EspriGas Benefit Guide 2022-2023

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2022-2023

BENEFITS GUIDE December 1, 2022 – September 30, 2023

A SMARTER WAY TO BETTER HEALTH

It’s Your Health. Get Involved

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

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

Preventative Health Care Services

Immunizations

Understanding What’s Covered

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

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

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

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

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

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

Qualifying Event Changes

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

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

Who is an Eligible Dependent?

IRS-approved qualifying life status changes include:

•

Your spouse to whom you are legally married

•

Marriage, divorce or legal separation

•

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

•

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

•

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

•

Death of a dependent

•

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

•

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

•

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

•

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

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

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

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

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

When Do Benefits Become Effective?

Your benefits become effective on your 1st day as a full-time employee with EspriGas. Annual Open Enrollment?

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

!

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

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E M P L O Y E E N AV I G AT O R E N R O L L M E N T G U I D E Step 1: Log In Go to www.employeenavigator.com and click Login •

Returning users: Log in with the username and password you selected. Click Reset a forgotten password.

•

First time users: Click on your Registration Link in the email sent to you by your admin or Register as a new user. Create an account and create your own username and password.

• The EspriGas company identifier = ESGAS

Step 2: Welcome!

After you login, click Let’s Begin to complete your enrollment and additional required tasks if applicable.

Step 3: Start Enrollments After clicking Start Enrollment, you’ll need to complete some personal & dependent information before moving to your benefit elections.

TIP Have dependent details handy. To enroll a dependent in coverage you will need their date of birth and Social Security number.

Step 4: Benefit Elections To enroll dependents in a benefit, click the checkbox next to the dependent’s name under Who am I enrolling?

Below your dependents you can view your available plans and the cost per pay. To elect a benefit, click Select Plan underneath the plan cost.

Click Save & Continue at the bottom of each screen to save your elections.

If you do not want a benefit, click Don’t want this benefit? at the bottom of the screen and select a reason from the drop-down menu.

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E M P L O Y E E N AV I G AT O R E N R O L L M E N T G U I D E

Step 5: Forms If you have elected benefits that require a beneficiary designation or completion of an Evidence of Insurability form, you will be prompted to add in those details.

Step 6: Review & Confirm Elections Review the benefits you selected on the enrollment summary page to make sure they are correct then click Sign & Agree to complete your enrollment.

You can either print a summary of your elections for your records or login at any point during the year to view your summary online.

TIP If you miss a step you’ll see Enrollment Not Complete in the progress bar with the incomplete steps highlighted. Click on any incomplete steps to complete them.

Step 7: You’re Finished You are finished. You can go back to your homepage to view your elections and you can make changes until the enrollment window closes.

You can login to review your benefits 24/7!

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MEDICAL PLAN OPTIONS AVAILABLE THROUGH HEALTHGRAM IN –NETWORK Plan Highlights

$1,500 PPO Plan

$3,000 HSA Plan

20%

10%

Individual

$1,500

$3,000

Family

$3,000

$6,000

Individual

$5,000

$5,000

Family

$10,000

$10,000

Preventive Care

$0

$0

TelaDoc

$0

$10

Primary Care Physician

$30

Ded + 10%

Specialist

$75

Ded + 10%

Emergency Room Copay (In and Out of Network)

$600

Ded + 10%

Urgent Care

$100

Ded + 10%

Inpatient Hospital & Services

Ded + 20%

Ded + 10%

Outpatient Hospital & Services

Ded + 20%

Ded + 10%

$10/$40/$75/25%

Ded + 10%

50%

50%

$6,000 | $18,000

$6,000 | $18,000

$10,500 | $31,500

$10,500 | $31,500

Coinsurance Calendar Year Deductible

Out-of-Pocket Maximum

Office Visit Copays

Prescription Drugs Tier 1 / Tier 2 / Tier 3 / Tier 4

OUT-OF-NETWORK Coinsurance Calendar Year Deductible Individual | Family Out-of-Pocket Maximum Individual | Family

COST PER PAYCHECK (26)

*HSA Compatible

Employee Only

$96.33

$81.33

Employee Spouse

$192.67

$174.40

Employee + Child(ren)

$178.22

$161.32

Family

$274.56

$248.52

*EspriGas will contribute a dollar-for-dollar match to the employee’s Health Savings Account up to $750.

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Above is a snapshot of the plan benefits. For a more comprehensive review, please refer to the Summary of Benefits produced by the insurance carrier. In the event of a conflict with the insurance carrier, the contract takes precedent.

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H O W T O AC C E S S YO U R M E D I C A L B E N E F I T S EspriGas has partnered with Healthgram to bring you valuable benefits.

IMPORTANT INFORMATION TO KNOW

CONTACTING HEALTHGRAM Healthgram is your medical carrier.

Member support: 1-866-904-9081 8:00am-5:00PM EST Contact your Advisor:

o o o o

For answers about your plan and benefits Before any planned medical procedure Billing assistance To confirm precertification for an upcoming procedure

YOUR MEDICAL ID CARD Your ID card details the benefits offered through EspriGas. It is being mailed to the home address you provided in Employee Navigator. Provide your new ID Card to your providers after December 1st.

Member support: 1-866-904-9081 8:00am-5:00PM EST

Your member portal: o o o o

Register at members.healthgram.com Verify coverage Request a copy of your ID card Check claims status

FINDING A DOCTOR

YOUR PHARMACY BENEFIT

Your network access is through Cigna.

Your pharmacy provider is SmithRx.

To find an in-network provider, login to your Member Portal at:

Your pharmacy information is printed on your new medical ID Card.

members.healthgram.com

To submit a mail in order, login to:

mysmithrx.com

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Welcome to Healthgram Connect Afamiliar situation.

You need help quickly to confirm that a local doctor is in network, or maybe you’ve developed a cough or been diagnosed with a condition and are not sure where to receive care. No matter how you enter the healthcare system, there are times when questions are met with even more questions, when what you need is answers.

Help is on the way.

Your employer has teamed up with Healthgram to bring you a solution. Healthgram Connect aligns you with a knowledgeable Health Advisor. Your Advisor, who is supported by a team of medical and benefits experts, is ready to answer any questions you have about your benefits or care. That means everything from network questions to appointment scheduling to billing!

A call to your Advisor can help you: Find the right doctor, hospital or facility for your specificneeds Resolve insurance-related issuesfrom claims status inquiries to billing Understandyour benefits including all coverage questions andissues Estimate medical costs and in some cases, help you earn money Stay healthy with the help of alert reminders for upcoming screenings

All you need to do is call!

866.904.9081 EspriGas Benefit Guide | 8

D E N TA L Dental benefits are available through Guardian. To find a dentist, log on to www.guardiananytime.com

Network: DentalGuard Preferred

In-Network

Your Deductible

$50 individual / $150 Family

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

$1,500

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

100% (Deductible waived)

Basic Services Filings, Extractions, Oral Surgery, Repair of Dentures

80% After deductible

Major Services Crowns, Bridgework, Full & Partial Dentures, Implants, Endodontics (root canal), Periodontics (gum surgery)

50% After deductible

Orthodontics (Children up to age 19)

50%

Lifetime Orthodontia Maximum

$1,500

COST PER PAYCHECK (26) Employee Only

$8.78

Employee + Spouse

$17.83

Employee + Child(ren)

$22.74

Family

$33.94

Oral Health Rewards Program: Regular visits to the dentist can help prevent and detect the early signs of serious disease. Guardian’s Maximum Rollover Oral Health Rewards Program encourages and rewards members who visit the dentist, by rolling over part of your unused annual maximum into a Maximum Rollover Account (MRA). This can be used in future years if your plan’s annual maximum is reached.

VISION Guardian offers easy access to thousands of conveniently located vision care providers including optometrists, ophthalmologists, opticians, Visionworks, and most Pearle Vision® locations through the VSP network To locate a participating network eye care doctor or location, log in at www.guardiananytime.com.

Network: VSP Exam (1x per calendar year) Frames (once every 12 months)

In-Network $10 $130 retail max + 20% off balance

Lenses (once every 12 months) Single

$15

Bifocal

$15

Trifocal

$15

Contact Lenses (in lieu of frames; once every 12 months)

$130 max

COST PER PAYCHECK (26) Employee Only

$1.57

Employee + Spouse

$3.12

Employee + Child(ren)

$3.32

Family

$5.26 EspriGas Benefit Guide | 9

I D E N T I T Y P RO T E C T I O N EspriGas employees have the option to purchase Identity Protection through Allstate. Coverage includes identity monitoring, credit monitoring, full remediation and up to $1 million expense coverage and stolen funds reimbursement.

COST PER PAYCHECK (26) Employee Only

$4.59

Family

$8.28

AC C I D E N T & CRITICAL ILLNESS Accident coverage provides lump sum benefits for common on/off-job accidental injuries and related treatments. Benefits are payable for covered injures such as dislocations, fractures and burns; and treatments including ER visits, x-rays and surgery.

Critical Illness is group specified disease insurance designed to help employees and their families maintain financial security during the lengthy, expensive recovery period of a serious medical event such as cancer, heart attack or stroke. Critical Illness provides a lump sum benefit if you or a covered family member are diagnosed with a critical illness.

See Employee Navigator for more details and pricing.

FIDELITY INVESTMENTS 401(k) https://www.fidelity.com/ To be eligible for participation in the plan, you must be an active employee with 6 full months of service. Once eligible, the Company will match your deferral contributions up to 3%, and then 50 cents on the dollar after, up to a 5% total match. You are welcome to transfer any funds into the plan prior to your payroll contribution eligibility date.

You are always 100% vested in your own employee Deferral Contributions and earnings in the Plan. Whole years of service with your Employer will be counted to compute your years of service for vesting purposes.

Years of Service less than 3 3

Vesting Percentage 0 100.00

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H E A LT H S AV I N G S AC C O U N T WHAT IS AN HSA? A Health Savings Account (HSA) is like a 401(k) for healthcare. It is a tax advantaged personal savings or investment account that you can use to save and pay for qualified health expenses, now or in the future.     

Funds contributed to the HSA are not subject to federal income tax at the time of deposit.

Withdrawals for qualified medical expenses are also tax-free.

HSA funds may be used to pay for qualified medical expenses at any time without federal tax liability or penalty.

HSAs are portable, which means you keep your HSA, even if you leave EspriGas or are unemployed.

Funds roll over and accumulate year to year if not spent.

HOW DOES AN HSA WORK? 1. You must have coverage under an HSA qualified HDHP - there can be no secondary medical coverage in place 2. Once covered by a qualified HDHP, you may open an HSA and contribute up to the 2022 regulatory limits 3. Pre-tax contributions to your HSA can continue until age 65 and you’re enrolled in Medicare Part A. If you are currently enrolled in Medicare, are currently being claimed as a dependent on another person’s tax return, or have coverage through Tricare or the Veteran’s Administration, you are not eligible to open an HSA. 3. Once your HSA is established and you have a qualified expense you may: • make a tax-free withdrawal from your account to cover the costs, or • pay out of your pocket and save your HSA for future qualified expenses 5. HSA money rolls over indefinitely so you may allow the money to accumulate for use in retirement!

Only IRS qualified healthcare expenses are eligible for reimbursement from an HSA. Any funds used for nonqualified expenses are taxable as income and subject to a 20% tax penalty.

CONTRIBUTIONS Maximum contributions for calendar year 2023 are listed below. This amount includes employer contributions.

• $3,850 for Individual coverage • $7,750 for Family coverage • Additional $1,000 for “Catch-Up” age 55 and older For the 2022-2023 plan year, EspriGas will contribute a dollar-for-dollar match to the employee’s Health Savings Account up to $750.

Looking to MAX OUT your employer contribution? Based on the 2023 contribution limits: Individual Coverage $3,850(max) - $750(employer contribution)= $3,100/26= $119.23 contribution per pay Family Coverage $7,750(max) - $750(employer contribution)= $7,000/26= $269.23 contribution per pay

WHAT ARE QUALIFIED MEDICAL EXPENSES? Examples of HSA eligible expenses are copays, deductibles, qualifying prescriptions, and qualifying medical equipment.

A full description of qualified HSA expenditures can be found in IRS Publication 502 and is located on the web at www.irs.gov/pub/irs-pdf/p502.pdf.

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F L E X I B L E S P E N D I N G AC C O U N T ( F S A ) You may not enroll in the FSA if you are contributing to an HSA.

Provided by Surency EspriGas 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 $570 carryover maximum annually.

Healthcare Flexible Spending Account You may defer up to $2,850 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 quality under Section 217 of the IRS code Deductibles Office visit copays Prescription medication Over-the-counter medications (require physician prescription) Hearing and dental expenses not covered by insurance

For a searchable list of FSA eligible expenses please visit: www.fsastore.com 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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24/7

+

ACCESS TO A DOCTOR Don’t wait weeks for an appointment and skip the trip to urgent care. Teledoc connects you with the right care — right now.

No matter what you face the Teledoc doctors, therapists and specialists are available 24/7 to diagnose and treat many common medical conditions and provide guidance to move forward in treating a serious medical condition.

Teladoc doctors can treat and diagnose many common medical conditions, including: • • • • • • •

Cold and flu symptoms Allergies Ear Infections Pink Eye Respiratory Infections Sinus Problems Skin Problems, and More

Save Money on Visits When you use Teledoc to treat an injury, illness or to get the advice you need, the cost is simple with a $0 or $10 copay per visit (depending on your medical plan).

DOCTORS LOCATED ACROSS ALL 50 STATES

THE RIGHT CARE WHEN YOU MOST NEED IT

EVERYDAY CARE

MEDICAL EXPERTS

MENTAL HEALTH

WELLNESS & PREVENTION

SET UP YOUR ACCOUNT IN MINUTES Most people download the app or get started online. You can also call 1-800-Teladoc. Then fill out a brief medical history like you would at a doctor’s office.

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WELLNESS Employees and dependents enrolled in medical coverage will be automatically enrolled in the Vitality wellness program.

Powering Up With Vitality The Vitality program has all kinds of healthy activities to inspire you to be the healthiest you can be for yourself, your friends and your family. Along the way, celebrate your accomplishments by earning Vitality Points® for the rewards you deserve.

1.

2.

Register at PowerofVitality.com Download the Vitality Today mobile app from your app store.

3.

Take the Vitality Health Review.

Vitality Points translate into Vitality Bucks that can be spent in the Vitality Mall, redeemable for gift cards and other great rewards like fitness devices and movie tickets.

Vitality Bucks = Vitality Currency!

Get Rewarded by EspriGas 

Employees reaching Gold status will receive a $800 wellness incentive bonus.



Bonuses will be paid quarterly to employees who have earned Gold following quarter end.



Employees who have achieved Silver or Gold in the 2021-2022 plan year will qualify for the first quarter bonus in 2023.

A D D I T I O N A L E M P L OY E E R E S O U RC E S Employees enrolled in medical will also have access to the following benefits.  Vitality Wellness Program – earn rewards by maintaining or improving well-being through nutrition, healthy activates and preventive education.  Husk (formerly GlobalFit) – discounted gym memberships nationwide. Use eligibility ID, P12608, when registering.  SmartMatch – offers Medicare-eligible employees alternative coverage options.  KisX Card – assist in scheduling planned surgeries and diagnostics at pre-negotiated prices with top providers. Procedures such as: ankle & foot, arthroscopy, ear, elbow, gastroenterology, general surgery, hip, knee, neck & throat, shoulder, spine, urology, wrist & hand, and more!  Before seeking In-Network Providers through the health plan, just call a KISx Card Nurse regarding your elective procedure. By choosing a KISx Card provider, you will always pay $0.  To learn more about Surgery and Imaging benefits that are available to you text “tmg” to 64554

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LIFE/AD&D AND DISABILITY EspriGas provides all Full-Time employees a $50,000 Basic Life and Accidental Death & Dismemberment (AD&D) benefit. Life insurance pays your named beneficiary in the event of your death. AD&D insurance will provide a benefit to your beneficiary if your death is the result of an accident. This coverage is provided through Guardian at NO COST to employees.

Voluntary Life Insurance and AD&D – Employees are offered the option to purchase additional life insurance through Guardian.

Rates will vary based on age and the benefit you select. All rates can be found in your Employee Navigator portal.

Plan Highlights Employee:

Increments of $10,000 up to a maximum of $500,000 subject to medical eligibility. At your initial enrollment, you are eligible for up to a $100,000 with no medical questions asked.

Spouse:

Increments of $5,000 up to a maximum of $150,000 (not to exceed 50% of employee’s amount). Subject to medical eligibility. At your initial enrollment, your spouse is eligible for up to a $20,000 with no medical questions ask.

Child(ren):

Increments of $5,000 up to a maximum of $10,000. Coverage begins at 15 days.

Short-Term Disability Through Guardian all full-time employees are provided short-term disability at NO COST. Benefit Amount: 60% of weekly salary up to a maximum of $1,500 for non-work related accidents or sicknesses.

Waiting Period: Benefits begin on day 8 Benefit Period: up to 24 weeks Voluntary Long-Term Disability Through Guardian all full-time employees are offered long-term disability. Rates will vary based on age and the benefit you select. All rates can be found in your Employee Navigator portal.

Benefit Amount: 60% of monthly earnings up to a maximum of $6,000 for a covered accidents or sicknesses.

Waiting Period: 180 days Benefit Period: up to Social Security Normal Retirement Age (SSNRA)

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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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Help for what matters most Your employee assistance program Our Employee Assistance Program offers services to help promote well-being and enhance the quality of life for you and your family.

Support and guidance are available for assistance with family and personal issues online at worklife.uprisehealth.com and by phone at 1-800-386-7055.

Help withhealth

Help withfamily

Helpwith legal and financial

• Healthy living

• Parentingsupport

• Le g a l issues

• Stressmanagement

• Child and elder care

• Willpreparation

• Mental health

• Learning programs

• Taxes anddebt

• Diet andfitness

• Special needs help

• ID the ft services

• Overall wellness

• Financial tools and assista nce • Medical bill negotiation tools

Connect to a counselor for complimentary support services: Email: eapcounselor@uprisehealth.com Phone: 1-800-386-7055 Available 24 hours a day, 7 days a week* Web: worklife.uprisehealth.com (Access code: worklife) *Office hours: Monday-Friday 6am-5pm PST. Live answer exchange available after hours. The Employee Assistance Program services are provided by Uprise Health, and its contractors. Guardian does not provide any part of the Employee Assistance Program. Guardian is not responsible or liable for care or advice given by any provider or resource under the program. This information is for illustrative purposes only. It is not a contract. Only the Administration Agreement can provide the actual terms, services, limitations and exclusions. Guardian and Uprise Health reserve the right to discontinue the Employee Assistance Program at any time without notice. Legal services provided through the Employee Assistance Program will not be provided in connection with or preparation for any action against Guardian, Uprise Health or your employer. The Employee Assistance Program is not an insurance benefit and may not be available in all states. (Future written communications may be in English only.) The Guardian Life Insurance Company of America, New York, NY. Uprise Health, Laguna Niguel, CA. Guardian® is a registered trademark of The Guardian Life Insurance Company of America and is used with express written permission. © Copyright 2022 The Guardian Life Insurance Company of America Pub3755 2022-133072 (Exp. 02/24 )

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

Human Resources Jennifer Norris

Your Employee Support Contact

770-367-9725 jnorris@esprigas.com

Benefit Questions Megan Montrois 770-635-2294 meganm@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)

Claims Questions

Kristie Mercer | Darlene Moorman 770-635-2293 kmercer@sspins.com

| 770-635-0439 | dmoorman@sspins.com

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LEGAL NOTICES THIS GUIDE - This brochure summarizes the health care and income protection benefits that are available to EspriGas and their eligible dependents. Official plan documents, policies, and certificates of insurance contain the details, conditions, maximum benefit levels and restrictions on benefits. These documents govern your benefits program. If there is any conflict, the official documents prevail. These documents are available upon request through your Human Resources department. Information provided in this brochure is not a guarantee of benefits.

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

WOMEN'S HEALTH ACT If you have had or are going to have a mastectomy, you may be entitled to certain benefits under the Women's Health and Cancer Rights Act of 1998 (WHCRA). For individuals receiving mastectomy-related benefits, coverage will be provided in a manner determined in consultation with the attending physician and the patient for: • All stages of reconstruction of the breast on which the mastectomy was performed; • Surgery and reconstruction of the other breast to produce a symmetrical appearance; • Prostheses; and • Treatment of physical complications of the mastectomy, including lymphedema. These benefits will be provided subject to the same deductibles and coinsurance applicable to other medical and surgical benefits provided under this plan. If you have any questions about your coverage, please contact your Human Resources department.

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

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

SPECIAL ENROLLMENT NOTICES

NEWBORNS' & MOTHERS' HEALTH PROTECTION ACT

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

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

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

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

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

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