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Urology Specialists of the Carolinas Benefits Guide

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EMPLOYEE BENEFITSGUIDE2023 - 2024An overview of the wide array of benefits provided byUrology Specialists of the Carolinas to help you enjoy increased well-being and financial security.

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This booklet provides only a summary of your benefits. All services described within are subject to the definitions, limitations and exclusions set forth in each insurance carrier's or provider's contract.Employee Benefits Guide2023 - 2024 Urology Specialists of the CarolinasAs an employee of Urology Specialists of the Carolinas, enjoying your work and making valuable contributions to business are equally vital. The health, satisfaction and security of you and your family are important, not only to your well-being, but ultimately, in terms of achieving the goals of our organization.For the 2023-2024 plan year, Urology Specialists of the Carolinas has worked hard to offer a competitive total rewards package that includes valuable and competitive benefit plans. These programs reflect our commitment to keeping our staff healthy and secure. We understand that your situation is unique, and Urology Specialists of the Carolinas is offering an overall benefits package that can be shaped and molded by you to fit your needs.This benefits booklet is a summary description of your Urology Specialists of the Carolinas benefit plans. If there is a discrepancy between these summaries and the written legal plan documents, the plan documents shall prevail. This booklet and plan summaries do not constitute a contract of employment.We hope this benefits booklet, along with our additional communication and decision-making tools, will help you make the best health care choices for you and your family.INTRODUCTIONEligibility & EnrollmentAs a full-time employee working 30+ hours/week you are eligible for benefits. You can enroll or make changes during our annual enrollment period or within 30 days if you experience a qualifying life event during the year. A qualifying life event includes changes in marital status, employment status, birth or adoption of a child, death of a dependent, entitlement to Medicaid or Medicare, loss of other coverage or eligibility of dependents.Benefits Begin 1stday of the month following 30 dates of employmentBenefits End Last day of the month following terminationDependentsUp to age 26 (for Voluntary Life unmarried children are covered to age 19 or 25 if full time student)Domestic Partner Same and opposite sex 2

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This booklet provides only a summary of your benefits. All services described within are subject to the definitions, limitations and exclusions set forth in each insurance carrier's or provider's contract.Employee Benefits Guide2023 - 2024 Urology Specialists of the CarolinasComparison of PlansCoverage Provided by NCMS Employee Benefits PlanIn-Network PPO 4000-70 PPO 3500-60 HDHP 3500-100Deductibles (Individual / Family)$4,000/$8,000 $3,500/$7,000$3,500/$7,000 ($6,550 individual family member)Out-of-Pocket Max (Individual / Family)$8,550/$17,100 $8,150/$16,300$3,500/$7,000 ($6,550 individual family member)Preventive Care Covered Covered CoveredPrimary Care Visit $50 Copay* $45 Copay* 0% after deductibleSpecialist Visit $100 Copay 40% after deductible 0% after deductibleTelehealth via Teladoc $50 Copay $45 Copay 0% after deductibleUrgent Care $100 Copay $135 Copay 0% after deductibleEmergency Room $1,000 Copay 40% after deductible 0% after deductibleOutpatient Procedure 30% after deductible 40% after deductible 0% after deductibleInpatient Visit 30% after deductible 40% after deductible 0% after deductiblePharmacy / RX(30 Day Supply)Essential Formulary$15/$35/$45/$90/25% up to $200 maxTier 1: $10 CopayTiers 2-5: 50% up to $100 maxEnhanced Preventive: 0%All Others: 0% after deductibleLens and Frames CoverageCovered up to $130 then 90%Covered up to $130 then 90%0% after deductibleMEDICALThe chart below is an overview of the In-Network benefits. Out-of-Network benefits are available; please review your NCMS Employee Benefit Plan documents for additional details.*Select your PCP in Blue Connect and your copay is waved for your first 3 visits to your selected PCP.3

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This booklet provides only a summary of your benefits. All services described within are subject to the definitions, limitations and exclusions set forth in each insurance carrier's or provider's contract.Employee Benefits Guide2023 - 2024 Urology Specialists of the CarolinasCoverage Provided by NCMS Employee Benefits PlanIn-Network High Performance Network 3500-60Deductibles (Individual / Family) $3,500/$7,000Out-of-Pocket Max (Individual / Family)$8,150/$16,300Preventive Care CoveredPrimary Care Visit$45 CopaySelect your PCP in Blue Connect and your copay is waved for your first 3 visits to your selected PCP.Specialist Visit 40% after deductibleTelehealth via Teladoc $45 CopayUrgent Care $135 CopayEmergency Room 40% after deductibleOutpatient Procedure 40% after deductibleInpatient Visit 40% after deductiblePharmacy / RX(30 Day Supply)Essential FormularyTier 1: $10 CopayTiers 2-5: 50% up to $100 maxLens and Frames Coverage Covered up to $130 then 90%MEDICALThe chart below is an overview of the High Performance Network plan option. In order for services to be covered under this plan you must receive care within the BlueHPN network. Out-of-Network benefits are not available, except for urgent and emergency care only. Visit: www.blueconnectnc.com and select “Blue High Performance Network” to find in-network providers. Please review your NCMS Employee Benefit Plan documents for additional details.4

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This booklet provides only a summary of your benefits. All services described within are subject to the definitions, limitations and exclusions set forth in each insurance carrier's or provider's contract.Employee Benefits Guide2023 - 2024 Urology Specialists of the CarolinasWellness and Health ManagementUnderstanding the full value of covered benefits allows you to take responsibility for maintaining good health and incorporating healthy habits into your lifestyle. Some examples include getting regular physical examinations, mammograms and immunizations. Through the plans offered by Urology Specialists of the Carolinas, all covered individuals and family members are eligible to receive routine wellness services like these, at no cost; all copays, coinsurance, and deductibles are waived.Which Preventive Care Services Are Covered?The US Preventive Services Task Force maintains a regular list of recommended services that all Affordable Care Act (i.e., Health Care Reform) compliant insurance plans should cover at 100% for in-network providers. Below is a list of common services that are included in the plans offered this year:• Routine physical exam• Well baby and childcare• Well women visits• Immunizations• Routine bone density test• Routine breast exam• Routine gynecological exam• Screening for Gestational diabetes• Obesity screening and counseling• Routine digital rectal exam• Routine colonoscopy• Routine colorectal cancer screening• Routine prostate test• Routine lab procedures• Routine mammograms• Routine pap smear• Smoking cessation• Health education/counseling services• Health counseling for STDs and HIV• Testing for HPV and HIV• Screening/counseling for domestic violencePREVENTIVE CAREPricing Per Pay Period PPO 4000-70 PPO 3500-60 HDHP 3500-100 HPN 3500-60Employee $69.24 $76.09 $124.07 $40.05Employee + Spouse $373.50 $387.39 $484.80 $314.04Employee + Child $166.71 $175.83 $239.64 $127.90Employee + Children $296.70 $308.82 $393.74 $245.03Employee + Family $595.05 $614.08 $747.46 $513.90Your Cost 5

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This booklet provides only a summary of your benefits. All services described within are subject to the definitions, limitations and exclusions set forth in each insurance carrier's or provider's contract.Employee Benefits Guide2023 - 2024 Urology Specialists of the CarolinasEmployees 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 specialists. Telehealth is a good option for minor health problems when you can’t see your regular doctor. It is also a convenient choice when you want to speak to a counselor or therapist. Some providers will also offer telehealth appointments. Check with your provider on the availability and cost.How Does Telehealth Work?Your virtual visit will take place via phone, video call on a laptop, tablet or cellphone; or through an app. The provider will ask you the same questions you'd be asked at an in-person visit and may recommend treatment based on their findings.What Can’t Telehealth Be Used For?• Life-threatening or emergency situations• Situations in which diagnostic care (e.g.,blood work, imaging or lab tests) arerequired• Situations of severe illness or complexconditionsHow Do I Access Telehealth?There are 3 ways to access Teladoc:• Download the Teladoc mobile app• Go to Teladoc.com and click “Log in/Register”• Call 1-800-835-2362Refer to your plan documentation for more information.TELEHEALTHWhat Can Telemedicine Be Used For?General, non-life-threatening doctor's visits or consultations for acute care, such as:• Allergies• Cough, cold and flu• Diarrhea, nausea and vomiting• Ear problems• Insect bites• Sinus problems• Urinary problems• And moreBehavioral health issues such as:• Addictions• Anxiety• Depression• Grief and loss• Relationship issues• And more6

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This booklet provides only a summary of your benefits. All services described within are subject to the definitions, limitations and exclusions set forth in each insurance carrier's or provider's contract.Employee Benefits Guide2023 - 2024 Urology Specialists of the CarolinasThrough our partnership with NCMS, enrolled members have access to several additional programs to help support you in achieving a healthy balanced life.Nurse Support Program Condition CareManaging a chronic condition can be complicated. This BCBSNC program connects you to additional tools, resources and care if you have a condition such as:• Asthma• Chronic Obstructive Pulmonary Disease• Congestive Heart Failure• Coronary Artery Disease• Diabetes• HypertensionA Nurse Advocate may call you to provide one-on-one support. If you have not already been contacted by the Nurse Advocate, you can call 1-888-229-8510, Monday through Friday, between 9:00 a.m. and 7:00 p.m.Eat Smart, Move More, Weigh LessEat Smart, Move More, Weigh Less is an online weight management program that uses strategies proven to work for weight loss and maintenance. Each lesson informs, empowers and motivates participants to live mindfully as they make choices about eating and physical activity.To register visit: https://esmmweighless.com/howitwork/enroll-choose-a-class/ and enter the employer code: ASONCMSUrologySpecCarolinas. 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 ProgramVITAL 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.MEDICAL SUPPORT PROGRAMS7

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This booklet provides only a summary of your benefits. All services described within are subject to the definitions, limitations and exclusions set forth in each insurance carrier's or provider's contract.Employee Benefits Guide2023 - 2024 Urology Specialists of the CarolinasA 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 inthe futureSetting aside pre-tax dollars into your HSA means you pay fewer taxes and increase your take-home pay by your tax savings. You save money on eligible expenses that you are paying for out of your pocket. The amount you save depends on your tax bracket. For example, if you are in the 30% tax bracket, you can save $30 on every $100 spent on eligible health care expenses.HSA funds roll over from year to year and accumulate in your account. There is no "use-it-or-lose-it" rule with HSAs, and you decide how and when to use your HSA funds, which can be used for eligible expenses you have now, in the future, or during retirement. Also, when you have a certain balance in your HSA, investment opportunities are available.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 AccountRefer to your HSA documentation for more information.HSA Contribution LimitsYou can contribute to your Health Equity HSA on a pre-tax basis through payroll deductions up to the IRS statutory maximums. These maximums include your employer contribution of $25 per month. The IRS has established the following maximum HSA contributions:2023 Tax Year 2024 Tax Year$3,850 Individual / $7,750 Family $4,150 Individual / $8,300 FamilyIf you are age 55 and over, you may contribute an extra $1,000 catch-up contribution. HEALTH SAVINGS ACCOUNT (HSA)8

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This booklet provides only a summary of your benefits. All services described within are subject to the definitions, limitations and exclusions set forth in each insurance carrier's or provider's contract.Employee Benefits Guide2023 - 2024 Urology Specialists of the CarolinasThis Is How An FSA Works:• You set aside money for your FSA from your paycheck before taxes are taken out.• You then use your pre-tax FSA funds throughout the plan year to pay for eligible health care ordependent care expenses.• You save money on expenses you're already paying for.Our plan through Flores, offers a carry over up to $610 of unused funds to the following year. Refer to your FSA documentation for more details.Health FSA Eligible Expenses• Medical expenses: copays, coinsurance and deductibles• Dental expenses: exams, cleanings, X-rays and braces• Vision expenses: exams, contact lenses, eyeglasses and laser eye surgery• Professional services: physical therapy, chiropractic and acupuncture• Prescription drugs and insulin• Over-the-counter health care items such as bandages, pregnancy tests and blood pressure monitorsIf enrolled in a HDHP with HSA then you can enroll in a limited purpose FSA. Limited Purpose Health FSA Eligible Expenses• Dental expenses: exams, cleanings, X-rays and braces• Vision expenses: exams, contact lenses, eyeglasses and laser eye surgeryDependent Care FSA Eligible Expenses• Care for your child who is under the age of 13• Before-school and after-school care• Babysitting and nanny expenses• Day care, nursery school and preschool• Summer day camp• Care for a relative who is physically or mentally incapable of self-care and lives in your homeRefer to your FSA documentation for more information. FLEXIBLE SPENDING ACCOUNT (FSA)9

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This booklet provides only a summary of your benefits. All services described within are subject to the definitions, limitations and exclusions set forth in each insurance carrier's or provider's contract.Employee Benefits Guide2023 - 2024 Urology Specialists of the CarolinasSummary of CoverageCoverage Provided by Delta Dental Low Plan In-Network High Plan In-NetworkPlan Year September 1, 2023-July 31, 2024 September 1, 2023-July 31, 2024Annual Deductibles(Individual / Family)$50/$150$50/$150Preventive Care 100% 100%Basic Procedures (fillings, crown repair and periodontal maintenance)80% after deductible 80% after deductibleMajor Procedures(crowns, dentures, etc.)Not Covered 50% after deductiblePlan Year Maximum Benefit $750 per covered person $1,000 per covered personDENTALBelow is a high-level summary of our dental benefits. While Out-of-Network coverage is available, using an In-Network provider will result in less out of pocket expenses. In-Network dentist cannot balance bill you for the amount over the allowable charges. Please review your plan documents for additional details.Pricing Per Pay Period Low Plan High PlanEmployee $2.82 $8.88Employee + Spouse $13.71 $25.84Employee + Child(ren) $22.60 $33.00Employee + Family $38.13 $55.55Your Cost10

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This booklet provides only a summary of your benefits. All services described within are subject to the definitions, limitations and exclusions set forth in each insurance carrier's or provider's contract.Employee Benefits Guide2023 - 2024 Urology Specialists of the CarolinasSummary of CoverageCoverage provided by USAblePlan FeaturesEmployee Benefit Amount $15,000AD&D Benefit $15,000Benefit Reductions begin at age 65Group life insurance coverage is an employer-sponsored safety net in case the worst happens, with no out-of-pocket costs to you. If you believe you need additional coverage, you may wish to enroll in voluntary life insurance as well. Employees must fill out an EOI form if they exceed the guaranteed issue amount.GROUP LIFE and AD&D INSURANCESummary of Coverage provided by Lincoln FinancialLife & ADD Benefit Employee Spouse DependentAmountLesser of 5x your basic annual earnings or $300,000 in $10,000 incrementsUp to 50% of the employee benefit in $5,000 increments$250 (14 days to 6 months) then $10,000 to age 19/25 if full time studentMinimum Amount $10,000 $5,000 $10,000Maximum Amount $300,000 $150,000 $10,000Guarantee Issue (Newly Eligible Employees)$150,000 $30,000 $10,000Benefits Will Reduce Starting at age 65 Starting at age 65 NAVOLUNTARY LIFE and AD&D INSURANCEFor summary of rate sheet, please see carrier summary or Employee Navigator.11

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This booklet provides only a summary of your benefits. All services described within are subject to the definitions, limitations and exclusions set forth in each insurance carrier's or provider's contract.Employee Benefits Guide2023 - 2024 Urology Specialists of the CarolinasSummary of CoveragePlan FeaturesShort TermProvided by Lincoln Financial Long TermProvided by The StandardCoverage Paid By Employee Urology Specialists Taxation Benefit is not taxable Benefit is taxableEmployee Benefit Amount60% of your total weekly earnings up to class maximum 60% of your total monthly earnings up to class definitions/maximum Benefit DurationUp to 11 weeks after 14 day elimination periodUp to SSNRA after elimination period Disability insurance is coverage that provides you with income protection should you be unable to work due to an injury or illness. With disability coverage, you are compensated for a portion of your lost income. Short-Term disability provides coverage in the near term, while Long-Term coverage is available for extended disabilities. DISABILITY INSURANCEPlease note, Evidence of Insurability may be required if enrolling outside of your initial enrollment. Pre-existing condition period may apply once you become covered. Please see policy for more information.12

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This booklet provides only a summary of your benefits. All services described within are subject to the definitions, limitations and exclusions set forth in each insurance carrier's or provider's contract.Employee Benefits Guide2023 - 2024 Urology Specialists of the CarolinasCarrier ResourcesBENEFIT CARRIER GROUP # PHONE NUMBER WEBSITEMedical NCMS/BCBSNC 141709381001 877-275-9787www.BlueConnectNC.comDental Delta Dental 0925 800-662-8856 www.deltadentalnc.comLife NCMS/USAble 50045022 800-370-5856 www.usablelife.comVol Life Lincoln FinancialGL 000400001000-20990800-423-2765https://www.mylincolnportal.com/customer/public/loginSTD Lincoln FinancialGL 000010215236800-423-2765https://www.mylincolnportal.com/customer/public/loginLTD The Standard 756109 800-628-8600 www.standard.comHSA HealthEquity 866-346-5800 www.healthequity.comFSA Flores and Associates 800-532-3327 www.flores247.comEAP Vital WorklifeUsername & Password: ncmsplan800-383-1908 www.VITALWorkLife.comHow to access ID CardsBENEFIT CARRIER HOW TO ACCESSMedical NCMSWill receive an ID Card in the mail. Can also access through the portal: www.blueconnectnc.comOr Mobile App.Dental Delta DentalYou can access an electronic ID Card through the portal: www.memberportal.com or Mobile App.13

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EMPLOYEE BENEFITS GUIDEPrepared By Sentinel Benefits Consulting | sentinelra.com2023 - 2024Urology Specialist of the Carolinas