Abrh 2018 enrollment guide hourly d3 101617

With Medical Coverage | FSA (Flexible Spending Account) | Two Dental Plan Options | Vision | 401(k) | Life Insurance | Accident Insurance | Critical Illness Insurance | Coverage Options for Part-time Team Members | Three Medical Plan Options | Medical Rates Start at $5/week | NEW! Virtual Medicine | Value Plan offers HSA (Health Savings Account) | Prescription Drug Included With Medical Coverage | FSA (Flexible Spending Account) | Two Dental Plan Options | Vision | 401(k) | Life Insurance | Accident Insurance | Critical Illness Insurance | Coverage Options for Part-time Team Members | Three Medical Plan Options | Medical Rates Start at $5/week | NEW! Virtual Medicine | Value Plan offers HSA (Health Savings Account) | Prescription Drug Included With Medical Coverage| FSA (Flexible Spending Account) | Two Dental Plan Options | Vision | 401(k) | Life Insurance | Accident Insurance | Critical Illness Insurance | Coverage Options for Part-time Team Members | Three Medical Plan Options | Medical Rates Start at $5/week | NEW! Virtual Medicine | Value Plan offers HSA (Health Savings Account) | Prescription Drug Included With Medical Coverage| FSA (Flexible Spending Account) | Two Dental Plan Options | Vision | 401(k) | Life Insurance | Accident Insurance | Critical Illness Insurance | Coverage Options for Part-time Team Members | Three Medical Plan Options | Medical Rates Start at $5/week | NEW! Virtual Medicine | Value Plan offers HSA (Health Savings Account) | Prescription Drug Included With Medical Coverage | FSA (Flexible Spending Account) | Two Dental Plan Options | Vision | 401(k) | Life Insurance | Accident Insurance | Critical Illness Insurance | Coverage Options for Part-time Team Members Three Medical Plan Options | Medical Rates Start at $5/week | NEW! Virtual Medicine | Value Plan offers HSA (Health Savings Account) | Prescription Drug Included With Medical Coverage | FSA (Flexible Spending Account) | Two Dental Plan Options | Vision | 401(k) | Life Insurance | Accident Insurance | Critical Illness Insurance | Coverage Options for Part-time Team Members | Three Medical Plan Options | Medical Rates Start at $5/week | NEW! Virtual Medicine | Value Plan offers HSA (Health Savings Account) | Prescription Drug Included With Medical Coverage | FSA (Flexible Spending Account) | Two Dental Plan Options | Vision | 401(k) | Life Insurance | Accident Insurance | Critical Illness Insurance | Coverage Options for Part-time Team Members | Three Medical Plan Options | Medical Rates Start at $5/week | NEW! Virtual Medicine | Value Plan offers HSA (Health Savings Account) | Prescription Drug Included With Medical Coverage| FSA (Flexible Spending Account) | Two Dental Plan Options | Vision | 401(k) | Life Insurance | Accident Insurance | Critical Illness Insurance | Coverage Options for Part-time Team Members | Three Medical Plan Options | Medical Rates Start at $5/week | NEW! Virtual Medicine | Value Plan offers HSA (Health Savings Account) | Prescription Drug Included With Medical Coverage | FSA (Flexible Spending Account) | Two Dental Plan Options | Vision | 401(k) | Life Insurance | Accident Insurance | Critical Illness Insurance | Coverage Options for Part-time Team Members | Three Medical Plan Options | Medical Rates Start at $5/week | NEW! Virtual Medicine | Value Plan offers HSA (Health Savings Account) | Prescription Drug Included With Medical Coverage | FSA (Flexible Spending Account) | Two Dental Plan Options | Vision | 401(k) | Life Insurance | Accident Insurance | Critical Illness Insurance | Coverage Options for Part-time Team Members | Three Medical Plan Options | Medical Rates Start at $5/week | NEW! Virtual Medicine | Value Plan offers | Three Medical Plan Options | Medical Rates Start at $5/week | NEW! Virtual For Full-time Hourly Team Members Medicine | Value Plan offers HSA (Health Savings Account) | Prescription Drug Included With Medical Coverage| FSA (Flexible Spending Account) | Two Dental Plan Options | Vision | 401(k) | Life Insurance | Accident Insurance | Critical Illness Insurance | Coverage Options for Part-time Team Members | Three Medical Plan Options | Medical Rates Start at $5/week | NEW! Virtual Medicine | Value Plan offers HSA (Health Savings Account) | Prescription Drug Included With Medical Coverage| FSA (Flexible Spending Account) | Two Dental Plan Options | Vision | 401(k) | Life Insurance | Accident Insurance | Critical Illness Insurance | Coverage Options for Part-time Team Members | Three Medical Plan Options | Medical Rates Start at $5/week | Two Dental Plan Options | Vision | 401(k) | Life Insurance | Accident Insurance | Critical Illness Insurance | Coverage Options for Part-time Team Members | Three Medical Plan Options | Medical Rates Start at $5/week | NEW! Virtual Medicine | Value Plan offers HSA (Health Savings Account) | Prescription Drug Included With Medical Coverage| FSA (Flexible Spending Account) | Two Dental Plan Options | Vision | 401(k) | Life Insurance | Accident Insurance | Critical Illness Insurance | Coverage Options for Part-time Team Members | Three Medical Plan Options | Medical Rates Start at $5/ week | NEW! Virtual Medicine | Value Plan offers HSA (Health Savings Account) | Prescription Drug Included With Medical Coverage | FSA (Flexible Spending Account) | Two Dental Plan Options | Vision | 401(k) | Life Insurance | Accident Insurance | Critical Illness Insurance | Coverage Options for Part-time Team Members | Three Medical Plan Options | Medical Rates Start at $5/week | NEW! Virtual Medicine | Value Plan offers | | Life Insurance | Accident Insurance | Critical Illness Insurance | Coverage Options for Part-time Team Members | Three Medical Plan Options | Medical Rates Start at $5/week | NEW! Virtual Medicine | Value Plan offers HSA (Health Savings Account) | Prescription Drug Included With Medical Coverage | FSA (Flexible Spending Account) | Two Dental Plan Options | Vision | 401(k) | Life Insurance | Accident Insurance | Critical Illness Insurance | Coverage Options for Part-time Team Members | Three Medical Plan Options | Coverage Options for Part-time Team Members v.1-09-17 Plan Options | Medical Rates Start at $5/week | NEW! Virtual Medicine | Value Plan offers HSA (Health Savings Account) | Prescription Drug Included | Three Medical With Medical Coverage| FSA (Flexible Spending Account) | Two Dental Plan Options | 401(k) | Life Insurance | Accident Insurance | Medical Rates Start at $5/week | NEW!

2018

BeneďŹ ts Enrollment Guide

Up Front Look for Links The blue links connect to relevant websites. Or, you may copy and paste them into your browser to connect with the information.

The company reserves the right, in its sole discretion, to terminate, suspend, withdraw, amend or modify the plans in whole or in part at any time, including, without limitation, the right to amend the plans to require participant contributions or to increase the amount of contributions that participants must make to the plans. If there is a disagreement between this summary and the plan documents, the plan documents always govern.

This Employee Benefits Guide is intended to only provide a high-level overview of the benefits program that is available to you. It is important that you not only read this entire Guide but also the Summary Plan Description, or SPD, for the ABRH, LLC Group Health and Welfare Plan (the “Plan”). You may find the SPD at www.dayforcehcm.com. The SPD describes the material terms and conditions of the Plan. If there is a conflict between this Guide, the SPD, and the Plan, the terms and conditions described in the Plan document will govern in all cases.

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To Our Team Members

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If You Don’t Elect 2018 Benefits

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Eligibility for 2018 Benefits

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Surcharges

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Manual Payments for Benefits Premiums

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Medical Plan

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Medical Plan Comparison Chart

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NEW for 2018! Virtual Medicine Through PhysicianNow

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401(k)

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Voluntary Dental Plan

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Voluntary Vision Plan

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Voluntary Term Life and Short-term Disability

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Voluntary Accident Insurance

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Voluntary Critical Illness Insurance

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Weekly Team Member Contributions for 2018

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Enrollment Checklist

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Benefit Provider Directory

You also have available to you a Summary of Benefits and Coverage (SBC), which is a tool provided through the Affordable Care Act (ACA) that was designed to outline your medical plan options in plain language and with examples.

For Full-time Hourly Team Members

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To Our Team Members Our new benefits and enrollment system, Dayforce, puts your HR and benefits functions in the palm of your hand through the mobile-compatible Dayforce website at www.dayforcehcm.com Or, the Dayforce app is available for both Android and Apple devices.

We’re pleased to announce that we’re once again able to offer all the benefits you appreciated in 2017.

You will see a 6% increase in premiums for the Value Plan and a 10% increase in premiums for the Traditional Plan in 2018. We don’t take it lightly when we have to share more cost with team members.

But, as a company we are continuing to cover the majority of team member healthcare cost, and are still able to keep our rates far below some that are increasing up to 30% year over year! We’re proud of that.

Remember that the Affordable Care Act (ACA) requires you to have medical coverage. If you don’t elect medical insurance during your enrollment window, you could have to pay a penalty to the IRS when you file your 2018 tax return.

Consider your options here and through the healthcare exchange. Choose your benefits carefully and think about the costs—in healthcare premiums and what will happen if you don’t have coverage when you need it.

Your healthcare is a valuable investment you share with the company. Take the time to learn about your options and choose the benefits that are right for you.

Throughout this guide where we suggest that you contact your HR Department for more information, please dial the following numbers: 800-432-4275 Press option 1 Then press 1 for O’Charley’s; 2 for Ninety Nine; 3 for Bakers Square or Village Inn; or 4 for Legendary Baking

For Full-time Hourly Team Members

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It’s Time to Enroll for Benefits Good news: everything you need to know about your benefit choices for 2018 is on these pages.

If you forget everything else, at least remember these three important things: 1. Know what coverage you need ... and what coverage you can afford. Again this year the company is offering an optional health savings account (HSA)—only if you enroll in a high-deductible health plan (HDHP), our Value Plan. An HSA can save you money on taxes. Choose the benefits that are right for your health and right for your wallet. Refer to page 8 to find out what happens if you miss payment of a healthcare premium.

2. Choose medical coverage through the company or the health insurance marketplace*. If you don’t, you could owe the IRS a penalty when you file your taxes next year—up to 2.5% of your household income.

3. You must enroll in benefits or you will not have healthcare coverage in 2018. Go to www.dayforcehcm.com and follow the enrollment process. * To avoid the IRS penalty for not having medical coverage, benefits-eligible team members can consider the healthcare options offered here, along with those available through the national or state healthcare marketplace. Enrollment on the exchange is November 1 through December 15, 2017. Visit Healthcare.gov for more information.

For Full-time Hourly Team Members

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If You Don’t Elect 2018 Benefits If you do not choose your benefit options through the online enrollment process, you will only be covered by the following company-sponsored plans: Basic Life and AD&D, Short-term Disability and Long-term Disability. Be sure to make your choices by the deadline!

If You Experience a Qualifying Life Event in 2018 You may make changes to certain benefits during the year only when you have a qualifying life event. Qualifying events include but are not limited to:

How to Enroll • Log in to Dayforce at www.dayforcehcm.com or through the Dayforce mobile app.

• Follow the steps through the site. Once you get to the Your Benefit Package page, click the Continue button at the bottom of the page to make your benefit choices for 2018.

• Any event that changes your number of dependents, including birth, death, adoption or placement for adoption.

• If you quit at any time during the enrollment process, you will lose any changes that you make. IMPORTANT: You must click the Complete button on the Check Out page in order for your elections to be saved.

An enrollment confirmation statement will be mailed to your registered address.

• Any event that changes your, your spouse’s or another dependent’s employment status, resulting in the gain or loss of eligibility for coverage, such as beginning or ending employment, starting or returning from an unpaid leave of absence, or changing from part time to full time or vice versa.

• You must complete the entire enrollment process at least one time to save your changes. However, you can reenter the online enrollment process to review and make changes as many times as you like until the end of your enrollment period. You’ll receive an enrollment confirmation to your Dayforce inbox.

• Any event that causes your dependent to become eligible or ineligible for coverage because of age, disability or other circumstances.

Payroll Deductions

• Any event that changes your legal marital status under federal law.

You have 30 calendar days starting on the date of a qualifying life event to make changes to your benefits. The changes you make must be consistent with the qualifying event. For example, if you gain a dependent, you may add that dependent to coverage. Please refer to the Summary Plan Description for a complete list of qualifying life events. To make a change, contact your HR Department.

If you enroll in healthcare coverage, you are automatically enrolled in a Section 125 Plan. What this means is that certain contributions will be deducted from your paycheck on a before-tax basis (see What Happens if Your Paycheck Doesn’t Cover Your Premiums). Because of the tax advantages you receive for having these deductions made on a beforetax basis, IRS rules do not allow you to change your benefits coverage during the plan year unless you have a qualifying life event. Any qualifying life event must be made within 30 days of the change.

For Full-time Hourly Team Members

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Eligibility for 2018 Benefits Eligibility You are eligible to participate in the benefits described in this guide if you are classified on our payroll system as an hourly team member whose average hours worked October 2016 through October 2017 is 30 or more per week.

Your dependents may only enroll in coverage you have for yourself.

Your eligible dependents include your: • Legally married spouse, • Children up to age 26 who are not on active military duty, and

Note Regarding Employment Status Changes Team members covered by our healthcare plans who voluntarily or involuntarily terminate their employment will lose their benefits eligibility at midnight on their last day of work.

Generally, you will remain eligible to participate in the medical plans for the remainder of the plan year, even if your eligibility otherwise changes. The specific terms and requirements of eligibility, including any exceptions to the general rules, are described more fully in the summary documents. If you have any questions regarding your eligibility, contact your HR Department.

• Dependent children who are physically or intellectually disabled and dependent on you.

Provided they meet the requirements above, eligible dependent children (regardless of where they reside) include your: • Natural children, • Adopted children or children placed with you for adoption, • Stepchildren, and/or • Children for whom you are the legal guardian.

Eligibility and Benefits for Part-time Team Members The benefits described in this Guide are available to team members who worked an average of 30+ hours per week from October 2016 through October 2017. If you worked less that that, on average, and have not been notified through Dayforce regarding your eligibility, contact your HR Department and ask about voluntary benefit options.

Dependent children also may be covered under the medical plan if they are required to be covered by a Qualified Medical Child Support Order as an “Alternate Recipient.”

For Full-time Hourly Team Members

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Surcharges Tobacco Surcharge

If you have used tobacco in the past 60 days, you will pay $100 more per month for medical benefits in 2018. The higher premium rate will be reflected during your enrollment process.

Using tobacco products puts you at a higher risk for developing major health conditions like diabetes, cancer and heart disease. It also makes you more likely than a nonsmoker to catch common viruses like a cold.

Basically, if you choose to use tobacco products, you’re more likely to need more medical care than an average person.

Working Spouse Surcharge If your spouse has access to medical coverage via his/her employer but is instead covered under your benefits, you’ll pay a working spouse surcharge. This is common practice for other companies like ours, and is one way we are able to keep our healthcare cost increase lower than the national average.

Free “Tobacco Quit” Program

All of our healthcare providers charge us more to cover smokers—and those who use tobacco products—because as a population, users of tobacco have a statistically higher rate of health incidents.

Improve your life and avoid the health risks that using tobacco brings.

The company offers team members and their families a proven program to quit the habit through BlueHealth Solutions, part of BlueCross BlueShield. Dependents over age 18 who are covered by our medical plans are also eligible. Call 866-498-9806 to enroll. Through the program you will receive: • Unlimited, confidential calls to a lifestyle coach • An individualized action plan • A free eight-week supply of nicotine replacement therapy (over-thecounter patch or gum), if indicated in your individual action plan • Education, guidance and support to reach your goal Upon successful completion of the tobacco quit program, your 2018 medical rates will convert to the non-tobacco user rates. If you think you might be unable to successfully complete this program, you might qualify for an opportunity to pay the non-tobacco user rates by different means. Contact your HR Department.

For Full-time Hourly Team Members

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Manual Payments for Benefits Premiums What Happens if Your Paycheck Doesn’t Cover Your Premiums We have set up a secure and convenient way for you to pay your benefit premiums whenever paycheck deductions are not possible, such as when you are on leave of absence or your pay amount will not cover premiums.

You will receive an email to the address we have on file, alerting you about the missed payment. If you need to add, update or change your email address, please do so through Dayforce.

You will need to log in to the Paylogix website to pay your missed premium: https://abrh.e.paylogix.com/. Note: The first time you access the system, click on “Forgot Password” to set up your access.

Log in and use a major credit card—Discover, MasterCard or Visa—to make your payment. If you don’t have a major credit card, you may set up a prepaid debit card from most major stores. There may be a set-up fee and/or usage surcharge for these methods of payment.

If you have any questions about paying missed premiums for benefits, contact your HR Department.

For Full-time Hourly Team Members

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Medical Plan For 2018, the company offers a choice of three medical plan options so you can select the coverage that’s right for you and your family.

Your medical plan options are: • Essential Plan • Value HDHP Plan with optional HSA • Traditional PPO Plan You and the company share the cost of coverage, which is based on the plan you choose and the number of dependents you enroll. Prescription drug coverage is included with each medical plan although the benefit is designed in different ways depending on the plan. OptumRx is our prescription drug program administrator (except Essential Plan). Read on to learn about each option.

Select the level of coverage you need: • Team member only • Team member plus spouse • Team member plus child(ren) • Team member plus family

GoodRx Comparison Tool Download the GoodRx app from Google Play or the App Store to compare costs of your prescription drugs at pharmacies in your area. Or, visit the website at ABRH.GoodRx.com. Any team member can use this tool, whether you’re covered by benefits or not.

Terms to Know Coinsurance: The percentage of the charges you are responsible for paying when you get care once you meet your annual deductible.

Copayment: A flat fee you pay to the provider based on the care or service you receive.

Cost of care: The plan’s negotiated rate with your medical provider, which is less than the cost of services, independent of medical coverage.

Deductible: The amount you pay for certain services each calendar year before the plan starts paying benefits. You pay the full cost of care you receive until what you have paid equals the amount of your deductible.

High Deductible Health Plan (HDHP): A plan with a high deductible in exchange for lower per-paycheck deductions, also known as a consumerdriven health plan (CDHP). Offered with a health savings account (HSA).

Health Savings Account (HSA): A tax-advantaged investment account used for healthcare expenses.

In network: The doctors, hospitals, laboratories, pharmacies, etc. that are members of the plan’s network. When you see a provider “in the network,” the plan pays a higher benefit.

Out of network: The doctors, hospitals, laboratories, pharmacies, etc. that are not members of the plan’s network. When you see a provider “outside the network,” the plan pays a lower benefit (or no benefit at all).

Out-of-pocket maximum: The maximum amount you would pay for covered care during the year after you pay your deductible. If you reach this maximum, the plan will pay 100% of your covered care for the rest of the year.

Preventive care: Routine services to prevent illness and improve your health, including annual check-ups, immunizations and certain screenings.

Our medical plan options pay 100% of the cost of in-network preventive care.

For Full-time Hourly Team Members

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Medical Plan: Essential Plan The Essential Plan is designed to help you meet the minimum essential coverage requirement that’s part of the Affordable Care Act (ACA)— also known as healthcare reform. This plan provides coverage in two parts: • A minimum essential coverage—or MEC—component that pays covered preventive care services at 100% when you visit an in-network provider. However, benefits will not be paid if you visit a provider outside the network.

• A fixed-payment medical component that provides reimbursement for some common medical events, such as doctor visits, X-rays, lab tests and inpatient hospital stays not included in the MEC plan.

A Note About the Essential Plan While Loomis provides administrative services for the MEC plan, only the fixed-payment medical policies are insured by The Loomis Company, P.O. Box 14354, Wyomissing, PA 19612-4354. The fixed-payment portion of the MEC-Select package is designed to provide benefits at a preselected, fixed dollar amount and does not satisfy the minimum essential coverage requirements of the Affordable Care Act. Coverage may be subject to exclusions, limitations, reductions and termination of benefit provisions.

Since we introduced the Essential Plan, many team members have asked how it's different from our other medical plan options. The best way to see the differences among the plans is to compare the coverage charts. The Essential Plans’ MEC component satisfies the federal government's healthcare coverage requirement with the lowest perpaycheck premiums of all our plans. As with our other medical plans, preventive care is covered at 100%. If you need medical care for something other than a well visit, the plan reimburses you a fixed dollar amount for covered services. More of your costs are covered if you stay in network.

In addition, prescription drug coverage is through reimbursement.

Benefits and reimbursement amounts have limits.

The Essential Plan uses the First Health network of providers.

You can search for a provider at: Firsthealth.CoventryHealthcare.com/locate-a-provider.

For more information, see the plan summary on www.dayforcehcm.com.

For Full-time Hourly Team Members

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Medical Plan: Essential Plan SELECT INDEMNITY REIMBURSEMENT

ESSENTIAL PLAN: BENEFITS SUMMARY

Doctor’s Office Visits

$50 per day, up to $300 per year

Outpatient Diagnostic Lab

$20 per day, up to 3 days per year

Outpatient Select Diagnostic Services

$75 per day, up to 2 days per year

MINIMUM ESSENTIAL COVERAGE

Outpatient Advanced Studies

$300 per day, up to 2 days per year

Preventive Care Services, including:

Emergency Room

IN-NETWORK

OUT-OFNETWORK

Annual Deductible

None

None

Annual Out-of-Pocket Maximum

None

None

FEATURES

For Adults: • Annual well visit

$75 per day, up to $300 per year

Inpatient Hospital (500 days per lifetime unless noted):

• Blood pressure, diabetes, cholesterol and blood pressure screening

• Hospital stay Anesthesia included

$200 per day, up to 60 days per year 25% of any surgical amount paid

• Colorectal cancer screening (if over age 50)

• Surgical care

$1,000 per day, up to 1 day per year

• Intensive care unit

$400 per day, up to 60 days per year

For Children: • Well visits with age-appropriate height, weight and BMI measurements

• Substance abuse facility

$200 per day, up to 60 days per year

• Mental health facility

$200 per day, up to 60 days per year

• Depression screening

• Autism and developmental screenings

Covered at 100%

Not covered

PRESCRIPTION DRUG COVERAGE

• Immunizations

FEATURES

• Vision screening

Outpatient Prescription Drugs (brand name)

For Women: • Annual gynecological exam with cervical cancer test • Mammography screenings

Self-administered Specialty Drugs

PLAN REIMBURSES (regardless of network) $25 per day, up to 6 days per year Not covered

• Contraception • Osteoporosis screening (if over age 60)

For Full-time Hourly Team Members

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Medical Plan: Value HDHP Plan With Optional HSA The Value HDHP Plan with optional HSA is a high-deductible health plan (HDHP), also called a consumer-driven health plan.

The advantages of an HDHP are two-fold. First, in exchange for a higher deductible you get lower per-paycheck deductions. Second, you can contribute pretax money to a health savings account (HSA) to help you fund your deductible and/or other qualified healthcare expenses including medical, dental, vision and prescription drug-related costs. An HSA is only available with an HDHP. After you meet your annual deductible, which is the same amount as your annual out-of-pocket maximum for the Value HDHP Plan, you pay nothing ($0) for in-network care. Until that point you pay the total cost of care. This plan is administered by BlueCross BlueShield of Tennessee. In-network providers are part of the BCBS-TN PPO network.

How to Find a Doctor in the BCBS-TN PPO Network • To find a provider in your area, visit BCBST.com and click Find a Doctor in the bottom-right corner. On the next screen, scroll down to search by name, location/ZIP code or specialty.

• You also may download the myBlue TN App, which is available on the App Store for iPhone and via Google Play. This will give you mobile access to the features of the website.

For Full-time Hourly Team Members

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Medical Plan: Value HDHP Plan With Optional HSA VALUE HDHP PLAN WITH OPTIONAL HSA: BENEFITS SUMMARY

PRESCRIPTION DRUG COVERAGE (through OptumRx)

FEATURES

FEATURES

IN-NETWORK

OUT-OF-NETWORK

IN-NETWORK

OUT-OF-NETWORK

Annual Deductible Individual/Family

$6,350 / $12,700

$12,700 / $25,400

Retail • Generic • Preferred • Non-preferred

100% after deductible

Annual Out-of-Pocket Maximum Individual/Family

50% after deductible

$6,350 / $12,700

$12,700 / $25,400 Not covered

Mail Order • Generic • Preferred • Non-preferred

Preventive Care Services

Covered at 100%

100% after deductible

50% after deductible

Office visits • Primary Care • Urgent Care • Routine Diagnostic Lab, X-ray & Injections

100% after deductible

50% after deductible

Prescription Contraceptives

Covered at 100%

50% after deductible

Preventive Drugs • Generic • Preferred • Non-preferred

$10 copay $40 copay $80 copay

50% after deductible

Self-administered Specialty Drugs

100% after deductible

Not covered

Inpatient Services

100% after deductible

50% after deductible

Outpatient Surgery

100% after deductible

50% after deductible

Emergency Care Services

100% after deductible

100% after deductible

Medical Equipment

100% after deductible

50% after deductible

Behavioral Health

100% after deductible

50% after deductible

Note! Prescription Drug Deductible Under the Value HDHP Plan with optional HSA, you must first reach your deductible before benefits apply for prescription drugs (except for contraceptive and preventive drugs). This is only the case for the Value HDHP Plan.

For Full-time Hourly Team Members

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Health Savings Account A health savings account (HSA) is a tax-advantaged savings account for healthcare expenses. This option is only available with the Value HDHP Plan.

You can set up an HSA and contribute money through automatic paycheck deductions. The money you put in is tax-free, the balance in the account earns tax-free interest and whenever you use the money to pay for eligible healthcare expenses, these expenditures are also tax-free.

An HSA’s balance is not forfeited at the end of the year if you don’t use it. The money you contribute and the interest it earns are always yours —you never lose it. If you leave the company, you can reinvest the funds into a qualified investment account, like a 401(k) or another HSA. You will receive an HSA debit card so you can conveniently pay healthcare expenses directly to the providers. If you spend HSA money for goods and services that are prohibited by the IRS, you’ll have to pay taxes and possibly a penalty of up to 20% of the amount. After you reach age 65, however, you have the option to use HSA funds like any retirement account.

For more information about setting up and using your HSA, including a contribution calculator, visit Healthequity.com/ed/ABRH. HealthEquity administers the HSA. For a list of qualified healthcare expenses for HSA funds, visit IRS.gov and search for Publication 969.

HSA Contribution Limits, per the IRS For 2018, the total amount one person can invest in a health savings account is $3,450. If you have family coverage under the Value HDHP Plan, you can invest up to $6,900. And, if you are age 55 or older, you can invest an additional $1,000 on top of the applicable contribution limit.

To establish an HSA, you will be asked for your name, address, birthdate and Social Security number. This requirement is in compliance with the U.S. Patriot Act. However, your personal information is kept secure by HealthEquity, our HSA administrator, just as other financial institutions that serve you also maintain strict security procedures.

If you have questions about this, please contact HealthEquity at 866-346-5800 or visit Healthequity.com/ed/ABRH. Federal rules pertaining to HSA eligibility state that, in order to have a health savings account you must: • Be enrolled only in a high-deductible health plan.

• Not be claimed as a dependent on anyone’s tax return.

• Not be on Medicare.

• Not have access to funds from a flexible spending account (FSA) to pay for healthcare, such as a spouse’s FSA. For more information visit IRS.gov and search Publications 502 and 969.

HSA Example With the HSA: $20 savings + $1 interest _______________ = $21 - $10 medication, tax-free _______________ $11 remaining

Without the HSA: $20 out of pocket + $0 interest _______________ = $20 - $11.50 ($10 medication, plus 15% tax) _______________ $8.50 remaining

For Full-time Hourly Team Members

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Medical Plan: Traditional PPO Plan The Traditional PPO Plan is a preferred provider organization.

Generally, you pay a copayment for certain services, such as office visits, before the plan pays benefits. In contrast to the Value HDHP Plan with optional HSA, with the Traditional PPO Plan you have a higher per-paycheck contribution in exchange for a lower annual deductible.

You receive a higher level of coverage and can take advantage of extra services like preventive and wellness care when you use in-network providers. Although the plan encourages you to use in-network providers, you do have the option to choose to see out-of-network providers, but you will pay higher out-of-pocket costs when you do.

This plan is administered by BlueCross BlueShield of Tennessee.

In-network providers are part of the BCBS-TN PPO network.

How to Find a Doctor in the BCBS-TN PPO Network • To find a provider in your area, visit BCBST.com and click Find a Doctor in the bottom-right corner. On the next screen, scroll down to search by name, location/ZIP code or specialty.

• You also may download the myBlue TN App, which is available on the App Store for iPhone and via Google Play. This will give you mobile access to the features of the website.

For Full-time Hourly Team Members

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Medical Plan: Traditional PPO Plan TRADITIONAL PPO PLAN: BENEFITS SUMMARY FEATURES

PRESCRIPTION DRUG COVERAGE (through OptumRx)

IN-NETWORK

OUT-OF-NETWORK

Annual Deductible Individual/Family

$3,000 / $6,000

$6,000 / $12,000

Annual Out-of-Pocket Maximum Individual/Family

$6,350 / $12,700

$12,700 / $25,400

Preventive Care Services

Covered at 100%

Office visits • Primary Care • Urgent Care • Routine Diagnostic Lab, X-ray & Injections

$35 copay $50 copay No additional copay

Inpatient Services

80% after deductible

50% after deductible

Outpatient Surgery

80% after deductible

50% after deductible

Emergency Care Services

$500 ER copay, then 80% after deductible

$500 ER copay, then 80% after deductible

Medical Equipment

80% after deductible

50% after deductible

Behavioral Health

80% after deductible

50% after deductible

FEATURES

IN-NETWORK

Retail • Generic • Preferred • Non-preferred

$10 copay $40 copay $80 copay

Not covered

Mail Order • Generic • Preferred • Non-preferred

$20 copay $80 copay $160 copay

50% after deductible

Prescription Contraceptives

OUT-OF-NETWORK

50% after deductible

50% after deductible

Covered at 100%

50% after deductible

$150 copay

Not covered

Self-administered Specialty Drugs

Example: Out-of-pocket costs in the ER

Under the Traditional PPO Plan, you can incur out-of-pocket costs when you go the emergency room. Here’s an example for a total ER bill of $1,600: IF YOU HAVEN’T MET THE DEDUCTIBLE:

IF YOU HAVE MET THE DEDUCTIBLE:

You pay a $500 copay up front.

The remaining $1,100 is subject to the deductible.

You pay a $500 copay up front, then 20% of the remaining charges, or $220.

Your total out-ofpocket cost is $720.

For Full-time Hourly Team Members

16

How to Choose Your Medical Plan Deciding what healthcare coverage you need is one of the most important decisions you’ll make.

Here are the steps you can follow: 1. Learn about your options.

2. Think about how you’ll use your benefits and decide what coverage you need and can afford. It’s a good idea to add up your estimated healthcare expenses for next year.

3. Compare your needs and budget to the three medical plans and what’s available to you on the healthcare marketplace*.

4. Make your choices!

If you don’t enroll, you won’t have coverage in 2018. * The benefits enrollment period for Healthcare.gov is November 1 through December 15, 2017.

See if their rationale will help you!

Examine their situations and priorities beginning on the next page.

For Full-time Hourly Team Members

17

Essential Plan: Alex PROFILE

DECISION-MAKING FACTORS

HEALTH PLAN

Basic Details:

Personal:

Goal:

• Age 19

• Income is inconsistent

• Single

• Consider healthcare marketplace options

• Doesn’t want to pay penalties for not having healthcare

Physical Activity Level: • Athletic, but not overly health-conscious Health Status:

Healthcare Needs: • Annual well visit to doctor • Few doctor visits

• Physically healthy

Financial:

• No recurring medical needs

• Beginning to build a career; statistically likely to change jobs

• Working through the emotions of his parents’ divorce

Coverage Needs: • Low. Being able to afford coverage and help with out-of-pocket costs are biggest motivators

• Not as focused on saving for the future

Benefit Fit: Essential Plan • Lowest premiums • ACA compliant* • Some coverage for common medical services *The Essential Plan provides the minimal essential coverage defined by healthcare reform.

For Full-time Hourly Team Members

18

Value HDHP Plan With Optional HSA: Britney PROFILE

DECISION-MAKING FACTORS

HEALTH PLAN

Basic Details:

Personal:

Goal:

• Age 21

• Will soon graduate from college

• Engaged to be married

• Staying healthy is important

• Be prepared if a health catastrophe happens

Physical Activity Level:

Healthcare Needs:

Coverage Needs:

• Maintains her weight to manage health condition

• Few doctor visits; self-manages her disease

• Low to moderate. Needs a plan that covers diabetic supplies and potential health emergencies

Health Status:

Financial:

• Diagnosed with diabetes as a child

• Strict budget • Helping pay for college • Saving for future healthcare needs using the health savings account

The Value HDHP Plan with optional HSA is the only medical plan that offers the tax-advantaged health savings account option.

Benefit Fit: Value HDHP Plan with optional HSA • Manageable premiums for a budgetminded individual • Medical expenses count toward annual deductible

For Full-time Hourly Team Members

19

Traditional PPO Plan: Ryan PROFILE

DECISION-MAKING FACTORS

HEALTH PLAN

Basic Details:

Personal:

Goal:

• Age 28

• Daughter

• Pay more up front to have a lower deductible

• Single; one dependent Physical Activity Level: • Inactive lifestyle Health Status: • Overweight • High blood pressure • Asthma

Healthcare Needs: • Primary and specialist doctor and hospital visits, blood pressure and asthma medication

Coverage Needs: • High. Willing to pay higher premiums for lower cost when they need care

Financial: • Works hard to increase customer base to increase income • Saving money to buy a house • Needs consistency in medical expenditures due to costs associated with raising a child

Benefit Fit: Traditional PPO Plan • Higher premiums • Annual deductible • Out-of-pocket maximum safety net

For Full-time Hourly Team Members

20

2018 Medical Plan Comparison Chart: Team Member’s Share ESSENTIAL PLAN FEATURES Annual Deductible Individual/Family Annual Out-of-Pocket Maximum Individual/Family Tobacco Use Surcharge Applies to all plans Working Spouse Surcharge Applies to all plans Preventive Care Services

VALUE HDHP PLAN WITH OPTIONAL HSA

TRADITIONAL PPO PLAN

IN-NETWORK

OUT-OF-NETWORK

IN-NETWORK

OUT-OF-NETWORK

IN-NETWORK

OUT-OF-NETWORK

None

None

$6,350 / $12,7001

$12,700 / $25,4001

$3,000 / $6,000

$6,000 / $12,000

None

None

$6,350 / $12,7001

$12,700 / $25,4001

$6,350 / $12,700

$12,700 / $25,400

$100 per month / $1,200 per year (Surcharge varies by coverage but will not exceed $100/month) $100 per month / $1,200 per year (Surcharge varies by coverage but will not exceed $100/month) Covered at 100%

Not covered

Covered at 100%

Not Covered

$50 reimbursement per visit, up to $300 per person/per calendar year maximum

$0 after deductible

50% after deductible

• $35 copay • $50 copay

50% after deductible2

Routine Diagnostic Lab, X-ray and Injections

Reimbursement amount varies depending on type of service. Refer to plan summary for details.

$0 after deductible

50% after deductible

No additional copay

50% after deductible2

Inpatient Services

For most services, $200 reimbursement per day, 60 days per person/per calendar year

$0 after deductible

50% after deductible

20% after deductible2

50% after deductible2

Reimbursement amount varies based on type of service

$0 after deductible

50% after deductible

20% after deductible2

50% after deductible2

Emergency Care Services

$75 reimbursement per day, up to $300 per person/per calendar year

$0 after deductible

$0 after deductible

$500 ER copay then 20% after deductible2

$500 ER copay then 20% after deductible2

Medical Equipment

Not covered

$0 after deductible

50% after deductible

20% after deductible2

50% after deductible2

Behavioral Health (Inpatient)

For most services, $200 reimbursement per day, 60 days per person/per calendar year

$0 after deductible

50% after deductible

20% after deductible2

50% after deductible2

Office Visits • Primary Care • Specialists

Outpatient Surgery

Covered at 100%

Not covered

PRESCRIPTION DRUG COVERAGE

(Administered by OptumRx)

Preventive • Generic • Preferred • Non-preferred

Limited coverage with no cost sharing for certain preventive medications

Retail • Generic • Preferred • Non-preferred

$25 per prescription, per day up to 6 days per year

Mail Order • Generic • Preferred • Non-preferred Prescription Contraceptives

Not covered Limited coverage in compliance with Affordable Care Act

Self-administered Specialty Drugs

Not covered Not covered

• $10 copay • $40 copay • $80 copay

Not covered

(Administered by OptumRx) • $10 copay • $40 copay • $80 copay • $10 copay • $40 copay • $80 copay

Not covered

$0 after deductible

50% after deductible

$0 after deductible

50% after deductible

Covered at 100%

50% after deductible

Covered at 100%

50% after deductible2

$0 after deductible

Not covered

$150 copay for 30-day supply

Not covered

• $20 copay • $80 copay • $160 copay

50% after deductible2

50% after deductible2

The company reserves the right, in its sole discretion, to terminate, suspend, withdraw, amend or modify the plans in whole or in part at any time, including, without limitation, the right to amend the plans to require participant contributions or to increase the amount of contributions that participants must make to the plans. If there is a disagreement between this summary and the plan documents, the plan documents always govern.

1Annual deductible and out-of-pocket maximum are the same for the high-deductible health plan.

2Up to annual out-of-pocket maximum

For Full-time Hourly Team Members

21

NEW for 2018! Virtual Medicine PhysicianNow: A new benefit designed to give you peace of mind and faster access to healthcare If you are enrolled in the BlueCross BlueShield (BCBS) medical plan, PhysicianNow is a convenient way to access a doctor from your home, office or while traveling. You are able to connect with doctors 24 hours a day, seven days a week from wherever you are. All you need is a phone, mobile device or computer.

PhysicianNow is a great option when it’s not an emergency or it’s not a convenient time to go to your doctor’s office.

PhysicianNow can help with common conditions such as: •

Allergies

•

Cold and flu

•

Fever

•

Respiratory issues

•

Sinus infections

•

Skin conditions (rashes or insect bites)

•

Sore throat

•

Urinary tract infections

Sign up for a PhysicianNow account today.

Online Have your BCBS Member ID card handy and visit BCBST.com to log into BlueAccess. Click on the My Health & Wellness tab. Select the PhysicianNow tile.

By phone To sign up by phone call 888-283-6691.

Contact PhysicianNow for a consultation starting January 1, 2018.

PhysicianNow saves you time and helps you fit a doctor’s consultation into your busy schedule. For the Traditional PPO Plan, the cost for access to a doctor by phone or video is a $25 copay. For the Value HSA Plan, you pay $38 towards your deductible.

After you’ve registered, you may use the mobile app for consultations.

Download the mobile app after registering online or by phone. Search for PhysicianNow (one word) on the App Store or Google Play.

For Full-time Hourly Team Members

22

401(k) When you enroll for benefits is a good time to think about how you’ll afford retirement. If retirement for you is still decades away, consider yourself fortunate! You have plenty of time to save and there’s no time like the present to start.

If you’re already saving for retirement, look closely at your contributions and make sure you’re on target to meet your retirement goals. The 401(k) offered by the company may be a great tool to augment your strategy. There’s a company match, decided annually at the discretion of the board of managers, and your contributions are tax-advantaged.

Check out the 401(k) FAQs available on Dayforce. Then, visit Benefits.ML.com or call Merrill Lynch at 877-820-2489 to enroll. You’re eligible beginning on your first date of hire, as long as you’re at least 21 years of age.

For Full-time Hourly Team Members

23

Voluntary Dental Plan The voluntary dental plan provides a comprehensive program to ensure your dental health, with coverage for important preventive care as well as for care needed as a result of dental disease. The plan is administered by BlueCross BlueShield of Tennessee (BCBST). You must pay 100% of the cost to participate in this benefit.

Select the level of coverage you need: • Team member only • Team member plus spouse • Team member plus child(ren) • Team member plus family

BASIC PLAN: BENEFITS SUMMARY Calendar-year Deductible • Individual • Family

$50 No family limit

Annual Maximum (per person)

$500

Coverage A: Preventive Care Exams and cleanings, Sealants, X-rays

100% (cleanings subject to a $15 copay)

Coverage B: Basic Services Fillings, Simple extractions, Adjustment and repairs (bridges, dentures)

80% (after 3-month waiting period)

Coverage C: Major Services Crowns and crown repair, Root canals, Gum disease treatment, Dental surgery, Prosthodontics, Bridges and dentures

50% (after 6-month waiting period)

Coverage D: Orthodontia

50%

For Full-time Hourly Team Members

24

Voluntary Vision Plan The VisionBlue Vision Plan provides comprehensive coverage through BlueCross BlueShield of Tennessee (BCBST). Team members must pay 100% of the cost to participate in this benefit.

The VisionBlue plan offers two levels of coverage— in-network and out-of-network. Benefits are higher when you use in-network providers. See the table at right for coverage highlights. For more details, visit BCBST.com.

Select the level of coverage you need: • Team member only • Team member plus spouse • Team member plus child(ren) • Team member plus family

Using a BlueCross BlueShield Network Provider

If you select a BCBST network vision provider, the cost of services will be less. If you choose to visit a provider who is not in the BlueCross BlueShield network, you still will have coverage, but the cost of services will be higher and you will be responsible for those charges that are over the maximum plan allowance. To find a network vision provider: • Visit BCBST.com and search by network, specialty or location.

• Call VisionBlue member services at 877-342-0737.

Online Tools and Resources Go to BCBST.com: • Find an eye doctor or other provider

VISION PLAN Exams (once exam and one contact lens fitting/follow-up within a 12-month period) • Comprehensive Eye Exam • Contact Lens Fitting and Follow Up—Standard • Contact Lens Fitting and Follow Up—Premium Eyeglass frames (one pair within a 24-month period) Eyeglass Lenses (one set of standard plastic lenses within a 12-month period; additional copays apply for other lens options) • Single Vision • Bifocal • Trifocal Contact Lenses (one set within a 12-month period) • Conventional

• Disposable • Medically Necessary

IN-NETWORK (SELECT)

OUT-OF-NETWORK REIMBURSEMENT

$10 copay $55 copay

10% off retail

Up to $35 Not covered

Not covered

$0 copay; $120 allowance; 20% off balance over $120

Up to $60

$25 copay $25 copay $25 copay

Up to $30 Up to $44 Up to $60

$0 copay; $120 allowance; 15% off retail price over $120

$0 copay; $120 allowance; 15% off retail price over $120

Paid in full

Up to $96

Up to $96

Not covered

Note: This plan is voluntary. It is offered by BCBST and made available to team members of the company.

• Confirm your benefits • Check your claims • Get answers to any question about your VisionBlue coverage For Full-time Hourly Team Members

25

Voluntary Term Life Insurance and Short-term Disability Voluntary Life Insurance

Voluntary Short-term Disability Plan

The company offers you the opportunity to purchase voluntary group term life insurance as an important part of your benefits package. This coverage provides financial protection for you and your family in the event of death.

Voluntary short-term disability (STD) coverage provides partial income replacement on a voluntary basis in the event you suffer an injury or illness and cannot work for an extended period of time. Mutual of Omaha is our voluntary STD insurance carrier. You pay the full cost of this voluntary coverage. You must be actively at work to be eligible for this coverage.

Mutual of Omaha is our voluntary life insurance carrier. You pay the full cost of this voluntary life insurance.

You can purchase the following insurance for yourself, your spouse* or child(ren): • Yourself: Up to $20,000 • Your spouse: Up to $10,000 (subject to evidence of insurability) • Your child(ren): Up to $10,000 for all eligible dependent children (ages 14 days to 26 years old) This voluntary life insurance is offered to new participants. Spouses are subject to evidence of insurability.

The benefit reduces by 35% at age 65 and by 50% of the pre-age 65 benefit once you reach age 70. Benefits end at retirement or if you are no longer eligible. *Evidence of insurability (EoI) applies to spouse coverage.

Here is a chart that summarizes voluntary STD benefits:

VOLUNTARY STD PLAN Elimination Period 7 days

Benefit Amount $150

Not to exceed 100% of your

basic weekly earnings

Maximum Benefit Duration 13 weeks

This benefit can be elected during each annual open enrollment period.

Your weekly STD benefit may be reduced by other eligible income sources, such as Social Security benefits. In addition, a number of rules apply to STD, including restrictions on pre-existing conditions and the taxability of payments.

For Full-time Hourly Team Members

26

Voluntary Accident Insurance You want to live your life to the fullest, doing the things with your family and friends that bring you pleasure and fulfillment. You should.

But accidents happen every day, and they can hurt your finances, too.

That’s where voluntary accident insurance through Mutual of Omaha comes in.

You pay the full cost of this coverage and you can enroll just yourself or you can also enroll your spouse and dependent children. To be eligible, you must be actively working a minimum of 30 hours per week. The plan pays you directly in the event of an accident; it does not coordinate with other insurance you have. There is no deductible, annual maximum or limit to the number of covered accidents. And the coverage is portable, which means you can take the plan with you in the event you leave the company.

The chart at right highlights some of the voluntary accident insurance benefits offered.

Wellness Benefit

Under the voluntary accident insurance program, covered individuals can receive an annual payment of $50 from Mutual of Omaha when they undergo a health screening test such as a mammogram, Pap test, PSA (Prostate-specific Antigen Test) and colonoscopy.

VOLUNTARY ACCIDENT INSURANCE

THE PLAN PAYS YOU:

ACCIDENTAL DEATH & DISMEMBERMENT Employee

$10,000

Spouse

$5,000

Dependent Children

$5,000

ACCIDENT TREATMENT Burns Emergency Treatment Emergency Dental Fractures and Dislocations (surgical/non-surgical)

Up to $5,000 $100 Up to $150 Up to $3,000 / Up to $1,500

Lacerations

Up to $400

Major Diagnostic Exam

Up to $100

Physician Office Visit

$50

Urgent Care Center

$75

For Full-time Hourly Team Members

27

Voluntary Accident Insurance continued FOLLOW-UP CARE

HOSPITAL CARE

Physician Follow-up

$50 / 2 per accident

Rehabilitation Unit

$50 / 30 days

Medical Device

$50

Physical Therapy

$25 / 6 visits

Prosthetic Device

$500 / 2 per accident

FAMILY LODGING AND TRANSPORTATION Family Lodging (for non-local hospital confinement)

Initial Hospitalization

$750

Hospital confinement (per day up to 365 days)

$100

Hospital ICU (per day up to 15 days)

$300

Surgery Ambulance

Up to $1,000 Up to $500

$100 / 30 days

Childcare (up to 30 days)

$20 per day

Transportation (for non-local treatment)

$150 / 3 trips

CATASTROPHIC BENEFITS (within 365 days of an accident; payable once per accident per covered individual) Principal Sum • You • Spouse/Child(ren) Common Carrier Accidental Death Transportation of Remains

$10,000 $5,000 300% of principal sum Up to $5,000

Dismemberment and Paralysis

100% of principal sum

Coma

50% of principal sum

For Full-time Hourly Team Members

28

Voluntary Critical Illness Insurance We all think it can’t happen to us. But cancer and other critical illnesses can strike anyone at any time, and there may be costs associated that go far beyond the medical alone. Mutual of Omaha’s voluntary critical illness coverage will help you with those non-medical costs that come along with a critical illness diagnosis and treatment, like loss of income, travel expenses and/or child care.

You pay the full cost of this coverage and you can enroll just yourself or you also can enroll your spouse* and dependent children.

Guarantee issue amounts are $10,000 for team members, $10,000 for spouses and $3,000 for dependent children.

To be eligible for coverage you must be actively working a minimum of 30 hours per week. The plan pays you directly in the event of a critical illness; it does not coordinate with other insurance you have. There is no deductible, annual maximum or limit to the number of covered accidents. And the coverage is portable, which means you can take the plan with you in the event you leave the company.

Wellness Benefit Under the voluntary critical illness insurance program, covered individuals can receive an annual payment of $50 from Mutual of Omaha when they undergo a health screening test such as a mammogram, Pap test, PSA (Prostate-specific Antigen Test) and colonoscopy.

Here’s a summary of benefits offered: COVERAGE FOR CRITICAL CONDITIONS

PERCENTAGE OF TOTAL AMOUNT

Heart Attack/Stroke Major Organ Transplant End Stage Renal Failure

100%

Aortic, Coronary Artery Bypass or Heart Valve Surgery

25%

Childhood Develop-impacting Conditions • Cerebral Palsy • Structural Congenital Defects • Genetic Disorders • Congenital Metabolic Disorders, Type 1 Diabetes

100%

COVERAGE FOR CANCER

PERCENTAGE OF TOTAL AMOUNT

Cancer Diagnosis

100%

Bone Marrow Transplant

50%

Carcinoma In Situ, Benign Brain Tumor

25%

*Evidence of insurability (EoI) applies to spouse coverage.

For Full-time Hourly Team Members

29

Weekly Team Member Contributions for 2018 TEAM MEMBER

TEAM MEMBER + SPOUSE

TEAM MEMBER + CHILD(REN)

FAMILY

MEDICAL WITHOUT TOBACCO OR WORKING SPOUSE SURCHARGE Traditional PPO Plan

$39.70

$97.24

$71.76

$142.47

Value HDHP Plan

$22.17

$63.42

$44.57

$92.91

Essential Plan

$5.00

$28.38

$22.12

$44.08

Traditional PPO Plan

$62.78

$120.32

$94.84

$165.54

Value HDHP Plan

$45.25

$86.49

$67.65

$115.99

Essential Plan

$18.01

$41.40

$35.14

$54.42

MEDICAL WITH TOBACCO SURCHARGE ONLY

MEDICAL WITH WORKING SPOUSE SURCHARGE ONLY Traditional PPO Plan

$39.70

$120.32

$71.76

$165.54

Value HDHP Plan

$22.17

$86.49

$44.57

$115.99

Essential Plan

$5.00

$47.45

$22.12

$54.42

MEDICAL WITH TOBACCO AND WORKING SPOUSE SURCHARGE Traditional PPO Plan

$62.78

$143.40

$94.84

$188.62

Value HDHP Plan

$45.25

$109.57

$67.65

$139.07

Essential Plan

$18.01

$47.45

$35.14

$54.42

For Full-time Hourly Team Members

30

Weekly Team Member Contributions for 2018 continued TEAM MEMBER

TEAM MEMBER + SPOUSE

TEAM MEMBER + CHILD(REN)

FAMILY

$3.97

$7.47

$7.47

$12.97

$1.49

$2.97

$3.12

$4.91

$2.77

$4.38

$5.08

$7.15

$1.50

$2.10

$1.98

$2.58

$1.77

NA

NA

NA

VOLUNTARY DENTAL BlueCross BlueShield of Tennessee DentalBlue Plan VOLUNTARY VISION BlueCross BlueShield of Tennessee VisionBlue Plan

VOLUNTARY ACCIDENT INSURANCE (AFTER-TAX COST) Voluntary Accident Insurance VOLUNTARY LIFE INSURANCE Voluntary Life Insurance VOLUNTARY SHORT-TERM DISABILITY Voluntary Short-term Disability VOLUNTARY CRITICAL ILLNESS PLAN for $10,000 OF COVERAGE AGE BAND

TEAM MEMBER

+SPOUSE

+CHILD

< 29

$1.57

$3.14

$1.57

30 – 39

$2.08

$4.15

$2.08

40 – 49

$3.69

$7.38

$3.69

50 – 59

$7.15

$14.31

$7.15

60 – 64

$10.85

$21.69

$10.85

65+

$13.15

$26.31

$13.15 For Full-time Hourly Team Members

31

Enrollment Checklist Use this checklist to help you through the enrollment process.

Before you enroll, take the time to educate yourself on all of the benefit options that are available to you. On Dayforce you’ll find detailed communication materials about all of our 2018 benefits.

During Enrollment q

Everyone must visit Dayforce to see what benefit options are available to you in 2018.

q

Compare the medical plan options to decide which one is right for you. Then, follow the prompts to complete the enrollment process. Save a copy of your enrollment confirmation in your records. If you do not enroll for benefits you will not have healthcare coverage through the company in 2018. You will not be allowed to make changes after your enrollment window closes unless you have a qualifying life event.

q

If you plan to enroll new dependents in benefits, you will need to add them to the My Household section of www.dayforcehcm.com prior to beginning your enrollment. Be sure to have your dependents’ Social Security numbers and dates of birth on hand.

Before Enrollment q Review this Benefits Guide and other information available on Dayforce, including the Medical Plan Comparison Chart and the 2018 Benefits Overview Video. q If you’re planning to choose the Value HDHP Plan with optional HSA, decide how much you would like to contribute to your health savings account. Use the contribution calculator tool at Healthequity.com/ed/ABRH.

After Enrollment q

You will receive a confirmation statement of your benefit choices following the completion of your electronic enrollment. It will be sent to you through Dayforce.

q

Verify your 2018 benefit choices and if you notice any errors, contact your HR Department.

For Full-time Hourly Team Members

32

BeneďŹ t Provider Directory BENEFIT / RESOURCE

PROVIDER

TELEPHONE

WEBSITE

Group Discount Program for Goods and Services

EC Purchasing

888-387-0223

ECPurchasing.com

Health Savings Account

HealthEquity

866-346-5800

Healthequity.com/ed/ABRH

Loomis

866-218-6020

Loomisco.com

Loomis Mobile Member Services

BlueCross BlueShield of Tennessee

844-658-7877

BCBST.com

myBlue TN

OptumRx

Elisa Wade: 844-265-1719

OptumRx.com/CTRSS

OptumRx

GoodRx

NA

ABRH.GoodRx.com

GoodRx

Mutual of Omaha

800-775-8805

MutualofOmaha.com

BlueCross BlueShield of Tennessee

844-658-7877

BCBST.com

Mutual of Omaha

Term life: 800-775-8805 STD: 800-877-5176

MutualofOmaha.com

BlueCross BlueShield of Tennessee

844-658-7877

BCBST.com

Medical Essential Plan Medical Value HDHP Plan with optional HSA Traditional PPO Plan Prescription Drugs (except Essential Plan) Prescription Drug Value Price Locator Voluntary Accident and Critical Illness Voluntary Dental Plan Voluntary Term Life and Short-term Disability Voluntary Vision Plan

MOBILE APP

myBlue TNSM

myBlue TNSM

For Full-time Hourly Team Members

33