Delaney Radiology Benefit Guide : simplebooklet.com

Benefits Guide Delaney Radiology 2 | P a g e - Non- e x e m p t E m p l o y e e s INTRODUCTION As an employee of Delaney Radiology, 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. This benefits booklet is a summary description of your medical plan offerings. 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 yo u and your family. Eligibility & Enrollment As a full-time employee 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 First of the month following 30 days of hire Benefits End Date of termination/loss of eligibility Dependents Your legal spouse and dependent children up to age 26 Domestic Partner Same and Opposite Sex 2024 - 2025

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Benefits Guide Delaney Radiology 3 | P a g e - Non- e x e m p t E m p l o y e e s Comparison of Plans MEDICAL The 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. Coverage Provided by North Carolina Medical Society Benefits Plan In-Network PPO 1-2-3 4000 HDHP 2700-80 HDHP 5000-100 Benefit Period Plan Year: 9/1-8/31 Plan Year: 9/1-8/31 Plan Year: 9/1-8/31 Deductibles (Individual / Family) $4,000/$8,000 $2,700/$5,450 ($5,450 family member) $5,000/$10,000 ($6,550 family member) Out-of-Pocket Max (Individual / Family) $8,150/$16,300 $5,000/$10,000 ($6,550 family member) $5,000/$10,000 ($6,550 family member) Primary Care Visit $35 Copay* 20% after deductible 0% after deductible Specialist Visit 50% after deductible 20% after deductible 0% after deductible Telehealth via Teladoc $35 Copay 20% after deductible 0% after deductible Urgent Care 50% after deductible 20% after deductible 0% after deductible Emergency Room 50% after deductible 20% after deductible 0% after deductible Outpatient Procedure 50% after deductible 20% after deductible 0% after deductible Inpatient Visit $250 copay, then 30% after deductible 20% after deductible 0% after deductible Pharmacy / RX (30 Day Supply) Essentials Formulary $10/$25/$40/$80/25% (up to $100 max per 30 day supply of tier 5 drugs) Enhanced Preventive: 0% All Others: 20% after deductible Enhanced Preventive: 0% All Others: 0% after deductible Lens and Frames Coverage Covered up to $130 then 90% 20% after deductible 0% after deductible *Register your PCP in Blue Connect and copay is waived for 1st three visits 2024 - 2025

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Benefits Guide Delaney Radiology 4 | P a g e - Non- e x e m p t E m p l o y e e s Your Cost Pricing Per Pay Period PPO 1-2-3 4000 HDHP 2700-80 HDHP 5000-100 Employee $0.00 $0.00 $0.00 Employee + Spouse Employee + Child Employee + Children Employee + Family PREVENTIVE CARE Understanding the full value of covered benefits allows you to take responsibility for maintaining good health and incorporating healthy habits into your lifestyle. Some examples include getting regular physical examinations, mammograms and immunizations. Through the plans offered by Delaney Radiology, 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 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 violence Amazon Pharmacy NCMS plan through BCBSNC 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 checkout you’ll see the lowest cost available for your prescription. Sign up and learn more at www.amazon.com/bluecrossnc. 2024 - 2025$310.07$99.35$231.80$535.85$320.61$102.72$239.68$554.07$302.17$96.81$225.90$522.21

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Benefits Guide
Delaney Radiology

5 | P a g e - Non- e x e m p t E m p l o y e e s

TELEHEALTH

Employees 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.

How 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
855-549-2214

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) arerequired
• Situations of severe illness or complex conditions

What Can Telemedicine Be Used For?

General, non-life-threatening doctor's visitsor consultations for acute care, such as:
• Allergies
• Cough, cold and flu
• Diarrhea, nausea and vomiting
• Ear problems
• Insect bites
• Sinus problems
• Urinary problems
• And more

Behavioral health issues such as:
• Addictions
• Anxiety
• Depression
• Grief and loss
• Relationship issues
• And more

Refer to your plan documentation for more information.

2024 -2025

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Benefits Guide Delaney Radiology 6 | P a g e - Non- e x e m p t E m p l o y e e s MEDICAL SUPPORT PROGRAMS Through 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 Care Managing 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 • Hypertension A 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 Less Eat 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: ASONCMSDelaneyRad. 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/. Employee Assistance Program VITAL WorkLife is available to assist you and your family with life issues which are confronting you., such as grief, anxiety, problems with your children, substance abuse and more. Unlimited phone consultation and website access to articles, assessments, seminars and much more. Face to face counseling is available. Legal, financial and identity theft services can also be accessed. Contact VITAL WorkLife at 800-383-1908 or visit www.vitalworklife.com username: ncmsplan; password: ncmsplan. 2024 - 2025

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Benefits Guide Delaney Radiology 7 | P a g e - Non- e x e m p t E m p l o y e e s HEALTH SAVINGS ACCOUNT (HSA) A 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. Why 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 future Setting aside pre-tax dollars into your HSA means you pay fewer taxes and increase your take-home pay by your tax savings. You save money on eligible expenses that you are paying for out of your pocket. The 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. 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 Account Refer to your HSA documentation for more information. HSA Contribution Limits You can contribute to your Health Equity HSA on a pre-tax basis through payroll deductions up to the IRS statutory maximums. The IRS has established the following maximum HSA contributions: If you are age 55 and over, you may contribute an extra $1,000 catch-up contribution. 2024 - 20252024 Tax Year$4,150 Individual / $8,300 Family$4,300 Individual / $8,550 Family2025 Tax Year

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Benefits Guide Delaney Radiology 8 | P a g e - Non- e x e m p t E m p l o y e e s GROUP LIFE and AD&D INSURANCE Delaney Radiology also provides group life insurance coverage through NCMS in partnership with USAble. This is an employer-sponsored safety net in case the worst happens, with no out-of-pocket costs to you. Summary of Coverage Coverage provided by NCMS/USAble Plan Features Employee Benefit Amount $30,000 AD&D Benefit $30,000 Benefit Reductions begin at age 65 Carrier Resources BENEFIT CARRIER GROUP # PHONE NUMBER WEBSITE Medical NCMS/BCBSNC 14171071 877-275-9787 www.BlueConnectNC.com EAP Vital Worklife Username & Password: ncmsplan 800-383-1908 www.VITALWorkLife.com Basic Life & ADD NCMS/USAble 50007139 800-370-5856 www.usablelife.com How to access ID Cards BENEFIT CARRIER HOW TO ACCESS Medical NCMS/BCBSNC Will receive an ID Card in the mail. Can also access through the portal: www.blueconnectnc.com Or Mobile App. 2024 - 2025

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Benefits Guide Delaney Radiology 9 | P a g e - Non- e x e m p t E m p l o y e e s DELTA DENTAL Delta Dental PPO plus Premier $50 Deductible; $2,250 Annual Benefit In-Network Dentist Nonparticipating Dentist* Diagnostic & Preventive Exams, cleanings, fluoride, & space maintainers 100% 100% Emergency palliative treatment – to temporarily relieve pain 100% 100% Sealants – to prevent decay 100% 100% Brush Biopsy – to detect oral cancer 100% 100% Radiographs – X-rays 100% 100% Basic Services Minor Restoratives – fillings and crown repair 80% 80% Endodontic Services – root canals 80% 80% Periodontic Services – to treat gum disease 80% 80% Oral Surgery – extractions and dental surgery 80% 80% Other Basic Services – misc. services 80% 80% Relines and Repairs – to bridges, implants, and dentures 80% 80% Major Services Major Restorative Services – crowns 50% 50% Prosthodontic Services – bridges, implants, dentures, and crowns over implants 50% 50% Orthodontic Services Braces (up to age 19) – Lifetime Maximum / % $1,500 / 50% *When you receive services from a Nonparticipating Dentist, the percentages in this column indicate the portion of Delta’s Nonparticipating Dentist Fee that will be paid for those services. This Nonparticipating Dentist Fee may be less than what your dentist charges, which means that you will be responsible for the difference. Your Cost Pricing Per Pay Period Employee $0.00 Employee + Spouse Employee + Children Employee + Family 2024 - 2025$20.40$36.27$56.68

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Benefits Guide Delaney Radiology 10 | P a g e - Non- e x e m p t E m p l o y e e s Other Voluntary Benefits (100% Optional and Employee Funded)  Expanded vision coverage available through Community Eye Care  AFLAC supplemental policies available to help cover unplanned healthcare costs  Voluntary Life insurance available up to $300,000. Guaranteed issuance of $30,000 without having to answer any health questions  Long-term Disability insurance which pays 60% of pre-disability after 6 months of disability Profit Sharing 401k After completing one year of service with Delaney and accumulating 1000+ hours, employees are eligible to participate in the 401k Profit Sharing Plan. Employee may make pre- or post-tax contributions through payroll deduction. Delaney makes an annual 3% safe harbor contribution. Profit sharing contributions are decided upon annually. Employees are always 100% vested in the safe harbor contribution and their own contributions. The Profit-Share contribution is on a vesting schedule, and after 5 years enrolled in the plan, employees are 100% vested in that portion. Paid Days Off (PDO) Delaney provides eligible employees Paid Days Off (PDO) which are intended to be used for vacation, personal business, or sickness. Full-time and Part-time employees are eligible to accrue PDO. Temporary and PRN employees are not eligible to accrue PDO under this policy. Employees are not eligible to use PDO during their 90-day introductory period. Rates of PDO accrual are based on employment classification and years of service. For non-exempt employees, PDO accrues on a per pay period basis based on hours paid for that pay period (up to a maximum of 80 hours paid in a pay period). Non-exempt employees must be paid for at least 32 hours in a pay period in order to accrue PDO in that pay period. Years of Service Accrual Rate Per Hour Worked in Pay Period Hours Accrued Per 80 Hour Pay Period 0-3 Months .0038 0.30 4-12 Months .0639 5.11 1 year but < 5 years .0923 7.38 5 years but < 8 years .1038 8.30 8 years but < 10 years .1154 9.23 10 years but <25 years .1231 9.85 25+ years .1385 11.08 2024 - 2025

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Benefits Guide Delaney Radiology 11 | P a g e - Non- e x e m p t E m p l o y e e s Holiday Pay Delaney grants paid time off to all full-time employees for eight annual holidays selected by management. A list of the holidays for each calendar year will be published at the beginning of the year. Typical holidays may include New Year’s Day, Good Friday (or Easter Monday), Memorial Day, July 4th, Labor Day, Thanksgiving, and Christmas. The Friday after Thanksgiving and the day after Christmas may be deemed a holiday at the discretion of the Executive Committee. Part-time employees receive paid time off for holidays which fall on their regularly scheduled work days. “Birthday Holiday” Delaney grants each full-time and part-time employee a paid “Birthday Holiday.” This in an annual paid holiday to be taken within 30 days following the employee’s actual birthday (unless the employee is out on leave or in their trial period). The Birthday Holiday is not an additional PDO day and cannot be paid out upon termination or for any other reason. Other Miscellaneous Benefits  Dependent Care FSA – Set aside pre-tax dollars each pay period to save money on your family’s child or elder care expenses.  Up to 3 days of paid Bereavement Leave in the event of the death of an immediate family member (the day before, the day of, and the day after the funeral if any of these days fall on the employee’s regularly scheduled work days. “Immediate Family Member” is defined as a parent, legal guardian, spouse, child, brother, sister, mother-in-law, father-in-law, or grandparent of the employee.  Discounts to various products, businesses, and attractions available through ADP LifeMart, TicketsAtWork, and Blue Cross Blue Shield. Eligibility Requirements:  Employees are eligible for medical, dental, and Aflac participation on the first day of the month following 30 days of employment.  For all other voluntary benefits, employees are eligible on the first day of the month following 60 days of employment.  Employees must work or be paid for 24 hours each week to be eligible for medical benefits.  Employees must work or be paid for 30 hours each week to be eligible for dental benefits. This document is intended for general information purposes and should not serve as a guarantee of benefits. All services described within are subject to the definitions, limitations, and exclusions set forth in each insurance carrier’s or provider’s contract. In the event that this information differs from the providers’ current plan documents or the Delaney Employee Handbook, those documents take precedence.2024 - 2025

Delaney Radiology Benefit Guide

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