Chemistry Pittsburgh 7.1.2022 Benefit Guide

Chemistry Communications

BENEFITS GUIDE July 1, 2022 - December 31, 2022

TA B L E O F

CONTENTS Eligibility & Enrollment

3

UPMC Medical Plans

4

Health Savings Account

5

FSA

6

Preventive Care

7

Dental

8

Vision

9

Life Insurance

10

Disability

11

Supplemental Benefits

12

Employee Assistance Program

13

Cost Summary

14

Company Contacts

15

Important Information

16

Chemistry Benefit Guide | 2

E L I G I B I L I T Y & E N RO L L M E N T Who is Eligible to Join the Benefit Plan?

Qualifying Event Changes

You and your dependents are eligible to enroll in our company welfare benefit plans if you are a full-time employee regularly scheduled to work 30 hours per week. You must be enrolled in the plan to add dependent coverage.

You are allowed to make changes to your current benefit elections during the plan year if you experience an IRSapproved qualifying change in life status. The change to your benefit elections must be consistent with and on account of the change in life status.

Who is an Eligible Dependent?

IRS-approved qualifying life status changes include:

•

Your spouse or legal domestic partner

•

Marriage, divorce or legal separation

•

Your dependent child under the maximum age specified in the Carriers’ plan documents including: • Natural child • Adopted child • Stepchild • Child for whom you have been appointed as the legal guardian

•

Birth or adoption of a child or placement of a child for adoption

•

Death of a dependent

•

Change in employment status, including loss or gain of employment, for your spouse or a dependent

•

Change in work schedule, including switching between fulltime and part-time status, by you, your spouse or a dependent

•

Change in residence or work site for you, your spouse, or a dependent that results in a change of eligibility

The Dependent Maximum Age Limits is up to age 26. The dependent does not need to be a full-time student; does not need to be an eligible dependent on parent’s tax return; is not required to live with you; and may be unmarried or married.

•

If you or your dependents lose eligibility for Medicaid or the Children’s Health Insurance Program (CHIP) coverage

•

If you or your dependents become eligible for a state’s premium assistance subsidy under Medicaid or CHIP

Once the dependent reaches age 26, coverage will terminate on the last day of the birth month.

If you experience a qualifying event, you must notify the HR Department by email at humanresources@chemistryagency.com within 30 days.

*Your child’s spouse and a child for whom you are not the legal guardian are not eligible.

A totally disabled child who is physically or mentally disabled prior to age 26 may remain on the if the child is primarily dependent on the enrolled member for support and maintenance.

If you do not notify the company during that time, you and/or your dependents must wait until the next annual open enrollment period to make a change in your benefit elections.

When Do Benefits Become Effective?

Your benefits become effective on the first day of the month following your full-time date of hire with Chemistry.

Annual Open Enrollment?

Each year during the annual Open Enrollment Period, you are given the opportunity to make changes to your current benefit elections. To find out when the annual Open Enrollment Period occurs, contact Human Resources.

!

Please note, loss of coverage due to nonpayment or voluntary termination of other coverage outside a spouse’s or parent’s open enrollment is not an IRS-approved qualifying life event and you do not qualify for a special enrollment period.

Chemistry Benefit Guide | 3

MEDICAL

B e n e f i t P l a n Ye a r 7 / 1 / 2 0 2 2 – 1 2 / 3 1 / 2 0 2 2

Chemistry provides flexibility in medical plans by offering two options through UPMC. The chart below summarizes the options available.

Be sure to use in-network providers to minimize out of pocket costs.

Register at www.upmchealthplan.com/members to find providers, view claims and obtain an electronic medical ID card.

UPMC MEDICAL PLAN OPTIONS Plan Highlights – UPMC Premium Network

EPO 500 (Copay Plan)

HSA 1400 (High Deductible Health Plan)

$500 | $1,000

$1,400 | $2,800

Embedded*

Aggregate*

0%

0%

$8,150 | $16,300

$2,800 | $5,600

No. FSA is available with this plan option.

Yes – Chemistry will contribute $500 for Individual or $1000 for Employee + Dependent(s) into your HSA.

Primary Care Physician Office Visit

$15 copay

Deductible

Specialist Office Visit

$30 copay

Deductible

$5 Virtual Urgent Care

Deductible

Plan pays 100%

Plan pays 100%

Laboratory Diagnostics & X-Ray

Deductible

Deductible

Complex Imaging Services (CT Scans, PET Scans & MRI’s)

Deductible

Deductible

Hospital Inpatient Care

Deductible

Deductible

Outpatient Surgery

Deductible

Deductible

Emergency Room**

$150 copay

Deductible

Urgent Care

$75 copay

Deductible

No Rx Deductible

Medical Deductible Applies

Tier 1 – Generic Drugs

$15 Copay

$15 Copay after ded

Tier 2 – Preferred Brand Name

$30 Copay

$30 Copay after ded

Tier 3 – Non-Preferred Brand Name

$50 Copay

$50 Copay after ded

Tier 4 – Specialty

$50 Copay

$50 Copay after ded

Mail Order Pharmacy (90 Day)

2x Retail Copay

2x Retail Copay after ded

Semi Monthly Payroll Deductions: Employee Only Employee + Spouse Employee + Child(ren) Family

$98.74 $264.24 $198.67 $275.49

$90.79 $242.96 $182.68 $253.31

Deductible: Individual | Family Deductible Type Member Coinsurance Annual Out-of-Pocket Maximum Individual | Family

HSA Eligible?

Telemedicine (UPMC AnywhereCare) Preventive Care Services

Prescription Drugs

!

*Embedded Deductible – if dependents are covered on the health plan, a participant is responsible for only the individual deductible. Aggregate Deductible – if dependents are covered on the health plan, the family deductible must be met before the plan will pay. **When you visit an ER for non-emergency medical care, services are subject to the deductible, then coinsurance This brochure summarizes the health care and income protection benefits that are available to Chemistry employees and their eligible dependents. Official plan documents, policies and certificates of insurance contain the details, conditions, maximum benefit levels and restrictions on benefits. These documents govern your benefits program. If there is any conflict, the official documents prevail. These documents are available upon request through your Human Resources department. Information provided in this brochure is not a guarantee of benefits.

Chemistry Benefit Guide | 4

H E A LT H S AV I N G S AC C O U N T ( H S A ) B e n e f i t P l a n Ye a r 7 / 1 / 2 0 2 2 – 1 2 / 3 1 / 2 0 2 2 Available only if you enrolled in the HSA Medical Plan through UPMC. Our HSA administrator is UPMC.

What is a Health Savings Account?

What Type of Expenses Can Be Paid From an HSA?

A Health Savings Account (HSA) is an account permitted under the federal tax law that allows you to save money for healthcare expenses on a tax-favored basis. It is an individual account that belongs to you and is not part of Chemistry’s medical plan. The account is portable, which means it is not tied to your employment at Chemistry. Your HSA stays with you if you retire or leave the company. Because the HSA has special tax status under the law, it is governed by numerous mandatory tax rules and regulations.

You can receive tax-free distributions from your HSA to pay for or to be reimbursed for qualified medical expenses that are incurred after you establish your HSA. These include:

Who is Eligible for an HSA?

When can I Begin Contributions to My HSA Account?

Generally, to be eligible to set up and contribute to an HSA, you:

You may begin funding your HSA account as soon as your account is established.

▪

Can I Invest My HSA Funds?

▪ ▪ ▪

Must be covered by a High Deductible Health Plan (HDHP) – the HSA medical plan Cannot be claimed as a dependent on anyone else’s tax return Are not enrolled in Medicare (due to age or disability) or Tricare Cannot be enrolled in a general purpose FSA, nor can your spouse

You may find information about these rules on the IRS website (www.irs.gov), including IRS Publication 969 and 502. You may also want to consult a tax-advisor.

How Does an HSA Work?

You fund the HSA with your dollars up to a certain limit each year by making a pre-tax payroll deductions directly into your HSA account. The account must be funded prior to any withdrawals. Then, as you have eligible qualified expenses, you may withdraw money from your HSA to pay expenses that are Loss of Other not otherwise paid Coverage by the health, dental or vision plans, e.g. your deductible or coinsurance. It’s up to you whether to use your HSA funds. You are not required to use the money, you may save it for the future and let it continue to accumulate.

▪ ▪

▪

Any medical expenses that apply toward your deductible, Any healthcare expenses that are qualified expenses for tax purposes under Section 213 of the Internal Revenue Code. Some of these expenses are described in IRS Publication 502 Once your reach age 65, Medicare premiums or other health insurance, other than a Medicare supplemental policy.

Yes, investment options are available once your account has accumulated certain thresholds.

Can I Use The Money in My HSA for Anything Other Than Eligible Medical Expenses?

You can withdraw your HSA at anytime and use it for any purpose; however, you will pay income taxes on the amount withdrawn, plus a 20% penalty. After age 65, the 20% penalty no longer applies.

How Much Can I Contribute to An HSA? As noted by federal law, the annual contribution limits are: ▪ The amount is $3,650 for individual coverage and $7,300 for family coverage.

▪ Individuals age 55 or older may be eligible to make a catch-up contribution of $1,000.

▪ Chemistry will contribute $500 for Individual or $1,000 for Employee + Dependent(s) into your HSA, so you can contribute up to $3,150 (Individual) or $6,300 (family).

These are annual amounts that are divided by the number of pay periods (24 pays in 1 year)

Health Savings Account (HSA) ▪ ▪ ▪ ▪ ▪ ▪ ▪

Use money in your account to pay for qualified health care expenses Reduce the amount of your federal taxes Earn tax-free interest on money in your HSA Funds in your account roll over every year The money is yours, so the account stays with you if you leave your employer Once you have a certain amount in your account, you may invest your funds Investment gains grow, tax-free Chemistry Benefit Guide | 5

F L E X I B L E S P E N D I N G AC C O U N T S ( F S A ) B e n e f i t P l a n Ye a r 7 / 1 / 2 0 2 2 – 1 2 / 3 1 / 2 0 2 2 Provided by UPMC

Chemistry offers employees the opportunity to participate in the Healthcare Flexible Spending Account (FSA), Dependent Care FSA and Parking/Transit FSA. These programs may provide you with significant tax advantages as they allow you to pay for eligible outof-pocket expenses with pre-tax dollars through payroll deductions. It is very important that you estimate your annual expenses as accurately as possible because the Healthcare FSA plan only allows for a $570 carryover maximum annually.

Participants will receive a UPMC debit card which can give you access to the funds for all of your UPMC FSA accounts. Additionally, you can administer the FSA benefits using the UPMC smartphone app to upload your receipts and eliminate the need for paperwork. **IMPORTANT NOTE** Because Chemistry is shifting the plan year from a 7/1 renewal to a 1/1 renewal, FSA amounts will be prorated to a 6 month time period for this plan year and will start over on 1/1/2023.

Healthcare Flexible Spending Account You may defer up to $2,850 to your Healthcare FSA to fund eligible out-of-pocket healthcare expenses. The Healthcare FSA will be front-loaded for the entire benefit year on 7/1 (or your new hire start date). The following list provides examples of expenses eligible for reimbursement under the IRS guidelines: • • • • • •

Non-covered medical expenses that quality under Section 217 of the IRS code Deductibles Office visit copays Prescription medication Over-the-counter medications (require physician prescription) Hearing and dental expenses not covered by insurance

Examples of non-eligible expenses include: cosmetic surgery, electrolysis, toiletries, vitamins, health club dues.

Dependent Care FSA You may defer up to $5,000 to your Dependent Care FSA to fund eligible out-of-pocket expenses for childcare and eldercare. To be eligible for reimbursement, expenses must meet the following criteria established by the IRS: ▪ ▪ ▪ ▪ ▪

The person cared for must be under age 13, or if older, physically or mentally incapable of self-care.

Day care must be necessary in order for you and your spouse to work.

The person cared for must be claimed as a dependent on your federal tax return and must reside in your home at least eight hours per day.

Payment for care cannot be made to anyone you claim as a dependent on your income tax return, to your spouse or to a child under age 19.

If care is provided by a center that cares for more than six individuals, it must be licensed.

Parking/Transit FSA A Parking FSA allows you to save pre-tax funds to spend on costs associated with parking near work or near public transportation that brings you to work. Similarly, if you commute to work using mass transit or a commuter highway vehicle, you can reduce your expenses by using a Transit FSA. You’ll receive a UPMC debit card which can be used to pay for covered transportation expenses. The Parking contribution limit is $280 plus you have a separate Transit contribution limit of $280 per month.

For a complete list of eligible medical and dependent care expenses, you may access publications #502 (healthcare), #503 (dependent care) and 15B (Transportation Benefits) on the web at www.irs.gov.

Chemistry Benefit Guide | 6

A SMARTER WAY TO BETTER HEALTH

It’s Your Health. Get Involved

Your health is a work in progress that needs your consistent attention and support. Each choice you make for yourself and your family is part of an ever-changing picture. Taking steps to improve your health such as going for annual physicals and living a healthy lifestyle can make a positive impact on your well-being.

It’s up to you to take responsibility and get involved, and we are pleased to offer programs that will support your efforts and help you reach goals.

Preventative Health Care Services

Immunizations

Understanding What’s Covered

Preventive care includes services like checkups, screenings and immunizations that can help you stay healthy and may help you avoid or delay health problems. Many serious conditions such as heart disease, cancer, and diabetes are preventable and treatable if caught early. It’s important for everyone to get the preventive care they need. Some examples of preventive care services are: o o o o

Blood pressure, diabetes, and cholesterol tests Certain cancer screenings, such as mammograms, colonoscopies Counseling, screenings and vaccines to help ensure healthy pregnancies Regular well-baby and well-child visits

Some immunizations and vaccinations are also considered preventive care services. Standard immunizations recommended by the Centers for Disease Control (CDC) Include: hepatitis A and B, diphtheria, polio, pneumonia, measles, mumps, rubella, tetanus and influenza although these may be subject to age and/or frequency restrictions.

Generally speaking, if a service is considered preventive care, it will be covered at 100%. If it’s not, it may still be covered subject to a copay, deductible or coinsurance. The Affordable Care Act (ACA) requires that services considered preventive care be covered by your health plan at 100% innetwork, without a copay, deductible or coinsurance. To get specifics about your plan’s preventive care coverage, call the customer service number on your member ID card. You may want to ask your doctor if the services you’re receiving at a preventive care visit (such as an annual checkup) are all considered standard preventive care.

If any service performed at an annual checkup is as a result of a prior diagnosed condition, the office visit may not be processed as preventive and you may be responsible for a copay, coinsurance or deductible. To learn more about the ACA or preventive care and coverage, visit www.healthcare.gov.

Chemistry Benefit Guide | 7

D E N TA L

B e n e f i t P l a n Ye a r 1 / 1 / 2 0 2 2 – 1 2 / 3 1 / 2 0 2 2

MetLife Our PPO Dental plan is administered by MetLife. This plan has an extensive list of in-network providers. We would recommend seeing in-network dentists in order to maximize benefits and minimize out of pocket costs. Dental maximums reset on January 1st every year.

Register at www.metlife.com/mybenefits to find providers, view claims and obtain an electronic dental ID card. No physical ID card is provided for your MetLife dental benefits, so it is critical to take advantage of their electronic ID card option.

In-Network

Out-of-Network

Your Deductible

$50 individual / $150 Family

$50 individual / $150 Family

Calendar Year Maximum Applies to preventive, basic, and major services

$1,250 combined In-network and Out-of-Network

$1,250 combined In-network and Out-of-Network

Preventive & Diagnostic Services Exams, Cleanings & Bitewing X-Rays

100% (Deductible waived)

100% (Deductible waived)

Basic Services Filings, Extractions, Endodontics, Periodontics

80% After deductible

80% After deductible

Major Services Crowns, Bridgework, Full & Partial Dentures, Implants

50% After deductible

50% After deductible

Orthodontics (Children under age 19)

50% to $1,500

50% to $1,500

Plan Reimbursement Levels

Based on Contracted Fees

Based on the 90th Percentile of Usual & Customary

MetLife DPPO Dental Plan Highlights

Semi Monthly Payroll Deductions: Employee Only Employee + Spouse Employee + Child(ren) Family

(Plan Pays)

(Plan Pays)

$4.32 $8.90 $11.07 $16.91

Chemistry Benefit Guide | 8

VISION

B e n e f i t P l a n Ye a r 7 / 1 / 2 0 2 2 – 1 2 / 3 1 / 2 0 2 2

UPMC Our UPMC Vision plan will be administered by National Vision Administrators. This plan has an extensive list of in-network providers.

We would recommend seeing in-network eye doctors in order to maximize benefits and minimize out of pocket costs.

To find a provider, log on to www.upmchealthplan.com and select “Find Care”.

UPMC / NVA VISION Services

In Network

Out Of Network

$15 Copay

$30 allowance

$100 frame allowance 20% off balance over allowance

$30 allowance

Single

$15 Copay

$25 allowance

Bifocal

$15 Copay

$35 allowance

Trifocal

$15 Copay

$45 allowance

Tint

Covered in Full

Not Covered

UV Coating

Covered in Full

Not Covered

Polycarbonate (up to age 19)

Covered in Full

Not Covered

Scratch Coating

Covered in Full

Not Covered

Other Add-Ons and Services

20% off retail

Eye Exam: Routine Exam with Dilation Frames: Any available frame at provider location Standard Plastic Lenses:

Lens Options:

Contact Lenses: (in lieu of eyeglasses) Standard Fitting and Follow Up

Covered in Full

$20 Daily Wear / $30 Extended Wear

Specialty Fitting and Follow Up

Covered up to $50

Up to $50

$100

$30

Paid in full

$200 allowance

Contact Lens Allowance Medically Necessary Frequency: Examination

12 months

Frames

12 months

Eyeglass Lenses

12 months

Contact Lenses

12 months

Semi Monthly Payroll Deductions: Employee Only Employee + Spouse Employee + Child(ren) Family

$0.63 $1.24 $1.97 $2.28 Chemistry Benefit Guide | 9

E M P L OY E R PA I D L I F E A N D A D & D B e n e f i t P l a n Ye a r 1 / 1 / 2 0 2 2 – 1 2 / 3 1 / 2 0 2 2 Chemistry provides all Full-Time employees a $25,000 basic life and Accidental Death & Dismemberment (AD&D) benefit. Life insurance pays your named beneficiary in the event of your death. AD&D insurance will provide a benefit to your beneficiary if your death is the result of an accident. AD&D insurance will provide a benefit to you if you suffer certain accidental injuries, such as the loss of limb (arm/leg), loss of eyesight or permanent paralysis. This coverage is provided through MetLife and is paid for by the company.

Basic & Supplemental Life benefit amounts will reduce to 65% of the original amount at age 65 and to 50% at age 70. Benefits terminate at retirement.

S U P P L E M E N TA L L I F E

B e n e f i t P l a n Ye a r 1 / 1 / 2 0 2 2 – 1 2 / 3 1 / 2 0 2 2 Employees may elect Supplemental life insurance of $10,000 up to $250,000, subject to guaranteed issue schedule. An employee’s Supplemental Life benefit may not exceed five times annual salary. Spouses may elect increments of $5,000 up to $125,000, subject to guaranteed issue schedule. The spouse’s Supplemental Life benefit cannot exceed 100% of the employee’s Supplemental Life amount. Dependent Child(ren) coverage is available up to a maximum benefit of $10,000. Amounts over the guaranteed issue schedule below will be subject to evidence of insurability.

Supplemental life amounts are portable should you retire or terminate employment at Chemistry.

Guaranteed Issue Schedule (Available for New Hires) • • •

Employee: $50,000 Spouse: $25,000 Child: All coverage is guarantee issue

Chemistry Benefit Guide | 10

DISABILITY INSURANCE B e n e f i t P l a n Ye a r 1 / 1 / 2 0 2 2 – 1 2 / 3 1 / 2 0 2 2 Disability coverage provides the financial security of knowing that you will continue to receive income if you are unable to work due to illness or injury.

Company Paid Short-Term Disability Even a few weeks away from work can make it difficult to manage household expenses. Short-Term Disability is a company-provided benefit through Mutual of Omaha. This coverage will pay up to 60% of your weekly salary up to a maximum of $1,500 for non work-related accidents or illnesses, so you can focus on getting better, and worry less about keeping up with your bills. Benefits begin on the 8th day of disability for accident and sickness. Benefits are payable up to a maximum of 12 weeks.

Voluntary Long-Term Disability Serious illnesses or accidents can come out of nowhere. They can interrupt your life and your ability to work for months or even years. Voluntary Long-Term Disability coverage is available to you through Mutual of Omaha. This benefit pays 60% of your monthly earnings in the event of a disability after 90 days for non workrelated accidents or illnesses up to a maximum monthly benefit of $10,000. The Long-Term Disability benefit pays up to the Social Security Normal Retirement Age (SSNRA).

For the first year that you are enrolled in the long-term disability benefit, the policy does not provide benefits for a disability caused by a pre-existing condition. A preexisting condition is any condition for which you received medical treatment, consultation, care or services including diagnostic measures, or took prescribed drugs or medicines 3 months prior to your effective date of coverage. Please refer to the plan certificate for the pre-existing guidelines.

If you decline the LTD benefit when you are first eligible as a new-hire and apply as a late-entrant, evidence of insurability will be required for you to be approved for coverage.

Please note that Chemistry has additional paid leave of absences available such as our Inclusive Parental Leave Policy that work in tandem with MoO to cover up to 100% of salary during certain LOAs.

Chemistry Benefit Guide | 11

S U P P L E M E N TA L B E N E F I T S AFLAC Chemistry offers 3 supplemental plans through Aflac described below. For pricing information, please consult with our Aflac representative. These benefits pay you directly to help offset the costs associated with illnesses and injuries.

Accident

Pays you specific dollar amounts for accidents/injuries requiring medical attention. Dollar amounts will vary based on the type and severity of the claim.

Critical Illness

Pays you a lump sum benefit if you are diagnosed with a critical illness such as a heart attack, stroke, cancer, coma, etc.

Hospital Indemnity

Pays you set dollar amounts for an initial hospital confinement of 23 hours or more, days spent in the hospital, physician visits and intensive care treatment.

FRINGE Chemistry has teamed up with Fringe to provide an all-in-one platform for personalized lifestyle benefits. From nannies and virtual childcare, to home cleaning and grocery/food delivery, Fringe has the services to make life a little easier. The 120+ services on Fringe will reduce stress, save time, impact your family and spark joy.

LIFEOMIC PRECISION WELLNESS Chemistry offers an employee wellness program through LifeOmic Precision Wellness. LifeOmic will help you prevent disease and maintain a healthy lifestyle. The program uses science to promote easy-to-follow, proven, healthy habits based on five pillars of health: Nutrition, Activity, Mindfulness, Sleep and Intermittent Fasting. The program provides a platform for social accountability and engagement, so please take advantage of this opportunity to be well! Download the smartphone app by hovering your phone camera over the QR code below.

The Sports Package increases the total benefit payment by 25%

Benefit Increase $397

Chemistry Benefit Guide | 12

E M P L OY E E A S S I S TA N C E P RO G R A M Help, when you need it most.

With your Employee Assistance Program and Work/Life Balance services, confidential assistance is as close as your phone or computer.

Employee Assistance Program (EAP) Your EAP is designed to help you lead a happier and more productive life at home and at work. Call for confidential access to a Licensed Professional Counselor* who can help you.

A Licensed Professional Counselor can help you with: • • •

Stress, depression, anxiety Relationship issues, divorce Job stress, work conflicts

• • •

Family and parenting problems Anger, grief and loss And more

Work/Life Balance You can also reach out to a specialist for help with balancing and life issues. Just call and one of our Work/Life Specialists can answer your questions and help you find resources in your community.

Ask our Work/Life Specialists about: • • • •

Always By Your Side • • • • •

Expert support 24/7 Convenient website Short-term help Referrals for additional care Online Articles and Resources

Child care Elder care Legal questions Identify theft

• • •

Financial services, debt management, credit report issues Even reducing your medical/dental bills!

And more

Help Is Easy To Access Online/phone support: Unlimited, confidential. 24/7 In-person: Your can get up to 6 visits available at no additional cost to you with a Licensed Professional Counselor. Your counselor may refer you to resources in your community for ongoing support.

Who is Covered?

Employee Assistance Program – Work/Life Balance

Mutual of Omaha’s EAP services are available to all eligible employees, their spouses or domestic partners, dependent children.

Toll-free 24/7 access:

!

1-800-316-2796 (bi-lingual) Mutualofomaha.com/eap

*The counselors must abide by federal regulations regarding duty to warn of harm to self or others. In these instances, the consultant may be mandated to report a situation to the appropriate authority.

Chemistry Benefit Guide | 13

C O S T O F C OV E R A G E Chemistry contributes towards the cost of Medical, Dental and Vision coverage for all eligible employees. Pricing below is taken on a pre-tax basis per pay period. The company contributes 100% of the cost towards Basic Life/AD&D and Short Term Disability. The cost for Supplemental Life and Long-Term Disability is based on employee age and/or income. Please reference the Paycor payroll portal for details.

Semi-Monthly Payroll Deductions UPMC Medical Plans

Employee Only

Employee & Spouse

Employee & Child(ren)

Family

EPO 500

$98.74

$264.24

$198.67

$275.49

HSA 1400

$90.79

$242.96

$182.68

$253.31

Employee Only

Employee & Spouse

Employee & Child(ren)

Family

$4.32

$8.90

$11.07

$16.91

UPMC Vision

Employee Only

Employee & Spouse

Employee & Child(ren)

Family

UPMC Vision

$0.63

$1.24

$1.97

$2.28

MetLife Dental MetLife Dental Plan

Basic Life / AD&D

100% Company Paid

Short Term Disability

100% Company Paid

Supplemental Life

See Paycor Payroll Portal for Pricing

Voluntary LTD

See Paycor Payroll Portal for Pricing

Chemistry Benefit Guide | 14

KEY CONTACTS & RESOURCES Questions on your benefits or need assistance with Claims, contact Sterling Seacrest Pritchard:

Your Employee Support Contacts Claims Questions?

Kristie Mercer 770.635.2293 kmercer@sspins.com BE SURE TO HAVE THE FOLLOWING INFORMATION WHEN CALLING: Subscriber ID # Date of Service Name of Patient Name of Doctor, Facility or Hospital Copy of Bill or Explanation of Benefits (EOB)

Benefit Questions?

Steven Katcoff 678.426.1572 stevenk@sspins.com Laura Delavan 770.635.4016 laurad@sspins.com

Benefit

Company

Phone

Website

Medical Coverage

UPMC

888-876-2756

www.upmchealthplan.com

Dental Coverage

MetLife

800-942-0854

metlife.com/mybenefits

Vision Coverage

UPMC

844-252-0687

www.upmchealthplan.com

Chemistry Benefit Guide | 15

I M P O R TA N T N O T I C E A B O U T Y O U R P R E S C R I P T I O N DRUG C OVE R AG E & M E DIC A R E CREDITABLE Please read this notice carefully and keep it where you can find it. This notice has information about your current prescription drug coverage with Chemistry and about 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.

•

Chemistry has determined that the prescription drug coverage offered by the UPMC plans are, 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. However, if you lose your current creditable prescription drug coverage, through no fault of your own, you will also be eligible for a two (2) 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 current Vero Biotech cover- age will not be affected. Please review prescription drug coverage plan provisions/options under the certificate booklet provided by UPMC. See pages 7- 9 of the CMS Disclosure of Creditable Coverage To Medicare Part D Eligible Individuals Guidance 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 Vero Biotech coverage, be aware that you and your dependents may not be able to get this coverage back.

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 coverage with Chemistry 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 carrier.

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 coverage through Chemistry 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. 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 1-800325-0778).

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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IMPORTANT INFORMATION COBRA Continuation of Coverage 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 and other members of your family when group health coverage would otherwise end. For more 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. For additional information regarding COBRA qualifying events, how coverage is provided and actions required to participate in COBRA coverage, please see your Human Resources department.

Newborns’ and Mothers’ Health Protection Act The group health coverage provided complies with the Newborns’ and Mothers’ Health Protection Act of 1996. Under this law 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 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 issuers may not, under federal law, require that a provider obtain authorization from the plan or the insurance issuer for prescribing a length of stay not in excess of 48 hours (or 96 hours).

Premium Assistance under Medical and CHIP If you or your children are eligible for Medicaid or CHIP (Children’s Health Insurance Program) and you are eligible for health coverage from your employer, your State may have a premium assistance program that can help you 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 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. Please see Human Resources for a list of state Medicaid or CHIP offices to find out more about premium assistance.

Special Enrollment Events An Eligible Person and/or Dependent may also be able to enroll during a special enrollment period. A special enrollment period is not available to an Eligible Person and his or her dependents if coverage under the prior plan was terminated for cause, or because premiums were not paid on a timely basis.

An Eligible Person and/or Dependent does not need to elect COBRA continuation coverage to preserve special enrollment rights.

Special enrollment is available to an Eligible Person and/or Dependent even if COBRA is elected. Please be aware that most special enrollment events require action within 30 days of the event. Please see Human Resources for a list of special enrollment opportunities and procedures.

Women’s Health and Cancer Rights Act 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 of reconstruction of the breast on which the mastectomy has been 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. These benefits will be provided subject to deductibles and coinsurance applicable to other medical and surgical benefits provided under this plan. If you would like more information on WHCRA benefits, call your plan administrator.

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IMPORTANT INFORMATION GINA The Genetic Information Nondiscrimination Act (GINA) prohibits health benefit plans from discriminating on the basis of genetic information in regards to eligibility, premium and contributions. This generally also means that private employers with more than 15 employees, its health plan or “business associate” of the employer, cannot collect or use genetic information, (including family medical history information). The once exception would be that a minimum amount of genetic testing results make be used to make a determination regarding a claim.

You should know that GINA is treated as protected health information (PHI) under HIPAA. The plan must provide that an employer cannot request or require that you reveal whether or not you have had genetic testing; nor can your employer require that you participate in a genetic test. An employer cannot use any genetic information to set contribution rates or premiums.

PPACA Compliant Plan Notice Since key parts of the health care law took effect in 2014, there is a new way to buy health insurance: the Health Insurance Marketplace. To assist you as you evaluate options for you and your family, this notice provides some basic information about the new Marketplace and employment based health coverage offered by your employer.

If your employer offers health coverage that meets the “minimum value” plan standard, you will not be eligible for a tax credit through the Marketplace and may wish to enroll in your employer’s health plan. The “minimum value” plan standard is set by the Affordable Care Act. Your health plans offered by [Company] are ACA compliant plans (surpassing the “minimum value” standard), thus you would not be eligible for the tax credit offered to those who do not have access to such a plan.

NOTE: If you purchase a health plan through the marketplace instead of accepting health coverage offered by your employer, then you will lose the employer contribution to the employer offered coverage. Also, this employer contribution, as well as your employee contribution to employer offered coverage, is excluded from income for Federal and State income tax purposed.

USERRA Notice The Uniformed Services Employment and Reemployment Rights Act of 1994 (USERRA) established requirements that employers must meet for certain employees who are involved in the uniformed services. In addition to the rights that you have under COBRA, you (the employee) are entitled under USERRA lo continue the coverage that you (and your covered dependents, if any) had under the Chemistry plan.

You Have Rights Under Both COBRA and USERRA. Your rights under COBRA and USERRA are similar but not identical. Any election that you make pursuant to COBRA will also be an election under USERRA, and COBRA and USERRA will both apply with respect to the continuation coverage elected. If COBRA and USERRA give you different rights or protections, the law that provides the greater benefit will apply. The administrative policies and procedures described in the attached COBRA Election Notice also apply to USERRA coverage, unless compliance with the procedures is precluded by military necessity or is otherwise impossible or unreasonable under the circumstances.

Definitions "Uniformed services" means the Armed Forces, the Army National Guard, and the Air National Guard when an individual is engaged in active duty for training, inactive duty training, or full-time National Guard duty (i.e., pursuant to orders issued under federal law), the commissioned corps of the Public Health Service, and any other category of persons designated by the President in time of war or national emergency.

"Service in the uniformed services" or "service" means the performance of duty on a voluntary or involuntary basis in the uniformed services under competent authority, including active duty, active and inactive duty for training, National Guard duty under federal statute, a period for which a person is absent from employment for an examination to determine his or her fitness to perform any of these duties, and a period for which a person is absent from employment to perform certain funeral honors duty. It also includes certain service by intermittent disaster response appointees of the National Disaster Medical System.

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IMPORTANT INFORMATION Duration of USERRA Coverage General Rule: 24-Month Maximum. When a covered employee takes a leave for service in the uniformed services, USERRA coverage for the employee (and covered dependents for whom coverage is elected) can continue until up to 24 months from the date on which the employee's leave for uniformed service began. However, USERRA coverage will end earlier if one of the following events takes place: A premium payment is not made within the required time; You fail to return to work or to apply for reemployment within the time required under USERRA (see below) following the completion of your service in the uniformed services; You lose your rights under USERRA as a result of a dishonorable discharge or other conduct specified in USERRA. Notice of Privacy Provision This Notice of Privacy Practices (the "Notice") describes the legal obligations of [Company] (the "Plan") and your legal rights regarding your protected health information held by the Plan under the Health Insurance Portability and Accountability Act of 1996 (HIPAA) and the Health Information Technology for Economic and Clinical Health Act (HITECH Act). Among other things, this Notice describes how your protected health information may be used or disclosed to carry out treatment, payment, or health care operations, or for any other purposes that are permitted or required by law. We are required to provide this Notice of Privacy Practices to you pursuant to HIPAA. The HIPAA Privacy Rule protects only certain medical information known as "protected health information." Generally, protected health information is health information, including demographic information, collected from you or created or received by a health care provider, a health care clearinghouse, a health plan, or your employer on behalf of a group health plan, from which it is possible to individually identify you and that relates to: • Your past, present, or future physical or mental health or condition; • The provision of health care to you; or • The past, present, or future payment for the provision of health care to you.

If you have any questions about this Notice or about our privacy practices, please contact your Human Resources department. The full privacy notice is available with your Human Resources Department.

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THE INSURANCE AND RISK MANAGEMENT BROKERAGE YOU NEVER EXPECTED.