DrFirst 2020 Benefit Guide

Your Benefits Medical Dental Vision Life & Disability Spending Accounts And more‌

Benefits Guide

2020

January 1st, 2020 - December 31st, 2020

Introduction Table of Contents Introduction

2

Contacts

3

How it Works

4

Contributions

5

Medical Plans

6-7

Blue Rewards

8

CareFirst Resources

9

Dental

10

Vision

11

Life & Disability

12

Voluntary Group Benefits

13

HSA

14

FSA

15

Additional Benefits

16-18

Annual Notices

19-22

Employee Eligibility All full-time regular status Employees who work 30 or more hours per week are eligible to enroll in the benefits included in this guide. DrFirst offers comprehensive, cost effective benefit options. Employees new to DrFirst are eligible for coverage on the first of the month following date of hire. You must enroll within 31 days of your eligibility or you forfeit your right to unroll until the following open enrollment.

Part-time regular status Employees who work 1000 hours annually are considered eligible for benefits under ACA.

Changing Your Elections It is very important to consider your choices carefully before you make your benefit elections. The benefits you choose will be in place from your eligibility date through the end of the plan year, unless you have a qualifying event during the year such as: •

Marriage, Divorce, Legal Separation, Birth or adoption of a child

•

Death of a spouse or child

•

You or one of your covered dependents gains or loses other benefits coverage due to a change in employment status Note: For additional information, Qualified Event Definition is determined by www.IRS.gov guidelines.

Dependent Eligibility •

Legal spouse or domestic partner

•

A dependent child under the age of 26 (coverage terminates at the end of the month in which the dependent turns 26)

Note: Under the Patient Protection and Affordable Care Act (PPACA), adult children enrolled under their parent’s medical plan may maintain their coverage until the age of 26, even if they’re a student, married or employed.

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Contacts CareFirst

Medical, Rx, & Connect Your Care HSA Vendor

Carefirst.com – MyAccount (877) 691-5856

Guardian

Dental, Voluntary Group Accident & Critical Illness

Guardiananytime.com (800) 627-4200

VSP

Voluntary Vision

Vsp.com (800) 877-7195

Infinisource

Flexible Spending Account (FSA)

infinisource.net (866) 370-3040

Prudential Employee Assistance Program

Employee Assistance Program

Guidanceresources.com Company Web ID: GEN311

Prudential

Life, LTD, STD, & AD&D

Prudential.com (888) 598-5671

Health Advocate

Claims and Procedure Assistance

Healthadvocate.com (866) 695-8622

DrFirst Human Resources

Human Resources

Heather.happe@drfirst.com (301) 231-9510 x 2940

EONE Benefits

Broker

mybenefits@eonebenefits.com (443) 218-6332

401(k)

401k.com (800) 294-4015 NFP Broker: Keith Bonardi: 301-581-7394/ keith.bonardi@nfp.com

Fidelity

Please Note: This booklet provides a summary of the benefits available, but is not your Summary Plan Description (SPD). DrFirst reserves the right to modify, amend, suspend, or terminate any plan at any time, for any reason without prior notification.

The plans described in this book are governed by insurance contracts and plan documents, which are available for examination upon request. We have attempted to make the explanations of the plans in this booklet as accurate as possible.

However, should there be a discrepancy between this booklet and the provisions of the insurance contracts or plan documents, the provisions of the insurance contracts or plan documents will govern.

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How it Works Some benefits are provided to you at no cost. The cost of other benefits, such as medical and dental are shared by you and DrFirst. Additional benefits, such as voluntary life are paid by you at discounted group rates. Having benefit options available means you can build your benefits to meet your needs and lifestyle.

Benefit

Who Pays

Medical/Rx

DrFirst & You

Dental

DrFirst & You

Voluntary Vision

You

Life and AD&D

DrFirst

Short-term Disability

DrFirst

Long-term Disability

DrFirst

Voluntary Life

You

Health Care Plan Information In-Network Advantage Consider your healthcare options highlighted in this guide. Some plans give you the freedom to use any healthcare provider of your choice; however, when you use an In-Network provider, the percentage you pay out-of-pocket will be based on a negotiated fee, which is usually lower than the actual charges. If you use a provider who is outside of the network, you may be responsible for paying the difference between CareFirst’s or Guardian’s allowable charges and the provider’s full charge. This is called Balance Billing.

Medical Benefits: Preventive Care Services Preventive care is covered In-Network at 100% (not subject to deductible, coinsurance, or copay) for those services that are generally linked to designated routine wellness exams and screenings. Examples include: • • • • • • • • • •

Annual wellness exams Annual well woman visits Well child care visits: exams and immunizations Mammograms Smoking Cessation intervention 1st tier oral contraceptives Colorectal cancer screenings (over age 50) Adult immunizations: influenzas, hepatitis A, Hepatitis B, Tetanus Cholesterol screening (age and risk schedule) Blood pressure screening

*please note that benefits are subject to a schedule of frequency and age restriction set by HHS and are jus a sampling of the benefits at no cost to the member.

Visit www.hhs.gov for a complete list of benefits and guidelines. There may be limits on how often you can receive preventive care treatments and services. You should ask your healthcare provider whether your visit is considered preventive or nonpreventive.

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Cost Monthly BlueChoice Advantage $750

Total

ER

EE

Per Pay Period

$579.31

$411.74

$167.57

$83.79

Employee + Spouse

$1,332.42

$772.47

$559.95

$279.98

Employee + Child(ren)

$1,071.73

$657.70

$414.03

$207.02

Employee + Family

$1,606.68

$893.20

$713.48

$356.74

Total

ER

EE

Per Pay Period

$510.10

$382.58

$127.53

$63.76

$1,173.24

$714.15

$459.10

$229.55

$943.70

$599.38

$344.33

$172.16

$1,414.71

$834.88

$579.83

$289.92

Total

ER

EE

Per Pay Period

Employee

$34.88

$26.16

$8.72

$4.36

Employee + Spouse

$63.87

$40.66

$23.22

$11.61

Employee + Child(ren)

$75.25

$46.33

$28.92

$14.46

Employee + Family

$120.83

$69.13

$51.70

$25.85

VSP Vision

Total

ER

EE

Per Pay Period

Employee

$9.46

$0.00

$9.46

$4.73

Employee + Spouse

$15.93

$0.00

$15.93

$7.97

Employee + Child(ren)

$16.26

$0.00

$16.26

$8.13

Employee + Family

$26.21

$0.00

$26.21

$13.11

Employee

BCBS Adv HSA Employee Employee + Spouse Employee + Child(ren) Employee + Family

Guardian Dental

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Medical Plan Summary

BlueChoice Advantage $750

Providing comprehensive and quality medical coverage at a reasonable cost is a challenge for all employers. DrFirst meets this challenge by providing employees two CareFirst BCBS Advantage medical options with prescription drug coverage In-Network Out-of-Network Annual Deductible*

$750 Individual | $1500 Family

$1,500 Individual | $3,000 Family

$2,000 Individual | $4,000 Family

$7,000 Individual | $14,000 Family

Physicians Office Visit

$30 Copay

40% of allowed benefit after deductible

Specialists Office Visit

$30 Copay

40% of allowed benefit after deductible

Preventive Care Services Well-Child Care (exams & immunizations) Adult Physical Exam (routine GYN) Breast Cancer Screening Pap Test Prostate & Colorectal Cancer Screening

No Charge

40% of allowed benefit

Lab and X-ray

No Charge

40% of allowed benefit after deductible

Other Diagnostic Tests (OP Facility)

No Charge

40% of allowed benefit after deductible

Annual Out-of-Pocket Maximum*

Inpatient Hospital Facility Services Outpatient Hospital Facility Services

Facility: Deductible, then $300 per admission Physician: Deductible, then 10% Facility: Deductible, then $300 per visit Physician: Deductible then 10%

Emergency Room

40% of allowed benefit after deductible 40% of allowed benefit after deductible

Deductible, then $200 per visit (waived if admitted)

Urgent Care

$50 per visit

Rehabilitations Services (Physical, Occupational, Speech)

Deductible, then $30 per visit

40% of allowed benefit after deductible

Outpatient Spinal Manipulation

Deductible, then $30 per visit

40% of allowed benefit after deductible

• Mental Health/Substance Abuse

Vision

• •

Inpatient Hospitalization: Deductible, then $300 per admission Office Visits: No Charge Outpatient Facility: No Charge

Exam: $10 copay at participating Davis Vision providers Glasses and Contacts: Discounts available at participating centers

25% of allowed benefit after deductible

Exam: Total charge minus $33 Allowed Benefit Glasses and contacts: Not Covered

Prescription Drugs Rx Deductible Rx Out-of-pocket Maximum Tier I – Generic Tier II – Preferred Brand Tier III – Non-Preferred Brand Tier IV – Specialty 90 Maintenance Supply

$0 ($0 family) $3,500 Individual/$7,000 Family $15 copay per script $35 copay per script $60 copay per script 50% to maximum of $100 2x Retail

Note: The information provided is only a partial, general description of plan benefits and does not constitute a contract. In case of a conflict between your plan documents and this information, the plan documents will govern.

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Medical Plan Summary

Blue Choice Advantage Integrated BlueFund HSA In-Network

Out-of-Network

Annual Deductible

$1,400 Individual | $2,800 Family

$2,800 Individual | $5,600 Family

Annual Out-of-Pocket Maximum

$2,800 Individual | $6,550 Family

$5,600 Individual | $11,200 Family

Physicians Office Visit

Deductible, then $30 Copay

30% of allowed benefit after deductible

Specialists Office Visit

Deductible, then $30 Copay

30% of allowed benefit after deductible

No Charge

30% of allowed benefit

Lab and X-ray

Deductible, then $30 Copay

30% of allowed benefit after deductible

Other Diagnostic Tests (OP Facility)

Deductible, then $30 Copay

30% of allowed benefit after deductible

Inpatient Hospital Facility Services

Deductible, then $300 per admission

30% of allowed benefit after deductible

Deductible, then $300 per visit

30% of allowed benefit after deductible

Preventive Care Services Well-Child Care (exams & immunizations) Adult Physical Exam (routine GYN) Breast Cancer Screening Pap Test Prostate & Colorectal Cancer Screening

Outpatient Hospital Facility Services Emergency Room

Deductible, then $300 per visit (waived if admitted)

Urgent Care

Deductible, then $75 per visit

Rehabilitations Services (Physical, Occupational, Speech)

Deductible, then $30 Copay

30% of allowed benefit after deductible

Outpatient Spinal Manipulation

Deductible, then $30 Copay

30% of allowed benefit after deductible

• Mental Health/Substance Abuse

Vision

•

Inpatient Hospitalization: Deductible, then $300 per admission Office Visits & Outpatient Facility: Deductible, then $30 Copay per visit

Exam: $10 copay at participating Davis Vision providers Glasses and Contacts: Discounts available at participating centers

30% of allowed benefit after deductible

Exam: Total charge minus $33 Allowed Benefit Glasses and contacts: Not Covered

Prescription Drugs Rx Deductible Rx Out-of-pocket Maximum Tier I – Generic Tier II – Preferred Brand Tier III – Non-Preferred Brand Tier IV – Specialty 90 Maintenance Supply

Shared with medical Shared with medical Deductible, then $10 copay per script Deductible, then $25 copay per script Deductible, then $45 copay per script Deductible, then 50% to maximum of $75 2x Retail

For the 2020 Plan Year, DrFirst will contribute the following amounts toward the HSA: • Single - $700 annually (prorated on start or end date) • Employee + Dependent(s) - $1,400 annually (prorate on start or end date) • DrFirst will make contributions for 2020 in 2 installments: January and April Note: The information provided is only a partial, general description of plan benefits and does not constitute a contract. In case of a conflict between your plan documents and this information, the plan documents will govern.

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CareFirst Blue Rewards

Blue Rewards Getting Healthy Has its Rewards At CareFirst BlueCross BlueShield (CareFirst), we know how important the health of your employees is to the overall well-being of your business. Earn $100-$600 for taking certain steps to get healthy and stay healthy. You can earn a participation-based award and additional funds for results-based progress. Amounts vary and visit your MyAccount portal for more information.

Blue Rewards encourages your employees to become aware of, and take an active role in, their own health by offering them financial rewards.

When they complete four important steps and achieve certain health measures, employees and their covered spouse/domestic partner can each earn up to $300.

How Blue Rewards benefits your business ■

Blue Rewards offers your employees financial incentives for taking steps to get and stay healthy— saving both of you money.

■

The Blue Rewards program emphasizes high- quality, high-value health care by encouraging the use of PCMH Providers.

1. Select a Primary Care Provider (PCP) who participates in the CareFirst Patient Centered Medical Home (PCMH) program.

2. Consent to receive wellness emails.

3. Answer an online Health Assessment

4. Complete a health screening by visiting your PCP or CVS Minute Clinic.

Complete within 120 days from your effective date 2020 Benefits Guide

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CareFirst Resources CareFirst Video Visit Available 24/7/365 Talk to a doctor anytime Visit CareFirstVideoVisit.com or download the app today!

Video Visit from CareFirst allows you to visit a doctor anywhere and anytime. You can see a board certified doctor without an appointment on your smartphone, tablet, or computer. Doctors can treat many common illnesses such at cough, cold, sinus infection, ear infection, UTI, pink eye, etc. and even call in a prescription if appropriate.

The cost depends on which plan you’re enrolled in. The cost will follow your specialist copay on the POS plan. For the HSA, it will cost $49 while in your deductible period. Once the deductible is met, it will become a specialist copay. The POS plan cost will also be the specialist copay.

CareFirst Mobile App

Have your health care information as close as your mobile device Get the information you need wherever you go with My Account.1  Quickly find a doctor or urgent care center and get directions from your location  View, print or email your ID card  Check your plan’s benefits,2 deductibles, copays and out-of-pocket costs  See who is covered  Manage your health care spending with the Treatment Cost Estimator  Review your claims status  Submit claims for out-of-network care  Track wellness program participation  Find and call important phone numbers  Send and receive information securely 1Register 2May

for My Account to view your personal information. not be available to all members at this time.

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Dental PPO Regular dental care is essential to good health. DrFirst provides a dental plan through Guardian which covers four main types of expenses: Preventive, Basic, Major, and Orthodontia.

The plan has an annual deductible which is waived on preventive services. It is the amount you must pay first for Basic and Major Services. The annual maximum is the most that Guardian will pay for eligible dental care expenses. Once you reach that maximum, you are responsible for 100% of eligible expenses. The maximum is less when you use an out-of-network provider.

Plan Highlights

• • • •

You can visit in-Network and out-of-network dentists Out-of-network providers can balance bill up to full charges National PPO network Orthodontia Coverage In-Network

Plan Year Deductible

Out-of-Network $50 Individual / $150 Family

Annual Plan Year Maximum Benefit

$2000

$1000

Preventive Care (such as cleanings, exams, and x-rays)

No Charge

No Charge

20% after deductible

20% after deductible

50% after deductible

50% after deductible

Basic Restorative Care (such as fillings, oral surgery, and root canals)

Major Restorative Care

(such as dentures, bridgework and crowns)

Orthodontia (Adults and Children) (such as braces and retainers)

50% up to a lifetime maximum of $1,500 per member

Guardian will roll over a potion of your unused annual maximum into your personal Maximum Rollover Account (MRA). If you reach your Plan Annual Maximum in future years, you can use money from your MRA. To qualify for an MRA, you must have at least one paid claim and must not have exceeded the paid claims threshold during the benefit year. Your MRA may not exceed the MRA limit. You can view your annual MRA statement detailing your account at GuardianAnytime.com Members now have an incentive to participate in the Guardian Dental plan. Team members can earn Tuition Rewards that can be used to pay up to one year’s tuition at over 340 SAGE Scholar Private Colleges and universities across the nation. That’s one third of the National Association of Independent Colleges and Universities (NAICU). Visit Guardiananytime.com for more information.

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Vision Benefits DrFirst offers a voluntary vision plan that covers routine eye exams and helps pay for eyeglasses and contacts. While you can choose your own eye care provider, costs are lowest if you remain In-Network to obtain eye exams and corrective lenses. You also do not have to complete claim forms when using an In-Network provider. Services and materials obtained from an Out-ofnetwork provider are generally higher and will be reimbursed to the amounts outlined in the schedule, and those providers can bill up to full their full charges, this is called Balance Billing.

In-Network

Out-of-Network

Eye Exams (every 12 months)

$10 copay

Up to $45 Reimbursement

Collection Frames (every 12 months)

$10 copay

Up to $70 Reimbursement

Lenses (every 12 months)

No Copay

Up to $65 Reimbursement

$130 Allowance

Up to $96 Reimbursement

Contact Lenses

• •

• •

When shopping for prescription eye glasses, there are multiple collections of frames that are included in your annual allowance. If you go over your allowance, there is a 20% savings. Members also receive a $70 allowance at Costco.

Standard Lens options do have an additional copay.

• Tints $0 • Standard Progressive $55 • Premium Progressive $95-$105 • Custom Progressive $150-$175 Using VSP is easy. To find a VSP provider or trail chain affiliate, visit VSP.com or call (800) 877-7195.

NO ID Cards are necessary, at your appointment, tell them you have VSP.

Note: The information provided is only a partial, general description of plan benefits and does not constitute a contract. In case of a conflict between your plan documents and this information, the plan documents will govern.

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Life & Disability Insurance Available for Full-time Employees Only

Employer Paid Life and AD&D Insurance DrFirst provides Basic Life and Accidental Death and Dismemberment (AD&D) at no cost to you.

• Available to eligible full-time employees.

• Benefits are a flat benefit of $50,000 for basic life and $125,000 for AD&D.

Voluntary Life and AD&D Insurance DrFirst sponsors a supplemental Life and AD&D plan which allows Employees the opportunity to purchase additional Life and AD&D for yourself, spouse and children at a discounted group rate.

Additional Life and AD&D Insurance for you: • Maximum benefit of 7x your salary up to $500,000 (available in $10,000 increments) • Initial guarantee issue amount of 7x salary up to $150,000 • Cost varies due to age • Evidence of Insurability may be required for late entrants electing over the guarantee issue amount Additional Life and AD&D Insurance for your spouse and children: • Max benefit of $250,000 ($10,000 increments not to exceed 100% of the Employee amount) with guaranteed issue amount of $50,000 • Evidence of Insurability may be required for late entrants • Benefits for your child(ren) aged 14 days to 6 months are available up to $250 • Child benefits available from 6 months to 19 (25 if full-time student) are available up to $25,000 in increments of $2,500.

Employer Paid Short Term Disability DrFirst provides Short Term Disability Insurance at no cost to you.

• This benefit replaces up to 60% of your weekly earnings should you become disabled, up to a maximum of $3,000 • Benefits would begin 1st day of a qualified accident and 8th consecutive day of a qualified illness (1st day coverage for hospitalization).

• Benefits may continue for up to 13 weeks

Employer Paid Long Term Disability

DrFirst provides Long Term Disability Insurance at no cost to you.

• This benefit replaces up to 60% of your monthly earnings to a maximum of $12,000, should you become disabled • Benefits would begin after you have been disabled for 90 days • Benefits may continue until your normal Social Security retirement age .

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Voluntary Group Coverage Voluntary Group Accident When an accident and injury occurs for yourself or a member of your family, you may incur out-of-pocket expenses beyond what medical insurance will cover. Unexpected costs can set a family back financially • Guardian pays you cash benefits based on covered injuries • Payments come directly to you, and you can pay for other expenses, like traveling to the hospital, childcare, and lost income.

• Per month rates: Employee Only

Employee & Spouse

Employee & Child

Family

$17.48

$29.68

$31.14

$43.34

Voluntary Critical Illness Even with medical insurance, you’re still responsible for copayments, deductibles, and other out-of-pocket costs, so a serious illness could really set you back. If you or a family member are diagnosed with a serious illness, could you handle the extra expense?

Guardian helps protect your savings. Critical Illness insurance supplements your medical plan. Guardian pays you cash for each eligible diagnosis. The cash benefits are paid directly to you – you decide how to use them.

• Employees may choose a lump sum benefit of $5,000 to $20,000 in increments of $5,000 (Guaranteed issue amount ; $20,000).

• Spouses may choose a lumpsum benefit of $2,500 to $10,000 in increments of $2,500 up to 50% of the employee benefit (Guaranteed issue amount: $10,000).

• Child Benefit: 25% of Employee Benefit (all amounts are guaranteed).

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Health Savings Account A health savings account (HSA) combines high deductible health insurance with a tax-favored savings account. Money in the savings account can help pay the deductible. Once the deductible has been met, the insurance starts paying.

If you want tax-free payroll deductions, you must use a Howard Bank HSA account. To continue using outside vendors, you will have to make a post-tax contributions and settle that annually when you file taxes.

Money left in the savings account earns interest and is yours to keep. So, it’s different from a traditional health insurance package because it adds a new self-funding option — an HSA savings product, which many banks and credit unions offer. Most financial institutions offer a variety of investment options for HSAs, including stocks, bonds, mutual funds and money market funds.

2020 HSA Contribution Limits

Individual: $3,550 | Family: $7,100 | Catch-up (age 55+): $1,000

With an HSA, you save in three ways: The money you put in your HSA account is not subject to income tax.

•

Funds in your account grow tax-free.

•

You don’t pay taxes on withdrawals (providing they are used for qualified medical expenses)

•

HSA-Compatible Health Insurance typically costs less in payroll deductions.

HSA Advantages

Your HSA can help you during certain financial hardships. For example, your HSA funds can be used if you’re between jobs and use them to pay your health insurance premiums without any penalty. You can also use them to pay for qualified long-term care premiums, as well as for Medicare insurance and expenses.

An HSA can help add to your retirement funds. That’s because any unused funds are rolled over and after you turn 65, you can withdraw funds from your HSA for any reasons without penalty. It does not have to be for a medical expense and could be for normal living expenses.

What an HSA and an HSA-Compatible Health Plan Pays For

Here’s a simple way to look at the way the two products that make up how an HSA works to pay for covered medical expenses during a calendar year.

Your Health Plan Pays For:

Your HSA Funds Pay For:

Covered medical expenses after the deductible has been met

Covered medical expenses until your deductible is met

Adult Preventive care

Qualified expenses, such as vision and dental care

Benefits & coverage based on your policy's terms

Copayment, coinsurance, out-of-pocket costs after your deductible is met

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Flexible Spending Account Flexible Spending Accounts (FSAs) allow you to be reimbursed for medical and dependent care expenses on a tax-free basis. If you can anticipate your family’s health care and dependent care costs for the next plan year, you may lower your taxable income. Here is how it works: •

You agree to set aside a portion of your pre-tax salary in the account.

•

The money comes out of your paycheck over the course of the year.

•

The amount you contribute to the FSA is not subject to Social Security (FICA), federal, state, or local income taxes— effectively adjusting your annual taxable salary.

•

Depending on your tax bracket, you may realize significant savings.

How it works Use It or Lose It Consider your expenses carefully before you decide how much to contribute to each FSA account. If your eligible expenses for the calendar year turn out to be less than the amount you contributed to your FSA account, federal law requires that the unused balance be forfeited (the “Use it or Lose it” rule). So do not contribute more than you are reasonably certain you will use. DrFirst does allow members to rollover up to $500 a year for the healthcare FSA.

Over-the-Counter (OTC) Drugs The IRS requires a doctor’s note or prescription for reimbursement of OTC products under the Health Care FSA. This requirement applies to items such as cough medicines and pain relievers. Submit a doctor’s prescription when you submit your claim.

Status Change Federal regulation prohibits you from changing your enrollment or the amount of your election during the plan year. You are only eligible to change your elections during the year if you have a status change. Only benefit changes consistent with the change in status are permitted. Status Changes that may warrant a change in benefit elections are described elsewhere in this benefit guide.

If You Leave the Company Your participation in the Flexible Spending Accounts will end on the date of your termination of employment. This means that you may submit for reimbursement any qualified expenses incurred on or before the date of your termination.

You have 90 days after the end of your plan year to file a claim for reimbursement of these expenses. Please refer to your Human Resource Representative for more details.

2020 Benefits Guide

Health Care Account You may pay for certain IRS approved medical care expenses not covered by your insurance plan with pretax dollars e.g. co-pays, deductibles, and other out-ofpocket expenses. Under this FSA, the maximum you may contribute each plan year is $2,700.

Limited Purpose FSAs are available if you are enrolled in the HSA plan. These FSA plans may only be used for Dental and vision.

Dependent Care Account The Dependent Care FSA lets you use pre-tax dollars toward qualified dependent care. The annual maximum amount you may contribute to the Dependent Care FSA per calendar year is $5,000 or $2,500 if married and filing separate tax returns.

The IRS defines an eligible dependent as: •

A child under the age of 13

•

A dependent over the age of 13 who is physically or mentally incapable of self-care, claimed as a dependent on your income tax return

Only the portion of expenses which enable you to remain employed are eligible. Educational expenses are not eligible.

Note: In order for your FSA contributions to be eligible for reimbursement, you must obtain a tax identification or social security number from your provider which will be reported on your federal income tax return.

Parking and Transit You may set aside funds to pay for your commuting expenses to and from work. The monthly maximum is $260 for Parking and $260 for Transit.

This amount may be changed throughout the plan year.

15

Additional Benefits Employee Assistance Program Employees and family plan have access to an Employee Assistance Program (EAP) through Prudential and ComPsych. The EAP is here for employees and their entire family to help navigate any personal issues you may be facing in your life. Members have access to unlimited telephonic consultations with an EAP Counselor and 24/7 phone and web access and all communication is confidential. Call 1-800-311-4327 or visit guidanceresources.com.

Company Web ID: GEN311 Services Include: • Emotional and Work/Life concern • Legal Issues • Financial Planning • Personal Coaching

401K DrFirst sponsors a retirement plan through Fidelity as a part of its benefits package.

Employees age 21 and older are eligible to participate in the plan on the first month following the completion of 3 months of employment. Interns must work 1000 hours to be eligible to participate. Employees are automatically 4% of their annual income after 3 months of employment unless other enrollment elections were made or reduced to 0% in Fidelity www.401k.com. DrFirst makes matching contributions equal to 50% of the first 5% of pay contributed to the plan with a 3-year vesting schedule based on date of hire.

PTO Employees benefit from paid time off which is accrued as follows:

• • •

0 – 3 Years (or 0-47 Months) of Service- Annual accrual rate of 18 days PTO 4 – 6 Years (or 48-83 Months) of Service Annual accrual rate of 23 days PTO 7 or More Years (or 84 Months and Beyond) of Service Annual accrual rate of 28 days PTO

•

Employees can accrue up to 200 hours of vacation time

Holidays (Fixed) Fixed holidays throughout the year for regular full-time employees: •

New Year’s Day – January 1, 2020

•

Memorial Day – May 27, 2020

•

Independence Day – July 4, 2020

•

Labor Day – September 2, 2020

•

Thanksgiving – November 28-29,2020

•

Christmas – December 25, 2020

Health Advocate Health Advocate is an added services at no cost to you! You have access to a personal Health Advocate courtesy of DrFirst. The mission is to help members get the most out of their healthcare experience by eliminating the hassles and frustrations typically encountered when dealing with the healthcare system.

For more information visit Healthadvocate.com or call 1-866-695-8622

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Additional Benefits (continued) Transit Benefits – MD/DC/VA  The maximum contribution is $3,240/ year/ $270/month.  Employees can enroll at any time  Free account  Employees save on income and payroll taxes due to lower taxable wages  Ride transit all month at a reduced cost  Contact HR for more details

Guardian College Tuition Benefit Included with your Guardian coverage is a college tuition benefit. As the cost of college continues to rise faster than inflation and medical costs,1 Guardian is helping families keep up by providing this benefit in arrangement with SAGE College Tuition Benefit.

• • • • •

Members enrolled in a Guardian plan earn $2,000 in annual Tuition Rewards®.

One Tuition Reward point = $1 in tuition reduction.

Tuition Rewards can be used at over 375 institutions, with 80% ranked among "America's Best" by US News and World Report in 2016.

Members can share the benefit with eligible relatives, including children, nieces, nephews, step-children and grandchildren, subject to certain restrictions.

Colleges participate as a way to boost their student recruitment

TO LEARN MORE ABOUT THE PROGRAM Go to: www.Guardian.CollegeTuitionBenefit.com to set up your account.

If you have any questions, please visit the website or contact College Tuition Benefit directly at 215-839-0119.

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Aflac Hospital Indemnity The average cost per inpatient day for a hospital stay is $2,157.

As health care costs continue to rise, you are responsible for paying more and more outof-pocket costs with every accident and illness. Aflac is designed to help families plan for the health care bumps ahead and take some of the uncertainty and financial insecurity out of getting better.

How will you help protect your savings when you have a covered accident or sickness?

If you are confined to the hospital, major medical insurance will help with many medical expenses, but you could be left with out-of-pocket expenses. You could also lose pay while you’re out of work. And you can be sure that the bills will keep coming. Aflac is here to help.

IT’S INSURANCE FOR DAILY LIVING: Aflac pays cash benefits directly to you, unless you choose otherwise. This means that you will have added financial resources to help with medical costs or ongoing living expenses.

Aflac group hospital indemnity insurance plans2 are designed to provide you with cash benefits to help with the following:

• • • •

Hospital Confinement Benefit Hospital Admission Benefit Hospital Intensive Care Benefit Intermediate Intensive Care Step-Down Unit

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• •

Everyday living expenses, like your rent or mortgage, utility bills, groceries, and more It even provides coverage for newborn children for 60 days from the date of birth

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Commonly Used Terms Allowable charge – sometimes known as the "allowed amount," or "usual, customary, and reasonable (UCR)" charge, this is the dollar amount considered by a health insurance company to be a reasonable charge for services or supplies based on the rates in your area.

Benefit — the amount payable by the insurance company to a plan member for medical costs.

Coinsurance — the amount you pay to share the cost of covered services after your deductible has been paid. The coinsurance rate is usually a percentage. For example, if the insurance company pays 80% of the claim, you pay 20%.

Coordination of benefits — a system used in group

Medicare — the federal health insurance program that

provides health benefits to Americans age 65 and older.

Signed into law on July 30, 1965, the program was first available to beneficiaries on July 1, 1966 and later expanded to include disabled people under 65 and people with certain medical conditions. Medicare has two parts; Part A, which covers hospital services, and Part B, which covers doctor services.

Network — the group of doctors, hospitals, and other health care providers that insurance companies contract with to provide services at discounted rates. You will generally pay less for services received from providers in your network.

health plans to eliminate duplication of benefits when you are covered under more than one group plan. Benefits under the two plans usually are limited to no more than 100% of the claim.

Out-of-network provider — a health care professional, hospital, or pharmacy that is not part of a health plan's network of preferred providers. You will generally pay more for services received from out-of-network providers.

Copayment — one of the ways you share in your medical

Out-of-pocket maximum — the most money you will pay during a year for coverage. It includes deductibles, copayments, and coinsurance, but is in addition to your regular premiums. Beyond this amount, the insurance company will pay all expenses for the remainder of the year.

costs. You pay a flat fee for certain medical expenses (e.g., $10 for every visit to the doctor), while your insurance company pays the rest.

Deductible — the amount of money you must pay each year to cover eligible medical expenses before your insurance policy starts paying.

Dependent — any individual, spouse or child, which is covered by the primary insured member’s plan.

Exclusion or limitation — any specific situation, condition, or treatment that a health insurance plan does not cover.

Exclusive Provider Organization (EPO) — a type of

health insurance plan that usually limits coverage to care from doctors who work for or contract with the EPO. It generally won't cover out-of-network care except in an emergency. An EPO may require you to live or work in its service area to be eligible for coverage. EPOs often provide integrated care and focus on prevention and wellness.

Preferred provider organization (PPO) — a health insurance plan that offers greater freedom of choice than HMO (health maintenance organization) plans. Members of PPOs are free to receive care from both in-network or outof-network (non-preferred) providers, but will receive the highest level of benefits when they use providers inside the network.

Provider — any person (i.e., doctor, nurse, dentist) or

institution (i.e., hospital or clinic) that provides medical care.

Waiting period — the period of time that an employer makes a new Employee wait before he or she becomes eligible for coverage under the company's health plan. Also, the period of time beginning with a policy's effective date during which a health plan may not pay benefits for certain pre-existing conditions

In-network provider — a health care professional,

hospital, or pharmacy that is part of a health plan’s network of preferred providers. You will generally pay less for services received from in-network providers due to negotiated discounts for services in exchange for the insurance company sending more patients their way.

For a complete glossary of healthcare terms visit

www.healthcare.gov/glossary

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Annual Notices Right to Rescind Coverage PPACA requires group health plans to provide notice 30 days prior of group health plan termination. The rules prohibit rescissions except in very limited situations such as employees who commit fraud or make intentional misrepresentations. For example, if plan documents require employees enrolling family members to assert that these individuals meet plan eligibility requirements and to immediately notify the employer if their status changes, rescission might be possible for an employee who intentionally misrepresented marital status to obtain coverage for a friend. Prospective terminations of coverage and retroactive terminations for failure to pay premiums or contributions are not rescissions.

DrFirst Group Health Plan the privacy rules under the Health Insurance Portability and Accountability Act (HIPAA) require the Group Health Plan (the “Plan”) to periodically send a reminder to participants about the availability of the Plan’s Privacy Notice and how to obtain a copy of this notice. The Privacy Notice explains participants’ rights and the Plan’s legal duties with respect to protected health information (PHI) and how the plan may use and disclose PHI. Mothers’ and Newborns’ Act Group health plans and health insurance issuers generally may not, under federal law, restrict benefits for any hospital length of stay in connection with childbirth for the mother or newborn child to less than 48 hours following a vaginal delivery, or less than 96 hours following a cesarean section. However, federal law generally does not prohibit the mother’s or newborn’s attending provider, after consulting with the mother, from discharging the mother or her newborn earlier than 48 hours (or 96 hours as applicable). In any case, plans and insurers may not, under federal law, require that a provider obtain authorization from the plan or issuer for prescribing a length of stay not in excess of 48 hours (or 96 hours).

Medicare Information Attention Members who are Medicare eligible or who have Medicare eligible dependents—(or those who will soon be eligible). Coordination of benefits between the group plan and Medicare Parts A & B depends on specific criteria and reason for election of Medicare. Please contact the DrFirst Human Resources department for more information in regards to these criteria and how the coordination of benefits would be determined.

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Uniformed Services Employment and Reemployment Rights Act (USERRA) Health Insurance Protection if you leave your job to perform military service, you have the right to elect to continue your existing employer-based health plan coverage for you and your dependents for up to 24 months while in the military. Even if you don't elect to continue coverage during your military service, you have the right to be reinstated in your employer’s health plan when you are reemployed, generally without any waiting periods or exclusions except for service-connected illnesses or injuries.

Women’s Health and Cancer Rights Act of 1998 If you have had or are going to have a mastectomy, you may be entitled to certain benefits under the Women’s Health and Cancer Rights Act of 1998 (WHCRA). For individuals receiving mastectomy-related benefits, coverage will be provided in a manner determined in consultation with the attending physician and the patient for: •

All stages or reconstruction of the breast on which the mastectomy was performed;

•

Surgery and reconstruction of the other breast to produce a symmetrical appearance;

•

Prostheses; and

•

Treatment of physical complications of the mastectomy, including lymphedemas.

These benefits will be provided subject to the same deductibles and coinsurance applicable to other medical and surgical benefits provided under the plan.

COBRA Under the Consolidated Omnibus Budget Reconciliation Act (COBRA) of 1985, COBRA qualified beneficiaries generally are eligible for group coverage during a maximum of 18 months for qualifying events due to award termination or reduction of hours of work. Certain qualifying events, or a second qualifying event during the initial period of coverage, may permit a beneficiary to receive a maximum of 36 months of coverage. COBRA coverage is not extended for those terminated for gross misconduct. Upon termination, or other COBRA qualifying event, the former fellows and any other beneficiary will receive COBRA enrollment information.

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Medicare Part D Notice Important Notice from the employer about Your Prescription Drug Coverage and Medicare Please read this notice carefully and keep it where you can find it. This notice has information about your current prescription drug coverage and your options under Medicare’s prescription drug coverage. This information can help you decide whether or not you want to join a Medicare drug plan. If you are considering joining, you should compare your current coverage, including which drugs are covered at what cost, with the coverage and costs of the plans offering Medicare prescription drug coverage in your area. Information about where you can get help to make decisions about your prescription drug coverage is at the end of this notice.

There are two important things you need to know about your current coverage and Medicare’s prescription drug coverage: Medicare prescription drug coverage became available in 2006 to everyone with Medicare. You can get this coverage if you join a Medicare Prescription Drug Plan or join a Medicare Advantage Plan (like an HMO or PPO) that offers prescription drug coverage. All Medicare drug plans provide at least a standard level of coverage set by Medicare. Some plans may also offer more coverage for a higher monthly premium. The employer has determined that the prescription drug coverage offered by the plan is, on average for all plan participants, expected to pay out as much as standard Medicare prescription drug coverage pays and is therefore considered Creditable Coverage.

Because your existing coverage is Creditable Coverage, you can keep this coverage and not pay a higher premium (a penalty) if you later decide to join a Medicare drug plan.

When Can You Join A Medicare Drug Plan? You can join a Medicare drug plan when you first become eligible for Medicare and each year from October 15th to December 7th. If you lose your current creditable prescription drug coverage, through no fault of your own, you will also be eligible for a two month Special Enrollment Period (SEP) to join a Medicare drug plan.

What Happens To Your Current Coverage If You Decide To Join A Medicare Drug Plan? If you decide to join a Medicare drug plan, your group coverage will not be affected. You and your dependents can keep this coverage if part D is elected and the plan will coordinate with Part D. See pages 7- 9 of the CMS Disclosure of Creditable Coverage To Medicare Part D Eligible Individuals Guidance (available at http://www.cms.hhs.gov/CreditableCoverage/), which outlines the prescription drug plan provisions/options that Medicare eligible individuals may have available to them when they become eligible for Medicare Part D. If you do decide to join a Medicare drug plan and drop your current coverage, be aware that you and your dependents will be able to get this coverage back but you/they may have to wait until the next open enrollment plan.

When Will You Pay A Higher Premium (Penalty) To Join A Medicare Drug Plan? You should also know that if you drop or lose your current group coverage and don’t join a Medicare drug plan within 63 continuous days after your current coverage ends, you may pay a higher premium (a penalty) to join a Medicare drug plan later. If you go 63 continuous days or longer without creditable prescription drug coverage, your monthly premium may go up by at least 1% of the Medicare base beneficiary premium per month for every month that you did not have that coverage. For example, if you go nineteen months without creditable coverage, your premium may consistently be at least 19% higher than the Medicare base beneficiary premium. You may have to pay this higher premium (a penalty) as long as you have Medicare prescription drug coverage. In addition, you may have to wait until the following October to join.

For More Information about This Notice or Your Current Prescription Drug Coverage. Contact your HR Department for further information. It is always best to discuss your personal situation with a Medicare expert when you are considering your options. NOTE: You’ll get this notice each year. You will also get it before the next period you can join a Medicare drug plan, and if this group coverage changes.

You also may request a copy of this notice at any time. More detailed information about Medicare plans that offer prescription drug coverage is in the “Medicare & You” handbook. You’ll get a copy of the handbook in the mail every year from Medicare. You may also be contacted directly by Medicare drug plans.

For more information about Medicare prescription drug coverage: Visit www.medicare.gov or call your State Health Insurance Assistance Program (see the inside back cover of your copy of the “Medicare & You” handbook for their telephone number) for personalized help Call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048. If you have limited income and resources, extra help paying for Medicare prescription drug coverage is available. For information about this extra help, visit Social Security on the web at www.socialsecurity.gov, or call them at 1- 800-772-1213 (TTY 1-800-325-0778).

Remember: Keep this Creditable Coverage notice. If you decide to join one of the Medicare drug plans, you may be required to provide a copy of this notice when you join to show whether or not you have maintained creditable coverage and, therefore, whether or not you are required to pay a higher premium (a penalty).

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New Health Insurance Marketplace Coverage Options PART A: General Information What is the Health Insurance Marketplace?

The Marketplace is designed to help you find health insurance that meets your needs and fits your budget. The Marketplace offers “onestop shopping” to find and compare private health insurance options. You may also be eligible for a new kind of tax credit that lowers your monthly premium right away. Open enrollment for health insurance coverage through the Marketplace begins in October 2015 for coverage starting as early as January 1, 2016.

Can I Save Money on my Health Insurance Premiums in the Marketplace?

You may qualify to save money and lower your monthly premium, but only if your employer does not offer coverage, or offers coverage that doesn’t meet certain standards. The savings on your premium that you’re eligible for depends on your household income.

Does Employer Health Coverage Affect Eligibility for Premium Savings through the Marketplace?

Yes. If you have an offer of health coverage from your employer that meets certain standards, you will not be eligible for a tax credit through the Marketplace and may wish to enroll in your employer’s health plan. However, you may be eligible for a tax credit that lowers your monthly premium, or a reduction in certain cost-sharing if your employer does not offer coverage to you at all or does not offer coverage that meets certain standards. If the cost of a plan from your employer that would cover you (and not any other members of your family) is more than 9.5% of your household income for the year, or if the coverage your employer provides does not meet the “minimum value” standard set by the Affordable Care Act, you may be eligible for a tax credit.

Note: If you purchase a health plan through the Marketplace instead of accepting health coverage offered by your employer, then you may lose the employer contribution (if any) to the employer- offered coverage. Also, this employer contribution – as well as your employee contribution to employer -offered coverage – is often excluded from income for Federal and State income tax purposes. Your payments for coverage through the Marketplace are made on an after-tax basis.

How Can I Get More Information?

For more information about your coverage offered by your employer, please check your summary plan description or contact your HR department. The Marketplace can help you evaluate your coverage options, including your eligibility for coverage through the Marketplace and its cost. Please visit HealthCare.gov for more information, including an online application for health insurance coverage and contact information for a Health Insurance Marketplace in your area.

Part B: Information about Health Coverage Offered by Your Employer This section contains information about any health coverage offered by your employer. If you decide to complete an application for coverage in the Marketplace, you will be asked to provide this information. This information is numbered to correspond to the Marketplace application.

Employer Name

Employer Identification Number (EIN)

DrFirst

52-2212902

Employer Address

Employer Phone Number

9420 Key West Ave. Ste 101

301-231-9510 ext. 2940

City

State

Zip Code

Rockville

MD

20850

Who can we contact about employee health coverage at this job?

Heather Happe Phone number (if different from above)

Email Address Heather.happe@drfirst.com

▪ Eligible members regularly scheduled to work more than 30 hours each week.

▪ Dependent coverage - eligible dependents are spouses and children (biological, adopted and step-children) ▪ Coverage meets minimum value standards, and the cost of this coverage to you is intended to be affordable, based on employee wages. ** Even if your employer intends your coverage to be affordable, you may still be eligible for a premium discount through the Marketplace. The Marketplace will use your household income, along with other factors, to determine whether you may be eligible for a premium discount. If, for example, your wages vary from week to week (perhaps you are an hourly employee or you work on a commission basis), if you are newly employed mid-year, or if you have other income losses, you may still qualify for a premium discount. ***

If you decide to shop for coverage in the Marketplace, HealthCare.gov will guide you through the process. Above is the employer information you’ll enter when you visit HealthCare.gov to find out if you can get a tax credit to lower your monthly premiums.

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