Benefits Guide - Operation HOPE - Plan Year 12/1/22 - 11/30/23 - California Employees

EMPLOYEE BENEFITS GUIDE

California Employees

December 1, 2022 – November 30, 2023

TABLE OF

CONTENTS Eligibility

4

Medical Plans

5-9

Telemedicine/Virtual Visits - KP

10

Kaiser Permanente Info

11-12

Virtual Visits – UHC

13

Rx Savings

14

Benefits That Pay You Cash

15-17

Flexible Spending Account (FSA & DCA)

18-20

Dental

21-23

Vision

24-26

Life Insurance

27

Disability

28

Wellness - UHC

29-32

How To Enroll

33

Employee Payroll Deductions

34

Employee Assistance Program

35-37

401k

38

Important Information

39-42

Health Insurance Marketplace

43-44

Medicare Notice

45

Things To Keep In Mind & Terminology

46

Key Contacts

47

At Operation HOPE, we know that our employees are crucial to our success. That’s why we provide you with an excellent, diverse benefits package that helps protect you and your family now and into the future.

This Benefits Guide outlines the health and welfare plans offered to 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. In the case of a discrepancy the plan specific documents will prevail over this benefits guide.

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 your goals.

Preventative Services

Preventative 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 preventative care they need. Some examples of preventative care services are: o o o o

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

Immunizations

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.

Understanding What’s Covered

Generally speaking, if a service is considered preventative care, it will be covered at 100% if the provider is in-network. If it’s not considered preventative, it may still be covered subject to a copay, deductible or coinsurance. The Affordable Care Act (ACA) requires that services considered preventative care be covered by your health plan at 100% in-network, without a copay, deductible or coinsurance. To get specifics about your plan’s preventative 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 preventative care visit (such as an annual checkup) are all considered standard preventive care.

If any service performed at an annual checkup is the needed because of a prior diagnosed condition, the office visit may not be processed as preventative, 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 Who is Eligible to Join the Benefit Plan?

Qualifying Event Changes

You and your dependents are eligible to join the employee benefits program Operation HOPE provides if you are a fulltime 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 certain changes to your current benefit elections during the plan year if you experience an IRS-approved 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?

•

Your spouse to whom you are legally married

•

Your same sex or opposite sex domestic partner with whom you have shared a residence and financial obligations with for 6 months or more

•

Your dependent children under the maximum age specified in the carriers’ plan documents including:  Biological children  Adopted children  Stepchildren  Children for whom you have been appointed as the legal guardian

IRS-approved qualifying life status changes include but are not limited to: •

Marriage, divorce or legal separation

•

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 full-time 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

•

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

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

The dependent maximum age limit 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.

Once the dependent reaches age 26, coverage will automatically terminate.

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

When Do Benefits Become Effective?

Your Basic Life benefits become effective on your date of hire, FSA benefits are effective first of the month following 90 days and all other benefits are effective the first day of the month following your 30 days as a full-time employee with Operation HOPE.

If you have a life status change, you must notify the company within 30 days of the life event, or within 60 days for changes in life status due to a Medicare or CHIP event.

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.

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 non-payment or voluntary termination of other coverage outside a spouse’s or parent’s open enrollment is not an IRSapproved qualifying life event and you do not qualify for a special enrollment period.

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MEDICAL PLAN OVERVIEW UHC $1,000 Deductible Plan Plan Highlights

In Network – You Pay

Out-of-Network – You Pay

Deductible

Individual $1,000 | Family $2,000

Individual $3,000 | Family $6,000

Coinsurance

20%

50%

Individual $5,000 | Family $10,000

Individual $15,000 | Family $30,000

Primary Care Physician Office Visit Only

$25 copay

Deductible, then 50%

Specialist Office Visit Only

$50 copay

Deductible, then 50%

Telemedicine (Phone/Video Chat)

Covered at 100%

Not Covered

Preventive Care Services

Covered at 100%

Not Covered

Covered in full @ Preferred Network Provider 20% @ Network Provider

Laboratory Diagnostics: Not Covered X-Ray: Deductible, then 50%

Complex Imaging Services (CT Scans, PET Scans & MRIs)

Deductible, then 20%

Deductible, then 50%

Hospital Inpatient Care

Deductible, then 20%

Deductible, then 50%

Outpatient Surgery

Deductible, then 20%

Deductible, then 50%

Emergency Room* Visit Only

Deductible, then 20%

Deductible, then 50%

$50 copay

Deductible, then 50%

Annual Out-of-Pocket Maximum

Diagnostic Testing (x-ray, blood work)

Urgent Care Visit Only Prescription Drugs

Quantity Limits: Retail = 30-day supply Mail Order = 90-day supply

Tier 1

Retail 30-day supply: $10 copay Mail Order 90-day supply: $25 copay

$10 copay

Tier 2

Retail 30-day supply: $50 copay Mail Order 90-day supply: $125 copay

$50 copay

Tier 3

Retail 30 day-supply: $100 copay Mail Order 90-day supply: $250 copay

$100 copay

Retail 30- day supply: $10/$150/$250 copay Mail Order 90-day supply: Not Available

$10/$150/$250

Specialty Drugs

!

* Emergency room visit for emergencies only. Non-emergencies may result in denied claim.

For complete details regarding benefits offered, please refer to the individual plan documents as the information contained herein is for illustrative purposes. In the case of a discrepancy the plan specific documents will prevail over this benefits guide.

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MEDICAL PLAN OVERVIEW UHC $2,500 Deductible Plan Plan Highlights

In Network – You Pay

Out-of-Network – You Pay

Deductible

Individual $2,500 | Family $5,000

Individual $7,500 | Family $15,000

Coinsurance

20%

50%

Individual $6,500 | Family $13,000

Individual $19,500 | $Family $39,000

Primary Care Physician Office Visit Only

$25 copay

Deductible, then 50%

Specialist Office Visit Office Visit Only

$50 copay

Deductible, then 50%

Telemedicine (Phone/Video Chat)

Covered at 100%

Not Covered

Preventive Care Services

100% covered

Not Covered

Diagnostic Testing (x-ray, blood work)

Deductible, then 20%

Lab Testing: Not Covered X-Ray/Diagnostics: Deductible, then 50%

Complex Imaging Services (CT Scans, PET Scans & MRIs)

Deductible, then 20%

Deductible, then 50%

Hospital Inpatient Care

Deductible, then 20%

Deductible, then 50%

Outpatient Surgery

Deductible, then 20%

Deductible, then 50%

Emergency Room* Visit Only

Deductible, then 20%

Deductible, then 50%

$50 copay

Deductible, then 50%

Annual Out-of-Pocket Maximum

Urgent Care Visit Only Prescription Drugs

Quantity Limits: Retail = 30-day supply Mail Order = 90-day supply

Tier 1

Retail 30-day supply: $10 copay Mail Order 90-day supply: $25 copay

Retail 30-day supply: $10 copay Mail Order: Not Available

Tier 2

Retail 30-day supply: $50 copay Mail Order 90-day supply: $125 copay

Retail 30-day supply: $50 copay Mail Order 90-day supply: Not Available

Tier 3

Retail 30 day-supply: $100 copay Mail Order 90-day supply: $250 copay

Retail 30 day-supply: $100 copay Mail Order 90-day supply: Not Available

Retail 30-day supply: $10/$150/$250 copay Mail Order 90-day supply: Not Available

Retail 30-day supply: $10/$150/$250 copay Mail Order 90-day supply: Not Available

Specialty Drugs

!

* Emergency room visit for emergencies only. Non-emergencies may result in denied claim.

For complete details regarding benefits offered, please refer to the individual plan documents as the information contained herein is for illustrative purposes. In the case of a discrepancy the plan specific documents will prevail over this benefits guide.

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MEDICAL PLAN OVERVIEW UHC $3,500 Deductible Plan Plan Highlights

In Network – You Pay

Out-of-Network – You Pay

Deductible

Individual $3,500 | Family $7,000

Individual $10,500 | Family $21,000

Coinsurance

20%

50%

Individual $7,000 | Family $14,000

Individual $21,000 | Family $42,000

Primary Care Physician Office Visit Only

$30 copay

Deductible, then 50%

Specialist Office Visit Office Visit Only

$60 copay

Deductible, then 50%

Telemedicine (Phone/Video Chat)

Covered at 100%

Not Covered

Preventive Care Services

100% covered

Not Covered

Diagnostic Testing (x-ray, blood work)

Deductible, then 20%

Laboratory Diagnostics: Not Covered X-Ray: Deductible, then 50%

Complex Imaging Services (CT Scans, PET Scans & MRIs)

Deductible, then 20%

Deductible, then 50%

Hospital Inpatient Care

Deductible, then 20%

Deductible, then 50%

Outpatient Surgery

Deductible, then 20%

Deductible, then 50%

Emergency Room* Visit Only

Deductible, then 20%

Deductible, then 20%

$50 copay

Deductible, then 50%

Annual Out-of-Pocket Maximum

Urgent Care Visit Only Prescription Drugs

Quantity Limits: Retail = 30-day supply Mail Order = 90-day supply

Tier 1

Retail 30-day supply: $10 copay Mail Order 90-day supply: $25 copay

Retail 30-day supply: $10 copay Mail Order 90-day supply: $25 copay

Tier 2

Retail 30-day supply: $50 copay Mail Order 90-day supply: $125 copay

Retail 30-day supply: $50 copay Mail Order 90-day supply: $125 copay

Tier 3

Retail 30 day-supply: $100 copay Mail Order 90-day supply: $250 copay

Specialty Drugs

Retail 30- day supply: $10/$150/$250 Mail Order 90-day supply: Not Available

Retail 30 day-supply: $100 copay Mail Order 90-day supply: $250 copay Retail 30- day supply: $10/$150/$250 Mail Order 90-day supply: Not Available

!

* Emergency room visit for emergencies only. Non-emergencies may result in denied claim.

For complete details regarding benefits offered, please refer to the individual plan documents as the information contained herein is for illustrative purposes. In the case of a discrepancy the plan specific documents will prevail over this benefits guide.

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MEDICAL PLAN OVERVIEW KAISER HMO $0 Deductible Plan Highlights

In Network – You Pay

Deductible

$0

Coinsurance

0%

Annual Out-of-Pocket Maximum

Individual $1,500 | Family $,3000

Primary Care Physician Office Visit

$20 copay

Specialist Office Visit

$20 copay

Telemedicine (Phone/Video Chat)

Covered at 100%

Preventive Care Services

100% covered

Laboratory Diagnostics & X-Ray

$10 copay per visit

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

$50 copay per procedure (non-hospital)

Hospital Inpatient Care

$500 copay per admission

Outpatient Surgery

$100 copay

Emergency Room

$100 copay

Urgent Care

$20 copay

Prescription Drugs*

No Medical Deductible Retail

Mail Order

Tier 1 - Generic Drugs

$15 copay

$30 copay

Tier 2 - Preferred Brand-Name

$35 copay

$70 copay

Tier 3 - Non-Preferred Brand-Name

$35 copay

$70 copay

Tier 4 - Specialty Drugs

!

30% up to $200; 30-day supply only

For complete details regarding benefits offered, please refer to the individual plan documents as the information contained herein is for illustrative purposes. In the case of a discrepancy the plan specific documents will prevail over this benefits guide.

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MEDICAL PLAN OVERVIEW KAISER DHMO $1,000 Deductible

!

Plan Highlights

In Network – You Pay

Deductible

Individual $1,000 | Family $2,000

Coinsurance

20%

Annual Out-of-Pocket Maximum

Individual $3,000 | Family $6,000

Primary Care Physician Office Visit

$30 copay

Specialist Office Visit

$30 copay

Telemedicine (Phone/Video Chat)

Covered at 100%

Preventive Care Services

Covered at 100%

Laboratory Diagnostics & X-Ray

$10 copay per visit

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

20% up to $150, deductible does not apply

Hospital Inpatient Care

Ded., then 20%

Outpatient Surgery

Ded., then 20%

Emergency Room

Ded., then 20%

Urgent Care

$30 copay

Prescription Drugs*

$250 Individual Deductible; Deductible does not apply to Generic Mail order: up to 100-day supply

Tier 1 - Generic Drugs

$10 copay

Tier 2 - Preferred Brand-Name

Drug Deductible, then $30 copay

Tier 3 - Non-Preferred Brand-Name

Drug Deductible, then $30 copay

Tier 4 - Specialty Drugs

Drug Deductible, then 20% up to $200, 30-day supply only

For complete details regarding benefits offered, please refer to the individual plan documents as the information contained herein is for illustrative purposes. In the case of a discrepancy the plan specific documents will prevail over this benefits guide.

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TELEMEDICINE

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Once you join…

Visit kp.org/newmember to get started. It’s easy to choose your doctor, register for kp.org, and transition your prescriptions. If you have questions or need help making your first routine appointment, just give us a call.

If you are already a member…

Make sure you get the most out of your membership. If you haven’t already, register on kp.org, where you can manage your care online, schedule a routine appointment for a family member, get help improving your health and more.

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Use the convenient features of My Health Manager right from your smartphone or other mobile device.

Email your doctor’s office View most testresults Schedule or cancel routine appointments Refill most prescriptions View past visits Just download the Kaiser Permanente a p p at no cost from your preferred app site.

Are you registered? If you’re already registered on kp.org, you’re all set to start using your Kaiser Permanente app. If not, you’ll n e e d to go to kp.org/registernow to set up your account from a computer.

Then use your new user ID and password to activate the app.

Managing your care online As a Kaiser Permanente member, kp.org is your online gateway to great health. When you register, you can securely access many timesaving tools for managing the care you get at our facilities.

• View most lab results.

• Refill most prescriptions.

• Email your doctor’s office with non-urgent questions.

• Schedule and cancel routine appointments.

• Print vaccination records for school, sports, and camp.

• Manage a family member’s health.

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Virtual Visits Access to care online at any time When you don’t feel well, or your child is sick, the last thing you want to do is leave the comfort of your home to sit in a waiting room. Now, you don’t have to.

A virtual visit lets you see and talk to a doctor from your mobile device or computer without an appointment. Most visits take about 10-15 minutes, and your virtual doctor can write a prescription*, if needed, that you can pick up at your local pharmacy. And it’s part of your health benefits.

Conditions commonly treated through a virtual visit

Doctors can diagnose and treat a wide range of non-emergency medical conditions, including: • • • • • • • • • •

Bladder infection/urinary tract infection Bronchitis Cold/flu Diarrhea Fever Migraine/headaches Pink eye Sinus problems Sore throat Stomachache

Brought to you by

To learn more, visit www.uhc.com/virtualvisits

Access virtual visits

Log in to myuhc.com® and click on Virtual Care where you can register for your virtual visit. After registering and requesting a visit, you will enter a virtual waiting room. During your visit you will be able to talk to a doctor about your health concerns, symptoms, and treatment options.

After your visit, you will be charged for your portion of the service costs. Virtual visits are covered under your benefits plan. The full cost of the visit will be paid by you until you reach your medical deductible.

Once your deductible has been met, you will pay your $30 generalist office visit co-pay. * Certain prescriptions may not be available, and other restrictions may apply.

Virtual Visits and video chat with a doctor are not an insurance product, health care provider or a health plan. Unless otherwise required, benefits are available only when services are delivered through a Designated Virtual Network Provider. Virtual Visits are not intended to address emergency or life-threatening medical conditions and should not be used in those circumstances. Services may not be available at all times or in all locations.

Insurance coverage provided by or through UnitedHealthcare Insurance Company or its affiliates. Administrative services provided by United HealthCare Services, Inc. or their affiliates. © 2019 United HealthCare Services, Inc. WF838583 52865C-102019

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Rx Savings 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

Lowest Rx Prices, Every Day

Safe & Secure

SAVINGS IS EASY

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BENEFITS THAT PAY YOU CASH You now have the option of purchasing benefits that cover the gaps in you 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 Operation HOPE’s medical plan to take advantage of these policies.

1.

ACCIDENT POLICY ($50 Wellness Benefit)

The UHC Accident policy provides employees the ability to get paid cash when an injury occurs. This is the most popular cash benefit for those with dependents and those physically active employees.

The following are some of the eligible benefits: -

2.

Emergency Care Transportation: Ambulance/Air Fractures Lacerations Dislocations Concussions Motor Vehicle Accidents Recovery Assistance More…

CRITICAL ILLNESS POLICY ($50 Wellness Benefit)

The UHC Critical Illness policy pays you cash upon diagnosis of a serious illness. This policy will pay you a lump-sum of up to $30,000 if you are diagnosed with one of the following below.

-

Benign Brain Tumor Cancer Invasive/Non-Invasive Chronic Renal Failure Coronary Artery Disease Heart Attack Heart Transplant Major Organ Transplant Permanent Paralysis Stroke ALS Complete Blindness Complete Hearing Loss Advanced Alzheimer’s Advanced Multiple Sclerosis

- Age Reduction: 50% at age 70.

- Maximum age limit for dependents: 26

Option 1

Option 2

Option 3

Employee

$10,000

$20,000

$30,000

Spouse

$5,000

$10,000

$15,000

Child(ren)

$5,000

$5,000

$7,500

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BENEFITS THAT PAY YOU CASH 3.

HOSPITAL INDEMNITY POLICY

The UHC Hospital Indemnity policy provides employees the ability to get paid cash when confined to the hospital.

- Hospital Admission - 1 day - Hospital Confinement – up to 364 days/plan year - ICU Confinement – up to 364 days/plan year

Plan Benefit

Option 1

Option 2

Option 3

Hospital Admission (1 day/plan year)

$500

$1,000

$1,500

Hospital Confinement (up to 364 days/plan year)

$100

$150

$200

ICU Confinement (up to 364 days/plan year)

$100

$150

$200

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BENEFITS THAT PAY YOU CASH

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FLEXIBLE SPENDING ACCOUNT (HCFSA) Healthcare

• • •

$570 will rollover from year-to-year The maximum contribution for 2023 is $3,050 For claims incurred in 2022, you have until Oct. 8th, 2023 to submit for reimbursement.

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FLEXIBLE SPENDING ACCOUNT (DCFSA) Dependent Care

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FLEXIBLE SPENDING ACCOUNT (HCFSA & DCFSA)

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DENTAL Select A Dental Plan That Meets Your Needs Operation HOPE offers a choice of 2 PPO Dental plan options. Both of the PPO Dental plan options are available in all states.

With a Low Option & a High Option, it allows employees to choose a plan that best fits their dental care needs. The PPO plans, or “Preferred Provider Organization”, are one of the most popular types of dental plans. When enrolled in a PPO dental plan, it allows you to visit any contracted dental provider within the United Healthcare Network and receive In-Network level of benefits. You also have the option to go outside of the provider network and, in doing so, dental benefits would fall under the Out-of-Network level of benefits.

To find a dentist, log on to www.uhc.com For the Low Option Dental Plan select the PPO20 Network.

For the High Option Dental Plan select the PPO30 Network.

Low Option Dental Plan

In-Network

Out-Of-Network

Calendar Year Deductible (Waived for Preventive & Diagnostic Services)

Individual $50 Family $150

Individual $100 Family $300

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

$1,000

$1,000

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

0% coinsurance

20% coinsurance

Basic Services Filings, Extractions, Endodontics (root canal), Periodontics (gum surgery), Oral Surgery, Repair of Dentures

20% coinsurance

40% coinsurance

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

50% coinsurance

60% coinsurance

Orthodontics (Children to Age 19)

50% coinsurance

50% coinsurance

Lifetime Orthodontia Maximum (Separate from $1,000 Annual Maximum)

$1,000

$1,000

High Option Dental Plan

In-Network (You Pay)

Out-Of-Network (You Pay)

Your Deductible (Waived for Preventive & Diagnostic Services)

Individual $50 Family $150

Individual $50 Family $150

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

$2,500

$2,500

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

0% coinsurance

0% coinsurance

Basic Services Filings, Extractions, Endodontics (root canal), Periodontics (gum surgery), Oral Surgery, Repair of Dentures

0% coinsurance

20% coinsurance

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

40% coinsurance

50% coinsurance

Orthodontics (Children to Age 19)

50% coinsurance

50% coinsurance

Lifetime Orthodontia Maximum (Separate from $2,500 Annual Maximum)

$1,500

$1,500

(You Pay)

(You Pay)

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DENTAL

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DENTAL

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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.myuhcvision.com.

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 eligible dependent children.

Dependent children are covered up to age 26, regardless of student status.

Vision Plan Benefits

In-Network

Out-of-Network

Exam

$10 copay

Not Covered

Frames

$180 allowance then 30% off amount over $180

$45 allowance

Lenses Single Vision Bifocal Trifocal

$10 copay $10 copay $10 copay

$40 allowance $60 allowance $80 allowance

Contact Lenses Contact Lens Material Fitting & Evaluation Medically Necessary Lenses

$130 allowance $60 allowance Plan pays 100%

$105 allowance Not Covered $210 allowance

Frequency Exam Lenses (Contacts OR Eyeglass) Frames

12 months 12 months 12 months

To find an In-Network Provider visit www.myuhcvision.com Or call 800-638-3120

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VISION

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VISION

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LIFE INSURANCE Company Paid Life Insurance Operation HOPE provides a Life and Accidental Death & Dismemberment (AD&D) insurance policy to full-time employees through United Healthcare.

Your benefit amount is $25,000 Personal Life and AD&D will be reduced as follows: • At age 65, benefits will reduce by 35% of the original amount • At age 70, benefits will reduce an additional 15% of the original amount Benefits will terminate when the Insured Person retires *Be sure to always keep your beneficiaries updated in ADP.

Employee Paid Life Insurance (Supplemental Life Insurance)

Employees can purchase additional life insurance, beyond what Operation HOPE has provided for you. Operation HOPE is offering Supplemental Life coverage at a group rate. The premiums for Supplemental Life are 100% Employee paid.

• Employee – You can elect from $10,000 to $500,000 in increments of $10,000, not to exceed 5x your basic

annual earnings rounded to the next higher $10,000. You will be required to answer medical questions for amounts in excess of $150,000 and for amounts that are increased after initial enrollment by more than 2 benefit increments. Coverage amounts reduce to 65% at age 65, an additional 25% at age 70 and an additional 15% at age 75.

• Spouse – For your Spouse, you can elect from $5,000 to $250,000 in increments of $5,000, not to exceed 50% of

the Employee’s elected amount or 2.5x the Employee’s annual salary rounded to the next higher $5,000. Your Spouse will be required to answer medical questions for amounts in excess of $30,000 and for amounts increased after initial enrollment by more than 2 benefit increments. Coverage amounts reduce to 65% at age 65.

Spouse’s rates are based on the Employee’s age. Coverage terminates at age 70.

• Dependent Child(ren) – For your Child(ren), you can elect increments of $10,000, to a maximum of $10,000 not to exceed 50% of the Employee’s elected amount. For children aged 0- 6 month the benefit is limited to $250.

Newly eligible employees and spouses will have a guaranteed issue amount offered.

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DISABILITY INSURANCE 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.

Long-Term Disability (100% Company Paid) Long-Term Disability (LTD), offers income protection if you become disabled and cannot work for an extended period of time. The LTD benefit begins after 90 days of disability and pays 60% of your monthly salary to a maximum of $9,000/month for salaried employees.

Benefits are paid as long as you remain disabled, until you reach your Social Security Normal RetirementAge.

Plan Highlights

Long-Term Disability

Elimination Period

90 days

Benefit Percentage

60%

Monthly Benefit Maximum

$9,000

Benefit Duration

Age 65 or SSNRA

Pre-existing condition limitation The disability policies include a pre-existing condition limitation. The policies will not pay, in the first 12 months of the policy, for a condition that you had within 3 months prior to the effective date.

You have a pre-existing condition if: •

You received medical treatment, consultation, care or services including diagnostic measures for the condition, or took prescribed drugs or medicines for it in the 3 months just prior to your effective date of coverage: and

•

The disability begins in the first 12 months after the effective date of coverage.

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WELLNESS

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WELLNESS

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WELLNESS

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HOW TO ENROLL Benefit elections & changes take place through Workforce Now Employee Self Service Portal.

1

On the Enrollments page, click Enroll Now or Make Changes next to your Open Enrollment profile.

2

You must go through the plan categories in the order presented either by clicking a plan category on the left (going from top to bottom) or by using the Continue option to move to the next plan category.

In the Open Enrollment flow, visual indicators are displayed to show the remaining steps and current plans for already enrolled employees. From the left navigation pane, select from the following: Flag icon – Plans that need your attention, Green check mark – Current plans that you have enrolled in Gray X – Plans that are waived, Blank - Available benefits

3

4

If you are currently enrolled, the plan will be hard-code with that notification. To switch from a currently enrolled plan to a new plan, click Select Plan to the right of the plan you want to enroll in. You must go through the plan

5

By clicking, this will remove your enrollment from the prior plan and enroll you in the new plan you have selected. Premiums will update based on dependents enrolled. (For more information about the plan, click Hyperlinked Plan Name if this option is available.)

Primary Care Provider and additional information will also be available with the Hyperlinked Provider Name When a Waive reason is needed for your enrollment, you will see a message “Operation HOPE requires you to enter a reason to waive this coverage.” When you select “Waive This Benefit”, you will be prompted to select a reason from a drop-down list.

Click on the icons for all the dependents that will be covered, it will determine the cost and the coverage level based on the dependents.

If you choose to add a dependent, select Manage Dependents within “Who do you want to cover?” section, (+) dependent and they will be added.

As you click or unclick dependents the cost changes based on coverage offering.

Once you made all of your selections for a plan type and click continue to the next benefit, you will get a popup with a summary of the benefit and the options you selected. Click Save and Continue to Summary. If it is a health and welfare or custom plan and the Physicians Group Info is needed, the pop-up will request that information be entered before you can move on.

When enrolling in an Employee Life, Employee ADD, 401k, 401b, or a custom plan that has the check box for requiring a beneficiary for employee self-service checked, you will get this error if you do not select a beneficiary.

If you click on Download, on the top right, you will get a summary of all your selections.

You can use the drop box next to the calendar icon to view the cost of the plans you selected by pay period, month, or year.

By clicking on the green hyperlink for each plan, you can edit the options you chose as needed.

There is a Save for Later button to come back and look at this later. This option is available throughout all stages of the wizard.

If you click Save for Later, you can come back and click make changes to continue, or Delete Event to clear out all the options you chose.

The navigational panel will allow you to return to the Summary page if changes were needed and performed within the selected enrollment.

Clicking Delete Event does not remove the ability for complete your enrollment. It will clear all previous selections in prior sessions and allows a restart from the beginning.

Clicking Submit Enrollment completes the wizard.

6 7 8 9 10 11

12 13 14 15 16 17 18 19 20

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EMPLOYEE PAYROLL DEDUCTIONS Operation HOPE contributes to the cost of medical, dental, vision, life and long-term disability insurance coverage for all eligible employees. For an additional premium employees can add dependent coverage. Please refer to the chart below for your bi-weekly payroll deductions.

Bi-Weekly Payroll Deductions Plan

Employee Only

Employee + Spouse

Employee + Child(ren)

Family

UHC $1,000 Deductible Medical Plan

$115.79

$381.61

$316.83

$571.48

UHC $2,500 Deductible Medical Plan

$90.62

$326.48

$269.01

$494.96

UHC $3,500 Deductible Medical Plan

$71.73

$285.11

$233.11

$364.36

Kaiser HMO $0 Deductible

$89.07

$314.51

$268.09

$408.20

Kaiser DHMO $1,000 Deductible

$71.73

$285.11

$233.11

$364.37

Dental – High Plan

$7.88

$15.76

$16.31

$25.32

Dental – Low Plan

$3.45

$6.29

$5.86

$9.93

Vision

$1.75

$3.59

$3.76

$5.43

Life Insurance

100% Company Paid

n/a

n/a

n/a

Supplemental Life Insurance

Rates are calculated in ADP based on your Age and Election Amount

Long Term Disability

100% Company Paid

Accident & Critical Illness

Rates are calculated in ADP based on your Election Amount

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EMPLOYEE ASSISTANCE PROGRAM

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EMPLOYEE ASSISTANCE PROGRAM

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EMPLOYEE ASSISTANCE PROGRAM

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401(k) Operation HOPE provides employees with an opportunity to save for retirement through our 401(k) plan. With a large variety of investment options, a company match on team member contributions, and flexible contribution methods, you can customize an investment strategy to meet your specific goals.

401(K) Matching Program Information Eligibility:

All full-time regular employees After 3 months of continuous employment 21 years of age

Employee Contribution:

Between 1% and 100% of pretax salary

2020 Maximum Contribution: 2020 Maximum Catch-Up Contribution:

$19,500 per year $6,500 per year (for age 50 and older)

Contributions may be changed on a monthly basis

Employer Match:

Maximum 50% match on the first 6% of employee contribution

Employee Vesting:

Immediately 100% vested on employee contribution

Employer Vesting (Match Portion):

Based on the following schedule beginning with second year of service:

Year 1: 0% Year 2: 20% Year 3: 40% Year 4: 60% Year 5: 80% Year 6: 100% 100% vested at Death

Provisions:

Loans (subject to plan rules)

Distributions:

Termination, Disability, Retirement and Death

Resources:

https://www.mykplan.com or (866) 695-7526

Enrollment Methods:

https://www.mykplan.com or (866) 695-7526

Operation HOPE Designated Financial Advisor

Roxie Ryvkin Investment Advisor Representative Cell (818) 371-6175 roxie@lazaricapital.com Operation HOPE Benefits Guide | 38

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 Operation HOPE 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 Operation HOPE 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 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 Operation HOPE (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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IMPORTANT INFORMATION 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

SPECIAL OPEN ENROLLMENT RIGHTS This notice is being provided to ensure 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.

Marriage, Birth, or Adoption

Loss of Other Coverage

Medicaid or CHIP

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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HEALTH INSURANCE MARKETPLACE 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 qualify to save money and lower your monthly premium, but only if your 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.

Does Employer Health Coverage Affect Eligibility for Premium Savings Through the Market Place?

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.

!

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 after-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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HEALTH INSURANCE MARKETPLACE 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 Operation HOPE

4. Employer Identification Number (EIN) 95-4378084

5. Employer Address 191 Peachtree St NE #3840

6. Employer Phone Number 404-941-2919

7. City Atlanta

8. State GA

9. Zip Code 30303

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

Rachael Doff 11. Phone Number (if different from above)

12. Email Address Rachael.Doff@operationhope.org

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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IMPORTANT NOTICE ABOUT YOUR PRESCRIPTION DRUG COVERAGE & MEDICARE 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 Operation HOPE 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.

•

Operation HOPE has determined that the prescription drug coverage offered by all of the UHC 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 Operation HOPE coverage will not be affected. Please review prescription drug coverage plan provisions/options under the certificate booklet provided by UHC. 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 Operation HOPE 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 Operation HOPE 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 Operation HOPE 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 (1800-633-4227). 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 1-800-325-0778).

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).

Operation HOPE Benefits Guide | 45

MEDICAL – THINGS TO KEEP IN MIND Since your plans run 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 Kaiser and UHC 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.

HEALTH INSURANCE TERMINOLOGY 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).

Coinsurance 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.

Operation HOPE Benefits Guide | 46

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

Your Employee Support Contact

Charlotte Jackson 404-832-8642 cjackson@sspins.com NEED HELP WITH A CLAIM 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

Contact

Phone

Website

MEDICAL - UHC

UHC Mail Order

800-357-0978 800-788-7871

www.myuhc.com www.optumrx.com

MEDICAL – KP

Kaiser Permanente

800-278-3296

www.kp.org

DENTAL

United Healthcare

800-445-9090

www.myuhc.com

VISION

United Healthcare

800-638-3120

www.myuhcvision.com

LIFE INSURANCE

United Healthcare

866-302-4480

www.myuhc.com

DISABILITY ACCIDENT CRITICAL ILLNESS HOSPITAL INDEMNITY

United Healthcare

888-299-2070

www.myuhcfp.com

FSA & DCA

HealthEquity

866-735-8198

www.HealthEquity.com

401(k) RETIREMENT PLAN

Investment Advisor Representative Roxie Ryvkin

818-371-6175

roxie@lazaricapital.com