Foertsch Corn Island Guide 2024

JANUARY 1 - DECEMBER 31 | 2024

BE NE FIT + + + GUI DE

WELCOME TO YOUR BENEFITS! Making the right choice is important. This benefit summary will help you understand the benefit choices you can make before your enrollment deadline. We want our team and their families to be happy and healthy. Whether that means keeping fit, eating right, knowing your health risks or changing lifestyle behaviors, your well-being is important to you, your family, your co-workers and Foertsch Companies.

At Foertsch, we are committed to a comprehensive employee benefit program that helps our employees stay healthy, feel secure, and maintain a work/life balance.

TABLE OF CONTENTS BENEFIT OVERVIEW MEDICAL

4

TRUESCRIPTS

6

ELECTRX

7

HEALTHCARE REIMBURSEMENT ACCOUNT

8

IMPORTANCE OF PREVENTIVE CARE

9

REGENEXX

10

MYHEALTH COST ESTIMATOR

12

VIRTUAL VISITS

14

DENTAL

15

VOLUNTARY VISION

16

LIFE AND AD&D

18

DISABILITY INSURANCE

19

401(K)

20

OTHER VOLUNTARY BENEFITS

21

IMPORTANT NOTICES

22-26

CONTACTS

27

2

Section 1 | Health Benefits

3

PPO $2,000 Plan Feature

In-Network

Out-of-Network

$2,000 $4,000

$3,000 $6,000

$3,000 $6,000

$7,350 $14,700

Preventive Care Exam

100% - no deductible or coinsurance required

60% after deductible

Office Visits - Specialists and Primary Care Physicians

80% after deductible

60% after deductible

Deductible Individual Family (Embedded) Out of Pocket Max (includes deductible) Individual Family

Emergency Room

$500 copay; deductible and coinsurance

Inpatient and Outpatient Hospital Services and Inpatient Mental Health, Substance Abuse and Chemical Dependency • Facility and Physician charges • Physician Charges/ Mental Health/Substance/Chemical

80% after deductible

60% after deductible

Outpatient Therapy Services Physical - Occupational, Speech and Manipulation Therapy

80% after deductible

60% after deductible

Individual: $100 Family: $200 Excludes Generic Tier

Prescription Deductible | Embedded

Individual: $1,000 Family: $2,000

Prescription Out-of-Pocket Max

1-34 Day Prescriptions

Prescription Drugs • • • •

Generic Preferred Brand Non-Preferred Brand Specialty

• • • •

35-90 Day Prescriptions

20% to max $75 25% to max $100 25% to max $125 $100 (also additional TrueScripts Tiers for Specialty)

Not Covered

Employee Weekly Contribution Employee

$20.91

Employee + Family

Please see Plan Document for full details.

4

$51.66

HDHP $3,000 Plan Feature

In-Network

Out-of-Network

$3,000 $6,000

$3,000 $6,000

$7,350 $14,700

$7,350 $14,700

Preventive Care Exam

100% - no deductible or coinsurance required

60% after deductible

Office Visits - Specialists and Primary Care Physicians

80% after deductible

60% after deductible

Deductible Individual Family (Embedded) Out of Pocket Max (includes deductible) Individual Family

Emergency Room

$500 copay; deductible and coinsurance

Inpatient and Outpatient Hospital Services and Inpatient Mental Health, Substance Abuse and Chemical Dependency • Facility and Physician charges • Physician Charges/ Mental Health/Substance/Chemical

80% after deductible

60% after deductible

Outpatient Therapy Services Physical - Occupational, Speech and Manipulation Therapy

80% after deductible

60% after deductible

Individual: $200 Family: $400 Excludes Generic Tier

Prescription Deductible | Embedded

1-34 Day Prescriptions

Prescription Drugs • • • •

Generic Preferred Brand Non-Preferred Brand Specialty

• • • •

35-90 Day Prescriptions

20% to max $75 25% to max $100 25% to max $125 $100 (also additional TrueScripts Tiers for Specialty)

Not Covered

Employee Weekly Contribution Employee

$0

Employee + Family

$0 Please see Plan Document for full details.

5

SAVE ON YOUR PRESCRIPTIONS | TRUESCRIPTS

HOW CAN TRUESCRIPTS HELP? TrueScripts manages your prescription drug benefits. PBMs reduce prescription drug costs and improve convenience and safety by negotiating more affordable rates, processing claims, and managing formularies so you know what medication is covered on your health plan.

ACCESS PHARMACY RESOURCES ON YOUR TRUESCRIPTS MEMBER PORTAL Register online at memberportal. truescripts.com to manage your pharmacy benefits.

TrueScripts member portal features: • Recent claim history • Network pharmacy locator • Drug price lookup—check real-time pricing on medication!

• Live chat available Mon-Fri, 8 a.m. to 6 p.m. ET

NEW FOR 2024!

PRICEPROTECTOR+, POWERED BY GOODRX You might have heard of—or even used—the GoodRx discount program in the past. GoodRx offers coupons to help you save on your prescriptions, but in the past it wasn’t compatible with your medical insurance. Now TrueScripts makes it easier for you to get the greatest savings possible while getting credit toward your deductible and out-of-pocket maximum.

With PriceProtector+, TrueScripts will automatically apply GoodRx discount card pricing if it is lower than the cost through your medical plan. No shopping around, no forms to send in, no headaches!

Learn more about PriceProtector+.

QUESTIONS? Call 844-257-1955

6

PRESCRIPTION PROGRAM | ELECTRX

With Elect Rx, you can have medications delivered directly to your home

FOR FREE!

AVAILABLE MEDICATIONS INCLUDE: •

Jardiance

•

Tradjenta

•

Trulicity

•

Synjardy XR

•

Ozempic

•

Xigduo XR

•

Farxiga

•

Janumet XR

•

Invokana

•

Janumet

•

Januvia

•

Steglujan

•

Soliqua

•

Glyxambi

•

Rybelsus

•

Invokamet

•

Ubrelvy

•

Synjardy

•

Steglatro

GET STARTED TODAY!

Call ElectRx Customer Service: 855-353-2879 • Have your medication list handy • Easy enrollment in the program • Questions regarding condition and allergies Have your doctor write a script with 3 refills and ask them to fax it directly to ElectRx at 833-353-2879 Automated reminder notification of pending renewal/ refill. Shipping takes 5-15 days from date of completed requirements.

QUESTIONS? Email Customer Service at info@ElectRx. com

7

HEALTHCARE REIMBURSEMENT ACCOUNT (HRA) Foertsch provides you with an easy way to help lower your out of pocket expenses. You have access to a Healthcare Reimbursement Account, also known as an HRA. Money that you earned from your wellness screenings will be put into your account by Foertsch. With that money, you can pay for medical, prescription, dental, and vision expenses throughout the year. If you do not currently have one, your HRA card will be sent to you with money your earned in your account.

How do I know if I get money put into my HRA? It depends on how you did at your Tri-State health screening. Tri-State measured five health metrics, each worth $100. If you passed just one metric, you will have $100 put into your HRA. If you passed all five metrics, you’ll have $500 put into your HRA. You will receive $100 into your HRA for each metric passed.

How do I use the money in my HRA to pay for medical, dental, vision, and prescription expenses?

You will be given a debit card loaded with your HRA funds to use from January 1 through December 31. To pay medical, dental, or vision bills, just give your provider’s office your account number on your card and you can use the funds in your HRA to pay those expenses. When you’re ready to use it at the pharmacy, just swipe it like a regular debit card. Be sure to keep your receipts. Any funds not used by the end of the calendar year are forfeited. You can use your HRA card for any tax-dependent.

What expenses can I use my HRA funds for?

Your HRA lets you pay for any medical, dental, vision, or prescription expenses you may have that are a result of being covered under Foertsch’s insurance plans. An eligible expense is defined as those expenses paid for care as described in Section 213 (d) of the Internal Revenue Code. For more detailed information, please refer to IRS Publication 502 titled, “Medical and Dental Expenses”.

8

IMPORTANCE OF PREVENTIVE CARE WHY DO YOU NEED PREVENTIVE CARE? Your health coverage covers specific preventive care services at no out-of-pocket cost when completed by an in-network provider. Even when you’re feeling fine, a serious condition with no symptoms may put your health at risk.

Taking advantage of available services at the right time can help you stay healthier by: •

Identifying minor issues now before they develop into a major issue later

•

Preventing certain illnesses and conditions

•

Proactively detecting health problems at early stages, when treatments may be more successful

WHAT IS PREVENTIVE CARE?

WHAT IS NOT PREVENTIVE CARE?

Services are considered preventive when you don’t have any symptoms or diagnosed health issues connected with the preventive service. These services are often provided as part of your wellness exam.

You and your doctor will determine what services are right for you based on your: Age | Gender | Personal health history | Current health

If you have been diagnosed by a doctor with a health issue, the additional screenings and tests following this diagnosis are no longer considered preventive.

Your health coverage still provides coverage for these services, but they are not covered under your preventive benefit.

WHAT’S YOUR SHARE OF COST? Our health plans cover preventive care services at 100% – no additional cost to you – when you go to an innetwork provider. Check your plan materials for details about your specific medical plan’s coverage and the provider directory for a list of health care professionals and facilities in your plan’s network.

9

Kokomo GrainSURGERY now covers Regenexx under your health plan ORTHOPEDIC ALTERNATIVE Regenexx uses your body’s natural healing agents to replace the need

Foertsch covers under your surgeries. health plan!Your stem cells and blood for upnow to 70% of Regenexx elective orthopedic platelets areyour concentrated in ourhealing on-siteagents orthobiologics and injected Regenexx uses body’s natural to replacelabthe need for upunder to 70% of elective image guidance into the precise area of your injury.

With Regenexx, you can orthobiologics orthopedic surgeries. Your stem cells and blood platelets are concentrated in our on-site lab and injected underwhat imageyou guidance into theinvasive precise area of your With Regenexx, you can get get back to doing love without surgery andinjury. lengthy recovery. back to doing what you love without invasive surgery and lengthy recovery.

Conditions Treated Shoulder . arthritis

Spine

bulging, collapsed, or herniated disc . ruptured or torn disc . degenerative disc disease . disc extrusion . disc protrusion . back or neck nerve pain .

. rotator cuff tears . labral tear . rotator cuff tendinosis . joint replacement alternative

Hand/Wrist/Elbow

Hip

arthritis . tennis elbow . ulnar nerve entrapment .

CMC joint arthritis (thumb) . carpal tunnel . trigger finger .

. osteonecrosis . bursitis . labral/labrum tear . tendinopathy . joint replacement alternative . arthritis

Knee

Ankle/Foot

arthritis . meniscus tear . sprain or tear of ACL/PCL . sprain or tear of the MCL/LCL . tendinopathy . joint replacement alternative .

. arthritis . instability . bunions . ligament sprain or tear . plantar fasciitis . achilles tendinopathy

To speak with a Kokomo Grain Regenexx Patient Liaison,

Next Call or chat with acall liveuspatient liaison to ask about Regenexx, discuss your joint at 765-227-4531 orquestions visit regenexxbenefits.com/kokomograin Steps schedule and an evaluation! to learn condition, more aboutorRegenexx how we can help you avoid surgery 866-482-1387 | regenexxbenefits.com/foertschgroup See the next page to learn more about Regenexx!

10

ORTHOPEDIC SURGERY ALTERNATIVE ARE YOU A CANDIDATE FOR REGENEXX? Regenexx procedures treat a broad range of chronic and acute orthopedic injuries. Whether you suffer from the lingering aches and pains often associated with aging or a tear or sprain due to activity, Regenexx may be able to help return you to full function without invasive surgery. Speak with your Foertsch Regenexx Patient Liaison to learn more.

THE PROCEDURE EXPERIENCE Regenexx procedures are injection-based, outpatient procedures. On procedure days, blood and/or stem cells are collected in the morning, processed in our on-site lab, and reinjected under imageguidance in the afternoon. Most patients describe only moderate discomfort, and patients are encouraged to re-engage in activity within a week following the procedure.

SCHEDULING AN EVALUATION Our dedicated patient liaisons understand Foertsch’s benefits and will guide you through the process of finding the clinic nearest to you and scheduling your evaluation. Phone evaluations are available for patients who have recent imaging and do not live close to a clinic location.

After a thorough evaluation by a Regenexx physician, you will be provided with a candidacy rating and treatment plan.

Call or chat with a live patient liaison to ask questions about Regenexx, discuss your joint condition, or schedule an evaluation!

866-482-1387 | regenexxbenefits.com/foertschgroup

11

MYHEALTH COST ESTIMATOR (MYHCE)

myHealthcare Cost Estimator (myHCE) is an online tool that gives you easy access to the information you need to make informed health care decisions.

It combines information from your health plan with health care costs in your area. It also shows estimates based on the doctors and medical facilities you choose. You can get a personalized estimate based on a location and medical provider. The quality and cost efficiency measurements make sure that you get the best service at a reasonable price. myHCE can help you through every step of your treatment. It allows you to find treatment options and learn about recommended care. You can even create and save a care path to track the appointments, tests and follow-up care related to your health needs.

12

MYHEALTH COST ESTIMATOR (MYHCE)

Can estimates vary from actual costs? myHCE is designed to account for the most common treatment provided or any given care path. Your health care provider may prescribe a different treatment plan based on your unique needs.

Take the time to talk with your health care provider about the care you plan to receive, so you understand as much as possible about the procedure, the associated services and the individuals who will be providing your care. This will help you understand and plan for, or minimize, any additional costs beyond the estimate.

The costs provided in this tool are estimates only and are not a guarantee of payment or benefits. It is possible your actual cost will be higher or lower than the estimate.

Take control of your personal health care costs myHCE helps take the guesswork out of some very important health care decisions. It can also assist you in taking control of your personal health and wealth. Feel at home making your cost estimates with myHCE! For more information, please call the customer service number on the back of your UMR ID card.

13

VIRTUAL VISITS | DOCTOR ON DEMAND

With Doctor On Demand you and your whole family will receive easy, stress-free access to Board Certified medical doctors and licensed psychologists through Video Visits on your Smartphone, tablet or computer.

Registering is easy! Here’s how to get started: 1. Download the Doctor on Demand app or go to www.doctorondemand.com.

2. You’ll be prompted to register with basic information. Make sure you enter your medical card information.

3. When you’re ready to see a doctor, click “See a Medical Doctor Now” in the app, type in the symptoms you’re experiencing and you’ll be connected with a physician in your state within minutes!

Visits are only $89!

Doctor on Demand’s team of MDs can diagnose, treat and even write prescriptions for nearly any nonemergency medical condition. The top 10 most common issues they treat are: Coughs, Colds and Sore Throats

Pediatric Issues

Nausea and Diarrhea

Women’s Health

Travel Medicine

Flu

Prescription Refills

Rashes and Skin Issues

Sports Injuries

Eye Issues

Note: Doctor on Demand is not currently able to treat chronic conditions like diabetes or medical emergencies such as chest pain, severe burns or head, neck or back injuries. Physicians will not prescribe medications for patients in Alaska, Arkansas & Louisiana.

Want to see what a video visit would be like?

Watch Doctor on Demand in action! https://vimeo.com/108184565

14

DENTAL

Type of Service

You Pay

Diagnostic and Preventive • Routine teeth cleaning, fluoride applications, space maintainers and sealants • Oral examinations, cavity checking • Full mouth X-rays, panoramic, TMJ arthrogram and supplementary single x-rays

0%

Dental Services • Filling restorations, Inlay/Onlay • Crowns • Root canal therapy, apexification, periapical procedures • Periodontic services • Dentures/Removable Prosthodontics • Fixed bridgework • Oral surgery, simple and surgical tooth extractions • Emergency treatment, anesthesia

50%

Orthodontic Services (to dependent children to age 19)

50%

Benefit Maximums • Diagnostic, Preventive, and Dental Services • Orthodontic Services

$1,000 per person per year $1,500 per eligible person per lifetime

Employee Weekly Contribution Employee

$4.25

Employee + 1

$10.09

Employee + Family

$17.19

Please see Plan Document for full details.

15

VOLUNTARY VISION INSURANCE

Voluntary vision insurance is available to all employees and their families. Foertsch Companies offers two different plans through VSP or EyeMed. Plans offer a $10 copay for annual eye exams and a $25 copay for materials. Eye exams and lenses are covered every 12 months and frames are covered every 24 months.

Weekly Contributions

EyeMed Plan

VSP Plan

Employee

$1.66

$2.07

Employee + Spouse

$3.58

$4.45

Employee + Children

$2.88

$3.60

Family

$4.80

$5.98

16

Section 3 | Financial Protection Benefits

LIFE AND AD&D INSURANCE

Foertsch Companies provides regular, full-time employees with $10,000 group life and $10,000 accidental death and dismemberment (AD&D) insurance. Foertsch Companies pays the full cost of this benefit.

Life coverage amounts reduce according to the following schedule: <age 65 - $10,000 Life and AD&D benefit Age 65-69: benefits reduce by 35% Age 70+ : benefits reduce another 50%

Voluntary Life Insurance Foertsch Companies offers additional life insurance through Reliance Standard. It is available to employees and their families in increments of $10,000 up to a maximum of $500,000. The Guaranteed Issue amount if under the age of 60 is $120,000. The Guaranteed Issue amount for a spouse under the age of 60 is $30,000.

Reliance will allow a re-enrollment of the lesser of $50,000 or the policy GI amount of $120,000 (for employees under the age of 60) or $10,000 for employees over 60. See HR for rates.

Please see Plan Document for full details.

18

DISABILITY INSURANCE Short Term Disability

Short Term Disability provides financial protection in the event you miss work from a non work-related injury or sickness, disability income benefits are provided as a source of income.

Benefits begin: On the 8th consecutive day after a disability caused by injury or sickness Weekly benefit: $125 per week Maximum duration: 26 weeks You are not eligible to receive short-term disability benefits if you are receiving workers’ compensation benefits. This benefit is provided by Foertsch Companies.

Voluntary Short Term Disability

Additional short term disability insurance through Allstate is available to employees only. It provides coverage in the event that an accident or a sickness occurs that prevents you from working. See HR for rates.

Benefits begin: On the 8th day after the event Weekly benefit: Up to 60% of your weekly pay Maximum duration: 6 months

Long Term Disability

Long Term Disability provides financial protection for you by paying a portion of your income while you are disabled. This coverage is voluntary and paid for by the employee.

Benefits begin: After 180 days of disability Monthly benefit: 60% of pre-disability earnings to maximum of $5,000 Maximum duration: Benefits payable to age 65 To calculate your cost per pay period, please use the following formula: ÷ 100 = Your annual earnings

Rate

=

X

=

÷ My Annual Cost

Your Rate

# of paychecks per year

Cost per Paycheck

<25

25-29

30-34

35-39

40-44

45-49

50-54

55-59

60-64

65-69

70+

0.26

0.32

0.50

0.77

1.06

1.52

2.05

2.68

2.75

3.65

4.38

Please see Plan Document for full details.

19

401(K)

Overview

Foertsch Companies provides a 401(k) Retirement Plan to employees over the age of 21 with more than 1 year of service upon reaching your entry date. You may contribute up to $23,000 for 2024 as a pre-tax or Roth deferral.

Participants age 50 and over may also contribute an additional $7,500.

Foertsch Companies provides a 401(k) Retirement Plan to employees over the age of 21 with more than 1 year or service upon reaching your entry date. You may contribute up to $18,500 Please refer to Summary Plan Description for additional information. for 2018 as a pre-tax or Roth deferral. Participants age 50 and over may also contribute an additional $6,000. Please refer to Summary Plan Description for additional information.

Visit principal.com or download the mobile app today!

Need help logging in?

Call 1-800-547-7754

Features & Tools • • •

Change Contributions Update Beneficiaries Manage Investments

• • •

Rollover Assistance • Retirement Wellness Score & Planner • Financial Education Articles •

Virtual Coach Education Monthly Education Seminars Link External Accounts

Maximize Your Contribution Foertsch Companies Retirement Plan If you put in:

1%

2%

Foertsch will give you:

1%

2%

John M. Ludwig, ChFC, AIF®, CRPS® Financial Advisor, LPL Financial P 317-705-2033 JLudwig@LHDretirement.com

Toll Free 855-250-9597 F 317-705-0621 20

OTHER VOLUNTARY BENEFITS

Voluntary Cancer Insurance

Voluntary Cancer Insurance is available to all employees and their families through Allstate. It pays cash benefits for cancer and 29 specified diseases to help with the cost of treatments and expenses as they happen. Benefits are paid directly to you unless otherwise agreed.

Weekly premium rates Premium Employee

$5.81

Family

$9.78

Voluntary Accident Policy

The policy is available to all employees and their families through Aflac. The Accident Policy provides coverage in the event of an off-the-job accident or if your child gets injured at a sports practice.

Benefits are paid directly to you unless otherwise assigned. Benefits are payable for things such as fractures, lacerations, concussions, burns, X-rays, etc. Payable amount depends on the injury and what treatment is utilized for the injury.

Weekly premium rates Premium Employee

$5.64

Employee + Spouse

$7.41

Employee + Children

$8.49

Family

$10.56

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IMPORTANT NOTICES General Notice of COBRA Continuation Coverage Rights INTRODUCTION You are receiving this notice because you have recently become covered under a group health plan (the Plan). This notice contains important information about your right to COBRA continuation coverage, which is a temporary extension of coverage under the Plan. This notice generally explains COBRA continuation coverage, when it may become available to you and your family, and what you need to do to protect the right to receive it.

The right to COBRA continuation coverage was created by a federal law, the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA). COBRA continuation coverage can become available to you when you would otherwise lose your group health coverage. It can also become available to other members of your family who are covered under the Plan when they would otherwise lose their group health coverage. This notice does not fully describe COBRA continuation coverage or other rights under the plan. For additional and more complete information about your rights and obligations under the Plan and under federal law, you should review the Plan’s Summary Plan Description or contact the Plan Administrator.

WHAT IS COBRA CONTINUATION COVERAGE COBRA continuation coverage is a continuation of Plan coverage when coverage would otherwise end because of a life event known as a “qualifying event.” Specific qualifying events are listed later in this notice. After a qualifying event, COBRA continuation coverage must be offered to each person who is a “qualified beneficiary.” You, your spouse, and your dependent children could become qualified beneficiaries if coverage under the Plan is lost because of the qualifying event. Under the Plan, qualified beneficiaries who elect COBRA continuation coverage may be required to pay for COBRA continuation coverage.

If you are an employee, you will become a qualified beneficiary entitled to elect COBRA continuation coverage if you lose your coverage under the Plan because either one of the following qualifying events happens: Your hours of employment are reduced, or Your employment ends for any reason other than your gross misconduct.

• •

If you are the spouse of an employee, you will become a qualified beneficiary entitled to elect COBRA continuation coverage if you lose your coverage under the Plan because any of the following qualifying events happens: Your spouse dies; Your spouse’s hours of employment are reduced; Your spouse’s employment ends for any reason other than his or her gross misconduct; Your spouse becomes entitled to Medicare benefits (under Part A, Part B, or both); or You become divorced or legally separated from your spouse. In the event your spouse, who is the employee, reduces or terminates your coverage under the Plan in anticipation of a divorce or legal separation which later occurs, the divorce or legal separation may be considered a qualifying event even though the coverage was reduced or terminated before the divorce or separation.

• • • • •

22

IMPORTANT NOTICES Your dependent children, including any child born to or placed for adoption with a covered employee during the period of COBRA coverage who is thereafter properly enrolled in the Plan, or a child of the covered employee who is receiving benefits under the Plan pursuant to a qualified medical child support order, will become qualified beneficiaries entitled to elect COBRA continuation coverage if they lose coverage under the Plan because any of the following qualifying events happens: The parent-employee dies; The parent-employee’s hours of employment are reduced; The parent-employee’s employment ends for any reason other than his or her gross misconduct; The parent-employee becomes entitled to Medicare benefits (Part A, Part B, or both); The parents become divorced or legally separated; or The child stops being eligible for coverage under the plan as a “dependent child.”

• • • • • •

WHEN IS COVERAGE AVAILABLE? The Plan will offer COBRA continuation coverage to qualified beneficiaries only after the Plan Administrator has been notified that a qualifying event has occurred. When the qualifying event is the end of employment or reduction of hours of employment, death of the employee, or the employee is becoming entitled to Medicare benefits (under Part A, Part B, or both), the employer must notify the Plan Administrator of the qualifying event.

YOU MUST GIVE NOTICE OF SOME QUALIFYING EVENTS For the other qualifying events (divorce or legal separation of the employee and spouse or a dependent child’s losing eligibility for coverage as a dependent child), you must notify the Plan Administrator in writing within 60 days after the qualifying event occurs. You must provide this notice to Foertsch Group: Lamar 812-529-8211 or Human Resources Department 812-362-8808.

HOW IS COBRA COVERAGE PROVIDED? Once the Plan Administrator receives timely notice that a qualifying event has occurred, COBRA continuation coverage will be offered to each of the qualified beneficiaries. Each qualified beneficiary will have an independent right to elect COBRA continuation coverage. Covered employees may elect COBRA continuation coverage on behalf of their spouses, and parents may elect COBRA continuation coverage on behalf of their children. If COBRA continuation coverage is not elected within the 60-day election period, a qualified beneficiary will lose the right to elect COBRA continuation coverage.

COBRA continuation coverage is a temporary continuation of coverage. When the qualifying event is the death of the employee, the employee’s becoming entitled to Medicare benefits (under Part A, Part B, or both), your divorce or legal separation, or a dependent child’s losing eligibility as a dependent child, COBRA continuation coverage may last for up to a total of 36 months. When the qualifying event is the end of employment or reduction of the employee’s hours of employment, and the employee became entitled to Medicare benefits less than 18 months before the qualifying event, COBRA continuation coverage for qualified beneficiaries other than the employee lasts until 36 months after the date of Medicare entitlement. For example, if a covered employee becomes entitled to Medicare 8 months before the date on which his employment terminates, COBRA continuation coverage for his spouse and children can last up to 36 months after the date of Medicare entitlement, which is equal to 28 months after the date of the qualifying event (36 months minus 8 months). Otherwise, when the qualifying event is the end of employment or reduction of the employee’s hours of employment, COBRA continuation coverage generally lasts for only up to a total of 18 months. There are two ways in which this 18-month period of COBRA continuation coverage can be extended.

23

IMPORTANT NOTICES DISABILITY EXTENSION OF 18 MONTH PERIOD OF CONTINUATION COVERAGE If you or anyone in your family covered under the Plan is determined by the Social Security Administration to be disabled and you notify the Plan Administrator in a timely fashion, you and your entire family may be entitled to receive up to an additional 11 months of COBRA continuation coverage, for a total maximum of 29 months. The disability would have to have started at some time before the 60th day of COBRA continuation coverage and must last at least until the end of the 18-month period of continuation coverage. The Plan procedures for this notice, including a description of any required information or documentation, the name of the appropriate party to whom notice must be sent, and the time period for giving notice, can be found in the most recent Summary Plan Description or by contacting the Plan Administrator. If these procedures are not followed or if the notice is not provided in writing to the Plan Administrator during the 60-day notice period and within 18 months after the covered employee’s termination of employment or reduction of hours, there will be no disability extension of COBRA continuation coverage. The affected individual must also notify the Plan Administrator within 30 days of any final determination that the individual is no longer disabled.

SECOND QUALIFYING EVENT EXTENSION OF 18 MONTH PERIOD OF CONTINUATION COVERAGE If your family experiences another qualifying event while receiving 18 months of COBRA continuation coverage, the spouse and dependent children in your family can get up to 18 additional months of COBRA continuation coverage, for a maximum of 36 months, if notice of the second qualifying event is properly given to the Plan. This extension may be available to the spouse and any dependent children receiving COBRA continuation coverage if the employee or former employee dies, becomes entitled to Medicare benefits (under Part A, Part B, or both), or gets divorced or legally separated, or if the dependent child stops being eligible under the Plan as a dependent child, but only if the event would have caused the spouse or dependent child to lose coverage under the Plan had the first qualifying event not occurred.

The Plan procedures for this notice, including a description of any required information or documentation, the name of the appropriate party to whom notice must be sent, and the time period for giving notice, can be found in the most recent Summary Plan Description or by contacting the Plan Administrator. If these procedures are not followed or if the notice is not provided in writing to the Plan Administrator during the 60-day notice period, there will be no extension of COBRA continuation coverage due to a second qualifying event.

IF YOU HAVE QUESTIONS Questions concerning your Plan or your COBRA continuation coverage rights should be addressed to the contact or contacts identified below. For more information about your rights under ERISA, including COBRA, the Health Insurance Portability and Accountability Act (HIPAA), and other laws affecting group health plans, contact the nearest Regional or District Office of the U.S. Department of Labor’s Employee Benefits Security Administration (EBSA) in your area or visit the EBSA website at www.dol.gov/ebsa. (Addresses and phone numbers of Regional and District EBSA Offices are available through EBSA’s website.)

KEEP YOUR PLAN INFORMED OF ADDRESS CHANGES In order to protect your family’s rights, you should keep the Plan Administrator informed of the current addresses and of any changes in the addresses of family members. You should also keep a copy, for your records, of any notices you send to the Plan Administrator.

PLAN CONTACT INFORMATION Foertsch Group: Lamar 812-529-8211 Human Resources Department 812-362-8808

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IMPORTANT NOTICES Women’s Health and Cancer Rights Act of 1998 In October 1998, Congress enacted the Women’s Health and Cancer Rights Act of 1998. This notice explains some important provisions of the Act. Please review this information carefully. As specified in the Women’s Health and Cancer Rights Act, a plan participant or beneficiary who elects breast reconstruction in connection with a covered mastectomy is also entitled to the following benefits:

• All stages of reconstruction of the breast on which the mastectomy was performed; • Surgery and reconstruction of the other breast to produce a symmetrical appearance; and • Prostheses and treatment of physical complications of the mastectomy, including lymphedemas.

Health plans must provide coverage of mastectomy-related benefits in a manner determined in consultation with the attending physician and the patient. Coverage for breast reconstruction and related services may be subject to deductibles and coinsurance amounts that are consistent with those that apply to other benefits under this plan.

Special Enrollment Rights If you are declining enrollment for yourself or your dependents (including your spouse) because of other health insurance or group health plan coverage, you may be able to enroll yourself and your dependents in this plan if you or your dependents lose eligibility for that other coverage (or if the employer stops contributing toward you or your dependents’ other coverage). However, you must request enrollment within 30 days after you or your dependents’ other coverage ends (or after the employer stops contributing toward the other coverage). In addition, if you have a new dependent as a result of marriage, birth, adoption, or placement for adoption, you may be able to enroll yourself and your dependents. However, you must request enrollment within 30 days after the marriage, birth, adoption, or placement for adoption. To request special enrollment or obtain more information, contact the Human Resources Department.

Mothers’ Health Protection Act Disclosure 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 does not prohibit the mother’s or newborn’s attending provider, after consulting with the mother, from discharging the mother or her newborn earlier than 48 hours (or 96 hours as applicable). In any case, plans and issuers may not, under Federal law, require that a provider obtain authorization from the plan or the issuer for prescribing a length of stay not in excess of 48 hours (or 96).

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 illness or injuries.

Wellness Incentive as part of a Group Health Plan If it is unreasonably difficult due to a medical condition for you to achieve the standards for the reduced contributions

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IMPORTANT NOTICES under this program, or if it is medically inadvisable for you to attempt to achieve the standards for the reward under this program, contact the Human Resources Department and we will work with you to develop another way to qualify for the reward.

Medicaid and the Children’s Health Insurance Program (CHIP) Offer Free Or Low-Cost Health Coverage To Children And Families If you are eligible for health coverage from your employer, but are unable to afford the premiums, some States have premium assistance programs that can help pay for coverage. These States use funds from their Medicaid or CHIP programs to help people who are eligible for employer-sponsored health coverage, but need assistance in paying their health premiums.

If you or your dependents are already enrolled in Medicaid or CHIP and you live in a State listed below, you can contact your State Medicaid or CHIP office to find out if premium assistance is available.

If you or your dependents are NOT currently enrolled in Medicaid or CHIP, and you think you or any of your dependents might be eligible for either of these programs, you can contact your State Medicaid or CHIP office or dial 1-877-KIDS NOW or www.insurekidsnow.gov to find out how to apply. If you qualify, you can ask the State if it has a program that might help you pay the premiums for an employer-sponsored plan.

Once it is determined that you or your dependents are eligible for premium assistance under Medicaid or CHIP, your employer’s health plan is required to permit you and your dependents to enroll in the plan – as long as you and your dependents are eligible, but not already enrolled in the employer’s plan. This is called a “special enrollment” opportunity, and you must request coverage within 60 days of being determined eligible for premium assistance.

For assistance in Kentucky:

For assistance in Indiana:

Website: http://chfs.ky.gov/dms/default.htm Phone: 800-635-2570

Healthy Plan for low-income adults, 19-64 Website: http://www.in.gov/fssa/hip/ Phone: 888-438-4479 All other Medicaid Website: http://www.indianamedicaid.com Phone: 800-403-0864

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BENEFIT CONTACTS UMR

www.umr.com 800-826-9781

• Medical Insurance TRUESCRIPTS

www.truescripts.com 844-257-1955

• Prescriptions

REGENEXX

www.regenexx.com/ foertschgroup 866-482-1387

• Orthopedic Surgery Alternative

OPTIONS DENTAL

www.insuringsmiles.com 800-727-1444

• Dental

UNUM

www.unum.com 866-679-3054

• Short and Long Term Disability • Life and AD&D

RELIANCE STANDARD

www.reliancestandard.com 800-351-7500

• Voluntary Life • Voluntary Vision

ALLSTATE

www.allstate.com 800-521-3535

• Voluntary Cancer • Voluntary Short Term Disability

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The information in this Enrollment Guide is presented for illustrative purposes and is based on information provided by the employer. The text contained in this Guide was taken from various summary plan descriptions and benefit information. While every effort was taken to accurately report your benefits, discrepancies or errors are always possible. In case of discrepancy between the Guide and the actual plan documents, the actual plan documents will prevail. All information is confidential pursuant to the Health Insurance Portability and Accountability Act of 1996.

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