2023 Colorado Employee Benefits and Rates

TABLE OF CONTENTS

Devereux Medical Plans p. 3

EPO p. 4

High Deductible Health Plan p. 5

Premiums - Cost of Medical Insurance p. 6

Part-time 30-39 hour Medical and Dental Benefits p. 7

Accarent Health No Cost Alternative Surgical Procedures through John Hopkins p. 8

Blue Distinction Total Care p. 9

MD Live Virtual Care p. 10

Dental Benefits: Cigna Dental PPO Plan A and Plan B p. 11

Dental Benefit: Cigna Dental Care Access PLUS HMO p. 12

Health Savings Account p. 13

Medical Flexible Spending Account p. 14

Dependent Care Flexible Spending Account p. 15

Commuter Ease Commuter Benefit p. 16

Health Advocate and Wellness Program p.17

TIAA 403 (b) Tax Deferred Annuity p. 18

Voluntary Insurance (Supplemental Life, AD&D), Accident. Short Term Disability, Supplemental Hospital Care p. 19 - 24

Voluntary Pet Benefit Solutions Plan #1 Total Pet Plan, Plan #2 Wishbone p. 25 26

Voluntary Legal and ID Theft LegalShield and IDShield p. 27 28

Devereux Benefits – Provided Fee to You p. 29 – 32

Explanation of Accruals for HML and TOB, and Other Benefits p. 33

Benefit Contact Information p. 34

Frequently Used Terms p. 35

CHOICE OF TWO MEDICAL PLANS

Devereux Colorado offers a choice of the Medical EPO and a High Deductible Health Plan (HDHP) to all full-time employees and their dependents including spouses, domestic partners and children. Part-time employees working specific hours have access to the High Deductible Health Plan for themselves and children only.

EPO

Lower deductible and out of pocket maximum. Primary Care visits are just $20.

Separate out of pocket maximum on Rx.

When you reach the out of pocket maximum for medical or Rx, Devereux pays 100% for your care.

Preventive care is covered at 100%

10% discount when you participate in the Health and Wellness program. You must complete the program a year in advance to receive the discount and must qualify each year.

Flexible Spending account (FSA), a pre-tax program to cover medical, dental, vision and other related medical expenses, is available. Funds are limited in the amount you can save pre tax and how much may be carried over into the next benefit year.

Vision benefits are included in medical at no cost to you through the Davis Vision network accessible at www.ibx.com. $0 eye exam, select frames from $0-$25 or $130 toward designer frames. Benefit frequency is 1x per calendar year – 1 day after your last year visit.

High Deductible Health Plan

You pay 100% of the deductible.

After reaching the deductible, Devereux pays 75% of the cost of care.

Once you reach the out of pocket maximum, Devereux pays 100% of the cost of care.

Premiums are much lower than the EPO Program.

No separate OOP for Rx.

Preventive care is covered at 100%

Health and Wellness participants receive a contribution to the Health Savings Account (HSA) - $5 Employee only coverage or $10 if covering other dependents.

Health Savings Account (HSA), a pre-tax program to cover medical, dental, vision and other medical related expenses is available. Contribution rates are higher than in the FSA, 100% of contributions carry over each year and investment options are available. Those 55 and older may contribute an additional $1000 in catch-up contributions.

Vision benefits are included in medical at no cost to you through the Davis Vision network accessible at www.ibx.com. $0 eye exam, select frames from $0 $25 or $130 toward designer frames. Benefit frequency is 1x per calendar year – 1 day after your last year visit. You do not have to meet your deductible to use vision benefits.

BENEFIT

DEDUCTIBLE $665 Individual $1,000 EE/Child $1,330 EE Spouse/DP or Family

COINSURANCE Plan Pays 75% You Pay 25%

OUT OF POCKET MAXIMUM (Includes Deductible) $4,380 Individual $6,580 EE/Child $8,760 EE Spouse or Family

PRIMARY CARE OFFICE VISIT 100% after $20 copay, NO deductible

SPECIALIST OFFICE VISIT 100% after $50 copay, NO deductible

MD LIVE (TELEMEDICINE)

URGENT CARE

CLINIC (EXAMPLE – MINUTE CLINIC, TAKE CARE CLINIC)

100% after $10 copay, NO deductible 100%, after $50 copay 100% after $20 copay

PEDIATRIC AND ADULT PREVENTIVE CARE (ACCORDING TO SCHEDULE) 100%, NO deductible

OUTPATIENT SURGERY

BARIATRIC SURGERY

75%, after deductible 50% after deductible No OOP Max

INPATIENT HOSPITAL $250 Copay, after deductible, then 75%

EMERGENCY CARE 100% after $275 copay, NO deductible (Copay waived if admitted)

OUTPATIENT X RAY/RADIOLOGY MRI/MRA, PET SCAN

CT/CTA

OUTPATIENT L

PHYSICAL

R

CAN

PHARMACY

75% after deductible 75% after $100 copay, NO deductible 100% after $100 copay, NO deductible

100%, NO deductible

100% after $40 copay, NO deductible 100% after $40 copay, NO deductible

15%/35%/50% Copay $5 Min Generic//$10 Min Brand

Individual

EE/Child

EE-Spouse/DP or Family

In Network Outpatient $20 copay In Network In-Patient 100% after medical deductible (top of page)

Out of network benefits available 50% UCR copay day and annual limitations apply

HIGH DEDUCTIBLE HEALTH PLAN

DEDUCTIBLE

$2,660 INDIVIDUAL $4,000 EE/CHILD $5,320 EE-SPOUSE/DP OR FAMILY

COINSURANCE PLAN PAYS 75%

YOU PAY 25%

OUT-OF-POCKET MAXIMUM (Includes Deductible) $4,265 INDIVIDUAL $6,390 EE/CHILD $8,530 EE SPOUSE/DP OR FAMILY

INPATIENT HOSPITAL

SKILLED NURSING FACILITY (120 days combined per calendar year)

75% AFTER DEDUCTIBLE

75% AFTER DEDUCTIBLE

EMERGENCY CARE 75% AFTER DEDUCTIBLE

URGENT CARE CLINIC (EXAMPLE MINUTE CLINIC, TAKE CARE CLINIC) 75% AFTER DEDUCTIBLE

MD LIVE (TELEMEDICINE) 75% AFTER DEDUCTIBLE

OUTPATIENT SURGERY 75% AFTER DEDUCTIBLE

BARIATRIC SURGERY 50%, AFTER DEDUCTIBLE, NO OOP MAX

OUTPATIENT X-RAY/RADIOLOGY

MRI/MRA, PET SCAN, CT/CTA SCAN 75% AFTER DEDUCTIBLE

OUTPATIENT LABORATORY/PATHOLOGY 75% AFTER DEDUCTIBLE

PRIMARY CARE OFFICE VISIT 75% AFTER DEDUCTIBLE

SPECIALIST OFFICE VISIT 75% AFTER DEDUCTIBLE

PEDIATRIC AND ADULT PREVENTIVE CARE (ACCORDING TO SCHEDULE) 100%, NO DEDUCTIBLE

PHYSICAL, SPEECH & OCCUPATIONAL THERAPY (Maximum of 30 visits combined per calendar year)

75% AFTER DEDUCTIBLE

RESTORATIVE SERVICES, INCLUDING CHIROPRACTIC CARE (Maximum of 15 visits combined per calendar year) 75% AFTER DEDUCTIBLE (20 VISITS)

DURABLE MEDICAL EQUIPMENT AND PROSTHETICS

PHARMACY BENEFITS THROUGH 30 DAY SUPPLY AT PHARMACY/90 DAY THROUGH MAIL ORDER

BEHAVIORAL HEALTH (BEHAVIORAL HEALTH AND SUBSTANCE ABUSE) THROUGH MEDICAL

HDHP PROGRAM THROUGH INDEPENDENCE BLUE CROSS

IIN-NETWORK BENEFITS ONLY NO OUT OF NETWORK BENEFITS - NETWORK IS THROUGH MAGELLAN BUT IN NETWORK ONLY

75% AFTER DEDUCTIBLE; NO MAXIMUM

75% AFTER DEDUCTIBLE

75% AFTER DEDUCTIBLE

2023 PREMIUMS

EPO

2023 NQ Per Pay Rate 2023 Qualified (participate in Health and Wellness Per Pay Rate

Single $61.06 $54.96

EE/Child $153.16 $137.85

EE/Spouse $191.83 $172.65

Family $273.76 $246.39

HIGH DEDUCTIBLE HEALTH PLAN

2023 NQ Per Pay Rate 2023 Qualified (participate in Health and Wellness Per Pay Rate

Single $35.09 $5 per pay contribution to HSA

EE/Child $100.34 $10 per pay contribution to HSA

EE/Spouse $132.14 $10 per pay contribution to HSA

Family $188.62 $10 per pay contribution to HSA

SURGICAL CARE

Blue Distinction Total Care +

Although Accarent Healthcare offers a substantial savings for our employees and families, we continue to provide local care through Blue Cross Blue Shield’s Blue Distinction Total Care +. A Blue Distinction Center must be used for bariatric surgery, knee and hip replacements, spine therapy, cardiac care, maternity care, cellular Immunotherapy, gene therapy and transplants.

Services must be prior authorized through Independence Blue Cross.

– Call the number on the back of your ID card.

Authorization will be denied for any facility that does not participate and members will be redirected to a Total Care + facility.

If you have surgery in a non-Blue Distinction facility, you will be responsible for 100% of the cost of services.

MD

Cigna Dental PPO

Annual

Orthodontia (Plan A) dependent

Orthodontia (Plan B) dependent to age 19;

Orthodontia (Plan A) Adult; separate $50 Deductible

Orthodontia (Plan B) Adult;

$2,000 $1,000 $1,000

$50/$150 $75/$225 $50/$150 $75/$225 $50/$150 $75/$225

Diagnostic

Procedure Paid by Cigna Dental

Plan

Preventive 100%

Basic Restorative

deductible

$75 deductible $1,500 $1,000 $1,000 $750 $1,000 $750

$75 Deductible $1,500 $1,000 $1,000 $750 $1,000 $750

Deductible

Composite Fillings in Molars 70% 70% 50% 50% Deductible Applies Deductible Applies

Major Restorative 60% 50% Deductible Applies

Oral Surgery 70% 50% Deductible Applies

Endodontics 70% 50% Deductible Applies

Periodontics 70% 50% Deductible Applies

Prosthodontics 60% 50% Deductible Applies

Denture Repair and Relining 70% 0% Deductible Applies

Orthodontics 50% 50% Separate Deductible

$10.62

$24.00 $20.77

Advantage Provider Premier Provider Out of Network

CIGNA DENTAL CARE ACCESS PLUS (DHMO)

The Cigna Dental Care Access PLUS (DHMO) plan requires you to select a general dentist for routine, preventive, diagnostic and emergency care.They will refer you to specialists as needed.



This plan covers most preventive and diagnostic services at a competitive rate, or at no extra cost.

Cost per pay:

Single: $6.46

2-Person EE/Child $11.08

2-Person EE/Spouse/DP $11.08

Family/2 Employees $14.77



The Cigna Dental Care Access PLUS plan does not have a deductible or a yearly dollar limit.



Search for Cigna Dental Care Access PLUS network providers in the directory on Cigna.com.

Example of Schedule of Covered Services

100% Amalgam (silver) fillings 90% Preventive Oral examinations 100%

Preventive Services

Basic Services 90% Composite fillings (anterior teeth only) 90% Cleanings Adult/Child 100%

Major Services 60% Stainless steel crowns 90% Fluoride 100%

Annual Benefit Maximum None Incision and drainage of abscess 90% Sealants (permanent molars only) 100%

Office Visit Copay $0 Uncomplicated extractions 90% Onlays/ Crowns 60%

Orthodontic Services (Adult and Child) 50%

Surgical removal of erupted tooth 90% Full and Partial Dentures 60%

Orthodontic Deductible None Surgical removal of impacted tooth (soft tissue) 90% Pontics 60%

Orthodontic Lifetime Maximum 24 months of comprehensive orthodontic treatment plus 24 months of retention

Major Inlay 60%

HEALTH SAVINGS ACCOUNT

Health Savings Accounts (HSA) - Goes with the High Deductible Health Plan

An HSA is similar to a flexible spending account but rolls over each year and is never forfeited. There is no “use it or lose it rule.”



The maximum amount for 2023 is $3,850 for employees with single coverage and $7,750 for employees with two-person or family coverage. The plan allows an additional $1,000 catch-up contribution for those aged 55-64. If you don’t enroll in Medicare Part A or Part B, you may continue participating.



These contributions can be used to cover medical, dental, vision and other healthcare related expenses.

Money saved in a HSA plan is the employee’s and he/she can take it with them if they leave Devereux. At retirement, there are additional post-employment uses for HSA savings, such as paying for Medicare premiums.

Investment options are available for long term savings.

MEDICAL FLEXIBLE SPENDING

Flexible Spending Account (FSA) – Goes with the EPO

 FSA’s are accounts you put money into that you use to pay for certain out-of-pocket healthcare costs - medical expenses, equipment and treatments, dental care and vision care. You don't pay taxes on this money, because the amount you decide to contribute is deducted from your salary before income taxes. This means you'll save an amount equal to the taxes you would have paid on the money you set aside. For more information, please refer to the Flex Spending Packet.



Contribution Limits for 2023: Pending (will update when available from IRS)

Medical FSA is $2,850 per year

 There is a $570 carryover limit for unused FSA funds. Any contributions over $570 are lost according to the IRS “Use it or lose it” rule.



DEPENDENT CARE FLEXIBLE SPENDING

A Dependent Care Flexible Spending Account is designed to reimburse you for expenses incurred to care for your eligible dependents under age 13 or other dependents that are physically or mentally incapable of self-care, such as elderly parents who live in your home at least eight hours each day and who qualify as exemptions on your federal income tax return. These programs are limited in the amount you can save pre-tax and in how much may be carried over into the next benefit year. For more information, please refer to the Flex Spending Packet.

 You don't pay taxes on this money, because the amount you decide to contribute is deducted from your salary before income taxes. This means you'll save an amount equal to the taxes you would have paid on the money you set aside.

 Contribution Limits for 2023: Pending (will update when available from IRS) is $5,000 per year



COMMUTE EASE TRANSPORTATION BENEFITS

CommuteEase is a pre-tax benefit that helps you pay transportation and parking costs if you take public transportation or have to pay to park at the train or office.



Contributions to your CommuteEase plan is directly through Employee Benefits Corporation’s member portal - paid by the 13th of each month for the upcoming month. Contributions will be available on the EBC Benefits Card. EBC provides Devereux the election amount and that amount is deducted from the employees check the last pay of each month.

 Unused funds carryover to the next year for CommuteEase.

Contribution Limit: $270 per month.



Available to employees, spouses, domestic partners, dependent children, parents and parents-in-law. Employees must be enrolled in one of Devereux’s Independence Blue Cross medical plans to be eligible. They provide:



Advocacy – They help navigate the healthcare system. A Personal Health Advocate(PHA) can assist with finding a doctor or service, getting a claim paid, finding out the cost of a service, and more.



Wellness Program - Contact a personal Wellness Coach by email, telephone or online chat, and receive motivation to help reach personal health goals.A wide range of online health tools are available at www.HealthAdvocate.com/Devereux



Earn 85 points by meeting with a health coach, tracking healthy behavior, participating in workshops, center events and Devereux challenges. Complete all requirements between October 1, 2022 and August 31, 2023 to qualify to receive a 10% discount on medical premiums or contributions to your HSA. The Personal Health Profile questionnaire and Tobacco Affidavit are required.

TIAA

CONTACTS AND CONTRIBUTION LIMITS FOR 2023

(800) 567-2687

(215) 665-6010,

Contribution limits:

The annual IRS maximum contribution for 2023 is expected to be $22,500

Employees age 50 or over can make a catch-up contribution of up to an expected additional $

Employees with 15 or more years of service can possibly make a catch-up contribution of up to an additional $3,000

Employees age 50 or over that have 15 or more years of service, can possibly make a catch-up contribution of up to an additional $9,500

Contribution

varies by center

is made 1x per year in January

VOLUNTARY BENEFITS

Supplemental Life Insurance

NY LIFE

We normally offer up to $200,000 guaranteed issue (no medical questions) for new hires only; and all other benefit eligible employees have the opportunity to elect or increase their current amount of supplemental life insurance by one increment of $10,000 and additional increments of $10,000 may be elected, subject to Evidence of Insurability approval.

However, see the red side box. We have approval for all full-time employees to choose up to $200,000 of supplemental life insurance at guarantee issue no evidence of insurability!

Supplemental insurance is in addition to the Devereux Provided Basic Term Life (free to you) 2x annual base salary, not to exceed $200,000.

Spouse/Domestic Partner: (new hires) Guaranteed Issue

Amount of $50,000 without Evidence of Insurability can be purchased in $5,000 increments. All other benefit eligible spouse/domestic partners may elect or increase their election by one increment of $5,000, not to exceed the plan guarantee issue amount.

Spouse/Domestic Partner and Children’s coverage does not require employee to purchase single coverage supplemental life insurance.

Unmarried Children: Age 14 days to 26 years $10,000

2023 Rates

Age Bi-Weekly Employee Bi-Weekly Spouse 0-19 $0.31 $0.29 20-24 $0.31 $0.29 25 29 $0.31 $0.46 30-34 $0.38 $0.60 35-39 $0.46 $0.74 40-44 $0.65 $1.03 45-49 $0.96 $1.66 50-54 $1.53 $2.62 55-59 $2.43 $4.27 60-64 $3.43 $5.40 65-69 $6.10 $7.85 70+ $9.89 $15.58 Child 14 days to 26 years $0.70

2023 Open Enrollment Only – guarantee issue up to $200,000 for employee coverage and $50,000 for Spouse/DP coverage without Evidence of Insurability –even if you were denied before.

VOLUNTARY BENEFITS

NY LIFE

Accidental Death and Dismemberment (AD&D)

AD&D insurance is an inexpensive way to provide additional life insurance benefits if the cause of death is accidental

It also pays a benefit if there is a loss of a limb, vision or hearing due to an accident.

$10,000 increments up to $500,000 (not to exceed 10x salary).

All Guaranteed issue coverage (no

Option of Employee Only or Family Plan Coverage.

questions).

Family plan provides 100% employee, 50% spouse and 15% Child of amount elected.

Coverage amount for employees that attain age 70 or older are reduced;

reduced

reduced by 40%; Age 80

reduced by 30% and Age 85

reduced by 15%

Amount

$30,000

$40,000

$50,000

$60,000 $1.08

$70,000 $1

$80,000

$90,000 $1.62

$100,000

Additional amounts available up to $500,000

To determine the cost for the amount you desire:

Amount of Insurance coverage x Cost /10,000

Example for $300,000:

Employee Only ($300,000 x $0.18 / 10,000 = $5.40);

Family ($300,000 x $0.26 / 10,000 = $7.80)

VOLUNTARY BENEFITS

– NY LIFE

Short-term Disability

When an unexpected illness or injury occurs, your focus should be on your health not your budget.



What is the cost for this benefit option and how is it paid? This voluntary benefit is paid 100 percent by the employee. Rates are based on age and base salary, which determines the amount of Short-term Disability benefit received.



Guaranteed issue is for new hires only. All others, including during Open Enrollment are subject to medical underwriting, including pre-existing conditions which includes pregnancy.

For new employees or those without much HML, this is an opportunity to cover your risk of lost income if you are out of work for a short period of time due to an off the job injury or illness, including maternity.

Coverage is 60% of your salary, up to a maximum of $1,500 per week.

• There is a 14-day and 28-day elimination period for sickness or accident.

• An elimination period is the number of days you have to wait until the benefit kicks in.

• Employees who select this insurance may use Health Medical Leave (HML) or Time off Benefit (TOB) or not be paid to satisfy the elimination period until Short-term Disability coverage begins.

• Except for new hires, employees are subject to Evidence of Insurability approval.

• Once approved, Short Term Disability lasts as long as you are unable to work due to a disabling condition, up to 11 weeks. If you continue to meet the definition of disability after 11 weeks, you will become eligible for Long-term Disability, a benefit paid by Devereux

Long Term Disability (LTD): Free to you! (Devereux Paid) - Devereux provides all full-time active employees with a minimum of 60% income replacement if out of work due to a disabling condition for 90 days or longer. This important paycheck protection benefit pays benefits directly to you and may be continued to Normal Social Security Retirement Age if you continue to meet the definition of disability. This benefit is offered at no cost to you.

VOLUNTARY BENEFITS

Short-term Disability - Rates

How

To calculate the bi weekly payroll deduction for voluntary Short term Disability coverage, use the indicated rate for your age and the formula below:

1. Enter your annual pre-disability earnings, not to exceed $130,000, divided by 52 weeks, and multiply by benefit of 60 percent and enter on Line 1 1)

<25 $0.94 $0.47

$1.14 $0.55

$1.35 $0.65

$1.02 $0.45

2. Select your rate from the rate table and enter on Line 2 2)

3. Multiply Line 1 by the amount shown on Line 2 and enter on Line 3 3)

4. Divide Line 3 by $10 and enter on Line 4 4)

5. Multiply Line 4 by 12 months and enter on Line 5)

6. Divide Line 5 by 26 pays and enter on Line 6 6)

The amount shown on Line 6 is your estimated bi-weekly payroll deduction for this benefit; premiums will be deducted directly from your paycheck.

VOLUNTARY BENEFITS

Voluntary Supplemental Hospital Care

Coverage and Benefit Amounts Benefit Type Benefit Amount

Hospital Admission

No elimination period. Limited to 1 day, 1 benefit(s) every 90 days.

Hospital Chronic Condition Admission

No elimination period. Limited to 1 day, 1 benefit(s) every 90 days.

$1,000 per day

CIGNA

$50 per day

Pays a fixed benefit to the covered person for hospital stays resulting from a covered injury or illness. The money can be used as the individual chooses. Benefits may be paid directly to the hospital upon assignment.

No restrictions on how the money can be used. Coverage continues after the first covered hospitalization helping provide additional protection for future hospital stays.

Hospital Stay

No elimination period. Limited to 30 days, 1 benefit(s) every 90 days.

Hospital Intensive Care Unit Stay

No elimination period. Limited to 30 days, 1 benefit(s) every 90 days.

Hospital Observation Stay

24-hour elimination period. Limited to 72 hours.

$100 per day

Supplements your medical plan – Benefits are separate from medical plan, do not coordinate, and are paid directly to you.

$200 per day

Cost-effective coverage. Benefits are employee paid and employees sign up at economical group rates

$100 per day

Guaranteed Issue (no pre-existing conditions when you enroll as a new hire or during Open Enrollment.

*Inpatient stay required to receive benefits.

A hospital stay can be expensive, and it can happen at any time. Even with our medical coverage, out of pocket expenses such as rehabilitation, transportation and childcare can quickly add up. Supplemental health benefits such as Cigna Hospital Care can offer a cost-effective solution to provide the additional coverage to help you bounce back from a health setback.

Rates per pay:

Employee $6.72

Employee/Spouse/DP $13.10 Employee/Child(ren) $11.49 Family $17.72

VOLUNTARY BENEFITS – CIGNA

Group Voluntary Accidental Injury through Cigna (OFF THE JOB ACCIDENTS ONLY)

Guaranteed Issue: No medical underwriting

Plan provides a schedule of benefits for covered injuries and accident-related expenses for Off the Job accident coverage only that results within 90 days of the accident.

A physician must diagnose covered losses.

Treatment must be received in the United States or its territories.

$50 per year Wellness, Health Screening and/or Preventative Care Benefit Credit per covered person per calendar year. (Must submit wellness claim within 90 days of the date of service.)

What is Accidental Injury Insurance?

Accidental Injury Insurance helps to pay for expenses associated with a covered accident or injury.

Covered injuries may include:

Broken bones

Burns

Torn ligaments

Concussions

Eye injuries

Ruptured discs

Cuts requiring stitches

Benefits may be payable for:

Ambulance

Initial treatment

Emergency room visit

Hospitalization

Admission (per occurrence)

Confinement (per day)

Follow up care

X-rays

MRI’s

Rehab

PET BENEFITS

TWO PLANS TO FIT THE NEEDS OF YOU AND YOUR FURRY FRIENDS!

Plan #1 - TOTAL PET PLAN

The pet care bundle includes everyday savings on veterinary care, pet products and access to other benefits from PetPlus, Pet Assure, AskVet and The Pet Tag.

No exclusions based on breed, age or pre-existing conditions.

Coverage for all pets from cats and dogs to exotic animals and farm animals.

Can be used alongside pet insurance you already have or with Wishbone Pet Insurance

Member only pricing (up to 40% discount) on brand name prescriptions, food, treats and toys.

Free shipping on all orders from petcarerx.com and same day-pickup on human grade prescriptions at over 50,000 Caremark pharmacies.

Instant 25% discount on in-house medical services at participating veterinarians which means no claim forms and not waiting for reimbursement.

Questions? Contact Pet Benefit Solutions at (800) 891-2565 or visit www.petbenefits.com

PET BENEFITS - TWO PLANS TO FIT THE NEEDS OF YOU AND YOUR FURRY FRIENDS!

Plan #2 – WISHBONE PET INSURANCE

Monthly, direct pay to Wishbone Insurance. Premium varies per policy because rates are based on the pet’s breed, age and zip code. Get an individual quote at www.petbenefits.com

$250 Annual Deductible, 90% coverage and $25,000 annual limit



Provides 90% reimbursement on accidents and illness, including office visits and prescription medications. You can choose to add on routine care coverage. Everything your pet needs for one low price. Save 65% on retail rates.

Accident and Illness Coverage includes office visits, exam fees and take-home Rx

Easy claim submission at www.wishboneinsurance.com/devereux. Claims are processed within 5 business days.

Coverage on hereditary & congenital conditions, but pre existing conditions do apply

No waiting period for injuries and illnesses and 6 months for cruciate ligament events. Waiting period starts on the policy effective date.

Choice of two add-on plans for routine veterinary care. The Pedigree add-on is a schedule of benefits that provides up to $305 in annual benefits with no deductible for approximately $14/month. The Best in Show Plan is a schedule of benefits that provides up to $535 in annual benefits with no deductible for approximately $23/month. These services include spay/neuter, rabies vaccine, flea/tick/heartworm prevention, vaccination, wellness exam, heartworm test, blood fecal, parasite exam, microchip, urinalysis and deworming.

Questions? Contact Pet Benefit Solutions at (800) 891-2565 or visit www.petbenefits.com

VOLUNTARY BENEFITS

IDSHIELD

IDShield helps to protect your, and if you choose your eligible family members identity, by providing consultative services to help you avoid ID Theft and fraud.

24/7/365 access for emergency situations if an identity theft occurs.

Privacy monitoring

Black Market website surveillance (internet monitoring)

Address change verification

Security monitoring of personally identifying information on:

Websites, Internet Relay Chat (IRC) channels, chat rooms and peer sharing networks.

Credit and Court Records monitoring

Credit Inquiry

Identity Restoration

licensed

of

restoration work required

pretheft status, including notifying the Social Security Administration, Federal Trade Commission, US Postal Service and Credit Reporting bureaus and much more.

DEVEREUX PROVIDED - FREE TO YOU

INSURANCE ASSISTANCE

Life insurance 2x Salary to a maximum of $200,000

Long Term Disability – Devereux provides all full-time active employees with a minimum of 60% income replacement if out of work due to a disabling condition for 90 days or longer. This important paycheck protection benefit pays benefits directly to you and may be continued to Normal Social Security RetirementAge if you continue to meet the definition of disability.

Autism Spectrum Disorder (ASD) Benefit: $5,000 reimbursement toward Applied Behavioral Analysis for diagnosis of and services for Autism Spectrum Disorders (ASD). This benefit will be administered through the National People Operations office. Submit your paid receipt or EOB for reimbursement to Ann DelCarlino or Jelsy Kravatz.

Health Advocacy support through NY Life at www.guidanceresources.com offers trained advocates to help you navigate healthcare even if you are not on a Devereux benefit plan. Services include claim and billing issues, appeal processes and simplifying complicated administrative services and address questions and concerns. Use ID: NYLGBS

Secure Travel through NY Life at www.guidanceresources.com offers pre-trip planning and 24/7/365 support when traveling more than 100 miles away on vacation. Services include help with medical evacuations, repatriation and lost fees due to travel changes or emergencies. Use ID: NYLGBS

DEVEREUX PROVIDED - FREE TO YOU

EDUCATION ASSISTANCE

Based on Center availability, Devereux pays a portion of tuition for continuing education and development opportunities. Check with People Operations to learn more.

Student Tuition Assistance (STAP)

Student Loan Debt Solution

In conjunction with TIAA, Savi can help you lower your interest rates and make sure you are on the right path to receive public service loan forgiveness.

– Savi offers Devereux employees two tiers of service for student loan assistance (including Parent Plus loans):

Free Student Loan Checkup: Quickly view repayment plan options and discover potential savings;

Savi Essential Services: Track payments, e-file paperwork and receive one-on-one assistance, reminders and more for a Devereux discounted $60 annual fee.

Visit www.tiaa.org/devereux/student to sign up for Devereux’s student loan debt solution. It takes about 15-20 minutes to get an estimate of your savings. Employees who take advantage of this benefit option will receive advice from Savi’s student loan experts on navigating Public Service Loan Forgiveness, as well as lowering interest rates, consolidating loans or reducing payments for private loans. To learn more, you can view the Student Debt Solution Guide and common FAQs. Questions? Contact your local People Operations representative or call Savi at (833) 604-1226 Monday-Friday 8:30 a.m. to 8 p.m. (ET).

DEVEREUX PROVIDED - FREE TO YOU

FINANCIAL ASSISTANCE

Visit www.tiaa.org/devereux for individual consultations, advice and counseling including ondemand webinars, calculator and tools. Help is also available by calling 800-842-2252.Advisors can also help with decisions regarding Devereux’s 403(b) Retirement Plan and the possible employer contribution that Devereux makes on your behalf.

Janney Montgomery Scott, Devereux’s Retirement Plan advisors are available to help with retirement and financial questions by calling (800) 567-2687 or emailing QKarpiak@janney.com.

Financial, Legal and Estate Guidance through NY Life at www.guidanceresources.com offers professional services that include unlimited financial support on issues like debt management, family budgeting, estate planning, law and tax consultations and much more. pre-trip planning and 24/7/365 support when traveling more than 100 miles away on vacation. Services include help with medical evacuations, repatriation and lost fees due to travel changes or emergencies. Use ID: NYLGBS

Family Source and Guidance Resources through NY Life at www.guidanceresources.com are specialists that provide customized research, educational materials and prescreened referrals for childcare, adoption, eldercare, education and pet care. They can also assist with question on home and auto insurance and general questions through “Ask the Expert” which provides personal responses to your questions. Use ID: NYLGBS

DEVEREUX

PROVIDED - FREE TO YOU

Well-being, Emotional, Behavioral Health Support

Carebridge can help with managing family and personal concerns including childcare, parenting, elder care, money management, education planning, time management, convenience services, legal resources, relocation and more.

Help is confidential and available 24/7/365 by calling (800) 437-0911.

Five free, per topic, in person or virtual counseling services to assist you and your dependent family members with emotional concerns such as grief, stress, relationship difficulties, depression, anxiety, or other behavioral health challenges and addictions.

Discounted shopping and other helpful resources are available at www.myliferesource.com and on the Carebridge app. The initial access code is ADC53.

eM Life Mindfulness – evidence-based sessions including short virtual or on-demand sessions that help refresh your mind, reduce stress and build resilience.

Access through Carebridge website: www.myliferesource.com or through the Carebridge app.

Resiliency – Learn how to grow, thrive and flourish by taking care of yourself first, so you can take care of others. Fill your pitcher and build your bounce with videos, webinars and other resources hosted by Devereux’s DCRC team.Access #DevereuxStrong to enhance your well-being.

Wellness support through NY Life at www.guidanceresources.com offers three face to face counseling sessions, five telehealth resiliency coaching sessions and wellness articles, podcasts, videos and more 24/7.

EXPLANATION OF ACCRUALS FOR HML AND TOB

Benefit Years of

Accrual

Accrual

HML

TOB

OOP < 1 Year 2.6 day

1 year

years 31 days

TOB

month

Determined

# of months

Front loaded 7/1 of each year

+ Years 36 days Front loaded 7/1 of each year

FT Staff 90 Days – 2 Years .0923 192 7.38 Hours

3 Years 4 Years .0962 200 7.70 Hours 5 Years 9 Years .1000 208 8.00 Hours 10 Years – 14 Years .1192 248 9.54 Hours 15+ Years .1385 288 11.08 Hours

Benefit Contact Information

Questions? Call Health Advocate at (866) 695-8622

Company Name Phone Number Website

Carebridge (EAP) & eM Life (Mindfulness)

(800) 437 0911

Group #

https://myliferesource.com/ ADC53

Cigna Accidental Injury and Hospital Care

Cigna Dental (Dental PPO and DHMO)

(800) 754 3207

(800) 564-7642

http://www.cignasupplementalhealthplans.com/

https://mycigna.com/

Employee Benefits Corporation (Flexible Spending Accounts) (800) 346 2126 www.ebcflex.com

Health Advocate (866) 695 8622 https://healthadvocate.com/Devereux

Independence Blue Cross (IBX) (Medical/Behavioral Health)

Independence Blue Cross (Rx)

(877) 393 6740 (888) 678 7012 www.ibx.com

MD Live (888) 632 2738 www.mdlive.com/IBX

New York Life Group Life, Supplemental Life, Accidental Death and Dismemberment, Short Term Disability and Long Term Disability (800) 238-2125 www.myNYLGBS.com

Savi (Student Loan Debt Solution)

(833) 604 1226

http://www.tiaa.org/devereux/student

TIAA (Retirement)

Optum Bank (Health Savings Account)

(800) 842 2252 www.tiaa.org/Devereux

(866) 234 8913 www.optumbank.com

Pet Benefit Solutions (800) 891 2565 www.petbenefits.com

KEY HEALTHCARE DEFINITIONS

Copay/Copayment – A fixed dollar amount that you usually pay when you receive services (e.g., office visits, prescriptions, emergency room usage, hospital admissions).

Coinsurance – The percentage of eligible medical or prescription expenses after the deductible amount that you pay.

Deductible –

A flat amount you must pay before the plan begins to pay for covered services you use. Review your plan, you do not have to meet your deductible for specific services before the plan will pay.

Out-of-Pocket Limit (OOP) – It is the most you could pay during the calendar year for your share of covered services. You have a different OOP for your medical and prescription expenses in the EPO. Your share includes your copays, coinsurance and deductibles. At times, you may see OOP referred to as out-of-pocket maximum, or abbreviated as OOM.

Health Savings Account (HSA) – An account that holds tax free income in reserve for health-related expenses. HSAs can be funded only when you are enrolled in the High Deductible Health Plan. Contributions are withheld from income before taxes and are not subject to taxes when used for qualifying medical expenses.

Flexible Spending Account (FSA) – Medical Flex or Dependent Care Flexible Spending allows you to save tax free for health or dependent care expenses. This account must be used each year. Only a limited amount may be carried over.

“Servant Leadership is a philosophy and set of practices that enriches the lives of individuals, builds better organizations and ultimately creates a more just and caring world. At Devereux, we strive to incorporate Servant Leadership into our culture and every aspect of our organizational framework; from the delivery of quality services to individuals served, their families, and other stakeholders to the development and empowerment of our employees. At Devereux, we are committed to being the employer of choice, and we know that offering high quality, affordable benefits is a key component. I am honored to partner with you in service of our important mission. Please reach out to People Operations if you have questions or comments on these materials.”

— Carl E. Clark II, Devereux President and CEO