ATG 2022 Voluntary Benefit Guide

2022-2023

BENEFITS GUIDE October 1, 2022 – September 30,, 2023

Welcome!

Our employees are our greatest resource, and so we are proud to offer a robust benefits package.

Please take the time to carefully review the information, carrier changes and all the benefits offered to you. We hope the benefits offered will inspire you and your dependents to take charge of your health and continue making wellness a priority.

OPEN ENROLLMENT Open Enrollment is your opportunity to add, cancel, or make changes to your benefits. This year, open enrollment for your Guardian plan; Dental, Vision, Hospital Confinement, Short Term Disability and Accident, will be Monday, September 19th – Thursday, September 29th.

Once you elect your benefits, the elections remain in effect for the plan year, October 1, 2022September 30th, 2023. You may only change coverage due to an IRS qualified “life event” and must do so within 30 days of the event. A qualifying event is a significant change in a person’s life that creates the need to add, cancel, increase, or change coverage. We encourage you to review all your benefits and make selections wisely.

This year we will be using Employee Navigator again to make our benefits elections. You must elect or decline coverage through the Employee Navigator. *Elections for medical benefits will take place in October for a January 1st effective date. No medical changes can be made at this time.*

ELIGIBILITY

QUALIFYING EVENTS

New hires are eligible for benefits on the first of the month following date of hire. You may enroll yourself and eligible dependents for coverage. You must enroll yourself in benefits in order to enroll your dependents.

Once you have made your elections, you are NOT eligible to change or drop coverage until the next Open Enrollment period unless you have a qualifying event. If you experience a qualifying life event, contact the Human Resources Department within 30 days of your qualifying event. If you fail to do so, you will have to wait until the next open enrollment period to make any changes to your coverage. Qualifying life events include, but are not limited to:

Dependent children are eligible for the group health plan until their 26th birthday regardless of whether they are a full-time student.

Eligible dependents include:

•

Marriage

•

Spouse

•

Divorce

•

Dependent children

•

Legally adopted children

• •

•

Stepchildren

Birth or adoption Employment changes from Part-time to Full-time Change in dependent status (i.e.

Dependent child reaches age 26 limit)

•

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HOW TO ENROLL If this is your first time logging in to Employee Navigator, you will need to register. To begin, visit www.employeenavigator.com and use the steps below to login.

1. Click "Login" at the top right-hand corner of the page.

2. Click on Register as a new user. For the 2022-2023 Open Enrollment, all employees will need to register as a NEW USER. Prior Employee Navigator logins will not be active.

3.

Create your account by entering: • Your first and last name as they appear in payroll.

• Company identifier – Atl.Inv.Co. • The last 4 digits of your SSN. • Your date of birth.

If you encounter a login error, please reach out to Marie Volk at Sterling Seacrest Pritchard – mvolk@sspins.com.

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D E N TA L Dental benefits are available through Guardian. To find dental providers visit Guardian.com Click Find a Dentist. The network is the DentalGuard Pref - Atlanta network.

Low Plan

High Plan

$1,000

$1,500

$50/$150

$50/$150

100% - Cleanings, Exams, X-Rays,

100% - Cleanings, Exams, X-Rays,

Annual Maximum (Per Person) Deductible - Employee/Family (Waived for Preventive) Type I - Preventive

Fluoride, Sealants, Space Maintainers Fluoride, Sealants, Space Maintainers 80% - Fillings, Simple Oral Surgery,

80% - Fillings, Simple Oral Surgery,

Emergency Palliative Treamtment,

Emergency Palliative Treamtment,

General Anesthesia, Endo, Perio

General Anesthesia, Endo , Perio

50% - Inlays, Onlays, Crowns,

50% - Inlays, Onlays, Crowns,

Dentures, Bridges

Dentures, Bridges

N/A

50% up to $1,000

90th UCR

90th UCR

Employee

$7.03

$8.85

Employee + Spouse

$13.82

$17.52

Employee + Child(ren)

$16.36

$20.98

Family

$25.23

$32.24

Type II - Basic Service

Type III - Major Services Orthodontia Services (lifetime limit) Out-of-Network Claims Payments COST PER PAYCHECK (52) - Weekly

VISION Vision benefits are available through Guardian. To find vision providers visit Guardian.com

In-Network

VSP

Exam (once per 12 months)

$10 copay

Lenses (once per 12 months)

$20 copay

Frames (once per 24 months)

$130 allowance

Contacts (in lieu of glasses)

$130 allowance

COST PER PAYCHECK (52) - Weekly

Employee

$1.50

Employee + Spouse

$3.02

Employee + Child(ren)

$2.55

Family

$4.21

Choose from a large network of ophthalmologists, optometrists and opticians, from private practices to retailers like Costco® Optical, Walmart, Sam’s Club and Visionworks.

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Vo l u n t a r y B e n e f i t s Benefits ar e provided through Guardian Voluntary Short-Term Disability – Employees have the option to purchase short-term disability. Rates are based on age and salary.

Benefit Amount: 60% of weekly salary up to a maximum of $1,000 for non-work related accidents or sicknesses.

Waiting Period: Benefits begin on day 15 Benefit Period: up to 11 weeks Accident coverage provides benefits for common on/off-job accidental injuries and related treatments. Benefits are payable for covered injures such as dislocations, fractures and burns; and treatments including ER visits, xrays and surgery.

Benefit

Basic

Advantage

Employee - $25,000

Employee - $50,000

Spouse - $12,500

Spouse - $25,000

Child - $5,000

Child - $10,000

$50

$50

Dislocations

up to $2,000

up to $5,000

Fractures

up to $3,000

up to $6,000

Admission - $500

Admission - $1,000

Confinement - $100/day

Confinement - $250/day

Employee

$1.34

$2.89

Employee + Spouse

$2.32

$5.05

Employee + Child(ren)

$2.75

$5.98

Family

$3.73

$8.14

Accidental Death & Dismemberment Wellness

Hospital See plan summary for additional benefits COST PER PAYCHECK (52) - Weekly

Hospital Confinement provides hospital benefits to help cover out-of-pocket costs created by co-pays and deductibles.

Low Plan

High Plan

$500 per day to a max of 1 day per

$1,000 per day to a max of 1 day per

year per insured, max of 3 days per

year per insured, max of 3 days per

covered family.

covered family.

$100 per day to max of 15 days

$200 per day to max of 15 days

Employee

$1.34

$2.89

Employee + Spouse

$2.32

$5.05

Employee + Child(ren)

$2.75

$5.98

Family

$3.73

$8.14

Hospital Admission Hospital Confinement

See plan summary for additional benefits COST PER PAYCHECK (52) - Weekly

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

Your Employee Support Contact Benefit Questions?

Claims Questions?

Marie Volk 770.635.0451 mvolk@sspins.com

Darlene Moorman 770.635.0439 dmoorman@sspins.com

Jeb Blazevich 704.996.6517 jblazevich@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)

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LEGAL NOTICES THIS GUIDE - This brochure summarizes the health care and income protection benefits that are available to Atlantic Investment Company 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.

HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT (HIPAA) Atlantic Investment Company, in accordance with HIPAA, protects your Protected Health Information (PHI). We will only discuss your PHI with medical providers and thirdparty administrators when necessary to administer the plan that provides you your medical, dental and vision benefits or as mandated by law. A copy of the Notice of Privacy is available upon request through your Human Resources department.

WOMEN'S HEALTH 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 was performed; • Surgery and reconstruction of the other breast to produce a symmetrical appearance; • Prostheses; and • Treatment of physical complications of the mastectomy, including lymphedema. These benefits will be provided subject to the same deductibles and coinsurance applicable to other medical and surgical benefits provided under this plan. If you have any questions about your coverage, please contact your Human Resources department.

CONTINUATION REQUIRED BY FEDERAL LAW FOR YOU & YOUR DEPENDENTS (COBRA) The continuation required by Federal Law does not apply to any benefits for loss of life, dismemberment or loss of income. Federal law enables you or your dependent to continue health insurance if coverage would cease due to a reduction of your work hours or your termination of employment (other than gross misconduct). Federal law also enables your dependents to continue health insurance if their coverage ceases due to your health, divorce, or legal separation, or with respect to a dependent child, failure to continue to qualify as a dependent. Continuation must be elected in accordance with the rules of your Employer's group health plan(s) and is subject to federal law, regulations and interpretations.

MEDICAID AND THE CHILDREN'S HEALTH INSURANCE PROGRAM (CHIP) The continuation required by Federal Law does not apply to any benefits for loss of life, dismemberment or loss of income. Federal law enables you or your dependent to continue health insurance if coverage would cease due to a reduction of your work hours or your termination of employment (other than gross misconduct). Federal law also enables your dependents to continue health insurance if their coverage ceases due to your health, divorce, or legal separation, or with respect to a dependent child, failure to continue to qualify as a dependent. Continuation must be elected in accordance with the rules of your Employer's group health plan(s) and is subject to federal law, regulations and interpretations.

SPECIAL ENROLLMENT NOTICES

NEWBORNS' & MOTHERS' HEALTH PROTECTION ACT

If you decline enrollment in your employer's health plan for you or your dependents (including your spouse) because of other health insurance or group health plan coverage, you or your dependents may be able to enroll in your employer's plan without waiting for the next open enrollment period if you: • Lose other health insurance or group health plan coverage. You must request enrollment within 30 days after the loss of other coverage.

• Gain a new dependent as a result of marriage, birth, adoption or placement for adoption. You must request (medical plan OR health plan) enrollment within 30 days after the marriage, birth, adoption or placement for adoption.

• Lose Medicaid, or Children's Health Insurance Program (CHIP) coverage because you are no longer eligible.

You must request medical plan enrollment within 60 days after the loss of such coverage.

Federal law prohibits the plan from limiting a mother's or newborn's length of hospital stay to less than 48 hours for a normal delivery or 96 hours for a Cesarean delivery or from requiring the provider to obtain pre-authorization for a stay of 48 or 96 hours, as appropriate. However, federal law generally does not prohibit the attending provider, after consultation with the mother, from discharging the mother or her newborn earlier than 48 hours for normal delivery or 96 hours for Cesarean delivery.

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