Pierce Group Benefits 2018 Booklet - 2018-2019 Plan Year (10.23.18) with page links

Arranged by Pierce Group Benefits

PIERCE GROUP BENEFITS PLAN YEAR: December 1, 2018 - November 30, 2019

What’s Inside

Benefits Plan Overview.................................................................................

2

Online Enrollment Instructions …………………………………………………

4

Health Insurance UnitedHealthcare Bronze Choice HSA 5,250-02 – Base Plan……....…….

Health Savings Account (HSA)…………………………….………………...

6 8 10 12 14 15 16 17 20 21

Dental Benefits……………………………………………

22

Vision Benefits……………………………………………

27

Group Term Life Insurance………………………………..

28

Health, Dental, Vision & Life Rates – 2018 - 2019…….….

31

UnitedHealthcare Silver Choice Plus 3,000-02 – Buy Up Option #1…......

UnitedHealthcare Silver Choice Plus HSA 2,250-24 – Buy Up Option #2...

Pierce Group Benefits Plan Year December 1, 2018 through November 30, 2019

Pierce Group Benefits is offering all eligible employees a comprehensive Benefits Program.

This booklet highlights the benefits offered through your employer for the current plan year. Benefits described in this booklet are voluntary, employee-paid benefits unless otherwise noted. You have the opportunity to select the benefits in which you wish to participate. Please see the Benefits Plan Overview section of the booklet for more details.

This is neither an insurance contract nor a Summary Plan Description and only the actual policy provisions will prevail. All information in this booklet including premiums quoted is subject to change. All policy descriptions are for information purposes only. Your actual policies may be different than those in this booklet.

Arranged & Enrolled by

myuhc.com – Step-by-Step Registration Process…..…..…..……..…..….. myNurseLine……………………………..…………………………………..

Virtual Visits………………………………………………………..………...

Generic Medications – Five Things You Need to Know……………….……

Getting to know your Prescription Drug List...………………….……..……

OptumRx Mail Service Pharmacy……………………….……….….………

Flexible Spending Accounts Medical & Dependent Care Flexible Spending Accounts……….…….

Limited Purpose Flexible Spending Account……………………………

Managing Your Account……………………………………………..……

The FSA Store……………………………………………..………………

33 38 39 40

Cancer Benefits…………………………………………...

41

Disability Benefits…………………………………………

52

Accident Benefits…………………………………………

61

Medical Bridge Benefits…………………………………..

65

Critical Care Benefits…………...…………………………

71

Supplemental Life Insurance……………..………………

78

Identity Theft Shield & Life Events Legal Plan ……………..

86

Rev. 10/23/2018

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PIERCE GROUP BENEFITS EMPLOYEE BENEFITS PROGRAM Pre-Tax Benefits Health Insurance

UnitedHealthcare

Dental Insurance*

MetLife* (New!)

Vision Insurance*

EyeMed* (New!)

Health Savings Accounts o Employee Maximum $3,500/year o Family Maximum $7,000/year HSA plans can only be established in conjunction with a qualified high-deductible health plan (HDHP)

Flexible Spending Accounts** o Medical Reimbursement FSA Maximum $2,650/year o Limited Purpose FSA Maximum $2,650/year*** o Dependent Care Reimbursement FSA Maximum $5,000/year

***Limited Purpose FSA funds can only be used for qualifying vision, dental and orthodontia expenses Cancer Benefits

Colonial Life

Accident Benefits

Colonial Life

Medical Bridge Benefits

Colonial Life

**You will need to re-sign for the Spending Accounts if you want them to continue next year.

IF YOU DO NOT RE-SIGN, YOUR CONTRIBUTION WILL STOP AT THE END OF THE PLAN YEAR.

Post-Tax Benefits Disability Benefits

Colonial Life

Critical Care Benefits

Colonial Life

Life Insurance o Group Term Life Insurance o Supplemental Term Life Insurance o Whole Life Insurance

Sun Life Colonial Life Colonial Life

Identity Theft Shield & Life Events Legal Plan Legal Shield

*EMPLOYEES WILL NEED TO RE-ENROLL IN DENTAL & VISION BENEFITS IN ORDER TO CONTINUE COVERAGE FOR THE NEW PLAN YEAR BEGINNING DECEMBER 1, 2018.

Insurance Products will remain in effect unless you see a representative to change them.

Enrollment Period:

October 24, 2018 through November 2, 2018

Effective Dates:

December 1, 2018 through November 30, 2019

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Qualifications • Employees must work 30 hours or more per week to participate in benefits.

• New Employees should speak with Human Resources for benefit effective dates following employment.

Important Information  The plan year for UnitedHealthcare Health, MetLife Dental, EyeMed Vision, Sun Life Group Term Life, Health Savings Accounts, Flexible Spending Accounts, Colonial Insurance products and Legal Shield Identity Theft Shield and Live Events Legal Plan lasts from December 1, 2018 through November 30, 2019.  Deductions for UnitedHealthcare Health, MetLife Dental, EyeMed Vision, Sun Life Group Term Life, Health Savings Accounts, Flexible Spending Accounts, Colonial Insurance products and Legal Shield Identity Theft Shield and Live Events Legal Plan will begin December 2018.  If signing up for any coverage on your spouse and/or children, please have their dates of birth and social security numbers available when enrolling online or meeting with the Benefits Representative.  If you will be receiving a new debit card, whether you are a new participant or to replace your expired card, please be aware that it may take up to 30 days following your plan effective date for your card to arrive. Your card will be delivered by mail in a plain white envelope. During this time you may use manual claim forms for eligible expenses, available from your Benefits Representative during the open enrollment period. Please note that your debit card is good through the expiration date printed on the card.  Elections made during this enrollment period CANNOT BE CHANGED AFTER THE ENROLLMENT PERIOD unless there is a family status change as defined by the Internal Revenue Code. Examples of a family status change are: marriage, divorce, death of a spouse or child, birth or adoption of a child, termination or commencement of a spouse's employment, or the transition of spouse's employment from full-time to part-time or vice-versa.  Once a family status change has occurred, an employee has 30 days to notify Human Resources to request a change in elections.  Medical Reimbursement and Dependent Care Reimbursement expenses must be incurred during the Plan Year in order to be eligible for reimbursement.  An employee has 90 days after the plan year ends to submit claims for medical reimbursement and/or dependent care expenses that were incurred during the plan year. Please note that if employment terminates during the plan year, that employee's plan year ends the day employment ends. The employee has 90 days after the termination date to submit claims.  Unlike Medical Reimbursement Accounts, with Dependent Care Flexible Spending Accounts the maximum reimbursement you can receive is equal to the current account balance in your Dependent Care account.  The Colonial Cancer plan and the Health Screening Rider on the Colonial Accident and Colonial Medical Bridge plan have a 30-day waiting period for new enrollees. Coverage, therefore, will not begin until December 31, 2018.  Additionally, some policies may include a pre-existing condition clause. Please read your policy carefully for full details.  Please be aware there are certain coverages that may be subject to federal and state tax when premium is paid by pretax deduction or employee contribution.  An employee taking a leave of absence, other than under the Family & Medical Leave Act, may not be eligible to re-enter the Benefits Program until the next plan year. Please contact your Pierce Group Benefits Benefit Administrator for more information.

FLEXIBLE SPENDING ACCOUNTS / HEALTH SAVINGS ACCOUNTS If an employee enrolls in an employer-sponsored High Deductible Health Plan, he/she may participate in a Health Savings Account (HSA). If enrolling during annual enrollment, the employer will make an annual contribution of $250.00 to the employee’s HSA – 1/12 will be contributed to your HSA in December and 11/12 contributed in January. Employees hired during the year will receive a pro-rated amount. If the employee is hired before the 15th of the month, the pro-rated amount will be calculated from the first of that month; if hired the 15 th or after, the pro-rated amount will be calculated from the next month. If the employee participates in an HSA, he/she may also participate in a Limited Purpose Flexible Spending Account (LPFSA).

-ORIf the employee enrolls in an employer-sponsored Preferred Provider Organization (PPO) plan, the employee may participate in a Flexible Savings Account (FSA). If enrolling during annual enrollment, the employer will make an annual contribution of $250.00 the first of the plan year to the employee’s FSA. Employees hired during the year will receive a pro-rated amount. If the employee is hired before the 15th of the month, the prorated amount will calculated from the first of that month; if hired the 15th or after, the pro-rated amount will be calculated from the next month.

If the employee does not wish to enroll in an employer-sponsored health plan, the employee may still participate in a Flexible Spending Account (FSA) or Limited Purpose FSA. No employer contributions will be made.

To enroll or make changes to your Benefits Plan, please see the representative during your Enrollment Period.

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ONLINE ENROLLMENT INSTRUCTIONS FOR YOUR ANNUAL ENROLLMENT PERIOD You can make the following benefit elections online from October 24, 2018 through November 2, 2018:  Enroll, change or cancel your Health insurance.  Enroll, change or cancel your Health Savings Account (HSA).  Sign up/re-enroll in your Flexible Spending Account (Medical, Limited Purpose & Dependent Care)*.  Enroll, change or cancel your Vision insurance*.  Enroll, change or cancel your Dental insurance*.  Enroll, change or cancel your Pre-Paid Legal.  Enroll, change or cancel your Group Term Life insurance.  Enroll, change or cancel your Colonial products (please see further details below) *Employees will need to re-enroll in Spending Accounts, Dental & Vision Benefits in order to continue coverage for the new plan year beginning December 1, 2018.

The following benefit elections must be made with your Benefits Representative during the enrollment period and are not available for online enrollment.  Enroll or change Colonial products (please see further details below) BENSELECT ONLINE ASSISTANCE 1. Complete the following steps to begin the online enrollment process. 

Go to https://harmony.benselect.com/Enroll



Enter your User Name: SSN with or without dashes



Enter your Password: Last 4 of SSN + Last 2 of Birth Year

Helpful Tips:  If you are a new employee and unable to log into the online system, please see the Benefits Representative while he/she is at your location or speak with Human Resources.  If you are an existing employee and unable to log into the online system, please speak with your Benefits Representative while he/she is at your location or speak with Human Resources.

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The screen prompts you to create a NEW PIN [____________________________].

Choose a security question and enter answer [______________________________________].

Confirm (or enter) an email address Click on ‘Save New PIN’ to continue to the enrollment welcome screen.

From the welcome screen click “Next”.

The screen shows ‘Personal Information’. Verify that the information is correct and enter the additional required information (marital status, work phone, e-mail address). Click ‘Next’.

The screen allows you to add family members. It is only necessary to enter family member information if adding or including family members in your coverage. Click ‘Next’.

The screen shows ‘Benefit Summary’. Review your current benefits and make changes/selections for the upcoming plan year.

Health Insurance Review current coverage (if applicable).

Follow the instructions to enroll in, change, cancel or keep coverage.

PLEASE NOTE: Employees should review the Summary of Benefits and Coverage and other required notices on BenSelect

Health Savings Account - HSA plans can only be established in conjunction with a qualified high-deductible health plan (HDHP) Review current coverage (if applicable).

Enter annual amount. EMPLOYEE MAX $3,500/year

FAMILY MAX $7,000/year

Health Care FSA You must enroll in this benefit in order to continue coverage for the new plan year.

Enter annual amount. MAX $2,650/year

Limited Purpose FSA – Limited Purpose FSA funds can only be used for qualifying vision, dental and orthodontia expenses You must enroll in this benefit in order to continue coverage for the new plan year.

Enter annual amount. MAX $2,650/year

Dependent Care FSA You must enroll in this benefit in order to continue coverage for the new plan year.

Enter annual amount. MAX $5,000/year Instructions continued on next page

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Online Enrollment Instructions

Dental You must enroll in this benefit in order to continue coverage for the new plan year.

Follow the instructions to enroll in coverage.

Vision You must enroll in this benefit in order to continue coverage for the new plan year.

Follow the instructions to enroll in coverage.

Legal Plan Review current coverage (if applicable).

Follow the instructions to enroll in, change, cancel or keep coverage.

Basic Group Term Life This is an employer-paid benefit.

Please review beneficiary information and follow the instructions to make changes, if needed.

Voluntary Group Term Life Review current coverage (if applicable).

Follow the instructions to enroll in, change, cancel or keep coverage.

COLONIAL SUPPLEMENTAL INSURANCE Disability – NCK1000 You may enroll online in NCK1000 – the North Carolina Educator Disability Plan.

Cancer Assist You may enroll online in Cancer Assist coverage.

Critical Care You may enroll online in Critical Care coverage.

Medical Bridge You may enroll online in Medical Bridge coverage.

Accident 1.0 You may enroll online in Accident 1.0; however persons over age 64 applying for coverage and employees wishing to purchase an individual policy for their spouse must meet with the Benefits Representative.

Term Life 1000 You may enroll online in Term Life 1000; however, employees wishing to purchase an individual policy for their spouse should meet with the Benefits Representative.

Whole Life 1000 You may enroll online in Whole Life 1000; however, employees wishing to purchase an individual policy for their spouse should meet with the Benefits Representative.

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Click ‘Sign & Submit’ once you have decided which benefits to enroll in.

Review your coverage. If any items are ‘Pending’, you will need to decide whether to enroll or decline this benefit.

Click ‘Next’ to review and electronically sign the authorization for your benefit elections.

Review the confirmation, then if you are satisfied with your elections, enter your PIN and click ‘Sign Form’.

Click ‘Download & Print’ to print a copy of your elections. Please do not forget this important step!!!

Click ‘Log Out’.

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HEALTH INSURANCE Provided by UnitedHealthcare Please visit your BenSelect Enrollment Site to review the Summary of Benefits and Coverage and other required notices

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Health Insurance Benefit Highlights Base Plan

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Health Insurance Benefit Highlights Buy Up Option #1 Please visit your BenSelect Enrollment Site to review the Summary of Benefits and Coverage and other required notices

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Health Insurance Benefit Highlights Buy Up Option #1

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Health Insurance Benefit Highlights Buy Up HSA Option #2 Please visit your BenSelect Enrollment Site to review the Summary of Benefits and Coverage and other required notices

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Health Insurance Benefit Highlights Buy Up HSA Option #2

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Health Insurance myuhc.com – Step-by-Step Registration Process

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Health Insurance myuhc.com – Step-by-Step Registration Process

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Health Insurance myNurseLine

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Health Insurance Virtual Visits

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Health Insurance Generic Medications – Five Things You Need to Know

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Health Insurance Getting to Know Your Prescription Drug List

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Health Insurance Getting to Know Your Prescription Drug List

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Health Insurance Getting to Know Your Prescription Drug List

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Health Insurance OptumRx Mail Service Pharmacy

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Health Insurance Health Savings Account (HSA) – Qualified Expenses

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DENTAL INSURANCE Provided by MetLife

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Dental Insurance High Plan

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Dental Insurance Low Plan

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Dental Insurance

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Dental Insurance

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VISION INSURANCE Provided by EyeMed

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GROUP TERM LIFE INSURANCE Provided by Sun Life

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Group Term Life Insurance Voluntary Life

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Group Term Life Insurance Voluntary Life

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HEALTH, DENTAL, VISION & GROUP TERM LIFE RATES Pierce Group Benefits December 1, 2018 - November 30, 2019 UNITEDHEALTHCARE HEALTH BASE PLAN

Employee Only

Employee/ Spouse

Employee/ Child(ren)

Family

Monthly Premium Employer Contribution Employee Contribution Monthly Employee Contribution (24 pay deducts)

$363.83 $363.83 $0.00 $0.00

$727.66 $363.83 $363.83 $181.92

$673.09 $363.83 $309.26 $154.63

$1,127.87 $363.83 $764.04 $382.02

UNITEDHEALTHCARE HEALTH BUY-UP COPAY PLAN

Employee Only

Employee/ Spouse

Employee/ Child(ren)

Family

Monthly Premium Employer Contribution Employee Contribution Monthly Employee Contribution (24 pay deducts)

$436.72 $411.01 $25.71 $12.86

$873.44 $411.01 $462.43 $231.22

$807.93 $411.01 $396.92 $198.46

$1,353.82 $411.01 $942.81 $471.41

Employee Only

Employee/ Spouse

Employee/ Child(ren)

Family

$464.90 $411.01 $53.89 $26.95

$929.80 $411.01 $518.79 $259.40

$860.07 $411.01 $449.06 $224.53

$1,441.19 $411.01 $1,030.18 $515.09

Employee Only

Employee/ Spouse

Employee/ Child(ren)

Family

$24.70 $24.70 $0.00 $0.00

$47.69 $24.70 $22.99 $11.50

$61.17 $24.70 $36.47 $18.24

$90.94 $24.70 $66.24 $33.12

Employee Only

Employee/ Spouse

Employee/ Child(ren)

Family

$37.80 $24.70 $13.10 $6.55

$72.91 $24.70 $48.21 $24.11

$86.88 $24.70 $62.18 $31.09

$131.08 $24.70 $106.38 $53.19

UNITEDHEALTHCARE HEALTH BUY-UP HSA PLAN Monthly Premium Employer Contribution Employee Contribution Monthly Employee Contribution (24 pay deducts)

METLIFE DENTAL LOW PLAN Monthly Cost Employer Monthly Contribution Employee Monthly Contribution Employee Deduction (24 deductions)

METLIFE DENTAL HIGH PLAN Monthly Cost Employer Monthly Contribution Employee Monthly Contribution Employee Deduction (24 deductions)

EYEMED VISION PLAN Monthly Cost Employer Monthly Contribution Employee Monthly Contribution Employee Deduction (24 deductions)

Employee Only

Employee + 1

Family

$6.31 $6.31 $0.00 $0.00

$10.17 $6.31 $3.86 $1.93

$15.52 $6.31 $9.21 $4.61

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HEALTH, DENTAL, VISION & GROUP TERM LIFE RATES SUPPLEMENTAL LIFE EMPLOYEE / SPOUSE SUN LIFE Semi-Monthly Life Rates Per $1,000 Benefit Age

Current Employee

Renewal Employee

Current Spouse

Renewal Spouse

<20

$0.026

$0.026

$0.026

$0.026

20-24

$0.052

$0.052

$0.052

$0.052

25-29

$0.057

$0.057

$0.057

$0.057

30-34

$0.078

$0.078

$0.078

$0.078

35-39

$0.104

$0.104

$0.104

$0.104

40-44

$0.161

$0.161

$0.161

$0.161

45-49

$0.244

$0.244

$0.244

$0.244

50-54

$0.437

$0.437

$0.437

$0.437

55-59

$0.842

$0.842

$0.842

$0.842

60-64

$1.248

$1.248

$1.248

$1.248

65-69

$1.997

$1.997

$1.997

$1.997

70-74

$3.614

$3.614

$3.614

$3.614

75+

$12.958

$12.958

$12.958

$12.958

Employee's Age on Policy Anniversary determines rate

AD&D Rate per $1,000 benefit

Current

Semi-Monthly

Employee Spouse

$0.026 $0.026

$0.013 $0.013

CHILD Amount Child Life and AD&D Premium per deduction Child Life Only Premium per deduction

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$1,000 $0.10 $0.09

$5,000 $0.53 $0.46

$10,000 $1.040 $0.910

FLEXIBLE SPENDING ACCOUNTS

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Flexible Spending Accounts

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Flexible Spending Accounts

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Flexible Spending Accounts

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Flexible Spending Accounts

Employer: Pierce Group Benefits Plan Year: December 1, 2018 through November 30, 2019

FREQUENTLY ASKED QUESTIONS What are my Maximum Annual Contributions?

The maximum you may contribute to the Healthcare Flexible Spending Account is $2,650 /year.

The maximum you may contribute to the Limited Purpose Flexible Spending Account is $2,650 /year.

The maximum you may contribute to the Dependent Care Account is $5,000 /year.

What happens if I don’t use all the money in my FSA by the end of the plan year?

By law, employers are not allowed to return leftover money to participants.

When can I start using the money in my FSA account?

You can access your annual contribution at the start of your plan year.

Will I get paid less every pay period if I enroll in an FSA? Your gross, or pre-tax, pay will remain the same. But your “net” pay will be lower because a portion of it will go into your FSA account. The advantage is that this money gets put into your FSA account before taxes, which lowers your “taxable” income.

You have complete access to these funds for any qualified medical expense for you and your family.

When do I choose my contribution amount and can I change it anytime?

You choose your FSA contribution amount during your annual enrollment; this is the time of year you can elect and/or change your benefits such as medical, dental, etc. Once your contribution election becomes effective, you won’t be able to change it until the next enrollment period, unless there is a change in your eligibility status, which the IRS refers to as a “qualifying event.” Some qualifying events include, but are not limited to (please refer to your Summary Plan Description for an exhaustive list):  Change in provider (Dependent Care only)  Change in cost of day care (Dependent Care only)  Change in legal marital status  Change in number of legal dependents The election change must be consistent with the qualifying event. A change is considered consistent with the qualifying event for healthcare FSAs if the following occurs:  The employee, spouse, or dependent is gaining or losing eligibility for health coverage.  The election change corresponds with the gain or loss of coverage.

Instead of enrolling in an FSA, why shouldn’t I just make these deductions on my income tax?

Claiming a tax return deduction is only beneficial for people with substantial uninsured medical expenses. According to the IRS, only medical/dental expenses that exceed 10% of your “adjusted gross income” and are not covered by insurance can be deducted from your income taxes. Most people do not have uninsured medical expenses high enough to qualify for this deduction.

Who is eligible to participate?

Employees who work at least 30 hours per week are eligible to participate. Eligible employees must sign a new enrollment form before the start of each plan year. New employees should speak with their Human Resources Representative to discuss enrollment options and waiting periods.

Eligible employees can claim expenses incurred by their dependents as defined under section 125 of the Internal Revenue Code.

What happens to my FSA contributions if I leave or am terminated from my job?

If you leave or are terminated from your job and have a positive balance in your FSA account, you do have COBRA rights. If you do not exercise those rights, the balance remaining in your FSA will be forfeited. Ameriflex will deactivate the terminated employee’s MyAmeriflex Card on the date they are notified of the termination. Any eligible expenses incurred, and not yet submitted for reimbursement prior to or on the date of termination, must be filed using a manual claim form and must be received by Ameriflex within the run-out period described in the Summary Plan Description.

How may I access my account information?

You may log in to your FSA account anytime to view your account balance, account activity and transaction history. Access your account at www.myameriflex.com. You may also call Ameriflex directly at 888-868-3539 to speak to a representative or to access the 24/7 Interactive Voice Response System.

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LIMITED PURPOSE FLEXIBLE SPENDING ACCOUNT

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Flexible Spending Accounts Managing Your Account

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Flexible Spending Accounts The FSA Store

The FSAStore – One Convenient Location for All Your FSA Purchases Pierce Group Benefits recently partnered with the FSAStore to provide one convenient location for all your FSA eligible purchases. Through our partnership, Pierce Group Benefits and the FSAStore can help you shop for FSA eligible items, search for local and eligible physicians, and answer the many questions that come along with having a Flexible Spending Account.

COMPONENTS The FSAstore focuses on three main channels to help you better understand your benefits and eligible services and products as an FSA participant:   

Products – Shop for more than 4,000 FSA eligible products Services – Find FSA eligible services and providers in your area Learning Center – Learn more about your FSA and get answers to your questions BENEFITS

By utilizing FSAStore, you get the following benefits:      

Easily understand which products require a prescription and which do not Get access to FSA eligible services and providers in your area Find answers to commonly and not-so-commonly asked FSA questions Enjoy free shipping on orders over $50 with a short 1-2 day turnaround time Have access to 24/7 customer support Get your favorite brands at discounted prices ACCESSING FSASTORE Accessing the FSAStore is easy. Simply visit www.FSAStore.com!

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CANCER BENEFIT Provided by Colonial Life The following information highlights the benefits of the current Cancer policy available through your benefits package. If you enrolled in a Cancer Plan prior to this year, you may have different benefits and features than those shown here. You should refer to your personal policy for your exact benefits and features.

Your Benefits Representative can provide you with further information on which plan you have, and assist with any questions.

Please meet with your Benefits Representative during your enrollment period or call the Pierce Group Service Center at 1-888-662-7500 for any assistance.

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Cancer Benefit

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Cancer Benefit

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Cancer Benefit

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Cancer Benefit

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Cancer Benefit

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Cancer Benefit

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Cancer Benefit

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Cancer Benefit

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Cancer Benefit

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Cancer Benefit

Individual Cancer Rates LEVEL 1 – Monthly Premiums - Composite Rates Employee

Employee /Spouse

One-Parent Family

Two-Parent Family

$18.25

$28.75

Level 1 with $100 Cancer Wellness/Health Screening Premium

$18.10

$28.60

LEVEL 2 – Monthly Premiums - Composite Rates Employee

Employee /Spouse

One-Parent Family

Two-Parent Family

$21.95

$34.15

Level 2 with $100 Cancer Wellness/Health Screening Premium

$21.65

$33.85

LEVEL 3 – Monthly Premiums - Composite Rates Employee

Employee /Spouse

One-Parent Family

Two-Parent Family

$27.10

$44.85

Level 3 with $100 Cancer Wellness/Health Screening Premium

$26.65

$44.40

LEVEL 4 – Monthly Premiums - Composite Rates Employee

Employee /Spouse

One-Parent Family

Two-Parent Family

$36.20

$60.00

One-Parent Family

Two-Parent Family

$1.75

$1.25

$1.75

$2.50

$1.60

$2.60

$7.80

$17.05

Level 4 with $100 Cancer Wellness/Health Screening Premium

$35.60

$59.40

OPTIONAL RIDERS Employee

Employee /Spouse

Specified Disease Hospital Confinement Rider Premium

$1.25

Initial Diagnosis of Cancer Rider (per $1,000) Premium

$1.50

Initial Diagnosis of Cancer Progressive Payment Rider Premium

$7.80

$17.05

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DISABILITY BENEFIT Short-Term Disability Benefit Provided by Colonial Life The following information highlights the benefits of the current Disability policy available through your benefits package. If you enrolled in a Disability Plan prior to this year, you may have different benefits and features than those shown here. You should refer to your personal policy for your exact benefits and features.

Your Benefits Representative can provide you with further information on which plan you have, and assist with any questions.

Please meet with your Benefits Representative during your enrollment period or call the Pierce Group Service Center at 1-888-662-7500 for any assistance.

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Disability Benefit Short-Term Disability

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Disability Benefit Short-Term Disability

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Disability Benefit Short-Term Disability

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Disability Benefit Short-Term Disability

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Disability Benefit Short-Term Disability

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Disability Benefit Short-Term Disability

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Disability Benefit Short-Term Disability

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Disability Benefit Short-Term Disability

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ACCIDENT BENEFIT Provided by Colonial Life The following information highlights the benefits of the current Accident policy available through your benefits package. If you enrolled in an Accident Plan prior to this year, you may have different benefits and features than those shown here. You should refer to your personal policy for your exact benefits and features.

Your Benefits Representative can provide you with further information on which plan you have, and assist with any questions.

Please meet with your Benefits Representative during your enrollment period or call the Pierce Group Service Center at 1-888-662-7500 for any assistance.

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Accident Benefit

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Accident Benefit

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Accident Benefit

Accident 1.0 â&#x20AC;&#x201C; Preferred with Health Screening Monthly Premiums Named Insured Employee & Spouse One-Parent Family Two-Parent Family

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$21.15 $28.97 $32.67 $40.48

MEDICAL BRIDGE BENEFIT Provided by Colonial Life The following information highlights the benefits of the current Medical Bridge policy available through your benefits package. If you enrolled in a Medical Bridge Plan prior to this year, you may have different benefits and features than those shown here. You should refer to your personal policy for your exact benefits and features.

Your Benefits Representative can provide you with further information on which plan you have, and assist with any questions.

Please meet with your Benefits Representative during your enrollment period or call the Pierce Group Service Center at 1-888-662-7500 for any assistance.

Pierce Group Benefits | 65

Medical Bridge Indemnity Benefit

66 | Pierce Group Benefits

Medical Bridge Benefit

Pierce Group Benefits | 67

Medical Bridge Benefit

68 | Pierce Group Benefits

Medical Bridge Benefit

Pierce Group Benefits | 69

Medical Bridge Benefit

70 | Pierce Group Benefits

CRITICAL CARE BENEFIT Provided by Colonial Life The following information highlights the benefits of the current Critical Care policy available through your benefits package. If you enrolled in a Critical Care Plan prior to this year, you may have different benefits and features than those shown here. You should refer to your personal policy for your exact benefits and features.

Your Benefits Representative can provide you with further information on which plan you have, and assist with any questions.

Please meet with your Benefits Representative during your enrollment period or call the Pierce Group Service Center at 1-888-662-7500 for any assistance.

Pierce Group Benefits | 71

Critical Care Benefit Plan 1 â&#x20AC;&#x201C; Cancer & Specified Disease

72 | Pierce Group Benefits

Critical Care Benefit First Diagnosis Building Benefit Rider â&#x20AC;&#x201C; Specified Disease & Cancer (Plan 1)

Pierce Group Benefits | 73

Critical Care Benefit Plan 3 â&#x20AC;&#x201C; Specified Disease

74 | Pierce Group Benefits

Critical Care Benefit Plan 3 â&#x20AC;&#x201C; Specified Disease

Pierce Group Benefits | 75

Critical Care Benefit First Diagnosis Building Benefit Rider â&#x20AC;&#x201C; Specified Disease (Plan 3)

76 | Pierce Group Benefits

Critical Care Benefit Health Screening Benefit

Pierce Group Benefits | 77

TERM LIFE INSURANCE Provided by Colonial Life The following information highlights the benefits of the current Term Life policy available through your benefits package. If you enrolled in a Term Life Plan prior to this year, you may have different benefits and features than those shown here. You should refer to your personal policy for your exact benefits and features.

Your Benefits Representative can provide you with further information on which plan you have, and assist with any questions.

Please meet with your Benefits Representative during your enrollment period or call the Pierce Group Service Center at 1-888-662-7500 for any assistance.

78 | Pierce Group Benefits

Term Life Insurance

Pierce Group Benefits | 79

WHOLE LIFE INSURANCE Provided by Colonial Life The following information highlights the benefits of the current Whole Life policy available through your benefits package. If you enrolled in a Whole Life Plan prior to this year, you may have different benefits and features than those shown here. You should refer to your personal policy for your exact benefits and features.

Your Benefits Representative can provide you with further information on which plan you have, and assist with any questions.

Please meet with your Benefits Representative during your enrollment period or call the Pierce Group Service Center at 1-888-662-7500 for any assistance.

80 | Pierce Group Benefits

Whole Life Insurance

Pierce Group Benefits | 81

Whole Life Insurance Long-Term Care Benefit Rider

82 | Pierce Group Benefits

Whole Life Insurance Long-Term Care Benefit Rider

Pierce Group Benefits | 83

Juvenile Whole Life Insurance

84 | Pierce Group Benefits

Juvenile Whole Life Insurance

Pierce Group Benefits | 85

IDENTITY THEFT SHIELD & LIFE EVENTS LEGAL PLAN Legal Plan Benefits Provided by Legal Shield

Special Group Rates: 24 Deduction

86 | Pierce Group Benefits

Legal Plan Only

9.48

IDShield Individual

4.48

Legal + IDShield Individual

13.95

IDShield Family

9.48

Legal + IDShield Family

16.95

UnitedHealthcare - Health Insurance Please see the inside of your Benefit Booklet for more information myuhc.com – Take advantage of easy, timesaving online tools. You can check eligibility, benefits, claims, claim payments, search for a doctor and hospital and more.

24-hour nurse support – A nurse is a phone call away and you have other health resources available 24-hours a day, 7 days a week to provide you with information that can help you make informed decisions. Call the number on the back of your ID card.

Customer Care telephone support – Call a customer care professional using the toll-free number on the back of your ID card.

MetLife - Dental Insurance

Flexible Spending Accounts – AMERIFLEX

Customer Service.........................................................1-800-438-6388 Internet Address…………………….…www.metlife.com/mybenefits

Mailing Address…..7 Carnegie Plaza Ste. 200, Cherry Hill, NJ 08003 Internet Address for Ameriflex………………www.myameriflex.com For questions, duplicate cards and other service questions contact:

EyeMed - Vision Insurance Customer Service.........................................................1-866-804-0982 Internet Address…...................................................www.eyemed.com

Sun Life – Group Term Life Insurance Customer Service.........................................................1-800-442-7742

Medical or Dependent Care Customer Service……....1-888-868-3539 Please fax claims to the number printed on your form For Directions on checking your Flexible Spending Account balance and history online (cardholders only) and accessing manual claim forms, please visit www.myameriflex.com.

Colonial Life Visit ColonialLife.com to set up your personal account. Download the free My Colonial Life app available at the Apple iTunes store to access claims and policy information!

Customer Service & Wellness Screenings 1-800-325-4368 TDD for hearing impaired customers call 1-800-798-4040

Internet Address www.coloniallife.com

Claims Fax 1-800-880-9325

If you wish to file a Wellness/Cancer Screening claim for a test performed within the past 18 months, you need the name and date of the test performed as well as your doctor’s name and phone number. Colonial also needs to know if this is for you or another covered individual and their name and social security number. You may:  FILE BY PHONE! Call 1-800-325-4368 and provide the information requested by Colonial’s Automated Voice Response System, 24 hours per day, 7 days a week, or  SUBMIT ON THE INTERNET using the Wellness Claim Form at www.coloniallife.com, or  Write your name, address, social security number and/or policy/certificate number on your bill and indicate “Wellness Test.” Fax this to Colonial at 1-800-880-9325 or MAIL to PO Box 100195, Columbia, SC 29202 If your Wellness/Cancer Screening test was more than one year ago, you must fax or mail Colonial a copy of the bill or statement from your doctor indicating the type of procedure performed, the charge incurred and the date of service. Please write your full name, social security number, and current address on the bill.

Please Note: If your cancer policy includes a second part to the screening benefit, bills for tests covered and a copy of the diagnostic report (reflecting the abnormal reading of your first test) must be mailed or faxed to us for benefits to be provided.

When you terminate employment with Pierce Group Benefits, you have the opportunity to continue your Colonial coverage either through direct billing or automatic payment through your bank account. Please contact Colonial at 1-800-325-4368 to request the continuation of benefits form.

To view your benefits online visit

www.piercegroupbenefits.com/piercegroupbenefits or for additional information concerning plans offered to employees of Pierce Group Benefits, please contact our North Carolina Service Center at 1-888-662-7500, ext. 100