Revere Bank 2019 Benefits Guide

Benefits Guide

2019 January 1st, 2019 - December 31st, 2019

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

Introduction

Table of Contents Introduction Contacts EONE BAT CoreSource Medical Plans HRA & TASC Dental Vision FSA Life & Disability Teladoc Cost Simplicity Annual Notices

2 3 4 5 6-7 8 9 9 10 11 12 13 14 15-18

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. Revere Bank offers comprehensive, cost effective benefits options. Employees new to Revere Bank 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 enroll until the following open enrollment.

Part-time regular status Employees who work a minimum of 20 hours are considered eligible for benefits in this guide, excluding life and disability.

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

•

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 CoreSource

Medical, Rx, Dental, & Vision Administrator

myCoreSource.com (800) 223-3943

Cigna

Medical Network

Cigna.com/hcpdirectory

Guardian

Dental Network

guardiananytime.com

Avesis

Vision Carrier

Avesis.com (855) 214-6777

Mutual of Omaha

Life, AD&D, &Disability

Mutualofomaha.com (800) 775-8805

Teladoc

Telemedicine Provider

Teladoc.com (800) 835-2632

Revere Bank Human Resources

Human Resources

Barbara Hoey (240) 264-5388 Florence Pritchett (240) 264-5411

Employee ONE Benefit Solutions

Benefits Advocate Team ID Cards and Eligibility

mybenefits@employee1.net (410) 719-2222 (410) 719-2221 fax

Please Note: This booklet provides a summary of the benefits available, but is not your Summary Plan Description (SPD). Revere Bank 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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EONE Benefit Advocacy Team

Plan Information & Questions Get the answers you’re looking for, and get back to your life.

410-719-2222 or mybenefits@employee1.net

During open enrollment make sure to take advantage of all group communication materials such as: Benefits Guides, Webinars and Open Enrollment Meetings. If you still have questions about your benefits after open enrollment, we’re here to help!

Provider Search If you’re having trouble navigating the carrier-specific Provider Search as indicated in this Benefits Guide, please give us a call! Remember to check your Benefits Guide for network information to help narrow your search.

ID Cards In most cases, you’re able to order and print your ID card (or temporary card) directly from the carrier website. Review your guide for information on how to register online with each carrier – it’s fast and easy!

Note: HIPAA privacy regulations may require the completion of a pre-authorization form prior to releasing information regarding deductible amounts or specific medical conditions (once a HIPAA form is submitted, it may take up to 48 hours before information can be released). Bank account information (including: 401(k), HSA, HRA and FSA) is generally considered classified and we recommend you reach out directly to the account holder.

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CoreSource Administration A Personal Online Gateway to Your Health Plan These days, people do their banking, pay utility bills and shop for just about anything online. It’s secure, fast, easy and convenient. At CoreSource, we believe accessing information about your health plan, and managing your accounts should be no different. That’s why we provide myCoreSource.com, a personal online portal to detailed claims data, out-of-pocket expense tracking, dedicated customer service with speedy responses to your important questions, and much more. Better yet, you can visit the portal to your health plan when it fits your busy schedule – at any time of the day or night.

Take advantage of all that myCoreSource.com has to offer: View claim detail •

Use a variety of filtering and sorting capabilities to help you find specific claims faster, including the ability to sort by patient status, type or service date.

View Custom Content • • •

Site Security and Login • •

Intense security protects members’ information.

Create separate logins for family members, and have the ability to block certain information from other members of the household.

Explanation of Benefits (EOB) • •

Online Message Center • • •

Quick, direct access to Customer Service.

Immediately send questions about a specific claim while viewing it.

Select certain topics so that your important questions are delivered to the appropriate department and answered as quickly as possible.

2019 Benefits Guide

Tailored messages from your employer when needed.

Informational articles on website functions, health and wellness and healthcare consumer advice.

View links and resources personalized to be relevant to your coverage.

•

View information on medical claims and payments made

by CoreSource with secure electronic EOB. Receive a secure e-mail automatically when electronic EOBs become available.

Update the e-mail address receiving secure electronic EOBs at any time.

Receive E-mail Alerts • •

When electronic EOBs are available to view.

Replies to your Message Center questions.

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Medical Plan Summary Buy-Up Plan Summary The CoreSource / Cigna Plan has in-network or out-of-network coverage. If you seek care from an out-of-network provider, you are subject to higher out-of-pocket expenses and balance billing by that provider. This plan does not require you to select a Primary Care Physician (PCP) or obtain a referral from your PCP in order to see a specialist.

In-Network

Out-of-Network

Annual Deductible

$2,500 Individual | $5,000 Family

$4,000 Individual | $8,000 Family

Annual Out-of-Pocket Maximum

$3,500 Individual | $6,550 Family

$8,000 Individual | $16,000 Family

Physicians Office Visit

Deductible, then no charge

Deductible, then 20%

Specialists Office Visit

Deductible, then no charge

Deductible, then 20%

No Charge

Deductible, then no charge

Lab and X-ray

Deductible, then no charge

Deductible, then 20%

Other Diagnostic Tests (OP Facility)

Deductible, then no charge

Deductible, then 20%

Inpatient Hospital Facility Services

Deductible, then $250 copay

Deductible, then 20%

Deductible, then no charge

Deductible, then 20%

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 $100 per visit (waived if admitted)

Urgent Care

Deductible, then no charge

Deductible, then 20%

Rehabilitations Services (Physical, Occupational, Speech)

Deductible, then no charge

Deductible, then 20%

Outpatient Spinal Manipulation

Deductible, then no charge

Deductible, then 20%

• Mental Health/Substance Abuse

• •

Inpatient Hospitalization: Deductible, then $250 copay Office Visits: Deductible, then no charge Outpatient Facility: Deductible, then no charge

Deductible, then 20%

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 Members have access to the Cigna network of providers

2019 Benefits Guide

Shared with medical Shared with medical Deductible, then $15 copay per script Deductible, then $35 copay per script Deductible, then $60 copay per script Deductible, then 50% to maximum of $75 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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How it Works

You must meet the plan deductible before the plan will pay for most services.

The steps below highlight how your plan works

Buy-Up Plan In-Network

Out-of-Network

$2,500 Individual $5,000 Family

$4,000 Individual $8,000 Family

Plan pays 100% You pay nothing (with some exceptions)

Plan pays 80% You pay 20% Plus Balance Billing

$3,500 Individual $6,550 Family

$8,000 Individual $16,000 Family

Step 1 Meet your deductible You’re responsible for the entire cost of services up to the amount of your deductible. Your provider should submit all expenses to CoreSource. Any amounts calculated toward your deductible can be satisfied using your TASC card, funded by Revere Bank.

You must provide all providers and facilities with your CoreSource card before paying for your services utilizing the TASC HRA card.

Any Prescription medications that do not fall under your deductible, will have to be paid using your FSA or out-of-pocket by you, the member.

If more than one person is covered on your plan, you will have to meet the Family deductible before the plan will pick up its portion of the coverage. The family deductible can be met by one person or a combination of people.

Step 2 Your plan will start to pay for services Calendar Year Deductible. After the deductible has been met, covered expenses will be paid based on the coinsurance level specified by the plan or you will have to pay the copay listed for that specific service.

Step 3 Your out-of-pocket maximum Your out-of-pocket maximum is the max amount you pay during your benefit period. Your plan deductible, all copays and coinsurance amounts contribute towards your out-of-pocket max. After each eligible family member meets his or her individual out of-pocket max, the plan will pay 100% of their covered expenses. Or, after the family out-of-pocket max has been met, the plan will pay 100% of each member’s covered expenses.

Track your deductible and out-of-pocket maximums at:

myCoreSource.com

For questions regarding benefits or claim concerns, contact the Employee One Benefit Advocate team: mybenefits@employee1.net

Members have access to the Cigna network of providers. Find a Doctor at:

Cigna.com/hcpdirectory

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Health Reimbursement Arrangement A TASC Health Reimbursement Arrangement (HRA) is an employer-sponsored benefit to reimburse a portion of your eligible out-of-pocket medical expenses, specifically the deductible on your medical plan.

Employees who enroll in the medical plan receive an HRA and debit card from Revere with $2,500 to offset the deductible. If enrolled with any dependents, an additional $2,500 will be funded into the account (the maximum is a total of $5,000 for a family).

Make sure to provide BOTH your CoreSource ID card along with the TASC HRA card at the time of service. Not doing so would cause your HRA funds to be depleted without having met your health insurance plan deductible.

Benefits of Using a TASC HRA • Bridge the gap on eligible healthcare expenses that you pay before your insurance or any other reimbursement kicks in • Use a debit card to pay for eligible expenses • Submit receipts for reimbursement right from your smart phone or tablet using the mobile app

Payment Options

Online Account Manage the account online. Set-up direct deposit and submit claims from one place. Review your account balances and update personal information from both the computer and a smart phone.

TASC makes it easy for you to use the money in your healthcare benefit accounts to pay for hundreds of eligible healthcare expenses. These payment options are fully automated. Log into your TASC account on either the web portal or the mobile app, select your preferred payment option, and follow the prompts. You can set up direct deposit or have checks mailed to you.

HRA card vs. FSA card HRA

FSA

The Health Reimbursement Account (HRA) is completely funded by Revere Bank at no cost to you! It is used to offset the high deductible on the medical/prescription plan.

Flexible Spending Accounts (FSA) allow employees to set aside pre-tax dollars to fund dental, vision, and hearing needs for yourself and dependents.

This account may only be used for medical expenses for yourself and any dependents on your plan.

This account can also fund medical expenses once the HRA has been exhausted.

You can only edit this amount during open enrollment unless you have a qualifying event.

This card can be swiped at the time of service, entered into provider payment portals, or paper provider bills after service.

Lowers taxable income and funds are NEVER taxed if used on qualified healthcare expenses.

There is no 12-digit member number below the name on the HRA card.

The FSA card contains the 12-digit member number below the cardholder’s name.

To check account balances or file for reimbursement, go to tasconline.com. Please write HRA or FSA on your respective cards to avoid confusion at the time of service.

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Dental PPO Regular dental care is essential to good health. Revere Bank provides preferred (PPO) dental coverage through CoreSource with access to the Guardian National PPO of dental providers. To find in-network dentists, visit GuardianAnytime.com and Choose “Find a Provider”. Select the “Dental Guard Preferred Select” under the network options.

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 In-Network

Plan Year Deductible

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

Annual Plan Year Maximum Benefit Preventive Care (such as cleanings, exams, and x-rays) Regular Restorative Care (such as fillings, oral surgery, and root canals)

Major Restorative Care (such as dentures, bridgework and crowns)

$1,500 No Charge

No Charge

20% after deductible

20% after deductible

50% after deductible

50% after deductible

Orthodontia (for children up to age 19)

50% up to $1,000 Lifetime Maximum

Avesis Vision Vision coverage is offered through Avesis. Avesis provides a national network of providers that includes many popular chains as well as private providers. Participating providers can be found at Avesis.com.

In-Network Eye Exams (every 12 months)

Frames (every 12 months)

Lenses (every 12 months) Contact Lenses (benefit for glasses OR contacts in a plan year)

$10 copay $130 Allowance for wide selection $150 allowance for featured brands 20% savings over allowance $70 Costco allowance $0 copay for single, lined bifocals and trifocals Enhancements starting at $55 copay $130 allowance $60 copay for lens fitting and evaluation

Out-of-Network

Up to $45 Reimbursement

Up to $70 Reimbursement

$30 - $65 Reimbursement based on lenses Up to $105 Reimbursement

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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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.

Log in to your account for real time access to account balance information, pending claim status, reimbursement forms, and to file for reimbursement. Visit tasconline.com and download the TASC app on your smartphone.

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. Each year you are able to roll over up to $500 annually. Take this into consideration when deciding how much to put into the account for the following plan year.

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.

2019 Benefits Guide

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

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.

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Life & Disability Insurance Available for Full-time Employees Only

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

• Available to eligible full-time employees.

• Benefits are 1x basic annual earnings (rounded up to the next higher $1,000) • Maximum of $250,000 • Benefits will reduce to 50% at age 70 • Benefits end on the date of your retirement • Conversion options may be available if you separate from the bank

Employer Paid Short Term Disability Revere Bank 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 $2,000 per week • Benefits would begin after 14 days for Accidents and Sickness • Benefits may continue for up to 11 weeks • Pre-existing conditions may apply

Employer Paid Long Term Disability Revere Bank provides Long Term Disability Insurance at no cost to you.

• This benefit replaces up to 60% of your monthly earnings should you become disabled • The maximum monthly benefit you may receive is $7,500 • Benefits would begin after you have been disabled for 90 days • Benefits may continue until your normal Social Security retirement age • Contains a pre-existing condition limitation for the first 12 months of coverage • Partial disability and Return to Work Incentives are included on the plan • Survivor benefits will be made to your beneficiary equal to 3 times your maximum LTD benefits

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Employee Assistance Program (EAP)

Available when employees need it most Life’s not always easy. Sometimes a personal or professional issue can affect your work, health and general well-being. You often turn to family or friends for support. But sometimes that’s not enough. Sometimes you need an experienced professional to talk with to know you’re not alone. Start today by calling (800) 316-2796 for confidential consultation and resource services … 24 hours a day, seven days a week.

Mutual of Omaha not only provides their telephonic sessions, but also has resources on many topics online at www.mutualofomaha.com/eap along with information to engage resources for more in-depth assistance.

Topics include: • Marriage counseling • Divorce assistance • Emotional wellbeing: Stress, Anxiety, etc.

• Financial Wellness • Substance Abuse • Legal Assistance and Will preparation • Work and Career Development • Relaxation Techniques • Many more…

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Teladoc® Available 24/7/365 Getting Started with Teladoc® Teladoc’s U.S. board-certified doctors are available 24/7/365 to resolve many of your medical issues through phone or video consults. Set up your account today so when you need care now, a Teladoc doctor is just a call or click away.

Set Up Your Account It’s quick and easy online. Visit the Teladoc website at Teladoc.com, click “Set up account” and provide the required information. You can also call Teladoc for assistance over the phone.

Request A Consult Once your account is set up, request a consult anytime you need care.

Provide Medical History Your medical history provides Teladoc doctors with the information they need to make an accurate diagnosis.

Online: Log into Teladoc.com and click “My Medical History”.

Mobile app: Log into your account and complete the “My Health Record” section. Visit Teladoc.com/mobile to download the app.

Call Teladoc: Teladoc can help you complete our medical history over the phone at 1-800Teladoc.

Talk to a doctor anytime | $40 Copay

Download the app:

© 2015 Teladoc, Inc. All rights reserved. Teladoc and the Teladoc logo are trademarks of Teladoc, Inc. and may not be used without written permission.

Teladoc does not replace the primary care physician. Teladoc does not guarantee that a prescription will be written. Teladoc operates subject to state regulation and may not be available in certain states. Teladoc does not prescribe DEA controlled substances, non therapeutic drugs and certain other drugs which may be harmful because of their potential for abuse. Teladoc physicians reserve the right to deny care for potential misuse of services. Teladoc phone consultations are available 24 hours, 7 days a week while video consultations are available during the hours of 7am to 9pm, 7 days a week.

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Simplicity CoreSource and Revere Bank have made a new financial benefit available to you called Simplicity. There’s no additional cost to use it, and it will revolutionize the way you manage your healthcare expenses. Participation in this program is completely voluntary.

What is Simplicity?

Simplicity gives you flexibility and control to manage healthcare expenses. Here’s how it works:

How can Simplicity help me?

Simplicity gives you control and eliminates confusion by consolidating all your in-network medical bills in one place—just like a credit card bill!

Simplicity gives you the flexibility to spread out your payments by using 12-month interest-free repayment options.

Simplicity gives you rewards in the form of up to 5% SimpleRewardsSM credits on the payments you make.

When you receive a statement from Simplicity, it is legitimate.

Simplicity is part of your employee health benefit plan.

If you’ve already paid your doctor for the services on this statement, don’t worry, you’re not being double-billed! If you have already paid, you can activate Simplicity online.

Go to www.simplicitypayments.com/Activate.

It only takes a few minutes.

If you have questions about Simplicity, just call the CoreSource number near the top of your medical ID card.

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Cost The rates listed below are per pay, based on 26 pays.

Medical

Employee Only

Employee & Spouse

Employee & Child(ren)

Employee & Family

Under $85,000

$29.11

$240.66

$173.98

$320.55

$85,000 - $175,000

$51.83

$299.79

$214.02

$405.72

Over $175,000

$69.29

$353.72

$255.34

$475.23

Employee Only

Employee & Spouse

Employee & Child(ren)

Employee & Family

-

$13.85

$9.38

$19.53

Employee Only

Employee & Spouse

Employee & Child(ren)

Employee & Family

$0.42

$2.05

$1.35

$2.87

Dental Guardian PPO

Vision Avesis

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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.

Revere Bank 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 Revere Bank Human Resources department for more information in regards to these criteria and how the coordination of benefits would be determined.

2019 Benefits Guide

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)

Revere Bank

20-8489814

Employer Address

Employer Phone Number

319 Main Street

240-264-5388

City

State

Zip Code

Laurel

MD

20707-4129

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

Barbara Hoey Phone number (if different from above)

Email Address Barbara.hoey@reverebank.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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Notes

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