MMFS Employee Benefits Guide 2022

BENEFITS GUIDE

Table of Contents

Mary McDowell Friends School (MMFS) is pleased to introduce our employee benefits plan offerings for the 2021-22 school year.

MMFS will continue to partner with Oxford for our medical benefits and Guardian for our vision, dental, disability, and life & AD&D benefits in the upcoming plan year. Elections made during your enrollment period will be effective September 1, 2021 through August 31, 2022. Any changes you wish to make outside the new hire or open enrollment periods will require a qualifying life event. You have 30 days from a qualifying life event to make changes to your coverage. Some examples of qualifying events include, but are not limited to:

Welcome Letter 2

Enrollment Instructions 3

BenefitsVIP 4

Medical Benefits 5

H.S.A. Benefits 7

 Loss or gain of coverage through your spouse  Loss of eligibility for a covered dependent  Death of your covered spouse or child  Birth or adoption of a child  Marriage, divorce or legal separation  Switch from part-time to full-time employment

Dental Benefits 9

Vision Benefits 11

Parking & Transit Benefits 12

F.S.A. Benefits 13

Eligible individuals include employees working 24 hours weekly or more, their spouses (same and opposite sex), their domestic partners (same and opposite sex) and their dependent(s) up to the age of 26.

Employee Contributions 15

Life and AD&D Benefits 16

Employee Assistance Program 17

Disability Benefits 18

Voluntary Benefits 19

Additional Benefits 20

Carrier Contact Information 22

Annual Notices 24

QUESTIONS? Call BenefitsVIP at 866.286.5354

ENROLLMENT INSTRUCTIONS

Our benefit enrollment platform will provide information about our plans, assist you with comparing plans and guide you through the enrollment process in an intuitive, educational and fun way! Important information regarding your on-line enrollment: Before you begin enrolling in your benefits, make sure you have the following items:  Social Security Number (SSN) for all legal dependents you wish to enroll in any coverage.  Date of Birth (DOB) for all legal dependents you wish to enroll in any coverage  Beneficiary Information for Life Insurance, which includes your beneficiaries’ name(s), DOB(s) and SSN(s) Let ’ s Get Started! Log into your Mary McDowell Friends School Gmail account. From the homepage, locate the grid in the top right corner (#1 below), scroll to the bottom and click on the pink PlanSource button (#2 below).

2.

1.

Once you are logged in, click on the green benefits button to begin selecting the benefits you want to enroll in. Once you have completed your enrollment, you can download or email a copy of your elections.

With a mobile responsive design, you can now access your benefit information from any device 24/7

Have Questions? If you have any issues navigating the site or trouble logging in, contact your dedicated BenefitsVIP Team: Phone: 866-286-5354 Email: answers@benefitsvip.com Monday – Friday, 8:30 a.m. – 8:00 p.m. (ET)

QUESTIONS? Call BenefitsVIP at 866.286.5354

HELP WHEN YOU NEED IT

BenefitsVIP is our one-stop contact center staffed by seasoned benefits specialists meant to get you the answers you need via phone, chat, or email. If you have ever missed HR office hours at your division or simply need an answer to your benefits question after 5 p.m., BenefitsVIP is a phone call away! This team of employee benefit advocates is ready to help you and your family members resolve your benefits issues.

WEBSITE Stay informed with the latest health news,

biometric tools, calculators and information at benefitsvip.com !

For service that’s confidential and responsive, contact:

866.286.5354 Monday - Friday, 8:30am - 8:00pm (ET) Fax: 856.996.2755

BLOG HealthDiscovery.org is a lifestyle blog with wellness articles, tips, quizzes, recipes, and more!

Answers@benefitsvip.com

QUESTIONS ANSWERED HERE

COMPLETELY CONFIDENTIAL! Your dedicated BenefitsVIP advocates understands the school’s benefit plans and are able to answer questions and quickly resolve claims and eligibility issues. A majority of inquiries are resolved the same day and all calls adhere to privacy best practices.

BenefitsVIP.com

QUESTIONS? Call BenefitsVIP at 866.286.5354

MEDICAL BENEFITS

FREEDOM PPO PLAN

SWEAT EQUITY PROGRAM Eligible Oxford plan members can get reimbursed up to $200 in a six-month period. That’s right. Oxford will send you $200 for every six-month period that you are in the program. If your spouse participates, Oxford will send $100 for every six-month period provided you both meet the required goals and submit a completed reimbursement form. Please download the form here . RALLY PROGRAM Learning how to live healthy is easier when you’ve got some help to find your way. That’s what Rally® is all about. It’s a website and a user-friendly digital experience available through oxfordhealth.com ® that will engage you in a new way by using technology, gaming and social media to help support you on your health journey. REAL APPEAL Real Appeal ® is an online weight loss program available to you and eligible family members at no cost as part of your health plan benefits. With one-on-one coaching, digital tools and more, you’ll have the support you need to reach your personal goals.

BENEFIT

IN-NETWORK

OUT-OF-NETWORK

Annual Deductible

Individual: None Family: None Individual: $2,500 Family: $5,000

Individual: $2,000 Family: $4,000 Individual: $4,000 Family: $8,000

Out-of-Pocket Maximum

Coinsurance

100%

20%

Lifetime Maximum

Unlimited

Unlimited

Preventive Care Adult Preventive Care

Covered 100%

20% after deductible

Annual Well Woman Visit Adult Annual Physical Exam Well-Child Care

Outpatient Care Primary care physician office visits Specialist office visits Outpatient facility surgery

$25 $40 $250 copay per visit

20% after deductible 20% after deductible 20% after deductible

Outpatient Lab & X-Ray

Covered 100%

20% after deductible

Inpatient Care

$500 copay per admit

20% after deductible

Emergency Care Ambulance when medically necessary Hospital emergency room (waived if admitted) Urgent Care

Covered 100% $300 $40

Covered 100% $300 20% after deductible

Maternity Care Prenatal and Postnatal care Hospital services for mother and child

Covered 100% $500 copay per admit

20% after deductible 20% after deductible

Mental Health Inpatient Outpatient

$500 copay per admit $40

20% after deductible 20% after deductible

Prescription Drug Deductible (Tier 1 waived) Retail Pharmacy (30 day supply) Tier 1/Tier 2/Tier 3 Mail Order (90 day supply) Tier 1/Tier 2/Tier 3

$100

N/A

$15/$35/$75

In-Network Only

$37.50/$87.50/$187.50

In-Network Only

A full Summary of Benefits & Coverage for each plan can be found in the benefits portal and on the Intranet

For more Oxford information

Visit www.myuhc.com or call 800.444.6222

QUESTIONS? Call BenefitsVIP at 866.286.5354

MEDICAL BENEFITS

LIBERTY EPO

LIBERTY HDHP EPO

BENEFIT HIGHLIGHT! Oxford Virtual Visits When you need quick care, a Virtual Visit is a convenient way to see a doctor and get on the path to healthier faster. With Oxford’s Virtual Visits, you can see and talk to a doctor via mobile device or computer 24/7, no appointment needed. The doctor can give you a diagnosis and in some cases, even have a prescription delivered to your pharmacy, all in about 20 minutes. Each Virtual Visit costs you $10 . (Please note for members in the HDHP plan, you will need to satisfy the deductible before the $10 copay kicks in.)

BENEFIT

IN-NETWORK

IN-NETWORK

Annual Deductible

Individual: None Family: None Individual: $2,500 Family: $5,000

Individual: $2,000 Family: $4,000 Individual: $3,000 Family: $6,000

Out-of-Pocket Maximum

Coinsurance

100%

100%

Lifetime Maximum

Unlimited

Unlimited

Preventive Care Adult Preventive Care

Covered 100%

Covered 100%

Annual Well Woman Visit Adult Annual Physical Exam Well-Child Care

Outpatient Care Primary care physician office visits Specialist office visits Outpatient facility surgery

$25 $40 $250 copay per visit

100% after deductible 100% after deductible 100% after deductible

Outpatient Lab & X-Ray

Covered 100%

100% after deductible

Inpatient Care

$500 copay per admit

100% after deductible

Emergency Care Ambulance when medically necessary Hospital emergency room (waived if admitted) Urgent Care

Covered 100% $300 $40

Covered 100% 100% after deductible 100% after deductible

Maternity Care Prenatal and Postnatal care Hospital services for mother and child

Covered 100% $500 copay per admit

Covered 100% 100% after deductible

Mental Health Inpatient Outpatient

$500 copay per admit $40

100% after deductible 100% after deductible

To get started with a Virtual Visit, go to www.uhc.com/ virtualvisits .

Prescription Drug Deductible (Tier 1 waived) Retail Pharmacy (30 day supply) Tier 1/Tier 2/Tier 3 Mail Order (90 day supply) Tier 1/Tier 2/Tier 3

$100

Subject to Plan Deductible

$15/$35/$75

$15/$35/$75

$37.50/$87.50/$187.50

$37.50/$87.50/$187.50

A full Summary of Benefits & Coverage for each plan can be found in the benefits portal and on the Intranet

For more Oxford information

Visit www.myuhc.com or call 800.444.6222

QUESTIONS? Call BenefitsVIP at 866.286.5354

H.S.A. BENEFITS

H.S.A. ELECTION REQUIRMENTS

HEALTH SAVINGS ACCOUNT (HSA) The HSA is a savings account that works with a high deductible health plan such as the Oxford HDHP & HSA Liberty plan that you can use to pay for certain medical costs. CONTRIBUTIONS If you enroll in the Oxford HDHP & HSA Liberty Plan, MMFS will contribute $500 to your HSA on a semi-annual basis (September 30th and January 30th).

You can only open a health savings account if you elect the Oxford high deductible health plan. If you elect the Oxford high deductible health plan, your employer HSA contributions will be placed in a HealthEquity bank account on your behalf. Manage your HealthEquity account online at https://healthequity.com/hsa/

The total 2021 annual HSA contribution limit (Employer and Employee combined) is:

 $3,600 Single  $7,200 Family

If you are age 55 or over, there is an additional contribution of $1,000 allowed.

HSAs HAVE MANY BENEFITS LIKE:  The money you put in your HSA account is tax deductible  Funds in your account grow tax-free  You don’t pay taxes on withdrawals when paying for qualified medical expenses  Your HSA balance can be carried over year after year  You can invest your HSA if you have a balance of at least $2,000 HSAs CAN BE USED TO PAY FOR VARIOUS MEDICAL EXPENSES. FOR EXAMPLE:  Health insurance plan deductibles, copayments and coinsurance  Prescription drugs

 Dental services including braces, bridges and crowns  Vision care including glasses and Lasik eye surgery  Long-term care services  Medically related transportation and lodging

QUESTIONS? Call BenefitsVIP at 866.286.5354

H.S.A. BENEFITS

HEALTH SAVINGS ACCOUNT FAQ

What happens if I don ’ t use all the money in my HSA? Once the money is deposited into your account. It is yours until you spend it. Unused dollars earn interest. This gives you choice and flexibility because you have the option to pay for medical expenses out of your pocket and save for expenses in future years or even after retirement. Can I see out-of-network doctors? The dollars in your HSA can pay for any qualified medical, dental or vision expense, in– or out-of-network. However, only in-network doctors and facilities are covered, discounted and applied to your plan deductible. Will providers collect any money from me at the time of service? In most cases, your doctor will not collect any money from you at the time of your visit. Instead your doctor will send the claim directly to UnitedHealthcare. UnitedHealthcare will process the claim and send you an Explanation of Benefits that will tell you if your plan covers the services and if so, what part of the covered services your plan pays. What if my plan coverage ends? If plan coverage ends, you can elect to maintain the account and continue to use it for qualified expenses until your account is depleted. You also have the option to transfer the account to another qualified plan or receive a check for the account balance (deposit your dollars into another HSA to avoid possible penalties).

SOME OTHER HSA ELIGIBLE EXPENSES INCLUDE:

 Alcoholism Treatment  Ambulance Services

 Laboratory fees  Orthopedic Inserts  Pregnancy /Fertility tests  Smoking Cessation Programs

 Transplants  Vaccines  Allergy Pills  Cold/Flu Medicine  Pain Relievers  Menstrual Products

Monitors  Chiropractor  Contact Lens Solution  Dental Treatment  First Aid Kits  Hearing Aid Batteries

 Breast Pumps  Blood Glucose Monitors  Blood Pressure

QUESTIONS? Call BenefitsVIP at 866.286.5354

DENTAL BENEFITS

MMFS gives employees the choice between a Dental PPO and DHMO plan for their dental care. Read the chart below carefully before choosing the plan that best fits you and your dependents’ needs.

Option 1: With your DHMO plan, you enjoy negotiated discounts from our network dentists. You pay a fixed copay for each covered service. Out-of-network visits are not covered.

Option 2: With your PPO plan, you can visit any dentist; but you pay less out-of-pocket when you choose a PPO dentist.

PPO PLAN

DHMO PLAN

BENEFIT

IN-NETWORK

OUT-OF-NETWORK

IN-NETWORK

Individual:

$50

Individual:

$50

Individual:

$0 $0

Annual Deductible

Family:

$150

Family:

$150

Family:

$1,000

$1,000

Unlimited

Calendar Year Maximum

Preventive Care Oral Exam Exams Cleaning (1x every 6 months) Fluoride Treatment Sealants

100%

100%

Various copays apply

Basic Services Anesthesia/Fillings Repair & Maintenance of Bridgework Major Services Extractions & Other Oral Surgery Endodontic/ Root Canal Periodontics Gold/Porcelain Crowns Installation of Bridgework & Dentures

90% after deductible

80% after deductible

Various copays apply

60% after deductible

50% after deductible

Various copays apply

HOW TO FIND A DENTAL PROVIDER STEP 1: Visit www.GuardianAnytime.com STEP 2: Click on Find a Provider under My Account/Login STEP 3: Select PPO or DHMO under plan type STEP 4: Click Search by Location, Dentist Last Name or Office Name

You can find the current DHMO Fee Schedule here .

QUESTIONS? Call BenefitsVIP at 866.286.5354

DENTAL BENEFITS

SAVE YOUR DENTAL ANNUAL MAXIMUM DOLLARS FOR A TIME WHEN YOU NEED THEM MOST! Your Dental PPO plan comes with Maximum Rollover. With Maximum Rollover, Guardian will roll over a portion of your unused annual maximum into your personal Maximum Rollover Account (MRA). The MRA can be used in further years, if you reach the plan’s annual maximum. To qualify, you must submit a claim for covered services for which a benefit payment is issued, in excess of any deductible or copay, and you must not exceed the paid claims threshold during the benefit year. You and your insured dependents maintain separate MRAs based on your own claim activity. Each MRA may not exceed the MRA limit. You can view your annual MRA statement detailing your account and those of your dependents on www.GuardianAnytime.com .

IN–NETWORK ONLY MAXIMUM ROLLOVER AMOUNT

OUT-OF-NETWORK MAXIMUM ROLLOVER AMOUNT

MAXIMUM ROLLOVER ACCOUNT LIMIT

PLAN ANNUAL MAXIMUM

ROLLOVER THRESHOLD

$1,000

$500

$350

$250

$1,000

Maximum claims reimbursement

Claims amount that determines rollover eligibility

Additional dollars added to Plan Annual Maximum for future years if only In-Network providers were used during the benefit year

Additional dollars added to Plan Annual Maximum for future years if Out-of-Network providers were used during the benefit year

Plan Annual Maximum plus Maximum Rollover

HOW YOUR BENEFITS WORK: Year One: Jane starts with a $1,000 Plan Annual Maximum. She submits $150 in dental claims. Since she did not reach the $500 Threshold, she receives a $250 rollover that will be applied to Year Two.

Year Two: Jane now has an increased Plan Annual Maximum of $1,250. This year, she submits $50 in claims and receives an additional $250 rollover added to her Plan Annual Maximum. Year Three: Jane now has an increased Plan Annual Maximum of $1,500. This year, she submits $1,200 in claims. All claims are paid due to the amount accumulated in her Maximum Rollover Account. Year Four: Jane's Plan Annual Maximum is $1,300 ($1,000 Plan Annual Maximum + $300 remaining in her Maximum Rollover Account).

QUESTIONS? Call BenefitsVIP at 866.286.5354

VISION BENEFITS

Guardian is our vision carrier for the 2021-22 plan year. Guardian uses the Davis Vision Designer network, which offers members a wide variety of retail chain options to choose from for vision care in addition to high quality benefits. Please read below for more information on how they can help you and your family.

BENEFIT

IN-NETWORK

OUT-OF-NETWORK

$10

Up to $50 reimbursement

Eye Exam

$25

See below

Materials

Frequency Exam

12 months 12 months 12 months

Lenses Frames

$130 Allowance + 20% off balance

Frames

Up to $48 reimbursement

Lenses Single Vision Lenses Bifocal Vision Lenses Trifocal Vision Lenses

Covered 100% after $25 copay Covered 100% after $25 copay Covered 100% after $25 copay

Up to $48 reimbursement Up to $67 reimbursement Up to $86 reimbursement

Contact Lenses Conventional

$130 allowance + 15% off balance $130 allowance + 15% off balance Covered 100% after $25 copay

Up to $105 reimbursement Up to $105 reimbursement Up to $210 reimbursement

Disposable Therapeutic

SOME PARTICIPATING RETAIL CHAINS:

CostCo JcPenney Pearle Vision Sam’s Club Target Visionworks Walmart

QUESTIONS? Call BenefitsVIP at 866.286.5354

PARKING & TRANSIT BENEFITS

There are two different types of Commuter Accounts – Transit and Parking. You may participate in one or both accounts. The accounts are separate and you cannot transfer money between these accounts.

By taking advantage of the parking plan, you can make your work place commute and parking more affordable and increase your take home income. You may claim expenses for a parking space close to your office or for a parking space from which you commute by public transit, van or car pool. The parking space cannot be near your place of residence.

Monthly elections for parking and transit will be placed on one commuter card.

MONTHLY CONTRIBUTION LIMITS Up to $270 on a pre-tax basis Any amount above $270 will be deducted post-tax Up to $270 on a pre-tax basis Any amount above $270 will be deducted after-tax

ACCOUNT TYPE

ELIGIBLE EXPENSES

 Train, bus and subway passes  Metrocards

Transit Account

 Parking at or near your work location or mass transit (used for commuting)

Parking Account

CHANGING YOUR ELECTION Changes to your parking and transit account can be made by the 7th of each month for the following benefit month. For example, if you currently ride your bike to work and move to Queens on September 1, you can enroll in the transit account on or by September 7th and your benefit will be effective October first. Applicable transit cards or passes will be mailed to employees by the 23rd of the month prior to the effective date.

To register for this benefit, please visit the Health Equity Registration portal . To change your elections or manage your account, please visit the participant site for more details. If you have any enrollment or registration issues please contact your HR Manager.

QUESTIONS? Call BenefitsVIP at 866.286.5354

F.S.A BENEFITS

FLEXIBLE SPENDING ACCOUNT (FSA)

The Flexible Spending Account allows employees to set aside up to $2,750 a year towards qualified medical, dental or vision expenses including deductibles, copays and coinsurance that are not covered through your health insurance plan. Your Health Care FSA is a great way to save money while keeping you and your family healthy. You may use tax-free funds to pay for out-of-pocket medical, dental, and vision care expenses as outlined below. Limited Purpose FSA If you enroll in the High Deductible Health with HSA Plan, you can also enroll in a “limited FSA” plan. This FSA plan is limited to dental and vision services only. Employees can set aside up to $2,750 in a pre- tax account to pay for qualified expenses. Dependent Care FSA A Dependent Care Account enables working parents to pay the cost of child or elder care services using pre-tax dollars. You may use the Dependent Care FSA for reimbursement of the cost of dependent care, while you and your spouse are at work. Employees can set aside up to $5,000 in a pre-tax account to pay for qualified expenses. *** A temporary COVID provision has been added to our plan allowing employees to enroll up to $10,500 for Calendar Year 2021. *** Anyone that wants to establish a FSA should plan carefully. Up to $500 will rollover from year-to-year, but the IRS requires that individuals forfeit any remaining funds left in their FSA. Think about all the possible medical and dental expenses that you may incur during the year. The FSA 2021-22 plan year runs from September 1, 2021 through August 31, 2022. *** Due to recent legislative changes Consolidated Appropriations Act 2021, in response to the challenges of the past year caused by the pandemic, Mary McDowell Friends School has the option to allow participants to roll over all unused balances in health and dependent care flexible spending accounts (FSAs and DCAs) from 2020 to 2021. *** PLAN CAREFULLY

Enrollments can be made via Plansource . To manage your current account(s), submit claims, or review balances, please login to WageWorks .

QUESTIONS? Call BenefitsVIP at 866.286.5354

F.S.A. BENEFITS

ANNUAL CONTRIBUTION LIMITS Maximum contribution is $2,750 for the 2021-2022 plan year

EXAMPLES OF ELIGIBLE EXPENSES

ACCOUNT TYPE

ACCESS TO FUNDS

PRE-TAX BENEFIT

 Medical Plan Deductibles  Prescription Drugs  Vision Exams/Glasses/ Contacts  Laser Eye Surgery

Allows immediate access to the entire election amount from the 1st payday of the plan year before all scheduled contributions have been made Allows immediate access to the entire election amount from the 1st payday of the plan year before all scheduled contributions have been made

Save 20% - 40% on your health care expenses Save on eligible purchases not covered by insurance Reduce your taxable income Save 20% - 40% on your dental or vision care expenses only Save on eligible purchases not covered by insurance Reduce your taxable income

Health Care FSA

 Dental and Vision expenses only

Employees enrolled in the HDHP/HSA may also contribute money to their Limited Purpose FSA. Maximum contribution is $2,750 for the 2021-2022 plan year Maximum contribution is $10,500 for the 2021-2022 plan year

Limited Purpose FSA (for employees who participate in the HDHP Plan)

 Child care  Nursery school  Before & after school care  Adult care  In-home dependent care  Day camp

You will be able to submit claims up to your year-to-date accumulated amount in your account (You will only be reimbursed based on your accumulated contribution amounts)

Save 20% - 40% on your dependent care expenses Reduce your taxable income

Dependent Care FSA

To manage your flex accounts, log-in to the Health Equity WageWorks website.

QUESTIONS? Call BenefitsVIP at 866.286.5354

EMPLOYEE CONTRIBUTIONS

SEMI-MONTHLY EMPLOYEE CONTRIBUTIONS

OXFORD MEDICAL PLANS

EMPLOYEE

EMPLOYEE + SPOUSE

EMPLOYEE + CHILD(REN)

FAMILY

Freedom Access PPO

$206.75

$434.17

$361.80

$630.57

$128.81

$270.50

$225.42

$392.87

Liberty EPO

Liberty EPO H.S.A

$90.38

$189.79

$158.16

$275.65

GUARDIAN DENTAL PLANS

EMPLOYEE

EMPLOYEE + SPOUSE

EMPLOYEE + CHILD(REN)

FAMILY

Preferred PPO

$8.06

$16.20

$17.93

$26.10

Managed Dental DMO

$3.23

$6.36

$6.81

$9.95

GUARDIAN VISION PLAN

EMPLOYEE

EMPLOYEE + SPOUSE

EMPLOYEE + CHILD(REN)

FAMILY

$0.86

$1.62

$1.71

$2.35

Vision

BI-WEEKLY EMPLOYEE CONTRIBUTIONS

OXFORD MEDICAL PLANS

EMPLOYEE

EMPLOYEE + SPOUSE

EMPLOYEE + CHILD(REN)

FAMILY

Freedom Access PPO

$190.84

$400.77

$333.97

$582.06

$118.90

$249.69

$208.08

$362.64

Liberty EPO

Liberty EPO H.S.A

$83.42

$175.19

$145.99

$254.45

GUARDIAN DENTAL PLANS

EMPLOYEE

EMPLOYEE + SPOUSE

EMPLOYEE + CHILD(REN)

FAMILY

Preferred PPO

$7.44

$14.95

$16.55

$24.09

Managed Dental DMO

$2.98

$5.87

$6.29

$9.18

GUARDIAN VISION PLAN

EMPLOYEE

EMPLOYEE + SPOUSE

EMPLOYEE + CHILD(REN)

FAMILY

$0.79

$1.50

$1.58

$2.17

Vision

QUESTIONS? Call BenefitsVIP at 866.286.5354

LIFE AND AD&D BENEFITS

BASIC LIFE AND AD&D MMFS provides eligible employees with Basic Life and Accidental Death & Dismemberment (AD&D) coverage at no cost to you. Basic life insurance coverage provides financial protection in the event of your death. AD&D insurance coverage provides protection in the event of accidental death, loss of hands, feet and/or vision. The benefit is two times your annual salary to a $600,000 maximum. The AD&D benefit is equal to the life benefit. Basic life insurance becomes a taxable benefit when the coverage amount exceeds $50,000 . VOLUNTARY TERM LIFE AND AD&D You can purchase voluntary life and AD&D coverage for yourself and your eligible dependents. You must elect coverage for yourself in order to elect coverage for any dependents. Evidence of Insurability will be required for amounts over the Guaranteed Issue Amount and for employees enrolling outside of the initial enrollment period.

Please note, if you had voluntary life and AD&D last year, you can increase coverage up to $50,000. However you cannot exceed the Guaranteed Issue Amount in doing so.

SUPPLEMENTAL LIFE/AD&D

BENEFIT AMOUNT

GUARANTEED ISSUE AMOUNT

$10,000 increments to $250,000 maximum*

$150,000

Employee Coverage

$5,000 increments to $250,000

$25,000

Spousal Coverage

(not to exceed employee amount, employee must elect coverage in order to have spousal)

Flat amount of $10,000

$10,000

Child Coverage to Age 19 or 26 if student

*Amount reduced by 50% at Age 70

BENEFICIARY DESIGNATION You will need to designate a beneficiary for your basic life, supplemental life and AD&D insurance coverage. You may name more than one beneficiary. You will need to indicate the percentage each beneficiary should receive; the percentages must total 100%. Be sure to keep your beneficiary designations up-to-date.

QUESTIONS? Call BenefitsVIP at 866.286.5354

EMPLOYEE ASSISTANCE PROGRAM

EMPLOYEE ASSISTANCE PROGRAM (EAP) The Employee Assistance Program is provided at no extra cost to you as part of your Guardian Ancillary Benefits. This EAP is designed to help you achieve work/life balance for the challenges you face on an everyday basis as well as for more serious issues involving emotional and physical well-being. Guardian’s comprehensive WorkLifeMatters Employee Assistance Program is available through Integrated Behavioral Health and provides you and your family members with confidential, personal and web-based support on a wide variety of important and relevant topics. Some of the key services provided are:  Telephonic Counseling — Unlimited, 24/7 consultations with master’s and doctoral-level counselors  Face-to-face Counseling — Up to 3 visits per employee/household member per year  Bereavement — Support available through telephonic or face-to-face sessions; online resources available on the EAP website  Tobacco Cessation Coaching — Unlimited telephonic support and resources to assist with tobacco cessation; refers members directly to the American Lung Association’s Quit program  EAP Website Resources — Comprehensive website that includes articles, videos, FAQs, etc. additionally, individuals can chat online with an EAP Consultant or email an EAP Counselor through the website  College Planning Resources — Expert assistance in finding the right college that fits your child academically, socially and financially, provided by College Planning USA

www.Ibhworklife.com User Name: Matters Password: wlm70101 Phone: 800.386.7055 Available 24 hours a day, 7 days a week

QUESTIONS? Call BenefitsVIP at 866.286.5354

DISABILITY BENEFITS

SHORT TERM DISABILITY (NYDBL) DBL benefits can protect you in the event of a disabling accident or sickness. DBL will provide income replacement of 50% of your weekly earnings to a maximum benefit of $170 for 26 weeks. Benefits begin on the 8th calendar day for injury or illness. PAID FAMILY LEAVE (NYPFL) NY Paid Family Leave is an employee-funded benefit that provides income and job protection for you while you care for a sick family member, bond with a newborn or adopted child, or to assist loved ones when a family member is deployed abroad on active military service. The maximum benefit is capped at 60% of the current Average NY State Weekly Wage, benefits increase through 2021. LONG TERM DISABILITY (LTD) MMFS provides eligible employees with long term disability (LTD) insurance for extended disability periods beyond 180 days. Approved disability claims will provide income replacement of the lesser of 60 % of your monthly earnings to a maximum benefit of $10,000.

BENEFIT

NYPFL

NYDBL

LTD

67% of weekly earnings

50% of weekly earnings

60% of Pre-disability earnings

Benefit Percentage

Monthly Maximum Benefit

$971.61

$170

$10,000

0 days

7 days

180 days

Elimination Period

12 weeks

26 weeks

SSNRA

Maximum Duration of Benefit

To determine whether you are eligible for these disability benefits, please refer to the employment policy manual.

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VOLUNTARY BENEFITS

CANCER CARE The plan pays a cash benefit upon initial diagnosis of a covered cancer, with a variety of other benefits payable throughout cancer treatment. You can use these cash benefits to help pay out-of-pocket medical expenses, the rent or mortgage, groceries, or utility bills—the choice is yours. ACCIDENT INDEMNITY Accidents happen. Aflac pays cash benefits directly to you to help with things like out-of-pocket medical expenses, the rent or mortgage, groceries, or utility bills. Helping you with the medical expenses that major medical doesn’t cover and more . HOSPITAL INDEMNITY Aflac Choice offers our best selection of hospital-related benefits to help with the expenses not covered by major medical, which can help prevent high deductibles and out-of-pocket expenses from derailing your life plans. VOLUNTARY SHORT TERM DISABILITY Aflac’s short term disability insurance policy can help make the difference if you become disabled. The difference that means you will still have a source of income and you will know Aflac is helping take care of your bills while you’re taking care of yourself. Enrollment is completed with Alvaro Montenegro, MMFS AFLAC Agent. You can email him directly at alvaro_montenegro@us.aflac.com to set up an info session or ask questions about rates or specific plan details. If you choose to enroll, Alvaro will help you after your initial phone conversation.

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ADDITIONAL BENEFITS

HEALTH & WELLNESS BENEFITS MMFS reimburses the costs for eligible health club memberships or wellness classes up to $400 per academic year for expenses incurred between September and May. Please refer to the employee policy manual for more information. RETIREMENT BENEFITS MMFS offers a retirement plan through TIAA. Under the plan, employees can make elective deferrals (contributions) and, when eligible, receive employer contributions.  Elective Deferrals : Employees may contribute to a pre-tax 403(b)retirement savings plan up to the maximum allowed by law. Eligible employees are able to participate in the plan on their first day of employment.  Employer Contributions: Upon eligibility, contributions vest immediately and are made based on the following schedule: • At the start of 3rd year of employment: 6% of an employee’s annual compensation • At the start of 8th year of employment: 8% of an employee’s annual compensation • At the start of 13th year and up of employment: 10% of an employee’s annual compensation PROFESSIONAL DEVELOPMENT & TUITION ASSISTANCE Eligible employees receive up to $300 annually in their first three years and $500 there after for professional development courses. The school offers two tuition assistance programs for eligible employees and their dependents after five continuous years of service; employees can earn up to $5,000 annually. LONGEVITY BONUS MMFS rewards employees for completing various milestones of employment. Each employee will receive a bonus at the end of the milestone year beginning in year five. PAID PARENTAL LEAVE Eligible employees receive up to 6 weeks of parental leave to bond with their child within 12 months of the child's birth, adoption, or foster placement. CITIBIKE MEMBERSHIP MMFS is making it easier to get to work by contributing to the cost of your Citi Bike Annual Membership. If you already have a Citi Bike membership, you should continue riding using your current membership. When you are ready to renew, eligible employees can take advantage of our discounted rate. Visit www.citibike.com/mmfs for more information. Detailed enrollment instructions can be found on the intranet.

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ADDITIONAL BENEFITS CONT’D

COMPUTER ADVANCE BENEFIT MMFS offers interest-free advances to three teachers and one administrator or staff member to purchase a personal computer. The maximum amount of this advance is $2,000. NY'S 529 COLLEGE SAVINGS PROGRAM A 529 college savings plan is an investment program that can be used for qualified education expenses, such as tuition, room and board, books, and computer-related expenses. Employees can contribute to this account on a post-tax basis via payroll deduction. Visit nysaves.org for more information on this program or to open an account. WORKERS' COMPENSATION & UNEMPLOYMENT INSURANCE MMFS pays 100% of the cost for unemployment and workers' compensation insurance for all eligible employees. PAID TIME OFF The school provides regular employees with sick and personal time benefits. The amount of time off to which an employee becomes entitled is determined by the employee’s length of service as of their employment anniversary date. Time off accrues on the 30th of each month as follows: Sick Faculty earn seven sick days in their first year of employment and ten days thereafter. Staff earn ten sick days in their first year of employment and twelve days thereafter; part-time employees earn sick days on a prorated basis.  Employees will accrue sick time on a monthly basis up to the annual maximum.  Employees may carry over up to seven days of accrued time annually up to a maximum of 70 days. Personal Faculty earn two personal days annually; staff earn three personal days annually. Part-time employees earn personal days on a prorated basis rounded to the nearest half-day  Employees earn one personal day every three months at the start of their employment period.

Vacation Eligible staff can earn up to 25 days of vacation annually; days are based on your length of service and employment group.

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CARRIER CONTACT INFO

PLAN

POLICY #

PHONE NUMBER

EMAIL/ WEBSITE

BenefitsVIP Employee Benefits Advocate

866.286.5354

Answers@benefitsvip.com

N/A

Oxford Medical/Rx

1320818

800.444.6222

www.myuhc.com

HealthEquity H.S.A.

7788948

866.346.5800

https://healthequity.com/hsa/

Guardian Dental Guardian Vision

425874

888.482.7342

www.GuardianAnytime.com

425874

888.482.7342

www.GuardianAnytime.com

WageWorks F.S.A. Commuter Benefit Guardian Basic Life/AD&D Voluntary LTD

https://participant.wageworks.com/ home.aspx?ReturnUrl=%2F

45564

877.924.3967

425874

888.482.7342

www.GuardianAnytime.com

AFLAC Cancer Care

NB950

Accident Indemnity Hospital Indemnity Voluntary STD

800.992.3522

alvaro_montenegro@us.aflac.com

Guardian Employee Assistance Program

800.386.7055

www.Ibhworklife.com

425874

NY 529 College Savings Program

ny529@nysaves.org nysaves.org

-

877.NYSAVES (877.697.2837)

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NOTES

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NEWBORNS’ ANDMOTHERS’ 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). THEWOMEN’S HEALTH AND CANCER RIGHTS ACT OF 1998 (WHCRA, ALSO KNOWN AS JANET’S LAW) 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. QUALIFIEDMEDICAL 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. COVERAGE EXTENSION RIGHTS UNDER THE UNIFORMEDSERVICES EMPLOYMENT AND REEMPLOYMENT RIGHTS ACT (USERRA) 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 absence from (or other change in enrollment) a postsecondary educational institution (college or university) because of a serious illness or injury, while covered

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 INFORMATIONNON- 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 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. covered employer lawfully (or inadvertently) acquires genetic 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 CONSOLIDATED OMNIBUS BUDGET RECONCILIATION ACT (COBRA)

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. PREMIUMASSISTANCE UNDERMEDICAID 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, youwon’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 inMedicaid 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 inMedicaid 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 NOWor 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 January 31, 2021. Contact your State for more information on eligibility:

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:

ALABAMA: Medicaid Website: http://myalhipp.com/ Phone: 855.692.5447 ALASKA: Medicaid The AK Health Insurance Premium Payment Program

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.

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ANNUAL NOTICES

Phone: 877.524.4718 Kentucky Medicaid Website: https://chfs.ky.gov

WISCONSIN: Medicaid and CHIP Website: https:// www.dhs.wisconsin.gov/ publications/p1/p10095.pdf Phone: 800.362.3002

Website: http://myakhipp.com/ Phone: 866.251.4861 Email: CustomerService@MyAKHIPP.com Medicaid Eligibility: http://dhss.alaska.gov/dpa/Pages/ medicaid/default.aspx ARKANSAS: Medicaid Website: http://myarhipp.com/ Phone: 855.MyARHIPP (855.692.7447) 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: 800.221.3943 / State Relay 711 CHP+: https://www.colorado.gov/ pacific/hcpf/childhealth-plan-plus CHP+ Customer Service: 800.359.1991/ State Relay 711 FLORIDA: Medicaid Website: http:// flmedicaidtplrecovery.com/hipp/ Phone: 877.357.3268 INDIANA: Medicaid Healthy Indiana Plan for low-income adults 19-64 Website: http://www.in.gov/fssa/hip/ Phone: 877.438.4479 All other Medicaid Website: http:// www.indianamedicaid.com Phone 800.403.0864 IOWA: Medicaid Medicaid Website: https://dhs.iowa.gov/ime/members Medicaid Phone: 800.338.8366 Hawki Website: KANSAS: Medicaid Website: http://www.kdheks.gov/hcf/ default.htm Phone: 800.792.4884 KENTUCKY: Kentucky Integrated Health Insurance Premium Payment Program (KI-HIPP) Website: https://chfs.ky.gov/ agencies/dms/member/Pages/ kihipp.aspx Phone: 855.459.6328 Email: KIHIPP.PROGRAM@ky.gov KCHIP Website: https://kidshealth.ky.gov/ Pages/index.aspx http://dhs.iowa.gov/Hawki Hawki Phone: 800.257.8563 GEORGIA: Medicaid Website: https:// medicaid.georgia.gov/health- insurancepremium-payment- program-hipp Phone: 678.564.1162 ext 2131

Website: https://dma.ncdhhs.gov Phone: 919.855.4100

LOUISIANA: Medicaid Website: www.medicaid.la.gov or www.ldh.la.gov/lahipp Phone: 888.342.6207 (Medicaid hotline) or 855.618.5488 (LaHIPP)

NORTH DAKOTA: Medicaid Website: http://www.nd.gov/dhs/ services/medicalserv/medicaid/ Phone: 844.854.4825 OKLAHOMA: Medicaid and CHIP Website: http:// www.insureoklahoma.org Phone: 888.365.3742 OREGON: Medicaid Website: http:// healthcare.oregon.gov/Pages/ index.aspx or http:// www.oregonhealthcare.gov/index- es.html Phone: 800.699.9075 PENNSYLVANIA: Medicaid Website: https://www.dhs.pa.gov/ providers/Providers/Pages/ Medical /HIPP-Program.aspx Phone: 800.692.7462 RHODE ISLAND: Medicaid Website: http://www.eohhs.ri.gov/ Phone: 855.697.4347 , or 401.462.0311 (Direct RIte Share Line) SOUTH CAROLINA: Medicaid Website: https://www.scdhhs.gov Phone: 888.549.0820 TEXAS: Medicaid Website: http://gethipptexas.com/ Phone: 800.440.0493 UTAH: Medicaid and CHIP Medicaid Website: https:// medicaid.utah.gov/ CHIP Website: http://health.utah.gov/chip Phone: 877.543.7669 VERMONT: Medicaid Website: http:// www.greenmountaincare.org/ Phone: 800.250.8427 VIRGINIA: Medicaid and CHIP Website: https://www.coverva.org/hipp/ Medicaid Phone: 800.432.5924 CHIP Phone: 855.242.8282 WASHINGTON: Medicaid Website: https://www.hca.wa.gov/ Phone: 800.562.3022 WEST VIRGINIA: Medicaid Website: http://mywvhipp.com/ Toll-free phone: 855.MyWVHIPP ( 855.699.8447 ) SOUTH DAKOTA: Medicaid Website: http://dss.sd.gov Phone: 888.828.0059

WYOMING: Medicaid Website: https://wyequalitycare.acs-inc.com/ Phone: 307.777.7531 To see if any other states have added a premium assistance program since January 31, 2021, or for more information on special enrollment rights, contact either: U.S. Department of Labor Employee Benefits Security Administration www.dol.gov/agencies/ebsa 866.444.EBSA (3272) U.S. Department of Health and Human Services Centers for Medicare & Medicaid Services www.cms.hhs.gov 877.267.2323 , Menu Option 4, Ext. 61565 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 20220 or email ebsa.opr@dol.gov and reference the OMB Control Number 1210-0137.

MAINE: Medicaid Website: http://www.maine.gov/dhhs/ofi/

publicassistance/index.html Phone: 800.442.6003 TTY: Maine relay 711

MASSACHUSETTS: Medicaid and CHIP Website: http://www.mass.gov/ eohhs/gov/departments/masshealth/ Phone: 800.862.4840 MINNESOTA: Medicaid https://mn.gov/dhs/people-we-serve/ children-andfamilies/health-care/health- care-programs/programs-andservices/ medical-assistance.jsp [Under ELIGIBILITY tab, see “what if I have other MISSOURI: Medicaid Website: http://www.dss.mo.gov/ mhd/participants/pages/hipp.htm Phone: 573.751.2005 MONTANA: Medicaid Website: http://dphhs.mt.gov/ MontanaHealthcarePrograms/HIPP Phone: 800.694.3084 www.ACCESSNebraska.ne.gov Phone: 855.632.7633 Lincoln: 402.473.7000 Omaha: 402.595.1178 NEVADA: Medicaid Medicaid Website: http://dhcfp.nv.gov Medicaid Phone: 800.992.0900 NEW HAMPSHIRE: Medicaid Website: https://www.dhhs.nh.gov/ oii/hipp.htm Phone: 603.271.5218 Toll free number for the HIPP program: 800.852.3345 , ext 5218 NEW JERSEY: Medicaid and CHIP Medicaid Website: http:// www.state.nj.us/humanservices/ dmahs/ clients/medicaid/ Medicaid Phone: 609.631.2392 CHIP Website: http:// www.njfamilycare.org/index.html CHIP Phone: 800.701.0710 NEW YORK: Medicaid Website: https://www.health.ny.gov/ health_care/medicaid/ Phone: 800.541.2831 health insurance?”] Phone: 800.657.3739 NEBRASKA: Medicaid Website: http://

OMB Control Number 1210-0137 (expires 1/31/2023)

NORTH CAROLINA: Medicaid

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