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This benefit guide only provides a summary of your group’s benefits. All lines of coverage described are subject to the definitions, limitations and exclusions set in each insurance carrier or providers contract. Page l Human Services Center Employee Benefits Enrollment Guide Plan Year: January 1, 2023 – December 31, 2023

This benefit guide only provides a summary of your group’s benefits. All lines of coverage described are subject to the definitions, limitations and exclusions set in each insurance carrier or providers contract. Page l 2 We know that your benefits are important to you and your family. Helping you understand the benefits offered by Human Services Center is important to us. That is why we have created this Benefit Guide. Included in this guide are summary of the benefits, cost information, and contact information for each provider. It is important to remember that only those benefit programs for which you are eligible and have enrolled in apply to you. We encourage you to review each section and to discuss your benefit options with your family members. Be sure to pay close attention to applicable co-payments and deductibles, along with networks and services that may be limited or not covered (exclusions). This guide is not a contract between you and Human Services Cen-ter. It is not intended to cover all provisions of all plans but rather is a quick reference to help answer most of your questions. Please see each Benefits Summary Plan Description for complete details. We hope this guide will give you a clear explanation of your benefits and help you be better prepared for the enrollment process. Welcome ............................................................................................... Page 2 Enrollment ............................................................................................ Page 3 ICHRA Educational Guide ........................................................................ Page 4 Flexible Spending Account (FSA) .............................................................. Page 13 Dental .................................................................................................. Page 14 Vision ................................................................................................... Page 16 Group Term Life ..................................................................................... Page 18 Voluntary Life Benefits ............................................................................ Page 20 Voluntary Short Term Disability ............................................................... Page 21 Long Term Disability ............................................................................... Page 24 Voluntary Accident ................................................................................. Page 27 Voluntary Critical Illness ......................................................................... Page 29 Voluntary Hospital Indemnity .................................................................. Page 32 Whole Life ............................................................................................. Page 33 Contact Information ............................................................................... Page 38 TABLE OF CONTENTS WELCOME

This benefit guide only provides a summary of your group’s benefits. All lines of coverage described are subject to the definitions, limitations and exclusions set in each insurance carrier or providers contract. Page l 3 HOW TO ENROLL Open Enrollment The first step is to review your current benefit elections. Verify your personal information and make any changes if necessary. Newly Eligible Make your benefit elections and complete the enrollment paperwork. Once you have made your elections, you will not be able to change them until the next open enrollment period unless you have a qualified change in status. Qualifying Events Employees are able to enroll or make changes to their benefits elections during the group’s annual open enrollment period. Once you elect an option you are bound to the decision for the entirety of the plan year unless you have a “qualifying event”. Employees have 30 days from the date of the qualifying event to add or change coverage. These may include, but are not limited to: • Changes in your employment status • Changes in your legal marital status • Change in number of dependents • Taking an unpaid leave of absence • Dependent satisfies or cease to satisfy eligibility requirement • Family Medical Leave Act (FMLA) leave • A COBRA qualifying event • Entitlement to Medicare or Medicaid • A change in the place of residence of the employee, resulting in the current carrier not being available ENROLLMENT

This benefit guide only provides a summary of your group’s benefits. All lines of coverage described are subject to the definitions, limitations and exclusions set in each insurance carrier or providers contract. Page l 4 MEDICAL - Bavvy

This benefit guide only provides a summary of your group’s benefits. All lines of coverage described are subject to the definitions, limitations and exclusions set in each insurance carrier or providers contract. Page l 5 MEDICAL - Bavvy

This benefit guide only provides a summary of your group’s benefits. All lines of coverage described are subject to the definitions, limitations and exclusions set in each insurance carrier or providers contract. Page l 6 MEDICAL - Bavvy

This benefit guide only provides a summary of your group’s benefits. All lines of coverage described are subject to the definitions, limitations and exclusions set in each insurance carrier or providers contract. Page l 7 MEDICAL - Bavvy

This benefit guide only provides a summary of your group’s benefits. All lines of coverage described are subject to the definitions, limitations and exclusions set in each insurance carrier or providers contract. Page l 8 MEDICAL - Bavvy

This benefit guide only provides a summary of your group’s benefits. All lines of coverage described are subject to the definitions, limitations and exclusions set in each insurance carrier or providers contract. Page l 9 MEDICAL - Bavvy

This benefit guide only provides a summary of your group’s benefits. All lines of coverage described are subject to the definitions, limitations and exclusions set in each insurance carrier or providers contract. Page l 10 MEDICAL - Bavvy

This benefit guide only provides a summary of your group’s benefits. All lines of coverage described are subject to the definitions, limitations and exclusions set in each insurance carrier or providers contract. Page l 11 MEDICAL - Bavvy

This benefit guide only provides a summary of your group’s benefits. All lines of coverage described are subject to the definitions, limitations and exclusions set in each insurance carrier or providers contract. Page l 12 MEDICAL - Bavvy

This benefit guide only provides a summary of your group’s benefits. All lines of coverage described are subject to the definitions, limitations and exclusions set in each insurance carrier or providers contract. Page l 13 Human Services Center provides you the opportunity to pay for out-of-pocket medical, dental, vision and dependent care expenses with pre-tax dollars through Flexible Spending Accounts. You can save approximately 25 percent of each dollar spent on these expenses when you participate in a FSA. A health care FSA is used to reimburse out-of-pocket medical expenses incurred by you and your dependents. A dependent care FSA is used to reimburse expenses related to care of eligible dependents while you and your spouse work. Contributions to your FSA come out of your paycheck before any taxes are taken out. This means that you don’t pay federal income tax, Social Security taxes, or state and local income taxes on the portion of your paycheck you contribute to your FSA. You should contribute the amount of money you expect to pay out of pocket for eligible expenses for the plan period. If you do not use the money you contributed it will not be re-funded to you or carried forward to a future plan year. This is the use-it-or-lose-it rule. The maximum that you can contribute to the Flexible Sending Account • Health Care = $3,050 • Dependent Care = $5000* The following example shows how you can save money with a flexible spending account. Bob and Jane’s combined gross income is $30,000. They have two children and file their income taxes jointly. Since Bob and Jane expect to spend $2,000 in adult orthodontia and $3,300 for day care next plan year, they decide to direct a total of $5,300 into their FSAs. Without FSAs With FSAs Gross income: $30,000 $30,000 FSA contributions: $0 -$5,000 Gross income: $30,000 $25,000 Estimated taxes: Federal -$2,550* -$1,776* State -$900** -$750** FICA -$2,295 -$1,913 After-tax earnings: $24,255 $20,314 Eligible out-of-pocket Medical and dependent care expenses: -$5,000 $0 Remaining spendable income: $19,255 $20,314 Spendable income increase: $1,306 *Assumes standard deductions and four exemptions. ** Varies, assume 3percent. The example above is for illustrative purposes only. Every situation varies and we recommend that you consult a tax advisor for all tax advice. FLEXIBLE SPENDING ACCOUNT

This benefit guide only provides a summary of your group’s benefits. All lines of coverage described are subject to the definitions, limitations and exclusions set in each insurance carrier or providers contract. Page l 14 DENTAL BENEFITS

This benefit guide only provides a summary of your group’s benefits. All lines of coverage described are subject to the definitions, limitations and exclusions set in each insurance carrier or providers contract. Page l 15 DENTAL BENEFITS

This benefit guide only provides a summary of your group’s benefits. All lines of coverage described are subject to the definitions, limitations and exclusions set in each insurance carrier or providers contract. Page l 16 VISION BENEFITS

This benefit guide only provides a summary of your group’s benefits. All lines of coverage described are subject to the definitions, limitations and exclusions set in each insurance carrier or providers contract. Page l 17 VISION BENEFITS

This benefit guide only provides a summary of your group’s benefits. All lines of coverage described are subject to the definitions, limitations and exclusions set in each insurance carrier or providers contract. Page l 18 GROUP TERM LIFE BENEFITS

This benefit guide only provides a summary of your group’s benefits. All lines of coverage described are subject to the definitions, limitations and exclusions set in each insurance carrier or providers contract. Page l 19 GROUP TERM LIFE BENEFITS

This benefit guide only provides a summary of your group’s benefits. All lines of coverage described are subject to the definitions, limitations and exclusions set in each insurance carrier or providers contract. Page l 20 VOLUNTARY LIFE BENEFITS

This benefit guide only provides a summary of your group’s benefits. All lines of coverage described are subject to the definitions, limitations and exclusions set in each insurance carrier or providers contract. Page l 21 VOLUNTARY SHORT TERM DISABILITY

This benefit guide only provides a summary of your group’s benefits. All lines of coverage described are subject to the definitions, limitations and exclusions set in each insurance carrier or providers contract. Page l 22 VOLUNTARY SHORT TERM DISABIL-

This benefit guide only provides a summary of your group’s benefits. All lines of coverage described are subject to the definitions, limitations and exclusions set in each insurance carrier or providers contract. Page l 23 VOLUNTARY SHORT TERM DISABILITY STD Age Banded Rates Rates per $10 of benefit Less than 30 $1.082 30-34 $1.138 35-39 $1.027 40-44 $1.110 45-49 $1.351 50-54 $1.684 55-59 $2.063 60-64 $2.442 65+ $2.923

This benefit guide only provides a summary of your group’s benefits. All lines of coverage described are subject to the definitions, limitations and exclusions set in each insurance carrier or providers contract. Page l 24 LONG TERM DISABILITY

This benefit guide only provides a summary of your group’s benefits. All lines of coverage described are subject to the definitions, limitations and exclusions set in each insurance carrier or providers contract. Page l 25 LONG TERM DISABILITY

This benefit guide only provides a summary of your group’s benefits. All lines of coverage described are subject to the definitions, limitations and exclusions set in each insurance carrier or providers contract. Page l 26 LONG TERM DISABILITY

This benefit guide only provides a summary of your group’s benefits. All lines of coverage described are subject to the definitions, limitations and exclusions set in each insurance carrier or providers contract. Page l 27 VOLUNTARY ACCIDENT INSURANCE

This benefit guide only provides a summary of your group’s benefits. All lines of coverage described are subject to the definitions, limitations and exclusions set in each insurance carrier or providers contract. Page l 28 VOLUNTARY ACCIDENT INSURANCE

This benefit guide only provides a summary of your group’s benefits. All lines of coverage described are subject to the definitions, limitations and exclusions set in each insurance carrier or providers contract. Page l 29 VOLUNTARY CRITICAL ILLNESS

This benefit guide only provides a summary of your group’s benefits. All lines of coverage described are subject to the definitions, limitations and exclusions set in each insurance carrier or providers contract. Page l 30 CRITICAL ILLNESS INSURANCE

This benefit guide only provides a summary of your group’s benefits. All lines of coverage described are subject to the definitions, limitations and exclusions set in each insurance carrier or providers contract. Page l 31 CRITICAL ILLNESS INSURANCE

This benefit guide only provides a summary of your group’s benefits. All lines of coverage described are subject to the definitions, limitations and exclusions set in each insurance carrier or providers contract. Page l 32 VOLUNTARY HOSPITAL INDEMNITY

This benefit guide only provides a summary of your group’s benefits. All lines of coverage described are subject to the definitions, limitations and exclusions set in each insurance carrier or providers contract. Page l 33 GROUP WHOLE LIFE

This benefit guide only provides a summary of your group’s benefits. All lines of coverage described are subject to the definitions, limitations and exclusions set in each insurance carrier or providers contract. Page l 34 GROUP WHOLE LIFE

This benefit guide only provides a summary of your group’s benefits. All lines of coverage described are subject to the definitions, limitations and exclusions set in each insurance carrier or providers contract. Page l 35 GROUP WHOLE LIFE

This benefit guide only provides a summary of your group’s benefits. All lines of coverage described are subject to the definitions, limitations and exclusions set in each insurance carrier or providers contract. Page l 36 GROUP WHOLE LIFE RATES

This benefit guide only provides a summary of your group’s benefits. All lines of coverage described are subject to the definitions, limitations and exclusions set in each insurance carrier or providers contract. Page l 37 GROUP WHOLE LIFE RATES

This benefit guide only provides a summary of your group’s benefits. All lines of coverage described are subject to the definitions, limitations and exclusions set in each insurance carrier or providers contract. Page l 38 The informaon in this Enrollment Guide is presented for illustrave purposes and is based on informaon provided by the employer. The text contained in this Guide was taken from various summary plan descripons and benet informaon. While every eort was taken to accurately report your benets, dis-crepancies or errors are always possible. In case of discrepancy between the Guide and the actual plan documents the actual plan documents will prevail. All informaon is condenal, pursuant to the Health Insurance Portability and Accountability Act of 1996. If you have any quesons about your Guide, contact Human Resources. BAVVY Customer Service 855-520-0188 Support@Bavvy.com CONTACT INFORMATION Title Name Email Phone Number Director of Sales Joe Turi jturi@keystoneinsgrp.com 216-217-4185 Senior Account Manager Mickie Range mrange@keystoneinsgrp.com 330-316-6704 Account Coordinator Rodney Pritchard rpritchard@keystoneinsgrp.com 574-406-6919 Benefits Coordinator Zach Chupp zchupp@keystoneinsgrp.com 574-231-6526 Serviceteam@keystoneinsgrp.com 574-231-6500 877-691-5424 Service Team General Glenn Lebby Anderson Insurance Group glenn@williams-cleaveland.com 724-652-6605 Copyright © Keystone Benefits - all rights reserved MET LIFE Customer Service 800-638-5433 www.metlife.com MASS MUTUAL Customer Service 800-272-2216 www.massmutual.com

This benefit guide only provides a summary of your group’s benefits. All lines of coverage described are subject to the definitions, limitations and exclusions set in each insurance carrier or providers contract. Page l 39 NOTES

This benefit guide only provides a summary of your group’s benefits. All lines of coverage described are subject to the definitions, limitations and exclusions set in each insurance carrier or providers contract. Page l 40 The information in this Enrollment Guide is presented for illustrative purposes and is based on information provided by the employer. The text contained in this Guide was taken from various summary plan descriptions and benefit information. While every effort was taken to accurately report your benefits, dis-crepancies or errors are always possible. In case of discrepancy between the Guide and the actual plan documents the actual plan documents will prevail. All information is confidential, pursuant to the Health Insurance Portability and Accountability Act of 1996. If you have any questions about your Guide, contact Human Resources. Copyright © Keystone Benefits - all rights reserved