Employee Benefits Guide - Atlanta Academy - Plan Year 12.1.20 - 11.30.21

Benefits Guide December 1st, 2020 – November 30th, 2021

Benefits Guide December 1st, 2019 – November 30th, 2020

TA B L E OF

CONTENTS

Atlanta Academy is pleased to offer our employees a comprehensive benefits program to meet the needs of you and your family members.

This Benefits Guide outlines the health and welfare plans offered to you and your family. It contains general information and is meant to provide a brief overview. For complete details regarding each benefit plan offered, please refer to the individual plan documents as the information contained herein is for illustrative purposes. Details can be found in the plan specific Summary Plan Description (SPD) and Summaries of Benefits and Coverage (SBC). In the case of a discrepancy the specific plan documents will prevail.

A S M A R T E R W A Y T O BET T E R H E ALT H Eligibility

4

Medical

5

Benefits That Pay You Cash

6-8

Flexible Spending Account

9

Health Savings Account

10

Dental

11

Vision

12

Company Paid Benefits

13

Supplemental Life Insurance

14

Employee Assistance Program

15

401(k)

16

Prescription Shopping Resources

17

Employee Payroll Deductions

18

Key Contacts

19

Important Information

20+

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A S MARTER WAY T O BE TT E R HE ALT H

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 your goals.

Preventive Health Care Services

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:    

Immunizations

Understanding What’s Covered

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% in-network, 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 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.

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Eligibility All full-time employees and their dependents are eligible to participate in Atlanta Academy’s benefits program. A full-time employee is defined as one who works a minimum of 30 hours per week on a regularly scheduled basis.

WHO IS A DEPENDENT?

QUALIFYING EVENT CHANGES

 Your spouse to whom you are legally married  Your dependent child(ren) • Medical Plan: Up to age 26 (through the end of the month in which they become 26); 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; may be unmarried or married (your child’s spouse and children are not eligible).

• Your unmarried children of any age who are permanently and totally disabled physically or mentally for whom you provide financial support. You must periodically provide medical documentation of such disability.

• Dental Plan: Covered until the end of the month in which the child turns 26, regardless of student status.

• Vision Plan: Covered until the end of the month in which the child turns 26, regardless of student status.

You are allowed to make certain changes to your current benefit elections during the year for the reasons below.

WHEN DO BENEFITS BECOME EFFECTIVE? Your benefits become effective on the first day of the month following your date of hire.

ANNUAL OPEN ENROLLMENT Each year during the annual open enrollment period, you are given the opportunity to make changes to your current benefit elections. Annual enrollment is the only time during the year you can make changes to your benefits unless you experience a qualified life status change.

 Marriage, divorce or legal separation  Birth or adoption of a child or placement of a child for adoption  Death of a dependent  Child no longer eligible due to reaching limiting age  Change in employment status, including loss or gain of employment, for your spouse or a dependent that results in a change in eligibility  Change in work schedule, including switching between full-time and part-time status, by you, your spouse or a dependent that results in a change in eligibility  Change in residence or work site for you, your spouse, or a dependent that results in a change of eligibility  If you or your dependents lose eligibility for Medicaid or the Children’s Health Insurance Program (CHIP) coverage or become eligible for a state’s premium assistance subsidy under Medicaid or CHIP, then you have 60 days from the date of the Medicaid/eligibility change to request enrollment in the Atlanta Academy plans. The change to your benefit elections must be consistent with a change in status. If you have a status change, you must notify Atlanta Academy’s Human Resource Department within 30 days of the event. If you do not notify your HR Department within that time, you and/or your dependents must wait until the next annual open enrollment period to make a change in your benefit elections. Your elections will become effective the first of the month following your status change, with the exception of a change due to birth or adoption.

Your annual open enrollment period will be within the month of November because your renewal date is 12/01/2020.

To get enrolled, visit: https://atlantaacademy.ease.com

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Medical Atlanta Academy offers two medical plan options through UnitedHealthcare. Utilizing in-network providers and services will help limit your out-of-pocket costs when you seek medical care. To search for participating primary care physicians, specialists and facilities, visit https://connect.werally.com/plans/uhc.

When searching for a provider, follow the steps below: 1. Select Medical Directory 2. Select All UnitedHealthcare Plans 3. Select the designated network Choice Plus You may also download the UnitedHealthcare app on your mobile device to manage your health plan, view your ID card and much more. Eligible employees may elect coverage for themselves, a spouse and/or dependent children. Dependent children are covered up to age 26, regardless of student status.

UnitedHealthcare Plan Highlights Deductible ‐ Individual

POS Choice Plus $1,500 In‐Network Out‐of‐ Network YOU PAY YOU PAY $3,000 $1,500

UnitedHealthcare HSA Choice Plus $3,000 In‐Network Out‐of‐Network YOU PAY YOU PAY $10,000 $3,000

Deductible ‐ Family

$3,000

$6,000

$6,000

$20,000

Coinsurance Out‐of‐Pocket‐Max ‐ Individual Out‐of‐Pocket‐Max ‐ Family Hospitalization

0%

30%

0%

30%

$4,000

$8,000

$3,000

$15,000

$8,000

$16,000

$6,000

$30,000

Deductible Only

Ded., then 30%

Deductible Only

Ded., then 30%

Outpatient Surgery

Deductible Only

Ded., then 30%

Deductible Only

Ded., then 30%

Emergency Room

$500 copay

$500 copay

Deductible Only

Deductible Only

Ded., then 30%

Deductible Only

Ded., then 30%

Ded., then 30%

Deductible Only

Ded., then 30%

Ded., then 30%

Deductible Only

Ded., then 30%

Ded., then 30%

Deductible Only

Ded., then 30%

Urgent Care $50 copay Diagnostic Test Freestanding Lab: 0% (X‐Ray, Blood work) Hospital Lab: 20% Imaging Freestanding Lab: 0% (CT/PET scans, MRIs) Hospital: $500 & Ded. Primary Care Physician $25 copay Specialist

$50 copay

Ded., then 30%

Deductible Only

Ded., then 30%

Preventive Care

Covered in Full

Ded., then 30%

Covered In Full

Ded., then 30%

Rx Deductible Tier 1 – Preferred Generic Tier 2 ‐ Preferred Brand Tier 3 ‐ Non‐Preferred Tier 4 ‐ Specialty Drugs

None

Medical Deductible Applies

$10 copay

Deductible Only

Ded., then 30%

$35 copay

Deductible Only

Ded., then 30%

$60 copay

Deductible Only

Ded., then 30%

Not Covered

Deductible Only

Ded., then 30%

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Benefits That Pay You Cash You now have the option of purchasing benefits that cover the gaps in your and your dependents’ medical insurance policy. These plans are supplemental to your regular health insurance plans and provide cash benefits to help cover expenses that normal insurance does not. You do not need to be enrolled in Atlanta Academy’s medical plan to take advantage of these policies.

GROUP ACCIDENT PLAN Group accident insurance can help with medical or other costs associated with a covered accident or injury that your health insurance may not cover. With this coverage you may not need to use your savings or secure a loan to help pay those unexpected out-of-pocket expenses. Coverage options are available for you, your spouse and eligible dependent children. Here is a great example:

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Benefits That Pay You Cash GROUP Critical Illness Insurance When life takes an unexpected turn due to a critical illness diagnosis, your focus should be on recovery — not finances. Colonial Life’s group critical illness insurance helps provide financial support by providing a lump-sum benefit payable directly to you for your greatest needs.

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Benefits That Pay You Cash Limited Medical Benefit – Health Insurance Our Individual Medical Bridge insurance can help with medical costs that your health insurance may not cover. These benefits are available for you, your spouse and eligible dependent children.

Individual Medical Bridge offers two optional benefit riders – the daily hospital confinement rider and the enhanced intensive care unit confinement rider. For an additional cost, these riders can help provide extra financial protection to help with outof-pocket medical expenses.

Cancer Assist Insurance Colonial’s cancer insurance helps provide financial protection through a variety of benefits. These benefits are not only for you but also for your covered family members. Here are some of the key benefits:

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Flexible Spending Account (FSA) You may not enroll in the FSA if you are contributing to an HSA Provided by MEDCOM Atlanta Academy offers employees the opportunity to participate in the Healthcare Flexible Spending Account (FSA) and Dependent Care FSA. These programs may provide you with significant tax advantages as they allow you to pay for eligible out-of-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 plan only allows for a $550 carryover maximum annually.

You may not participate in the medical reimbursement account if you are contributing to an HSA. Healthcare Flexible Spending Account You may defer up to $2,750 to your Healthcare FSA to fund eligible out-of-pocket healthcare expenses. The following list provides examples of expenses eligible for reimbursement under the IRS guidelines: ▪ ▪ ▪ ▪ ▪ ▪

Non-covered medical expenses that qualify 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.

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

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Health Savings Account (HSA) Available only if you enrolled in the HSA Choice Plus $3,000 plan What is a Health Savings Account?

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 Atlanta Academy’s medical plan. The account is portable, which means it is not tied to your employment at Atlanta Academy. 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.

Who is eligible for an HSA? Generally, to be eligible to set up and contribute to an HSA, you: ▪ Must be covered by a Consumer Directed Health Plan (CDHP) – the HSA Choice Plus $3,000 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 deposit 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 not otherwise paid 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. It’s important to understand that the HSA, unlike a Healthcare Flexible Spending Account (FSA), will not pay for qualified expenses that exceed the balance in the HSA. When filing your taxes each year, you will provide your tax advisor a report showing the amount you contributed to the HSA account, and you will receive a tax deduction for that amount.

How do I enroll in an HSA? You can go to any banking institution of your choice and apply for an HSA account.

This account works similarly to how a bank would manage your personal savings or checking account. When you open your HSA, you receive a debit card and/or checkbook to be used on many out-of-pocket qualified expenses like doctor visits, vision and dental care, and prescriptions.

What type of expenses can be paid from an HSA? 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: ▪ 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.

When can I begin contributions to my HSA account? You may begin funding your HSA account as soon as your account is established.

Can I invest my HSA Funds? Depending upon who you choose to be your HSA custodian – there could be different options.

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: ▪ 2020: $3,550 for individuals and $7,100 for families ▪ 2021: $3,600 for individuals and $7,200 for families ▪ Individuals age 55 or older may be eligible to make a catch-up contribution of $1,000.

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

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Dental Staying healthy includes obtaining quality dental care for you and your family. Our dental benefits, administered by MetLife, provide a wide range of dental services including preventive care, fillings, and x-rays.

You have the freedom of choice to utilize in-network or out-of-network providers. For a list of innetwork providers, visit www.metlife.com.

When searching for a provider, follow the steps below: 1. Select Find a Dentist 2. Select PDP as the network When you visit an in-network dentist, your out-of-pocket expenses are lower. In-network dentists will file the claim for you and services are paid at the MetLife negotiated rate.

Eligible employees may elect coverage for themselves, a spouse and/or dependent child(ren).

Dependent child(ren) are covered up to age 26, regardless of student status.

PPO Plan

BENEFIT Your Deductible

In-Network YOU PAY

Out-of-Network YOU PAY

Individual Family Waived for Preventive Services

$50 $150

$50 $150

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

$1,000

$1,000

Preventive & Diagnostic Services Exams, Cleanings, X-Rays, Fluoride up to age 19, Sealants up to age 16

0%

0%

Basic Services Fillings, Extractions, Oral Surgery, Periodontics (gum surgery)

20%

20%

Major Services Bridges & Dentures, Endodontics (root canal), Single Crowns, Bridges Inlays

50%

50%

Orthodontic Services Children Up to age 19 Lifetime Max – Orthodontics

50% $1,000

50% $1,000

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Vision Your eyes deserve the best care to keep them healthy year after year. Regular eye examinations may determine your need for corrective eyewear and may also detect general health problems in their earliest stages.

For a list of in-network providers, visit www.metlife.com.

When searching for a provider, follow the steps below: 1. Select Find a Vision Provider 2. Select MetLife Vision PPO When you visit an in-network vision provider, your out-of-pocket expenses are lower.

Eligible employees may elect coverage for themselves, a spouse and/or dependent child(ren).

Dependent child(ren) are covered up to age 26, regardless of student status.

BENEFIT

In Network

Out of Network

Exam

$10 copay

up to $45

Frame

$130 allowance

up to $70

Lenses Single Vision Lined Bifocal Lined Trifocal

$25 copay $25 copay $25 copay

up to $30 up to $50 up to $65

Elective Lenses

$130 allowance

up to $105

Medically Necessary Lenses

100% Covered

up to $210

Contact Lenses

Frequency Exam Lenses (glasses OR contacts) Frames

12 months 12 months 24 months

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Company Paid Benefits

Life Insurance

Atlanta Academy provides all full-time employees with a school-paid Life and Accidental Death & Dismemberment (AD&D) policy through MetLife. As an eligible employee you will receive Life/AD&D coverage in the amount of $50,000 at no cost to you. *Be sure you name a beneficiary when you enroll in Life and AD&D benefits.

Short-Term Disability

Atlanta Academy provides all full-time employees with a Short-Term Disability (STD) benefit. Your STD benefit provides income protection in the event you are unable to work due to illness, injury, accident or pregnancy. The plan pays you 60% of your weekly earnings up to a maximum weekly benefit of $1,500.

Benefits begin after 14 days of disability and are payable up to 11 weeks.

Long-Term Disability

Atlanta Academy provides all full-time employees with a Long-Term Disability (LTD) benefit. Your LTD benefit provides income protection if you become totally disabled. The plan pays you 60% of your monthly earnings up to a maximum monthly benefit of $6,500. Benefits begin after 90 days of disability and are payable until you reach Social Security Normal Retirement Age.

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Supplemental Life Insurance Eligible employees can purchase supplemental life insurance through MetLife for themselves, a spouse and/or child(ren).

During this enrollment period, if you elect coverage above the guaranteed issue amount of $150,000, you are required to complete the Statement of Health form.

During this enrollment period, if you elect coverage above the guaranteed issue amount of $25,000 for your spouse, he or she is required to complete the Statement of Health form.

During this enrollment period, you may elect coverage up to $10,000 per child without being required to complete the Statement of Health form.

Any elected coverage above the guaranteed issue amount(s) will be effective once written approval is received from MetLife. Upon approval, the additional premium cost will be deducted on a per pay period (semi-monthly) basis. *Be sure you name a beneficiary when you enroll in Supplemental Life Insurance.

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EAP Employee Assistance Program Support for you and your family when you need it most.

Full time employees and their families are eligible to utilize the EAP through MetLife at no cost to you. MetLife offers a variety of services to promote well-being and help enhance the quality of life for you and your family. This service includes family support, legal assistance, mental health resources, financial guidance and work-related help. MetLife’s Employee Assistance Program provides access to solutions and support for the challenges of daily living. Help is available from a counselor by email, chat or phone. Below is more information about this benefit.

Integrated services, including • EAP Consultation–access to qualified EAP consultants for information, support, crisis intervention, educational materials in electronic format, and referral to local resources and assistance • Distance Counseling includes up to five (5) virtual sessions–assessment and short-term problem resolution by network of qualified EAP consultants. If it is determined that the presenting clinical issue is not appropriate for short-term counseling, the participant will be referred to the appropriate resources.

Work-Life Services • Work-Life Consultation–access to qualified consultants for information, assessment, action planning and resources, educational materials and referral to local resources and assistance in areas like: o Parenting, Eldercare and aging o Consumer and community needs o Disability o Adoption o Referrals matched and confirmed for vacancies for childcare and eldercare o Emotions and stress o Workplace issues Other Services Include (please inquire further about the details of each below) • Financial Consultation Services • Legal Services – Access to Network Attorneys • Identity Theft Recovery Services • Telephonic Life Coaching • Substance Abuse Support How to Connect to a Counselor or Support Advocate #1 Call: 1-888-319-7819 #2 MetLife (LifeWorks) Mobile App: Apple & Android Stores User ID: metlifeeap Password: eap #3 Website: www.metlifeeap.lifeworks.com User ID: metlifeeap Password: eap Benefits Guide | 15

401(k) Atlanta Academy has established a 401(k) savings plan to assist eligible employees with preparing for future financial security upon retirement. To enroll in the 401(k) savings plan, you must be a full or part-time regular employee maintaining greater than 1,000 hours of service per year, be at least 21 years of age, and have completed 90 days of service.

Eligible employees may participate in the 401(k)-savings plan subject to all terms and conditions of the plan. The 401(k) savings plan allows you to elect how much salary you want to contribute subject to IRS limitations, and direct the investment of your plan account, so you can customize your own retirement investments to meet your individual needs.

Complete details of the 401(k) savings plan are described in the Summary Plan Description provided to all eligible employees as the Plan documents govern this benefit. For more information or to enroll please see the Director of Finance and Operations.

Mobile Solutions – Connect to your account on any mobile device. Visit troweprice.com/mobilesolutions to choose the option that’s best for you.

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PRESCRIPTION ALTERNATIVES Find the lowest price on prescriptions right from your phone or iPad. Our free, easy-to-use mobile apps feature: • Instant access to the lowest prices for prescription drugs at more than 75,000 pharmacies • Coupons and savings tips that can cut your prescription costs by 50% or more • Side effects, pharmacy hours and locations, pill images, and much more!

One Low Price No Membership Fees Refundable Purchases

Same Medication Lower Price.

Accepted Everywhere Available to Everyone Safe & Secure

Lowest Rx Prices, Every Day

SAVINGS IS EASY

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Employee Payroll Deductions EMPLOYEE PAYROLL DEDUCTIONS PER PAY PERIOD (Semi-Monthly) EFFECTIVE: December 1, 2020 – November 30, 2021

PLAN

EMPLOYEE ONLY

EMPLOYEE + SPOUSE

EMPLOYEE + CHILD(REN)

FAMILY

POS Choice Plus $1,500

$81.54

$376.73

$349.82

$547.15

HSA Choice Plus $3,000

$65.66

$303.45

$281.77

$440.76

MetLife Dental

$5.87

$22.27

$25.00

$41.93

MetLife Vision

$ .70

$2.92

$3.07

$4.52

The payroll deductions above will begin in the first pay cycle of December.

Coinsurance Coinsurance is your share of the costs of a covered service, calculated as a percent of the allowed amount for the service.

Deductible Deductible is a fixed dollar amount you must pay each year before the plan pays for services that require coinsurance.

Copay A flat dollar amount that you pay for certain services like doctor’s office visits and prescriptions.

OOP - Out of Pocket Maximum OOP is the maximum amount you will pay for services in a calendar year. The OOP does not include monthly premiums. Once you reach your OOP, the plan pays 100% of your eligible expenses.

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KEY CON TACTS

Atlanta Academy Human Resources

Amy Pennington

770‐810‐3907

apennington@atlantaacademy.com

Debra Erwin

770‐810‐3911

derwin@atlantacademy.com

Medical

UnitedHealthcare

866‐414‐1959

www.myuhc.com

Dental

MetLife

800‐275‐4638

www.metlife.com

Vision

MetLife

800‐275‐4638

www.metlife.com

Life and AD&D, LTD and STD

MetLife

800‐275‐4638

www.metlife.com

401K

T. Rowe Price

800‐354‐2351

rps.troweprice.com

Accident, Cancer, Critical Illness, Hospital Reimbursement

Colonial Life

803‐325‐4368

www.ColonialLife.com

Benefits Advocate Team Account Manager Client Service Advocate

Pritchard & Jerden Amber Salway Wes Jenkins

404‐238‐9090 678‐538‐2892 404‐419‐4613

www.pjins.com asalway@pjins.com wjenkins@pjins.com

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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 one exception would be that a minimum amount of genetic testing results may 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 Atlanta Academy 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 purposes.

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 to continue the coverage that you (and your covered dependents, if any) had under the Atlanta Academy 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 Atlanta Academy (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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I M P O R TA N T I N F O R M AT I O N This guide provides a summary of your employee benefits rights and regulations as determined by Federal and State Laws.

Information included in this guide includes the following: Special Open Enrollment Rights Children’s Health Insurance Program (CHIP) Premium Assistance

General Notice of the Cobra Continuations Rights Affordable Care Act (ACA) – Insurance Mandate

Health Insurance Marketplace Coverage Options and Your Group Health Coverage Affordable Care Act (ACA) – Preventive Services for Non-grandfathered Plans Newborns’ and Mothers’ Health Protection Act of 1996 Break Time for Nursing Mothers Under the Fair Labor Standards Acts (FLSA) Women’s Health & Cancer Rights Act The Generic Information Nondiscrimination Act of 2008 (GINA) HIPAA Privacy Rules

S P E C I A L O P E N E N RO L L M E N T R I G H T S This notice is being provided to insure that you understand your right to apply for group health insurance coverage. A special enrollment period is a time outside of the annual open enrollment period during which you and your family have a right to sign up for health coverage. In the Marketplace, you qualify for a special enrollment period 60 days following certain life events that involve a change in family status (for example, marriage or birth of a child) or loss of other health coverage. Job-based plans must provide a special enrollment period of 30 days. Some events will require additional documentation to be submitted with the application at the time of enrollment. You should read this notice even if you plan to waive coverage at this time.

If you have a new dependent as a result of a marriage, birth, adoption, or placement for adoption, you may be able to enroll yourself and your dependents. However, you must request enrollment within 30 days after the marriage, birth, or placement for adoption.

If you are declining coverage for yourself or your dependents (including your spouse) because of other health insurance or group health plan coverage, you may be able to enroll yourself and your dependents in this plan if you or your dependents lose eligibility for that other coverage (or if the employer stops contributing toward your or your dependents’ other coverage). However, you must request enrollment within 30 days after your or your dependents’ other coverage ends (or after the employer stops contributing toward the other coverage).

If you or your dependents lose eligibility for coverage under Medicaid or the Children’s Health Insurance Program (CHIP) or become eligible for a premium assistance subsidy under Medicaid or CHIP, you may be able to enroll yourself and your dependents. You must request enrollment within 60 days of the loss of Medicaid or CHIP coverage or the determination of eligibility for a premium assistance subsidy.

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H E A L T H I N S U R A N C E M A R K E T P L AC E PART A: GENERAL INFORMATION When key parts of the health care law took effect in 2014, there was 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.

What is the Health Insurance Marketplace?

The Marketplace is designed to help you find health insurance that meets your needs and fits your budget. The Marketplace offers “one-stop shopping” to find and compare private health insurance options. You may also be eligible for a new kind of tax credit that lowers your monthly premium right away. Open enrollment for health insurance coverage through the Marketplace begins in October for coverage starting as early as January 1st.

Can I Save Money on my Health Insurance Premiums in the Marketplace?

You may quality to save money and lower your monthly premium, but only if our employer does not offer coverage, or offers coverage that doesn’t meet certain standards. The savings on your premium that you’re eligible for depends on your household income.

Yes. If you have an offer of health coverage from your employer that meets certain standards, you will not be eligible for a tax credit through the Marketplace and may wish to enroll in your employer’s health plan. However, you may be eligible for a tax credit that lowers your monthly premium, or a reduction in certain cost-sharing if your employer does not offer coverage to you at all or does not offer coverage that meets certain standards. If the cost of a plan from your employer that would cover you (and not any other members of your family) is more than 9.5% of your household income for the year, or if the coverage your employer provides does not meet the “minimum value” standard set by the Affordable Care Act, you may be eligible for a tax credit.

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If you purchase a health plan through the Marketplace instead of accepting health coverage by your employer, then you may lose the employer contribution (if any) to the employer-offered coverage. Also, this employer contribution – as well as your employee contribution to employer-offered coverage – is often excluded from income for Federal and State income tax purposes. Your payments for coverage through the Marketplace are made on an alter-tax basis.

How Can I Get More Information?

For more information about your coverage offered by your employer, please check your summary plan description or contact HR. The Marketplace can help you evaluate your coverage options, including your eligibility for coverage through the Marketplace and its cost. Please visit www.healthcare.gov for more information, including an online application for health insurance coverage and contact information for a Health Insurance Marketplace in your area.

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H E A L T H I N S U R A N C E M A R K E T P L AC E PART B: INFORMATION ABOUT HEALTH COVERAGE OFFERED BY YOUR EMPLOYER This section contains information about any health coverage offered by your employer. If you decide to complete an application for coverage in the Marketplace, you will be asked to provide this information. This information is numbered to correspond to the Marketplace application.

3. Employer Name Atlanta Academy

4. Employer Identification Number (EIN) 58‐2574521

5. Employer Address 2000 Holcomb Woods Pkwy

6. Employer Phone Number (678) 461‐6102

7. City Roswell

8. State GA

9. Zip Code 30076

10. Who can we contact about health coverage at this job?

Amy Pennington 11. Phone Number (if different from above)

12. Email Address apennington@atlantaacademy.com

Here is some basic information about health coverage offered by this employer: As your employer, we offer a health plan to: All employees. Eligible employees are: Active full-time employees working 30 or more hours a week.

Some employees. Eligible employees are:

With respect to dependents: We do offer coverage. Eligible dependents are: Spouses and children up to age 26.

We do not offer coverage.

If checked, this coverage meets the minimum value standard and the cost of this coverage to you is intended to be affordable, based on employee wages. ** Even if your employer intends your coverage to be affordable, you may still be eligible for a premium discount through Marketplace. The Marketplace will use your household income, along with other factors, to determine whether you may be eligible for a premium discount. If for example, your wages vary from week to week (perhaps you are an hourly employee or you work on a commission basis), if you are newly employed mid-year, or if you have other income losses, you may still qualify for a premium discount.

If you decide to shop for coverage in the Marketplace, Healthcare.gov will guide you through the process. Here’s the employer information you’ll enter when you visit to find out if you can get a tax credit to lower your monthly premiums.

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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 D RU G C OV E R AG E & M E D I C A R E CREDITABLE - NONCREDITABLE Please read this notice carefully and keep it where you can find it. This notice has information about your current prescription drug coverage with Atlanta Academy 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.

• Atlanta Academy has determined that the prescription drug coverage offered by the POS Choice Plus $1,500 plan is, on average for all plan participants, expected to pay out as much as standard Medicare prescription drug coverage pays and is therefore considered Creditable Coverage. Because your existing coverage is Creditable Coverage, you can keep this coverage and not pay a higher premium (a penalty) if you later decide to join a Medicare drug plan.

When 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 Atlanta Academy 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.

• The HSA plan is noncreditable.

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 Atlanta Academy coverage will not be affected. Please review prescription drug coverage plan provisions/options under the certificate booklet provided by United Healthcare. See page 7 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 Atlanta Academy coverage, be aware that you and your dependents may not be able to get this coverage back.

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 Atlanta Academy 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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MEDICAL – THINGS TO KEEP IN MIND Since your annual deductible runs on a calendar year basis, all deductible and out of pocket amounts will reset to $0 on January 1.

You will receive a new ID card in the mail from United Healthcare within 7-10 business days from the date of your enrollment. It will be a plain white envelope so be careful not to overlook and toss it.

H E A LT H I N S U R A N C E T E R M I N O L O G Y Health insurance terminology can be confusing. As a result, understanding your benefits and what you may owe out of pocket can be difficult. In order to make sure you are using your coverage effectively; it is important to understand some key insurance terms.

You can purchase either group or individual health insurance. Group health insurance is typically acquired through your employer and covers many people.

Individual insurance, on the other hand, is usually purchased by an individual or a family and is not tied to a job.

To better understand your health insurance, be aware of the following terms: Participant There are a few different participants involved in health insurance. One is the “provider”, or a clinic, hospital, doctor lab, health care practitioner or pharmacy. The ”insurer” or the “carrier” is the insurance company providing coverage. The “policyholder” is the individual or entity who purchased the coverage, and the “insured” is the person with the coverage.

Premium The amount of money charged by an insurance company for coverage. Rates are typically paid annually or in smaller payments over the course of the year (for example monthly).

Deductible The amount you owe for health care services each year before your insurance company begins to pay. Your deductible may not apply to all services, such as preventive care.

Copayment The fixed amount that you pay for a covered health care service. That amount can vary by the type of covered health care service (for example, a doctor’s office visit or a specialist, urgent care or emergency room visit).

Coisurance The percentage of a medial bill that you pay (for example, 20 percent) and the percentage that the health plan pays (for example, 80 percent). You pay coinsurance plus any deductible you owe for a covered health service.

20%

80%

You Pay Health Plan Pays

Out-of-pocket maximum (OOPM) The most you should have to pay for health care during a year, excluding the monthly premium. After you reach the annual OOPM, your plan begins to pay 100 percent of the allowed amount for covered health services.

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THE INSURANCE BROKERAGE YOU NEVER EXPECTED.