JC - 2024 Employee Benefits Guide - (FINAL 11.28.2023) SPR

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CONTENTS

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UNITEDHEALTHCARE (PPO) BI-WEEKLY MEDICAL CONTRIBUTIONS

CHOICE PLUS PPO PLAN (HIGH PLAN)

TIER

Employee

$250.33

Employee + Spouse

$723.16

Employee + Child(ren)

$524.22

Employee + Family

$1,041.58

UNITEDHEALTHCARE (HDHP) BI-WEEKLY MEDICAL CONTRIBUTIONS

CHOICE PLUS HSA PPO (LOW PLAN)

CHOICE PLUS HSA PPO (MIDDLE PLAN)

TIER

Employee

$47.05

Employee

$122.95

Employee + Spouse

$343.10

Employee + Spouse

$484.45

Employee + Child(ren)

$353.02

Employee + Child(ren)

$242.86

Employee + Family

$719.72

Employee + Family

$503.41

AMERITAS BI-WEEKLY DENTAL CONTRIBUTIONS

AMERITAS BI-WEEKLY VISION CONTRIBUTIONS

TIER

PPO PLAN

TIER

CHOICE NETWORK PLAN

Employee

$17.54

Employee

$3.40

Employee + Spouse

$34.52

Employee + Spouse

$7.59

Employee + Child(ren)

$41.52

Employee + Child(ren)

$6.17

Employee + Family

$58.51

Employee + Family

$10.36

CHOICE PLUS PPO PLAN (HIGH PLAN)

BENEFIT

IN-NETWORK

OUT-OF-NETWORK

Annual Deductible (calendar year)

Individual:

$1,500 $3,000

Individual:

$3,000 $9,000

Family:

Out-of-Pocket Maximum (calendar year)

Individual:

$5,000 $10,000

Individual:

$8,000 $16,000

Family:

Coinsurance

UnitedHealthcare pays 80% Employee pays 20%

UnitedHealthcare pays 60% Employee pays 40%

Preventive Care Adult Preventive Care Adult Annual Physical Exam Well-Child Care

100% 100% 100%

60% after deductible 60% after deductible 60% after deductible

Inpatient Care

80% after deductible

60% after deductible

Outpatient Care Primary care physician office visits Specialist office visits Outpatient Diagnostic Services Surgery Laboratory & Diagnostic X-rays (Designated Network) (Advanced Imaging (MRI. PET, CT) (Designated Network) Emergency Care Ambulance when medically necessary At hospital emergency room Urgent Care

100% after $25 Copay 100% after $50 Copay

60% after deductible 60% after deductible

20% after deductible No Charge 100% $450 copay per visit

60% after deductible 60% after deductible 60% after deductible 60% after deductible 60% after deductible

80% after deductible 80% after deductible 100% after $55 Copay

80% after in-network deductible 80% after in-network deductible 60% after deductible

Mental Health Inpatient Outpatient

20% after deductible 100% after $25 Copay

60% after deductible 60% after deductible

Prescription Drugs Annual Deductible (calendar year)

None

Retail Pharmacy (30 day supply) Tier 1/Tier 2/Tier 3 Mail Order (90 day supply) Tier 1/Tier 2/Tier 3

$10/$50/$85

$25/$125/$212.50

Dependent Age Limit

To age 30 (coverage terminates at the end of the calendar year in which the dependent turns 30)

For additional information, please refer to your detailed plan summary. In the event of a discrepancy, the carrier Plan Document shall prevail.

CHOICE PLUS HSA PPO HDHP (MIDDLE PLAN)

CHOICE PLUS PPO HSA HDHP (LOW PLAN)

BENEFIT

IN-NETWORK

OUT-OF-NETWORK

IN-NETWORK

OUT-OF-NETWORK

Individual:

$1,600 $3,200

Individual:

$3,000 $6,000

Annual Deductible (calendar year)

Individual:

$2,500 $5,000

Individual:

$5,000 $10,000 $11,600 $23,200

Family:

Out-of-Pocket Maximum (calendar year)

Individual:

$4,500 $9,000

Individual:

$9,000 $18,000

Individual:

$5,000 $10,000

Individual:

Family:

Coinsurance

UnitedHealthcare pays 80% Employee pays 20%

UnitedHealthcare pays 60% Employee pays 40%

UnitedHealthcare pays 80% Employee pays 20%

UnitedHealthcare pays 60% Employee pays 40%

Preventive Care Adult Preventive Care Adult Annual Physical Exam Well-Child Care

100% 100% 100%

60% after deductible 60% after deductible 60% after deductible

100% 100% 100%

60% after deductible 60% after deductible 60% after deductible

Outpatient Care Primary care physician office visits Specialist office visits

80% after deductible 80% after deductible

60% after deductible 60% after deductible

80% after deductible 80% after deductible

60% after deductible 60% after deductible

Inpatient Care

80% after deductible

$500 deductible plus 60% after plan deductible

80% after deductible

$500 deductible plus 60% after plan deductible

Outpatient Diagnostic Services Laboratory & Diagnostic X-rays

80% after deductible 80% after deductible 80% after deductible 80% after deductible 80% after deductible

60% after deductible 60% after deductible 60% after deductible 60% after deductible 60% after deductible

80% after deductible Deductible; coinsurance waived Deductible; coinsurance waived

60% after deductible 60% after deductible 60% after deductible 60% after deductible 60% after deductible

(Independent Clinical Lab) (Value Choice Specialist ) (Independent Diagnostic Testing Center)

80% after deductible 80% after deductible

Advanced Imaging (MRI. PET, CT) (office setting/outpatient facility)

Emergency Care Ambulance when medically necessary At hospital emergency room Urgent Care

80% after deductible 80% after deductible 80% after deductible

80% after In-Network deductible 80% after In-Network deductible 80% after deductible

80% after deductible 80% after deductible 80% after deductible

80% after In-Network deductible 80% after In-Network deductible 80% after In-Network deductible

Mental Health Inpatient Outpatient

80% after deductible 80% after deductible

60% after deductible 60% after deductible

80% after deductible 80% after deductible

60% after deductible 60% after deductible

Prescription Drugs Annual Deductible (calendar year)

Medical Deductible Applies Individual: $1,600 Family: $3,200

Medical Deductible Applies Individual: $3,000 Family: $6,000

Medical Deductible Applies Individual: $2,500 Family: $5,000

Medical Deductible Applies Individual: $5,000 Family: $10,000

Retail Pharmacy (30 day supply) Tier 1/Tier 2/Tier 3 Mail Order (90 day supply) Tier 1/Tier 2/Tier 3

$10/$35/$70 After deductible $25/$87.50/$175 After deductible

To age 30 (coverage terminates at the end of the calendar year in which the dependent turns 30)

Dependent Age Limit

For additional information, please refer to your detailed plan summary. In the event of a discrepancy, the carrier Plan Document shall prevail.

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2024 CONTRIBUTION LIMITS

Single

$4,150

$8,300

Family

$1,000

Catch Up (age 55 or older)

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For additional information, please refer to your detailed plan summary. In the event of a discrepancy, the carrier Plan Document shall

Urgent Care Center

Primary Care Physician

Emergency Room

For additional information, please refer to your detailed plan summary. In the event of a discrepancy, the carrier Plan Document shall prevail.

DENTAL PPO PLAN

BENEFIT

IN-NETWORK

OUT-OF-NETWORK

Annual Deductible (calendar year)

Individual: $50 Family: $150

Individual:

$50

Family:

$150

Annual Benefit Maximum

$1,000

Diagnostic & Preventive Services Prophylaxis (Cleanings); Oral Examinations; Topical Fluoride; X-rays; Bitewing; Sealants (up to age 16); Space Maintainers Basic Services Restorative Amalgams; Restorative Composites; Denture Repair; Simple & Complex Extractions; Anesthesia Major Services Onlays; Crowns; Crown Repair; Endodontics (non-surgical & surgical); Periodontics (non-surgical & surgical); Prosthodontics (fixed bridge; removable complete/partial dentures)

100% Deductible waived

80% After deductible

50% After deductible

Dependent Age Limit

To age 25 (coverage terminates date dependent turns 25)

For additional information, please refer to your detailed plan summary. In the event of a discrepancy, the carrier Plan Document shall prevail.

EYECHOICE FOCUS VSP CHOICE NETWORK PLAN

BENEFIT

IN-NETWORK

OUT-OF-NETWORK

Eye Exam with Dilation Contact Lens Exam

$10 copay Member cost up to $60

$10 copay In-Network only

Hardware

$25 copay

Frequency Exam

12 months 12 months 24 months 12 months

Lenses Frames Contact Lenses

Frames

$100 allowance

Up to $70

Lenses Single Vision Lenses Bifocal Vision Lenses Trifocal Vision Lenses Lenticular Lenses

Covered 100% Covered 100% Covered 100% Covered 100%

Up to $30 Up to $50 Up to $65 Up to $100

Contact Lenses in lieu of Glasses Medically Necessary Elective

Covered 100% $115 allowance

Up to $210 Up to $105

Dependent Age Limit

To age 31 (coverage terminates date dependent turns 31)

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For additional information, please refer to your detailed plan summary. In the event of a discrepancy, the carrier Plan Document shall prevail.

GLOSSARY OF HEALTH COVERAGE AND MEDICAL TERMS

Complications of Pregnancy Conditions due to pregnancy, labor and delivery that require medical care to prevent serious harm to the health of the mother or the fetus. Morning sickness and a non emergency caesarean section aren’t complications of pregnancy. Copayment A fixed amount (for example, $15) you pay for a covered health care service, usually when you receive the service. The amount can vary by the type of covered health care service. Deductible The amount you owe for health care services your health insurance or plan covers before your health insurance or plan begins to pay. For example, if your deductible is $1000, your plan won’t pay anything until you’ve met your $1000 deductible for covered health care services subject to the deductible. The deductible may not apply to all services. Durable Medical Equipment (DME) Equipment and supplies ordered by a health care provider for everyday or extended use. Coverage for DME may include: oxygen equipment, wheelchairs, crutches or blood testing strips for diabetics. Emergency Medical Condition An illness, injury, symptom or condition so serious that a reasonable person would seek care right away to avoid severe harm. Emergency Medical Transportation Ambulance services for an emergency medical condition. Emergency Room Care Emergency services you get in an emergency room. Emergency Services Evaluation of an emergency medical condition and treatment to keep the condition from getting worse.

Excluded Services Health care services that your health insurance or plan doesn’t pay for or cover. Grievance A complaint that you communicate to your health insurer or plan. Health Insurance A contract that requires your health insurer to pay some or all of your health care costs in exchange for a premium. Home Health Care Health care services a person receives at home. Hospice Services Services to provide comfort and support for persons in the last stages of a terminal illness and their families. Hospitalization Care in a hospital that requires admission as an inpatient and usually requires an overnight stay. An overnight stay for observation could be outpatient care. Hospital Outpatient Care Care in a hospital that usually doesn’t require an overnight stay. In-Network Coinsurance The percent (for example, 20%) you pay of the allowed amount for covered health care services to providers who contract with your health insurance or plan. In-Network co-insurance usually costs you less than Out-of-Network coinsurance. In-Network Copayment A fixed amount (for example, $15) you pay for covered health care services to providers who contract with your health insurance or plan. In Network copayments usually are less than Out-of-Network copayments.

This glossary has many commonly used terms, but isn’t a full list. These glossary terms and definitions are intended to be educational and may be different from the terms and definitions in your plan. Some of these terms also might not have exactly the same meaning when used in your policy or plan, and in any such case, the policy or plan governs. An example showing how deductibles, co-insurance and out-of-pocket limits work together in a real life situation is located on page 21. Allowed Amount Maximum amount on which payment is based for covered health care services. This may be called “eligible expense,” “payment allowance" or "negotiated rate." If your provider charges more than the allowed amount, you may have to pay the difference. (See Balance Billing.) Appeal A request for your health insurer or plan to review a decision or a grievance again. Balance Billing When a provider bills you for the difference between the provider’s charge and the allowed amount. For example, if the provider’s charge is $100 and the allowed amount is $70, the provider may bill you for the remaining $30. A preferred provider may not balance bill you for covered services. Coinsurance Your share of the costs of a covered health care service, calculated as a percent (for example, 20%) of the allowed amount for the service. You pay coinsurance plus any deductibles you owe. For example, if the health insurance or plan’s allowed amount for an office visit is $100 and you’ve met your deductible, your coinsurance payment of 20% would be $20. The health insurance or plan pays the rest of the allowed amount.

For additional information, please refer to your detailed plan summary. In the event of a discrepancy, the carrier Plan Document shall prevail.

Medically Necessary Health care services or supplies needed to prevent, diagnose or treat an illness, injury, condition, disease or its symptoms and that meet accepted standards of medicine Network The facilities, providers and suppliers your health insurer or plan has contracted with to provide health care services. Non-Preferred Provider A provider who doesn’t have a contract with your health insurer or plan to provide services to you. You’ll pay more to see a non preferred provider. Check your policy to see if you can go to all providers who have contracted with your health insurance or plan, or if your health insurance or plan has a “tiered” network and you must pay extra to see some providers. Out-of-Network Coinsurance The percent (for example, 40%) you pay of the allowed amount for covered health care services to providers who do not contract with your health insurance or plan. Out-of-Network coinsurance usually costs you more than In-Network coinsurance. Out-of-Network Copayment A fixed amount (for example, $30) you pay for covered health care services from providers who do not contract with your health insurance or plan. Out-of-Network copayments usually are more than In-Network copayments. Out-of-Pocket Limit The most you pay during a policy period (usually a year) before your health insurance or plan begins to pay 100% of the allowed amount. This limit never includes your premium, balance-billed charges or health care your health insurance or plan doesn’t cover. Some health insurance or plans don’t count all of your copayments, deductibles, coinsurance payments, Out-of-Network payments or other expenses toward this limit.

Physician Services Health care services a licensed medical physician (M.D. – Medical Doctor or D.O. – Doctor of Osteopathic Medicine) provides or coordinates. Plan A benefit your employer, union or other group sponsor provides to you to pay for your health care services. Preauthorization A decision by your health insurer or plan that equipment is medically necessary. Sometimes called prior authorization, prior approval or precertification. Your health insurance or plan may require preauthorization for certain services before you receive them, except in an emergency. Preauthorization isn’t a promise your health insurance or plan will cover the cost. Preferred Provider A provider who has a contract with your health insurer or plan to provide services to you at a discount. Check your policy to see if you can see all preferred providers or if your health insurance or plan has a “tiered” network and you must pay extra to see some providers. Your health insurance or plan may have preferred providers who are also “participating” providers. Participating providers also contract with your health insurer or plan, but the discount may not be as great, and you may have to pay more. Premium The amount that must be paid for your health insurance or plan. You and/or your employer usually pay it monthly, quarterly or yearly. Prescription Drug Coverage Health insurance or plan that helps pay for prescription drugs and medications. Prescription Drugs Drugs and medications that by law require a prescription. a health care service, treatment plan, prescription drug or durable medical

Primary Care Physician A physician (M.D. – Medical Doctor or D.O. – Doctor of Osteopathic Medicine) who directly provides or coordinates a range of health care services for a patient. Primary Care Provider A physician (M.D. – Medical Doctor or D.O. – Doctor of Osteopathic Medicine), nurse practitioner, clinical nurse specialist or physician assistant, as allowed under state law, who provides, coordinates or helps a patient access a range of health care services. Provider A physician (M.D. – Medical Doctor or D.O. – Doctor of Osteopathic Medicine), health care professional or health care facility licensed, certified or accredited as required by state law. Specialist A physician specialist focuses on a specific area of medicine or a group of patients to diagnose, manage, prevent or treat certain types of symptoms and conditions. A non-physician specialist is a provider who has more training in a specific area of health care. UCR (Usual, Customary and Reasonable) The amount paid for a medical service in a geographic area based on what providers in the area usually charge for the same or similar medical service. The UCR amount sometimes is used to determine the allowed amount. Urgent Care Care for an illness, injury or condition serious enough that a reasonable person would seek care right away, but not so severe as to require emergency room care.

For additional information, please refer to your detailed plan summary. In the event of a discrepancy, the carrier Plan Document shall prevail.

BENEFIT

Who’s Eligible?

All regular full-time employees working at least 30 hours per week

Life Benefit Amount

Flat $50,000

AD&D Benefit Amount

Flat $50,000

Reduction of Benefits Schedule*

Reduces by 35% of original amount at age 65 Reduces by 50% of original amount at age 70

Retirement

Benefits terminate at retirement

*Note: Automatic reduction of benefit occurs at end of year after attained age

ONLY AVAILABLE IF EMPLOYEE COVERAGE IS ELECTED

BENEFIT

EMPLOYEE

BENEFIT

SPOUSE

Benefit Amount

5 times (5x) annual salary

Benefit Amount

2.5 times (2.5x) annual salary

Minimum Benefit Amount

Increments of $10,000

Maximum Benefit Amount

Minimum Benefit Amount

$300,000

Increments of $5,000

Guaranteed Coverage Amount* Reduction of Benefits Schedule**

Maximum Benefit Amount

The lesser of 50% of the Employee amount or $150,000

$150,000

Guaranteed Coverage Amount*

$30,000

Reduces by 35% of original amount at age 65 Reduces by 50% of original amount at age 70

Reduction of Benefits Schedule**

Spouse Benefits are reduced when employees’ spouse attains age 65 and terminate when employee is no longer eligible or at retirement, whichever come first

Portability

Available

Retirement

Benefits terminate at retirement

Portability

Available

BENEFIT

DEPENDENT CHILDREN

Benefit Amount

Flat $10,000

Portability

Available

For additional information, please refer to your detailed plan summary. In the event of a discrepancy, the carrier Plan Document shall prevail.

EMPLOYEE/SPOUSE (BASED ON EMPLOYEE AGE)

CHILD(REN)

RATE PER $1,000

RATE PER $10,000

AGE

WITH AD&D

Under 30

$0.040

$0.065

$2.00

30-34

$0.080

$0.105

35-39

$0.080

$0.105

40-44

$0.140

$0.165

45-49

$0.210

$0.235

50-54

$0.390

$0.415

55-59

$0.610

$0.635

60-64

$0.630

$0.655

65-69

$1.170

$1.195

70-74

$2.500

$2.525

75-79

$2.500

$2.525

80-99

$2,500

$2.525

EXAMPLE OF VOLUNTARY LIFE AND AD&D COSTS - (Example assumes 52 year old employee electing $20,000 of Voluntary Life and AD&D for himself )

Voluntary Benefit Amount

Multiplied by Monthly Rate by Age Band Per $1,000 of Benefit

Total Monthly Cost

Benefit

Cost Per Bi-Weekly Pay

Employee/Life

$20,000

$7.80

x 12 = $93.60 ÷ 26 = $3.60

$0.390

Employee/AD&D

$20,000

$0.50

x 12 = $6.00 ÷ 26 = $0.23 Total Bi-Weekly Cost for Voluntary Life and AD&D Benefit $3.83

$0.025

For additional information, please refer to your detailed plan summary. In the event of a discrepancy, the carrier Plan Document shall prevail.

BENEFIT

LONG TERM DISABILITY

Benefit Percentage

60% of pre-disability monthly earnings

Definition of Disability

2 year own occupation

Maximum Monthly Benefit

$5,000

Elimination Period

180 days

Maximum Benefit Duration

Social Security Retirement Age

Pre-existing Conditions Limitations

3/12*

For additional information, please refer to your detailed plan summary. In the event of a discrepancy, the carrier Plan Document shall prevail.

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For additional information, please refer to your detailed plan summary. In the event of a discrepancy, the carrier Plan Document shall prevail.

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For additional information, please refer to your detailed plan summary. In the event of a discrepancy, the carrier Plan Document shall prevail.

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For additional information, please refer to your detailed plan summary. In the event of a discrepancy, the carrier Plan Document shall prevail.

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BENEFITS

MY PET PROTECTION WITH WELLNESS

MY PET PROTECTION

Accidents, including poisoning and allergic reactions

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Injuries, including cuts, sprains and broken bones

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Common illnesses, including ear infections, vomiting and diarrhea

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Serious/chronic illnesses, including cancer and diabetes

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Hereditary and congenital conditions

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Surgeries and hospitalization

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X- rays, MRI’s and CT Scans

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Prescription medications and therapeutic diets

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Wellness exams

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Vaccinations

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Spray/neuter

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Flea and tick prevention

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Heartworm testing and prevention

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Routine blood tests

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For additional information, please refer to your detailed plan summary. In the event of a discrepancy, the carrier Plan Document shall prevail.

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For additional information, please refer to your detailed plan summary. In the event of a discrepancy, the carrier Plan Document shall prevail.

CARRIER OR CONTACT

TELEPHONE NUMBER

EMAIL ADDRESS

PLAN

PAGE

PPO: 866-633-2446 HSA: 866-314-0335

Medical Plans

UnitedHealthcare

www.UHC.com/www.myUHC.com

4-5

Health Savings Account (HSA) Information

HealthEquity

866.735.8195

www.myHealthEquity.com

Dental Plan

Ameritas

800.487.5553

www.ameritas.com

Vision Plan

Ameritas

800.487.5553

www.ameritas.com

Group: Basic Life/AD&D & Voluntary Life/AD&D

USAble Life

800.370.5856

www.usablelife.com

12-13

Long Term Disability

Lincoln Financial

800.423.2765

www.lfg.com

Absence Management

Lincoln Financial

800.423.2765

www.LincolnFinancial.com

Employee Assistance Program

www.lincoln4benefits.com or www.guidanceresources.com

Lincoln Financial

888.628.4824

Dignity Planner

USAble Life

800.370.5856

www.thedignityplanner.com/USAbleLife

Identity Theft Travel Assistance Program

accounts.travel-eye-axa.com/en/registration/ usa_life_emp.

USAble Life/AXA

866.384.2786

https://www.colonial-paulrevere.com/ https://www.colonial-paulrevere.com/individuals/ claims

Colonial Life (call center)

Voluntary Benefits

800.325.4368

16-17

Pet Insurance

Nationwide

877.738.7874

www.petinsurance.com/jerseycollege

BenefitsVIP

Corporate Synergies

866.286.5354

Answers@BenefitsVIP.com

iSolved Benefit Services Elliot J. Cohen, QPFC, Actuarial Ideas, Inc.

https://www.isolvedbenefitservices.com/login qbmail@isolvedhcm.com

COBRA Administration

800.594.6957

401(k) & Roth Plans John Hancock

Tel: (845)622-1400 Fax: (845)704-3487

myplan.johnhancock.com eli@actuarial-ideas.com

NEWBORNS’ AND MOTHERS’ HEALTH PROTECTION ACT OF 1996 (NEWBORN’S ACT) Group health plans and health insurance issuers generally may not, under federal law, restrict benefits for any hospital length of stay in connection with childbirth for the mother or newborn child to less than 48 hours following a vaginal delivery, or less than 96 hours following a cesarean section. However, federal law generally does not prohibit the mother's or newborn's attending provider, after consulting with the mother, from discharging the mother or her newborn earlier than 48 hours (or 96 hours as applicable). In any case, plans and issuers may not, under federal law, require that a provider obtain authorization from the plan or the issuer for prescribing a length of stay not in excess of 48 hours (or 96 hours). Under WHCRA, group health plans, insurance companies and health maintenance organizations (HMOs) offering mastectomy coverage must also provide coverage for reconstructive surgery in a manner determined in consultation with the attending physician and the patient. Coverage includes reconstruction of the breast on which the mastectomy was performed, surgery and reconstruction of the other breast to produce a symmetrical appearance, and prostheses and treatment of physical complications at all stages of the mastectomy, including lymph edemas. Call your Plan Administrator for more information. QUALIFIED MEDICAL CHILD SUPPORT ORDER (QMCSO) QMCSO is a medical child support order issued under State law that creates or recognizes the existence of an “alternate recipient’s” right to receive benefits for which a participant or beneficiary is eligible under a group health plan. An “alternate recipient” is any child of a participant (including a child adopted by or placed for adoption with a participant in a group health plan) who is recognized under a medical child support order as having a right to enrollment under a group health plan with respect to such participant. Upon receipt, the administrator of a group health plan is required to determine, within a reasonable period of time, whether a medical child support order is qualified, and to administer benefits in accordance with the applicable terms of each order that is qualified. In the event you are served with a notice to provide medical coverage for a dependent child as the result of a legal determination, you may obtain information from your employer on the rules for seeking to enact such coverage. These rules are provided at no cost to you and may be requested from your employer at any time. SPECIAL ENROLLMENT RIGHTS (HIPAA) If you have previously declined enrollment for yourself or your dependents (including your spouse) because of other health insurance coverage, you may in the future be able to enroll yourself or your dependents in this plan, provided that you request enrollment within 30 days after your other coverage ends. In addition, if you have a new dependent as a result of marriage, birth, adoption, or placement for adoption, you may be able to enroll yourself and your dependents, provided that you request enrollment within 30 days after the marriage, birth, adoption, or placement for adoption. If you leave your job to perform military service, you have the right to elect to continue your existing employer-based health plan coverage for you and your dependents (including spouse) for up to 24 months while in the military. Even if you do not elect to continue coverage during your military service, you have the right to be reinstated in your employer’s health plan when you are reemployed, generally without any waiting periods or exclusions for pre-existing conditions except for service-connected injuries or illnesses. MICHELLE’S LAW Michelle’s Law permits seriously ill or injured college students to continue coverage under a group health plan when they must leave school on a full-time basis due to their injury or illness and would otherwise lose coverage. The continuation of coverage applies to a dependent child’s leave of THE WOMEN’S HEALTH A ND CANCER RIGHTS ACT OF 1998 (WHCRA, ALSO KNOWN A S JANET’S LAW) COVERAGE EXTENSION RIGHTS UNDER THE UNIFORMED SERVICES EMPLOYMENT AND REEMPLOYMENT RIGHTS ACT (USERRA)

absence from (or other change in enrollment) a postsecondary educational institution (college or university) because of a serious illness or injury, while covered under a health plan. This would otherwise cause the child to lose dependent status under the terms of the plan. Coverage will be continued until: 1. One year from the start of the medically necessary leave of absence, or 2. The date on which the coverage would otherwise terminate under the terms of the health plan; whichever is earlier. MENTAL HEALTH PARITY AND ADDICTION EQUITY ACT OF 2008 This act expands the mental health parity requirements in the Employee Retirement Income Security Act, the Internal Revenue Code and the Public Health Services Act by imposing new mandates on group health plans that provide both medical and surgical benefits and mental health or substance abuse disorder benefits. Among the new requirements, such plans (or the health insurance coverage offered in connection with such plans) must ensure that: The financial requirements applicable to mental health or substance abuse disorder benefits are no more restrictive that the predominant financial requirements applied to substantially all medical and surgical benefits covered by the plan (or coverage), and there are no separate cost sharing requirements that are applicable only with respect to mental health or substance abuse disorder benefits. GENETIC INFORMATION NON-DISCRIMINATION ACT (GINA) GINA broadly prohibits covered employers from discriminating against an employee, individual, or member because of the employee’s “genetic information,” which is broadly defined in GINA to mean (1) genetic tests of the individual, (2) genetic tests of family members of the individual, and (3) the manifestation of a disease or disorder in family members of such individual. GINA also prohibits employers from requesting, requiring, or purchasing an employee’s genetic information. This prohibition does not extend to information that is requested or required to comply with the certification requirements of family and medical leave laws, or to information inadvertently obtained through lawful inquiries under, for example, the Americans with Disabilities Act, provided the employer does not use the information in any discriminatory manner. In the event a covered employer lawfully (or inadvertently) acquires genetic information, the information must be kept in a separate file and treated as a confidential medical record, and may be disclosed to third parties only in very limited situations. CONSOLIDATED OMNIBUS BUDGET RECONCILIATION ACT (COBRA) The Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA) requires employers who provide medical coverage to their employees to offer such coverage to employees and covered family members on a temporary basis when there has been a change in circumstances that would otherwise result in a loss of such coverage [26 USC §4980B ] This benefit, known as “continuation coverage,” applies if, for example, dependent children become independent, spouses get divorced, or employees leave the employer. CHILDREN'S HEALTH INSURANCE PROGRAM REAUTHORIZATION ACT (CHIPRA) Effective April 1, 2009 employees and dependents who are eligible for coverage, but who have not enrolled, have the right to elect coverage during the plan year under two circumstances: • The employee’s or dependent’s state Medicaid or CHIP (Children's Health Insurance Program) coverage terminates because the individual cease to be eligible. • The employee or dependent becomes eligible for a CHIP premium assistance subsidy under state Medicaid or CHIP (Children's Health Insurance Program). Employees must request this special enrollment within 60 days of the loss of coverage and/or within 60 days of when eligibility is determined for the premium subsidy. PREMIUM ASSISTANCE U NDER MEDICAID AND CHILDREN’S HEALTH INSURANCE PROGRAM (CHIP) If you or your children are eligible for Medicaid or CHIP and you’re eligible for health coverage from your employer, your state may have a premium assistance program that can help pay for coverage, using funds from their

Medicaid or CHIP programs. If you or your children aren’t eligible for Medicaid or CHIP, you won’t be eligible for these premium assistance programs but you may be able to buy individual insurance coverage through the Health Insurance Marketplace. For more information, visit www.healthcare.gov. If you or your dependents are already enrolled in Medicaid or CHIP and you live in a State listed below, contact your State Medicaid or CHIP office to find out if premium assistance is available. If you or your dependents are NOT currently enrolled in Medicaid or CHIP, and you think you or any of your dependents might be eligible for either of these programs, contact your State Medicaid or CHIP office or dial 1-877-KIDS NOW or www.insurekidsnow.gov to find out how to apply. If you qualify, ask your state if it has a program that might help you pay the premiums for an employer-sponsored plan. If you or your dependents are eligible for premium assistance under Medicaid or CHIP, as well as eligible under your employer plan, your employer must allow you to enroll in your employer plan if you aren’t already enrolled. This is called a “special enrollment” opportunity, and you must request coverage within 60 days of being determined eligible for premium assistance. If you have questions about enrolling in your employer plan, contact the Department of Labor at www.askebsa.dol.gov or call 1-866-444-EBSA (3272). If you live in one of the following states, you may be eligible for assistance paying your employer health plan premiums. The following list of states is current as of July 31, 2023.

Contact your State for more information on eligibility –

ALABAMA – Medicaid Website: http://myalhipp.com/ Phone: 1-855-692-5447

ALASKA – Medicaid The AK Health Insurance Premium Payment Program Website: http://myakhipp.com/ Phone: 1-866-251-4861 Email: CustomerService@MyAKHIPP.com Medicaid Eligibility: https://health.alaska.gov/dpa/Pages/ default.aspx

ARKANSAS – Medicaid Website: http://myarhipp.com/ Phone: 1-855-MyARHIPP (855-692-7447)

CALIFORNIA – Medicaid Health Insurance Premium Payment (HIPP) Program Website: http://dhcs.ca.gov/hipp Phone: 1-916-445-8322/Fax: 1-916-440-5676 Email: hipp@dhcs.ca.gov

COLORADO – Health First Colorado (Colorado’s Medicaid Program) & Child Health Plan Plus (CHP+) Health First Colorado Website: https://www.healthfirstcolorado.com/ Health First Colorado Member Contact Center: 1-800-221-3943/State Relay 711 CHP+: https://hcpf.colorado.gov/child-health-plan-plus CHP+ Customer Service: 1-800-359-1991/State Relay 711. Health Insurance Buy-In Program (HIBI): https://www.mycohibi.com/ HIBI Customer Service: 1-855-692-6442

FLORIDA – Medicaid Website: https://www.flmedicaidtplrecovery.com/ flmedicaidtplrecovery.com/hipp/index.html Phone: 1-877-357-3268

GEORGIA – Medicaid GA HIPP Website: https://medicaid.georgia.gov/health-insurance

NEVADA – Medicaid Medicaid Website: http://dhcfp.nv.gov/ Medicaid Phone: 1-800-992-0900

WASHINGTON – Medicaid Website: https://www.hca.wa.gov/

premium-payment-program-hipp Phone: 1-678-564-1162, Press 1

Phone: 1-800-562-3022/ Website: https://dhhr.wv.gov/bms/ Toll free number for the HIPP program: 1-800-852-3345, ext. 5218

GA CHIPRA Website: https://medicaid.georgia.gov/programs/third party-liability/childrens-health-insurance-program-reauthorization-act -2009-chipra. Phone: 1-678-564-1162, Press 2 INDIANA – Medicaid Healthy Indiana Plan for low-income adults 19-64 Website: http://www.in.gov/fssa/hip/ Phone: 1-877-438-4479 All other Medicaid - Website: https://www.in.gov/medicaid/ Phone: 1-800-457-4584 IOWA – Medicaid and CHIP (Hawki) Medicaid Website: https://dhs.iowa.gov/ime/members Medicaid Phone: 1-800-338-8366 Hawki Website: http://dhs.iowa.gov/Hawki Hawki Phone: 1-800-257-8563 HIPP Website: https://dhs.iowa.gov/ime/members/medicaid-a-to-z/ hipp HIPP Phone: 1-888-346-9562 KENTUCKY – Medicaid Kentucky Integrated Health Insurance Premium Payment Program (KI-HIPP) Website: https://chfs.ky.gov/agencies/dms/member/Pages/ kihipp.aspx Phone: 1-855-459-6328 Email: KIHIPP.PROGRAM@ky.gov KCHIP Website: https://kidshealth.ky.gov/Pages/index.aspx Phone: 1-877-524-4718 Kentucky Medicaid Website: https://chfs.ky.gov/agencies/dms LOUISIANA – Medicaid Website: www.medicaid.la.gov or www.ldh.la.gov/lahipp Phone: 1-888-342-6207 (Medicaid hotline) or 1-855-618-5488 (LaHIPP) MAINE – Medicaid Enrollment Website: https://www.mymaineconnection.gov/benefits/ s/?language=en_US KANSAS – Medicaid Website: https://www.kancare.ks.gov/ Phone: 1-800-792-4884/HIPP Phone: 1-800-967-4660

NEW HAMPSHIRE – Medicaid Website: https://www.dhhs.nh.gov/programs-services/medicaid/ health-insurance-premium-program Phone: 1-603-271-5218 NEW JERSEY – Medicaid and CHIP Medicaid Website: http://www.state.nj.us/humanservices/dmahs/clients/medicaid/ Medicaid Phone: 1-609-631-2392 CHIP Website: http://www.njfamilycare.org/index.html CHIP Phone: 1-800-701-0710 NEW YORK – Medicaid Website: https://www.health.ny.gov/health_care/medicaid/ Phone: 1-800-541-2831

WEST VIRGINIA – Medicaid and CHIP http://mywvhipp.com/ Medicaid Phone: 1-304-558-1700 CHIP Toll-free phone: 1-855-MyWVHIPP (1-855-699-8447) WISCONSIN – Medicaid and CHIP Website: https://www.dhs.wisconsin.gov/badgercareplus/p 10095.htm Phone: 1-800-362-3002 WYOMING – Medicaid Website: https://health.wyo.gov/healthcarefin/medicaid/programs and-eligibility/ Phone: 1-800-251-1269 To see if any other states have added a premium assistance program since July 31, 2023, or for more information on special enrollment rights, contact either:

NORTH CAROLINA – Medicaid Website: https://medicaid.ncdhhs.gov/ Phone: 1-919-855-4100 NORTH DAKOTA – Medicaid Website: https://www.hhs.nd.gov/healthcare Phone: 1-844-854-4825 OKLAHOMA – Medicaid and CHIP Website: http://www.insureoklahoma.org Phone: 1-888-365-3742

U.S. Department of Labor Employee Benefits Security Administration www.dol.gov/agencies/ebsa 1-866-444-EBSA (3272) U.S. Department of Health and Human Services Centers for Medicare & Medicaid Services www.cms.hhs.gov 1-877-267-2323, Menu Option 4, Ext. 61565

OREGON – Medicaid Website: http://healthcare.oregon.gov/Pages/index.aspx Phone: 1-800-699-9075 PENNSYLVANIA – Medicaid and CHIP Website: https://www.dhs.pa.gov/Services/Assistance/Pages/HIPP Program.aspx Phone: 1-800-692-7462 CHIP Website: Children's Health Insurance Program (CHIP) (pa.gov) CHIP Phone: 1-800-986-KIDS (5437) RHODE ISLAND – Medicaid and CHIP Website: http://www.eohhs.ri.gov/ Phone: 1-855-697-4347, or 1-401-462-0311 (Direct RIte Share Line)

PAPERWORK REDUCTION ACT STATEMENT According to the Paperwork Reduction Act of 1995 (Pub. L. 104-13) (PRA), no persons are required to respond to a collection of information unless such collection displays a valid Office of Management and Budget (OMB) control number. The Department notes that a Federal agency cannot conduct or sponsor a collection of information unless it is approved by OMB under the PRA, and displays a currently valid OMB control number, and the public is not required to respond to a collection of information unless it displays a currently valid OMB control number. See 44 U.S.C. 3507. Also, notwithstanding any other provisions of law, no person shall be subject to penalty for failing to comply with a collection of information if the collection of information does not display a currently valid OMB control number. See 44 U.S.C. 3512. The public reporting burden for this collection of information is estimated to average approximately seven minutes per respondent. Interested parties are encouraged to send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the U.S. Department of Labor, Employee Benefits Security Administration, Office of Policy and Research, Attention: PRA Clearance Officer, 200 Constitution Avenue, N.W., Room N-5718, Washington, DC 20210 or email ebsa.opr@dol.gov and reference the OMB Control Number 1210-0137.

Phone: 1-800-442-6003/TTY: Maine relay 711 Private Health Insurance Premium Webpage: https://www.maine.gov/dhhs/ofi/applications-forms Phone: 1-800-977-6740 TTY: Maine relay 711 MASSACHUSETTS – Medicaid and CHIP Website: https://www.mass.gov/masshealth/pa Phone: 1-800-862-4840 TTY: 711 Email: masspremassistance@accenture.com

SOUTH CAROLINA – Medicaid Website: https://www.scdhhs.gov/Phone: 1-888-549-0820

SOUTH DAKOTA - Medicaid Website: http://dss.sd.gov/Phone: 1-888-828-0059

TEXAS – Medicaid Website: Health Insurance Premium Payment (HIPP) Program | Texas Health and Human Services Phone: 1-800-440-0493

MINNESOTA – Medicaid Website: https://mn.gov/dhs/people-we-serve/children-and families/health-care/health-care-programs/programs-and-services/ other-insurance.jsp Phone: 1-800-657-3739 MISSOURI – Medicaid Website: http://www.dss.mo.gov/mhd/participants/pages/hipp.htm Phone: 1-573-751-2005 MONTANA – Medicaid Website: http://dphhs.mt.gov/MontanaHealthcarePrograms/HIPP Phone: 1-800-694-3084/Email: HHSHIPPProgram@mt.gov

UTAH – Medicaid and CHIP Medicaid Website: https://medicaid.utah.gov/ CHIP Website: http://health.utah.gov/chip Phone: 1-877-543-7669

OMB Control Number 1210-0137 (expires 1/31/2026)

VERMONT – Medicaid Website: Health Insurance Premium Payment (HIPP) Program | Department of Vermont Health Access Phone: 1-800-250-8427 VIRGINIA – Medicaid and CHIP Website: https://coverva.dmas.virginia.gov/learn/premium assistance/famis-select https://coverva.dmas.virginia.gov/learn/premium-assistance/health insurance-premium-payment-hipp-programs Medicaid/CHIP Phone: 1-800-432-5924

NEBRASKA – Medicaid Website: http://www.ACCESSNebraska.ne.gov Phone: 1-855-632-7633/Lincoln: 1-402-473-7000/ Omaha: 1-402-595-1178

This benefit summary provides selected highlights of the employee benefits program available. It is not a legal document and shall not be construed as a guarantee of benefits nor of continued employment. All benefit plans are governed by master policies, contracts and plan documents. Any discrepancies between any information provided through this summary and the actual terms of such policies, contracts and plan documents shall be governed by the terms of such policies, contracts and plan documents. Our company reserves the right to amend, suspend or terminate any benefit plan, in whole or in part, at any time. The authority to make such changes rests with the Plan Administrator.

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