. BENEFIT OPTIONSWe offer a comprehensive benefits package consisting of:• Medical Insurance• Health Savings Account• Flexible Spending Accounts• Dental Insurance• Vision Insurance• Basic Life and Accidental Death & Dismemberment Insurance• Disability Insurance• Employee Assistance Program• 401(k) Retirement Savings PlanHOW TO ENROLLDuring this annual enrollment period, you may request changes to the above plans subject to the completion of the proper forms and approval by the insurance carriers. Benefits will become effective January 1, 2023. Many of the plans offer coverage for eligible dependents, including:• Your legal spouse• Your children to age 26, regardless of student, marital, or tax-dependent status (including stepchild, legally adopted child, a child placed with you for adoption, or a child for whom you are the legal guardian)• Your dependent children over age 26 who are physically or mentally unable to care for themselvesWHEN TO ENROLLOther than during the designated Open Enrollment period, you can enroll in benefits or change your elections at the following times:• 30 days prior to your initial eligibility date as a newly hired employee• Within 30 days of experiencing a qualifying life eventWELCOME TO OPEN ENROLLMENT4Open Enrollment Period: <Date(s)>

5WELCOME TO COMPANY NAMEAs an employee of ABC Company you are eligible to participate in a variety of employee benefit plans. ABC Company knows how important it is to provide quality employee benefits to our employees and their dependents. We always strive to provide a total benefit package that meets your needs as well as the needs of the company. BENEFIT OPTIONSWe offer a comprehensive benefits package consisting of:• Medical Insurance• Health Savings Account• Flexible Spending Accounts• Dental Insurance• Vision Insurance• Basic Life and Accidental Death & Dismemberment Insurance• Disability Insurance• Employee Assistance Program• 401(k) Retirement Savings PlanHOW TO ENROLLDuring this enrollment period, you may enroll in the above plans subject to the completion of the proper forms and approval by the insurance carriers. Benefits will become effective 1st of the month following 30 days. Many of the plans offer coverage for eligible dependents, including:• Your legal spouse• Your children to age 26, regardless of student, marital, or tax-dependent status (including stepchild, legally adopted child, a child placed with you for adoption, or a child for whom you are the legal guardian)• Your dependent children over age 26 who are physically or mentally unable to care for themselvesWHEN TO ENROLLOther than during the designated Enrollment period, you can enroll in benefits or change your elections at the following times:• 30 days prior to your initial eligibility date as a newly hired employee• Within 30 days of experiencing a qualifying life event

CHANGING BENEFITS AFTER OPEN ENROLLMENTYou may pay your portion of your select coverages, Medical, Dental, Vision and fund the Flexible Spending Accounts, on a pre-tax basis. Thus, due to IRS regulations, once you have made your elections for the plan year, you cannot change your benefits until the next annual open enrollment period. The only exception is if you experience a qualifying event, and election changes must be consistent with your life event.To request a benefits change, notify Human Resources within 30 days of the qualifying life event. Change requests submitted after 30 days cannot be accepted. You may need to provide proof of the life event.Qualifying life events include, but are not limited to:• Marriage, divorce, or legal separation• Birth or adoption of an eligible child• Death of your spouse or covered child• Change in your spouse’s work status that affects his or her benefits• Change in your child’s eligibility for benefits• Qualified Medical Child Support Order6QUALIFYING EVENTS

7MEDICAL INSURANCE CARRIER: CARRIER NAME● Locate an in-network provider at www.carriername.comCOVERED BENEFITSMedical Plan In-Network Out-of-NetworkYear Deductible: Individual/Family $750/$1,500 $1,500/$3,000Out of Pocket Maximum: Individual/Family (includes deductible, copays and coinsurance)$5,000/$10,000 UnlimitedCoinsurance 80% 60%Preventive Care Plan pays 100% Not CoveredPhysician ServicesPrimary Care/ Specialist Office Visit $30/$60 copay Deductible & CoinsuranceUrgent CarePrimary Care/ Specialist Office Visit $30/$60 copay Deductible & CoinsurancePreventative Care 100% Deductible & CoinsuranceDiagnostic Testing Deductible & Coinsurance Deductible & CoinsuranceDiagnostic Imaging (CT/PET/ MRI) Deductible & Coinsurance Deductible & CoinsuranceInpatient Facility Deductible & Coinsurance Deductible & CoinsuranceOutpatient Facility Deductible & Coinsurance Deductible & CoinsuranceEmergency Room Deductible & Coinsurance Deductible & CoinsurancePrescription Drug Deductible $100 per person Not Applicable Prescription Drug Benefit(Retail - 30 day supply)Tier 1: $25 copay Tier 2: $40 copayTier 3: $75 copayTier 4: N/ATier 1: $25 copay Tier 2: $40 copayTier 3: $75 copayTier 4: N/AELECTION MEDICAL PREMIUMPER PAY PERIODEmployee Only $Employee + Spouse $Employee + Child(ren) $Employee + Family $Please refer to the official plan documents for additional information on coverage and exclusions.

COVERED BENEFITSMEDICAL PLAN A MEDICAL PLAN BIn-Network Out-of-Network In-Network Out-of-NetworkYear Deductible: Individual/Family$1,000/$3,000 $2,000/$6,000 $4,000/$12,000 $8,000/$24,000Out of Pocket Maximum: Individual/Family (Includes deductible, copays, and coinsurance) $3,250/$6,500 $6,500/$13,000 $6,350/$12,700 $12,700/$25,400Coinsurance 80% 20% 80% 20%Preventive Care Plan pays 100% 40% coinsurance Plan pays 100% 40% coinsurancePhysician ServicesPrimary Care / Specialist Office Visit$40 / $55 copay $40% after deductible $40 copay 40% after deductibleUrgent Care $55 copay $40% after deductible $55 copay $40% after deductibleDiagnostic Lab/X-Ray 20% after deductible 40% after deductible 20% after deductible 40% after deductibleHigh-Tech Services (MRI, CT, PET) 20% after deductible 40% after deductible 20% after deductible 40% after deductibleInpatient Hospital Services 20% after deductible 40% after deductible 20% after deductible 40% after deductibleOutpatient Hospital Services 20% after deductible 40% after deductible 20% after deductible 40% after deductibleEmergency Room 20% after in-network deductible 20% after in-network deductiblePrescription Drug Deductible $100 No benefit $100 No benefitPharmacy CopaysTier 1: $15Tier 2: $35Tier 3: $75Tier 4: $100No benefitTier 1: $15Tier 2: $35Tier 3: $75Tier 4: $100No benefit8THINGS TO CONSIDER1. Do you prefer to pay more for medical insurance out of your paycheck, but less when you need care?2. Or, do you prefer to pay less out of your paycheck, but more when you need care?3. What planned medical services do you expect to need in the upcoming year?4. REMOVE IF GROUP DOES NOT HAVE AN FSA OR HSA Are you able to budget for your deductible by setting aside pre-tax dollars from your paycheck in an HSA or FSA?5. Do you or any of your covered family members take prescription medications on a regular basis?MEDICAL INSURANCE CARRIER: CARRIER NAMEChoosing the right medical plan is an important decision. Take the time to learn about your options to ensure you select the right plan for you and your family.Please refer to the official plan documents for additional information on coverage and exclusions.

COVERED BENEFITSMEDICAL PLAN A MEDICAL PLAN B MEDICAL PLAN CIn-Network Out-of-Network In-Network Out-of-Network In-Network Out-of-Network Year Deductible: Individual/Family$1,000/$3,000 $2,000/$6,000 $4,000/$12,000 $8,000/$24,000 $3,300/$6,600 $6,600/$13,200Out of Pocket Maximum: Individual/Family (Includes deductible, copays, and coinsurance) $3,250/$6,500 $6,500/$13,000 $6,350/$12,700 $12,700/$25,400 $6,350/$12,700 $12,700/$25,400Coinsurance 80% 20% 80% 20% 80% 20%Preventive Care Plan pays 100% 40% coinsurance Plan pays 100% 40% coinsurance Plan pays 100% 50% coinsurancePhysician ServicesPrimary Care / Specialist Office Visit$40 / $55 copay$40% after deductible$40 copay40% after deductible30% after deductible50% after deductibleUrgent Care $55 copay$40% after deductible$55 copay$40% after deductible30% after deductible50% after deductibleDiagnostic Lab/X-Ray20% after deductible40% after deductible20% after deductible40% after deductible30% after deductible50% after deductibleHigh-Tech Services (MRI, CT, PET)20% after deductible40% after deductible20% after deductible40% after deductible30% after deductible50% after deductibleInpatient Hospital Services20% after deductible40% after deductible20% after deductible40% after deductible30% after deductible50% after deductibleOutpatient Hospital Services20% after deductible40% after deductible20% after deductible40% after deductible30% after deductible50% after deductibleEmergency Room 20% after in-network deductible 20% after in-network deductible 20% after in-network deductiblePrescription Drug Deductible $100 No benefit $100 No benefit $100 No benefitPharmacy CopaysTier 1: $15Tier 2: $35Tier 3: $75Tier 4: $100No benefitTier 1: $15Tier 2: $35Tier 3: $75Tier 4: $100No benefitTier 1: $15Tier 2: $35Tier 3: $75Tier 4: $100No benefit9MEDICAL INSURANCE CARRIER: CARRIER NAMEChoosing the right medical plan is an important decision. Take the time to learn about your options to ensure you select the right plan for you and your family.THINGS TO CONSIDER1. Do you prefer to pay more for medical insurance out of your paycheck, but less when you need care?2. Or, do you prefer to pay less out of your paycheck, but more when you need care?3. What planned medical services do you expect to need in the upcoming year?4. REMOVE IF GROUP DOES NOT HAVE AN FSA OR HSA Are you able to budget for your deductible by setting aside pre-tax dollars from your paycheck in an HSA or FSA?5. Do you or any of your covered family members take prescription medications on a regular basis?Please refer to the official plan documents for additional information on coverage and exclusions.

COVERED BENEFITSPLAN A PLAN B PLAN CIn-Network Out-of-Network In-Network Out-of-Network In-Network Out-of-Network Year Deductible: Individual/Family$1,000/$3,000 $2,000/$6,000 $4,000/$12,000 $8,000/$24,000 $3,300/$6,600 $6,600/$13,200Out of Pocket Maximum: Individual/Family (Includes deductible, copays, and coinsurance) $3,250/$6,500 $6,500/$13,000 $6,350/$12,700 $12,700/$25,400 $6,350/$12,700 $12,700/$25,400Coinsurance 80% 20% 80% 20% 80% 20%Preventive Care Plan pays 100% 40% coinsurance Plan pays 100% 40% coinsurance Plan pays 100% 50% coinsurancePhysician ServicesPrimary Care / Specialist Office Visit$40 / $55 copay$40% after deductible$40 copay40% after deductible30% after deductible50% after deductibleUrgent Care $55 copay$40% after deductible$55 copay$40% after deductible30% after deductible50% after deductibleDiagnostic Lab/X-Ray20% after deductible40% after deductible20% after deductible40% after deductible30% after deductible50% after deductibleHigh-Tech Services (MRI, CT, PET)20% after deductible40% after deductible20% after deductible40% after deductible30% after deductible50% after deductibleInpatient Hospital Services20% after deductible40% after deductible20% after deductible40% after deductible30% after deductible50% after deductibleOutpatient Hospital Services20% after deductible40% after deductible20% after deductible40% after deductible30% after deductible50% after deductibleEmergency Room 20% after in-network deductible 20% after in-network deductible 20% after in-network deductiblePrescription Drug Deductible $100 No benefit $100 No benefit $100 No benefitPharmacy CopaysTier 1: $15Tier 2: $35Tier 3: $75Tier 4: $100No benefitTier 1: $15Tier 2: $35Tier 3: $75Tier 4: $100No benefitTier 1: $15Tier 2: $35Tier 3: $75Tier 4: $100No benefit10MEDICAL INSURANCE CARRIER: CARRIER NAMEChoosing the right medical plan is an important decision. Take the time to learn about your options to ensure you select the right plan for you and your family.MEDICAL RATES PLAN A PLAN B PLAN CELECTION Per Pay Period Per Pay Period Per Pay PeriodEmployee Only $ $ $Employee & Spouse $ $ $Employee & Child(ren) $ $ $Employee & Family $ $ $Please refer to the official plan documents for additional information on coverage and exclusions.

REGULAR RETAIL PHARMACY(CVS, Walgreens, Walmart)ENHANCED PHARMACY COPAYGENERIC $ $FORMULARY BRAND $ $NON-FORMULARY BRAND$ $SPECIALTY / INJECTABLE $ $MAIL ORDER COPAY(90-day supply)ENHANCED PHARMACY COPAYGENERIC $ $FORMULARY BRAND $ $NON-FORMULARY BRAND $ $11PHARMACY COST SAVINGS PROGRAMYou can significantly save on your prescription cost by utilizing this benefit.

ABC Company provides all employees with access to an employer-paid clinic. Employees (part-time and full-time), their spouses and children; which must be 2 or older, can visit this convenient clinic at no charge. CONDITIONS TREATED / SERVICES OFFERED● Blood pressure screening, monitoring and education● Women’s health needs (including yearly Pap smears and breast exams)● Men’s health needs (prostate exam)● Diabetes screening, monitoring, and education● Basic vision screening● Basic hearing screening● Pulmonary lung function screening● Skin cancer education● Pharmaceutical information● Variety of free medicine samples and over the counter drugs● Lab capabilities (calendar labs free)● Annual physicals, school & sports physicals, pre-employment and DOT physicals● Minor suturing & suture removal● Wound care● Wart, mole and skin tag removals● Simple splinting● Simple eye care (including simple debris removal)● Asthma & allergy treatment (breathing treatments)● Colon cancer screening● Patient referrals (mammogram, specialists, etc.)● Health care counseling, prevention, and education● And much moreHOURS OF OPERATIONText here COSTText here 12EMPLOYER HEALTH CLINIC

TELEMEDICINE / VIRTUAL VISITSWhen it comes to healthcare, access is important. You want care that is convenient, high-quality and low-cost. But depending on your condition, going to your personal physician or an urgent care clinic might not be your best option. We are proud to offer telemedicine / virtual visits. HOW TO REGISTER● Step 1: Visit www.CARRIERNAME.com/virtualvisitpagename or download the CARRIER NAME app.● Step 2: Click “NAME OF BUTTON” to sign in to (or create) your account. ● Step 3: Click "Request a Visit" to schedule a virtual visit through your phone or computer.COSTText here TREATED THROUGH TELEMEDICINE NOT TREATED THROUGH TELEMEDICINEAllergiesCold & Flu SymptomsCoughEar Infection Pink EyePrescription RefillsRespiratory InfectionSinus Problems / Nasal CongestionUrinary Tract InfectionAnd more!Sprains, broken bones or injuries requiring bandagingAnything that needs a hands-on examAnything that needs a lab test or X-rayChronic conditions13

HEALTH REIMBURSEMENT ARRANGEMENTCARRIER: CARRIER NAMEA Health Reimbursement Arrangement (HRA) is an employer-funded health spending account provided and owned by an employer. The money in it pays for qualified expenses that are determined by an employer. Employees are reimbursed tax-free for qualified medical expenses up to a fixed dollar amount per year. YOUR HRA PLAN DESIGN:● Payment and Reimbursement: (HRA PAYS FIRST) You use the funds until gone then you pay expenses your plan doesn’t cover. (OR YOU PAY FIRST) You pay for expenses not covered by your plan until you reach an amount set by COMPANY NAME, then the HRA pays.● Rollover: Unused funds (CAN OR CANNOT) roll over from one year to the next.HRA-ELIGIBLE EXPENSES INCLUDE:● Individual health insurance premiums● Individual dental or vision premiums● Amounts paid toward a policy's deductible● Copays● Office visits● Prescription drugs● Nonprescription drugs (with a doctor's note)● Mileage for travel to/from eligible health care14

HSA EMPLOYER CONTRIBUTIONS● Company Name will help you save by contributing $XX per pay period.● Contributions to a health savings account (including the employee contributions) cannot exceed the annual IRS contribution maximums. ● Employees age 55+ by DATE may contribute additional funds to their HSA (up to $X,XXX in YEAR).● You must open your HSA through CARRIER NAME to receive contributions. INDIVIDUAL$3,850ALLOTHER TIERSAGE 55+ CATCH-UP CONTRIBUTION$7,750 $1,000If you enroll in the High-Deductible Health Plan (HDHP), you may be eligible to fund a Health Savings Account (HSA). An HSA is a personal health care savings account that you can use to pay out-of-pocket health care expenses with pre-tax dollars. Your contributions are tax free and the money remains in the account for you to spend on eligible expenses no matter where you work or how long it stays in the account.WHO IS ELIGIBLE? You are eligible to open and fund an HSA if:● You are enrolled in the (INSERT HERE) plan● You are not covered by a non-HSA plan, health care FSA, or health reimbursement arrangement● You are not eligible to be claimed as a dependent on someone else’s tax return● You are not enrolled in Medicare● You have not received Veterans Administration Benefits in the last three monthsCompany Name CONTRIBUTES $XXX TO YOUR HSA EACH YEAR15HEALTH SAVINGS ACCOUNTCARRIER: CARRIER NAME

MAXIMIZE YOUR TAX SAVINGS•Contributions to an HSA are tax-free and can be made through payroll deduction on a pre-tax basis. •This money in your HSA (including interest and investment earnings) grows tax-free. •As long as you use the funds to pay for qualified medical expenses, the money is spent tax-free. YOU INDIVIDUALLY OWN YOUR HSA • You own and administer your HSA. • You determine how much you will contribute to your account and when to use the money to pay for eligible health care expenses. • You can change your contributions at any time during the plan year without a qualifying event. • Like a bank account, you must have a balance in order to pay for eligible health care expenses. • Keep all receipts for tax documentation.• An HSA allows you to save and “rollover” money from year to year. • The money in the account is always yours, even if you change health plans or jobs. • There are no vesting requirements or forfeiture provisions.ACCESSING YOUR HSA FUNDS (CHOOSE ONE OPTION)Debit Card: Draws directly from your HSA and can be used to pay for eligible expenses at your doctor’s office, pharmacy, or other locations where you purchase health related items or services. Checkbook: Works just like your personal checkbook, with the exception that it draws from your HSA, and can be used to pay for expenses you’ve paid out of your pocket. Checkbooks are issued upon request by Health Equity. USE YOUR HSA TO PAY QUALIFIED MEDICAL EXPENSES• You can use your HSA money to pay for eligible expenses now or in the future. • Funds in your HSA can be used for your expenses and those of your spouse and eligible dependents, even if they are not covered by the BCBSLA HDHP (Plan C).• Eligible expenses include deductibles, doctor’s office visits, dental expenses, eye exams, prescription expense and LASIK eye surgery. • A complete list of eligible expenses can be found at www.irs.gov. 16HEALTH SAVINGS ACCOUNT CONT. CARRIER: CARRIER NAME

Copay vs HDHPWhich plan is right for me?HEALTH SAVINGS ACCOUNT vs. FLEXIBLE SPENDING ACCOUNTWhat is a Copay Plan?Overview• Higher Monthly Premiums• Lower Deductibles • Has Fixed Dollar Amounts (called “Copays”) when you go in for medical services • Copay plans will usually have a coinsurance on higher ticket services, like hospital stays, maternity care, x-rays, etc. Does this Plan make sense for me?Copay plans may make sense for people who don’t make many trips to the doctor, but want the security of first dollar coverage. Copay plans also tend to work well for people who don’t have the budget to pay the full price of a medical bill or prescription out-of-pocket or for people who are willing to pay more each month for peace of mind knowing how much they will pay when they visit the doctor. Perks of a Copay Plan • Lower deductible• Peace of mind knowing how much you’ll pay when you visit the doctor.• Co-pay plans will still have a deductible and out-of-pocket maximum. Co-pays usually do not count towards the deductible, but they do count towards your annual out-of-pocket maximum. If you reach your out-of-pocket maximum, the insurance company pays 100%, eliminating the need to pay your co-pays.What is a HDHP?Overview• Lower Monthly Premiums• Higher Deductibles • HSA eligible • Deductible has to be met before insurance company pays their portion (Coinsurance)Does this Plan make sense for me?HDHPs tend to work well for people who don’t go to the doctor often or don’t expect medical expenses on a regular basis. HDHPs may also make sense for people who know they’ll meet their deductible early in the year and who can afford to pay the deductible over the course of the year (sometimes in one lump sum).Perks of HDHP • Lower Monthly Premiums than Copay plans• If you have an HDHP, you’re often eligible for a health savings account (HSA). This is essentially a tax advantaged savings account where you can put money aside to help cover qualified medical expenses.

Company Name offers two Flexible Spending Account (FSA) options – the Health Care FSA and the Dependent Care FSA – that allow you to pay for eligible health care and dependent care expenses with the pre-tax dollars. Log into your account at www.carriername.com to view your account balance(s), calculate tax savings, view eligible expenses, download forms, view transaction history, and more. HEALTH CARE FSA• Set aside pre-tax money from your paycheck to pay for eligible out-of-pocket expenses, such as deductibles, copays, and other health-related expenses, that are not paid by the medical, dental, or vision plans. • Over-the-counter (OTC) medications are eligible for reimbursement without a prescription. DEPENDENT CARE FSA• Set aside pre-tax money from your paycheck for daycare expense to allow you and your spouse to work or attend school full time.• Eligible dependents are children under age 13 or a child over 13, spouse, or elderly parent residing in your house who is physically or mentally unable to care for himself or herself. • Examples of eligible expenses are daycare facility fees, before and after-school care, and in-home babysitting fees (income must be reported by your care provider).HOW DOES AN FSA WORK?●You will receive a debit card from CARRIER NAME, which can be used to pay for eligible health care expenses at the point of service. If you do not use your debit card or if you have dependent care expenses to be reimbursed, submit a claim form and a bill or itemized receipt from the provider to CARRIER NAME. Keep all receipts in case CARRIER NAME requires you to verify the eligibility of a purchase. HEALTH CARE FSADEPENDENT CARE FSA$5,000$3,050$2,500married filing jointly or single / head of householdmarried filing separately18FLEXIBLE SPENDING ACCOUNT CARRIER: CARRIER NAMEYou have the ability to roll over up to $610from one plan year to the next.You have the ability to roll over up to $610from one plan year to the next.ROLLOVER

LIMITED-PURPOSE FLEXIBLE SPENDING ACCOUNTSCARRIER: CARRIER NAMEA Limited-Purpose Flexible Spending Account (FSA) is a special account that lets you set aside money (before it is taxed) to help pay for eligible dental and vision expenses.LIMITEDPURPOSE FSA$3,050LIMITED-PURPOSE FLEXIBLE SPENDING ACCOUNT (FSA) HEALTH SAVINGS ACCOUNT (HSA)WHAT’S THE DIFFERENCE BETWEEN A STANDARD HEALTH CARE FSA AND A LIMITED-PURPOSE FSA?Under current IRS rules, you cannot deposit money into a health savings account (HSA) if you participate in a standard health care FSA. However, because a limited-purpose FSA restricts reimbursements to specific dental and vision care expenses, the IRS allows you to participate in both a limited-purpose FSA and an HSA at the same time. By having both accounts, you can maximize your tax and savings benefits.Log into your account at www.carriername.com to view your account balance(s), calculate tax savings, view eligible expenses, download forms, view transaction history, and more. HOW DOES A LIMITED-PURPOSE FSA WORK?● You will receive a debit card from CARRIER NAME, which can be used to pay for eligible health care expenses at the point of service. If you do not use your debit card or if you have dependent care expenses to be reimbursed, submit a claim form and a bill or itemized receipt from the provider to CARRIER NAME. Keep all receipts in case CARRIER NAME requires you to verify the eligibility of a purchase. 19You have the ability to roll over up to $610 from one plan year to the next.You have the ability to roll over up to $610 from one plan year to the next.ROLLOVER

COVERED BENEFITS PLAN PAYSDeductible (waived for Preventive Services) $50 per person, $150 per familyAnnual Plan Benefit Maximum $1,200 per covered memberLifetime Orthodontia Plan Max $1,000 per covered childPreventive Care Exams, cleanings, fluoride treatments (to age 19), sealants (to age 16), palliative treatment, and space maintainers (to age 19).100%Basic Services Simple extractions, periodontal maintenance, restorations, periodontics, endodontics, oral surgery, and general anesthesia.80%Major Services*Inlays, onlays, crowns, crown buildup, dentures, bridges, and surgical implants.50%Orthodontia Services* Available to dependent child(ren) to age 2650%*Waiting Period: 6 month for all Basic Restorations, 12 month for All Other Basic Services, 24 months for all Major Services and 24 months for Orthodontia Services. 20DENTAL INSURANCE CARRIER: CARRIER NAME● You will pay less out of pocket when you choose an in-network provider. ● Locate an in-network provider at www.carriername.com. ● Be sure to ask for a pre-treatment estimate.● Out-of-network providers can balance bill, or bill you for the difference between the provider’s charge and the allowed amount.Please refer to the official plan documents for additional information on coverage and exclusions.ELECTION DENTAL PREMIUMPER PAY PERIODEmployee Only $Employee + Spouse $Employee + Child(ren) $Employee + Family $

COVERED BENEFITS IN-NETWORK OUT-OF-NETWORKEye Exam (every 12 months) $10 copay $30 allowanceStandard Plastic Lenses (every 12 months)Single / Bifocal / Trifocal / Lenticular$0 copay $35 / $40 / $60 / $80 allowanceFrames (every 24 months) $100 allowance + 20% off balance $50 allowanceContact Lenses (every 12 months in lieu of standard plastic lenses)ElectiveMedically Necessary$150 allowance + 15% off balancePlan Pays 100%$120 allowance$210 allowance21VISION INSURANCE CARRIER: CARRIER NAME● You will pay less out of pocket when you choose an in-network provider. ● Locate an in-network provider at www.carriername.com. ● You must submit a claim form for out-of-network expenses.● LASIK surgery discounts available.Please refer to the official plan documents for additional information on coverage and exclusions.ELECTION VISION PREMIUMPER PAY PERIODEmployee Only $Employee + Spouse $Employee + Child(ren) $Employee + Family $

LIFE and ACCIDENTAL DEATH & DISMEMBERMENT (AD&D)Basic Life and AD&D Insurance are automatically provided to all benefits-eligible employees at no cost. If you die as a result of an accident, your beneficiary would receive both the Life and the AD&D benefit. ● Life Insurance Amount: $15,000● AD&D Amount: Equal to life insurance amount● Benefit Reduction Schedule: 35% at age 65 and 50% at age 70Review your beneficiary designationsREMINDERWHAT IS VOLUNTARY LIFE INSURANCE?Voluntary Life Insurance is offered through an employer but is paid by employees.WHY PURCHASE VOLUNTARY LIFE INSURANCE?● This type of life insurance has limited underwriting required. This allows for people with health conditions or lifestyles that might otherwise disqualify them to qualify for life insurance.● The group rates are lower than what you could purchase on your own. ● You may purchase a policy for your spouse and children.● You may purchase a policy for your spouse and children IF you elect coverage for yourself.● Portability - INSERT CARRIER SPECIFIC INFORMATION● Conversion - INSERT CARRIER SPECIFIC INFORMATION22GROUP LIFE INSURANCECARRIER: CARRIER NAMEVOLUNTARY LIFE INSURANCECARRIER: CARRIER NAME

23AGEEMPLOYEERate per $1,000SPOUSERate per $1,000<2525-2930-3435-3940-4445-4950-5455-5960-6465-69CHILD(REN)Rate per $1,000Employee● $10,000 increments to a maximum of the lesser of 5x salary or $500,000● A minimum benefit of $10,000● Guarantee Issue Amount: $100,000● Age Reduction: No age reduction● AD&D amount is 100% of supplemental life benefit amount● Employees are eligible to increase their annual benefit election by $XX,XXX without answering medical questions REMOVE IF APPLICABLESpouse● $5,000 increments to a maximum of $100,000, not to exceed 50% of employee’s life amount● A minimum benefit of $5,000● Guarantee Issue Amount: $25,000● Age Reduction/Coverage End:● AD&D amount is 100% of supplemental life benefit amount● Spouse cost is based on employee or spouse's ageChild(ren)● Child 15 days to 6 months old: $100● Child more than 6 months old: Options $1,000 / $2,000 / $4,000 / $5,000 / $10,000● Child limiting age: 26, if a full time student● Guarantee Issue Amount: $10,000Please refer to the official plan documents for additional information on coverage and exclusions.VOLUNTARY LIFE INSURANCE CONT.CARRIER: CARRIER NAME

SHORT-TERM DISABILITY INSURANCEShort-Term Disability (STD) Insurance is designed to help you meet your financial needs if you become unable to work due to a non-work related illness or injury. This is a voluntary plan; employees are responsible for 100% of the cost. Premiums are calculated as a percentage of your annual base salary. Benefit may be offset due to other benefits such as paid sick leave, workers’ compensation.•Benefit Amount: 60% of base weekly salary up to $1,750 per week•Elimination Period: 14 Days•Benefit Durations: Up to 24 weeks•Guarantee Issue: INSERT Carrier Information•Evidence of Insurability: INSERT Carrier Information•Pre-Existing Condition Waiting Period: INSERT Carrier InformationLONG-TERM DISABILITY INSURANCELong-Term Disability (LTD) Insurance is automatically provided to all benefits-eligible employees at no cost. LTD insurance is designed to help you meet your financial needs during longer disability periods. Benefit may be offset due to oter benefits such as paid sick leave, workers’ compensation.• Benefit Amount: 60% of base monthly salary up to $3,000 per month•Elimination Period: 90 Days• Benefit Duration: Until Social Security Normal Retirement Age (SSNRA)• Evidence of Insurability: INSERT Carrier Information• Pre-Existing Condition Waiting Period: INSERT Carrier InformationReview your beneficiary designationsREMINDER24DISABILITY INSURANCE CARRIER: CARRIER NAMEPlease refer to the official plan documents for additional information on coverage and exclusions.

Prepare for retirement through a 401(k) retirement savings plan. Employees are eligible to begin contributions on either January 1 or July 1, following 90 days of employment.WHAT IS A 401(k) PLAN? A 401(K) is an employer-sponsored retirement savings plan that allows employees to save and invest a percentage of their paycheck before taxes are taken out. Employers may also choose to make matching contributions. WHO IS ELIGIBLE? Participation in the plan is open to employees who meet the following requirements:✔ Age 21✔ Completion of 90 days employmentWHAT ARE THE ADVANTAGES OF A 401(k) PLAN?Participation in this plan is a good way to invest money for retirement. You can reduce your current income taxes and set aside money for retirement at the same time. Since federal income taxes re calculated on your income after your retirement plan contribution has been deducted, you may pay less in federal income taxes. Most states also exempt 401(k) plan contributions from state income taxation until a distribution is taken from the plan. Thus, you may actually have more spendable income than you would if you were contributing a comparable amount to a savings account where contributions and earnings and subject to current income tax rules. HOW MUCH CAN I CONTRIBUTE TO A 401(k) PLAN?For the 2018 calendar year, you may contribute up to $18,500. This amount will be adjusted for inflation as needed in future years. Additional deferral amounts for participants 50 years and older are available through catch-up contributions. HOW CAN I CHANGE THE AMOUNT THAT IS CONTRIBUTED TO MY 401(k) ACCOUNT? Notify Human Resources if you would like to change your salary deferral amount. You may stop contributions at any time, or you can increase or decrease you contributions at the beginning of each quarter. 25401(k) RETIREMENT SAVINGS PLAN CARRIER: CARRIER NAME

CAN I ROLL OVER OR TRANSFER AN EXISTING QUALIFIED RETIREMENT PLAN ACCOUNT INTO MY 401(k) ACCOUNT?Yes, you can rollover or transfer an existing qualified retirement plan account in to your 401(k) account. Please contact Human Resources for information on qualifying roll over plans and eligibility. WHAT OPTIONS ARE AVAILABLE WHEN I TERMINATE EMPLOYMENT OR RETIRE? When you terminate employment or retire, depending on your account balance, you may keep your money in the plan, transfer or roll it over to another eligible retirement plan or Individual Retirement Account (IRA), receive the money in a lump sum or select annuity payments (if allowed by your plan). TO ENROLL: 1.Go to Human Resources and request a 401(k) Enrollment Booklet. 2.Complete the Participant Enrollment Forms in the 401(k) Enrollment booklet.3.Return the completed forms to Human Resources. WHEN CAN I WITHDRAW MY 401(K) CONTRIBUTIONS?Like other retirement plans, a 401(k) plan is intended to be a long-term retirement investment vehicle. As a result, withdrawals are allowed when you reach age 59 ½, terminate employment, retire, become disabled or experience financial hardship. Withdrawals of both contributions and earnings will be subject to ordinary income taxes in the year in which you received the money. Withdrawals prior to age 59 ½ may also be subject to early withdrawal and tax penalties.26401(k) RETIREMENT SAVINGS PLAN

401(k) CONTRIBUTION MATCH(based on bi-weekly earnings)Employee Contribution Employer Match1.00% 0.25%2.00% 0.50%3.00% 0.75%4.00% and up 1.00% max401(k) VESTING SCHEDULEYears of Service Vested MatchLess than 2 years 0%2 years 20%3 years 40%4 years 60%5 years 80%6 years 100%27401(k) RETIREMENT SAVINGS PLAN MATCHING & VESTING

All employees, regardless of enrollment in other benefits, have 24/7 access to confidential support, guidance, and resources. SERVICES INCLUDE:● Work/life services for assistance with relationships, financial issues, child care, elder care, and adoption● Up to X in-person or telephonic sessions to help with short-term issues● 24/7 toll-free phone and web access ● To access services, (INSERT INFO HERE)28EMPLOYEE ASSISTANCE PROGRAM CARRIER: CARRIER NAME

Cancer Insurance supplements your existing medical insurance in case you are diagnosed with cancer; medical insurance alone may not be enough to cover your expenses. The plan pays a cash benefit during the term of your coverage following a positive diagnosis of an internal cancer.WHY PURCHASE CANCER INSURANCE?You and your loved ones can rest a little easier knowing you have protection in place to help avoid depleting your bank accounts or taking on additional debt to cover day-to-day living expenses.● Help cover medical plan deductibles, co-pays and other out-of-pocket costs ● Help cover everyday living expenses such as groceries, rent and mortgage payments● Hire extra help for around the house, such as in-home caregivers● Pay for travel to treatment facilities away from home as well as family visits29VOLUNTARY CANCER INSURANCE CARRIER: CARRIER NAMEPlease refer to the official plan documents for additional information on coverage and exclusions.

30CANCER RATES PER PAY PERIODCOVERAGE AMOUNT<29 30-39 40-49 50-59 60-69CANCER RATES PER PAY PERIODCOVERAGE AMOUNT<29 30-39 40-49 50-59 60-69VOLUNTARY CANCER INSURANCE CARRIER: CARRIER NAMEADJUST CHART TO CARRIER SPECIFIC RATE GRID

Critical Illness Insurance supplements your existing medical insurance in case you are diagnosed with a covered condition, like a heart attack or stroke; medical insurance alone may not be enough to cover your expenses. The plan pays a cash benefit during the term of your coverage following a covered diagnosis. ● Critical Illness Insurance may not cover all types of cancer, but it does cover heart and vascular conditions, cancer-related conditions and major organ failure.31VOLUNTARY CRITICAL ILLNESS INSURANCE CARRIER: CARRIER NAMEPlease refer to the official plan documents for additional information on coverage and exclusions.

32CRITICAL ILLNESS RATES PER PAY PERIODCOVERAGE AMOUNT<29 30-39 40-49 50-59 60-69CRITICAL ILLNESS RATES PER PAY PERIODCOVERAGE AMOUNT<29 30-39 40-49 50-59 60-69VOLUNTARY CRITICAL ILLNESS INSURANCE CARRIER: CARRIER NAMEADJUST CHART TO CARRIER SPECIFIC RATE GRID

Accident Insurance supplements your existing medical insurance in case you have an accident; medical insurance alone may not be enough to cover your expenses. The plan pays a cash benefit during the term of your coverage following a covered accident and could help cover: ● Out-of-pocket expenses such as copays and deductibles● Transportation● Lodging costs ● Emergency room expenses33VOLUNTARY ACCIDENT INSURANCE CARRIER: CARRIER NAMEPlease refer to the official plan documents for additional information on coverage and exclusions.ELECTION EMPLOYEE CONTRIBUTIONPER PAY PERIODEmployee Only $Employee + Spouse $Employee + Child(ren) $Employee + Family $

Hospital Indemnity insurance helps protect your finances if an unexpected hospital stay occurs and those expenses are not covered by your health plan. This benefit would pay in addition to any other coverage(s) you may already have. Benefits are payable for hospital stay due to: ●Sickness●Mental and nervous disorders●Substance abuse●Accidents*●Routine pregnancy**34VOLUNTARY HOSPITAL INDEMNITY INSURANCE CARRIER: CARRIER NAMEPlease refer to the official plan documents for additional information on coverage and exclusions.ELECTION EMPLOYEE CONTRIBUTIONPER PAY PERIODEmployee Only $Employee + Spouse $Employee + Child(ren) $Employee + Family $

Pet insurance reimburses you for vet bills when your pet is sick or injured, to help take the financial worry out of vet visits.• Fast claims processing and payment• Optional direct deposit and direct vet pay options• Use any veterinarian in the U.S., including specialty and emergency clinics• Optional coverage for routine care• Access to a 24/7 pet helpline 35HOW IT WORKS1. When your pet becomes ill or injured, get treatment from any licensed veterinarian2. Use your mobile app or file a claim online; there is no need to send us medical records unless requested.3. Your claim will be quickly processed, and you can be reimbursed directly into your bank account. PET INSURANCECARRIER: CARRIER NAME

Whether you’re 100 miles away for a business trip or 5,000 miles away on vacation, travel assistance makes sure you and your loved ones are never too far from help when you need it.The service is available globally and around the clock, to make sure you can get the assistance you need, when you need it.• Preventive information and tips before you travel• Security/response services and 24/7 assistance• Medical referrals and medical transportation services36HOW IT WORKSIf the condition is an emergency, go immediately to the nearest physician or hospital, and then contact the 24-hour Emergency Response Center. We will then take appropriate actions to assist you and monitor your care until the situation is resolved.TRAVEL INSURANCECARRIER: CARRIER NAME

Paying for college is one of the most significant financial goals families face. That can mean decades of saving, but with this program, you can get closer to your college savings goals by earning valuable rewards that can help you pay for tuition.37HOW IT WORKSInfo hereHOW TO SIGN UPInfo hereCOLLEGE TUITION PROGRAM CARRIER: CARRIER NAME

STEP 1: Please go to the following link to create an account as an employee: www.employeenavigator.com/benefits/Account/RegisterSTEP 2: You will be asked for personal identifying data, as well as, the following company identifier: (INSERT)STEP 3: Write down the username and password you created for future reference. *Note: It is recommended that you use an email address for your UsernameThis summary of benefits is not intended to be a complete description of the terms of Company Name’s insurance benefit plans. Please refer to the plan document(s) for a complete description. Each plan is governed in all respects by the terms of its legal plan document, rather than by this or any other summary of the insurance benefits provided by the plan. In the event of any conflict between a summary of the plan and the official document, the official document will prevail. Although Company Name maintains its benefit plans on an ongoing basis, Company Name reserves the right to terminate or amend each plan, in its entirety or in any part at any time.NEW HIRE ENROLLMENT INSTRUCTIONSDuring the Employee Benefits Enrollment process, a representative will cover the extensive benefits package that Company Name offers eligible employees. STEP 4:You are ready to make your benefit elections! Please select the ‘Start Enrollment’ button. The system will guide you through the process when you select ‘Save & Continue’ on every screen. *Note: If you are covering a spouse and /or child, please have their full name, DOB, and SSN available.STEP 5:Please select the ‘Agree’ button to complete your enrollment. Once you have created your account, you may use the following link anytime to view your benefit elections. www.employeenavigator.com/benefits/account/loginREMEMBER:Benefits Enrollment must be completed by the deadline or you may not be able to enroll yourself and/or your eligible dependents until our next open enrollment, or a qualifying event occurs.38

STEP 1: Please go to the following link to sign in or to create your account: www.employeenavigator.com/benefits/account/login*If you have previously logged in, but do not remember your password, click ‘Forgot password’. You will be prompted to enter your username and birth year to reset your password.STEP 2: You are ready to make your benefit elections! Please select the ‘Start Enrollment’ button. The system will guide you through the process when you select ‘Save & Continue’ on every screen. *Note: If you are covering a spouse and /or child, please have their full name, DOB, and SSN available.This summary of benefits is not intended to be a complete description of the terms of Company Name’s insurance benefit plans. Please refer to the plan document(s) for a complete description. Each plan is governed in all respects by the terms of its legal plan document, rather than by this or any other summary of the insurance benefits provided by the plan. In the event of any conflict between a summary of the plan and the official document, the official document will prevail. Although Company Name maintains its benefit plans on an ongoing basis, Company Name reserves the right to terminate or amend each plan, in its entirety or in any part at any time.ENROLLMENT INSTRUCTIONSDuring the Employee Benefits Enrollment process, a representative will cover the extensive benefits package that Company Name offers eligible employees. *If you do not request any changes for the new plan year, your current elections WILL automatically renew with the exception of the Flexible Spending Account (FSA), as this benefit must be re-elected each year. Please review the new plan year information closely.STEP 3: Once you have reviewed your elections, please select the ‘Agree’ button to complete your enrollment. You may use the following link anytime to view your benefit elections. www.employeenavigator.com/benefits/account/logincREMEMBER:Benefits Enrollment must be completed by the deadline or you may not be able to enroll yourself and/or your eligible dependents until our next open enrollment, or a qualifying event occurs.39

40BENEFIT CARRIER PHONE WEBSITEMedical InsuranceFlexible Spending AccountHealth SavingsAccountDental InsuranceVision InsuranceLife and AD&DInsurance Disability Insurance401(k) Retirement Savings PlanEmployee Assistance ProgramIMPORTANT CONTACTSYOUR CADENCE INSURANCE ACCOUNT REPRESENTATIVE: Jane Doe 555-555-5555Jane.Doe@cadenceinsurance.com

GLOSSARYCoinsurance: Your share of the cost of a covered health care service, calculated as a percent (for example, 20%) of the allowed amount for the service, typically after you meet your deductible. For instance, if your plan’s allowed amount for an office visit is $100 and you’ve met your deductible (but haven’t yet met your out-of-pocket maximum), your coinsurance payment of 20% would be $20. Your plan sponsor or employer would pay the rest of the allowed amount.Copay: The fixed amount, as determined by your insurance plan, you pay for health care services received. Deductible: The amount you owe for medical services before your medical insurance or plan sponsor (employer) begins to pay its portion. For example, if your deductible is $3,000, your plan does not pay anything until you’ve met your $3,000 deductible for covered health care services. This deductible may not apply to all services, including preventive care. Preventive care is 100% covered by the plan. Employee Contribution: The per pay period amount you pay for your insurance coverage. Explanation of Benefits (EOB) / Personal Health Statement (PHS): A statement sent by your insurance carrier that explains which procedures and services were provided, how much they cost, what portion of the claim was paid by the plan, and what portion is your liability, in addition to how you can appeal the insurer’s decision. These statements are also posted on the carrier’s website for your review. Flexible Spending Accounts (FSA): An option that allows participants to set aside pre-tax dollars to pay for certain qualified expenses during a specific time period (usually a 12-month period). Health Care Cost Transparency: Also known as Market Transparency or Medical Transparency. Health care provider costs can vary widely, even within the same geographic area. To make it easier for you to get the most cost-effective health care products and services, online cost transparency tools, which are typically available through health insurance carriers, allow you to search an extensive national database to compare costs for everything from prescription drugs and office visits to MRIs and major surgeries. Health Reimbursement Arrangement (HRA): An employer-funded health spending account provided and owned by an employer. The money in it pays for qualified expenses that are determined by an employer. Employees are reimbursed tax-free for qualified medical expenses up to a fixed dollar amount per year. Health Savings Account (HSA): A personal health care bank account funded by you or your employer’s tax-free dollars to pay for qualified Medical expenses. You must be enrolled in a HDHP to open an HSA. Funds contributed to an HSA roll over from year to year and the account is portable, meaning if you change jobs, your account goes with you.High Deductible Health Plan (HDHP): Plan option that provides choice, flexibility and control when it comes to spending money on health care. Preventive care is covered at 100% with in-network providers, there are no copays, and all qualified employee-paid Medical expenses count toward your deductible and your out-of-pocket maximum. In-Network: In-network providers are doctors, hospitals and other providers that contract with your insurance company to provide health care services at discounted rates.Out-of-Network: Out-of-network providers are doctors, hospitals and other providers that are not contracted with your insurance company. If you choose an out-of-network doctor, services will not be provided at a discounted rate and your cost sharing (deductibles and coinsurance) will increase.Out-of-Pocket Maximum: The maximum amount of money you will pay for medical services during the plan year. The out-of-pocket maximum is the sum of your deductible and coinsurance payments. Vested/Vesting: The amount your 401(k) funds you can take with you when you leave your company. All the money that you personally have contributed to your 401(k) is yours and will go with you if you choose to leave your position, but the amount contributed by your employer that you may keep is typically based on the amount of time you have been employed with the company. 41

42_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________NOTES

INTERNAL NOTE:Going forward, disclosures should not be included in any benefit guides.Requests for exceptions to this rule MUST be submitted to Kelsey Mullett, Client Care Supervisor.

Prepared by:Prepared for:Company Name