Georgia Dermatology 2022-2023 Benefit Guide

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

TABLE OF CONTENTS

Page 2 A Smarter Way to Better Health

Page 3 Eligibility & Enrollment

Page 4 5 New!Allied Medical Information

Page 6 7 New!Medical Plans

Page 8 New!How to Find a Health Care Provider

Page 9 New! Allied Member Portal Instructions

Page 10 New!SmithRX Connect Alternative RX Cost Solutions

Page 11 HRA and Medical Coverage Considerations

Page 12 Dental Plan

Page 13 Vision Plan

Page 14 Employer Paid Life/AD&D and Voluntary Life/AD&D Insurance

Page 15 Disability, Accident, Critical Illness

Page 16 EAP Work/Life Employee Assistance Program

Page 17 Employee Payroll Deductions

Page 18 Key Contacts & Resources

Page 19 25 Important Notices

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

Preventive Health Care Services

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

▪

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

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

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

If any service performed at an annual checkup is 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.

ELIGIBILITY & ENROLLMENT

Who is an Eligible Dependent?

• Medical: Your dependent children up to age 26

• Dental, Vision, Accident & Critical Illness: Your spouse & dependent children up to age 26

• Voluntary Life: Your spouse & dependent children up to age 20 (or up to age 26 if a full time student)

• Your dependent child is specified in the Carriers’ plan documents including:

o Natural child

o Adopted child

o Stepchild

o Child for whom you have been appointed as the legal guardian

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

The Dependent does not need to be an eligible dependent on their parent’s tax return; is not required to live with you; and may be unmarried or married

Coverage will terminate on the last day of the birth month when a dependent child ages off the plan

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 benefits become effective on the 90th day following your date of hire

Annual Open Enrollment

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

The annual enrollment period occurs each year during the month of September

Qualifying Event Changes

You are allowed to make changes to your current benefit elections during the plan year if you experience an IRS approved qualifying change in life status If you have a status change, you must notify Human Resources within 30 days of the event If you do not notify Human Resources during that time, you and/or your dependents must wait until the next open enrollment to change your coverage.

IRS approved qualifying life status changes include:

• Marriage, divorce or legal separation

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

• Death of a dependent

• Child no longer eligible due to reaching age limit

• 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 or become eligible for a state’s premium assistance subsidy under Medicaid or CHIP, then you have 60 days from the date of the Medicaid/eligibility change to request enrollment in Georgia Dermatology’s plans.

This notice is being provided to ensure that you understand your right to apply for group health insurancecoverage. Aspecialenrollmentperiodisa time outside of the annual open enrollment period duringwhichyouandyourfamilyhavearighttosign up for health coverage. In the Marketplace, you qualify for a special enrollment period 60 days followingcertainlifeeventsthatinvolveachangein family status (for example, marriage or birth of a child) or loss of other health coverage Job based plansmustprovideaspecialenrollmentperiodof30 days Some events will require additional documentationto be submittedwith theapplication at the time of enrollment . Find more information on page 30 You should read this notice even if you plantowaivecoverageatthistime.

Please note, loss of coverage due to non payment or voluntaryterminationofothercoverage outsideaspouse’sor parent’s open enrollment is not an IRSapproved qualifying life event and you do not qualify for a special enrollment period.

Your Health Plan Administrator

Life is unexpected, but your health care coverage shouldn’t be.

Allied is committed to helping you and your family make the most of your benefits all year round. With access to on demand tools and one on one customer service support, Allied makes it easy to manage your benefits and stay on track towards a healthier you.

Manage your benefits at-home or on the go

Allied’s online member portal allows you to manage your benefits at any time from any device. Simply log in at alliedbenefit.com to:

• Access your digital ID card

• Look up claims and deductible progress

• Review your benefits, copays and coinsurance amounts

• Pull up your customized Personal Health Record (PHR)

Expert advice, just a phone call away

When you need help, Allied's Member Services team is ready to answer any and all questions, including:

• Help submitting claims, or understanding your medical bills

• Verify your benefits and coverage details directly with your providers

• Find in network providers

• Navigate your benefits and tools through your online member portal

Call 800 288 2078

Monday Thursday, 8:30 am to 8:00 pm ET

Friday 9:00 am to 6:00 pm ET

Saturday 10:00 am to 1:00 pm ET

Medical Plan Options

Your Employer offers a choice of medical plans designed to help you and your family maintain good health and financial well being. Deciding which plan is best for you depends on your specific health care needs, preferences, budget, and lifestyle.

For the 2022 plan year, you have two plan options to choose from:

1. Base Plan $5,000

2. Buy Up Plan $2,500

When you enroll in any one of the Allied medical plans, you and your family will have:

• Comprehensive coverage for major medical services (unless noted otherwise).

• Free Preventive Care. Your plan pays 100% for certain in network preventive care services with no out of pocket costs to you. Preventive benefits are determined by national guidelines (incl. USPSTF, HRSA, and the CDC) and may differ from what your doctor recommends. Make sure to check your Summary Plan Description for a complete list of covered services.

• Prescription drug benefits through your plan’s selected pharmacy partner.

• 24/7 access to Allied’s member website, so you can manage your benefits at any time from any device.

• Dedicated support. When you have a question or need assistance, Allied’s Customer Service team is ready to help.

MEDICAL

Georgia Dermatology offers you two medical plan choices through Allied. Please refer to the following charts for a list of the major features for each plan. As a plan member, you have access to many consumer education tools and value added programs designed to help you manage you and your dependents’ medical care. See page 8 9 for access to your own personalized member portal to navigate your benefits and to find a provider to proactively manager your healthcare at any time.

The prescription drug coverage provided by both medical plans is expected to pay out as much as standard Medicare prescription drug coverage pays. This is important because members who enroll in a Medicare prescription drug plan after their initial eligibility period, may pay a higher premium (a penalty) if they were enrolled in a group health plan with non creditable prescription drug coverage.

$5000 BASE PLAN

Plan Highlights

In Network You Pay

Out of Network You Pay

Deductible (see HRA page 6) $5,000 Individual | $10,000 Family $10,000 Individual | $20,000 Family Coinsurance

You Pay 10%

You Pay 40%

Annual Out of Pocket Maximum $7,900 Individual | $15,800 Family $15,800 Individual | $31,600 Family

Primary Care Physician Office Visit $30 copay Deductible, then 40%

Specialist Office Visit $75 copay Deductible then 40%

Preventive Care Services Plan pays 100% Deductible then 40% Diagnostic Tests (x ray, blood work)

Deductible then 10% Deductible then 40%

Imaging (CT/PET scans, MRIs) in Office Setting $250 copay (deductible does not apply) Deductible then 40%

Imaging (CT/PET scans, MRIs) in Outpatient Facility Deductible then 10%

Hospital Inpatient Care Deductible then 10% Deductible then 40%

Outpatient Surgery Deductible then 10% Deductible then 40%

Emergency Room $500 copay then 10%

Urgent Care $75 copay Deductible then 40%

Rx Calendar Year Deductible $150 per person (all tiers except Generic)

Tier 1 (Generic) $15 copay

Tier 2 (Brand) $40 copay after $150 deductible

Tier 3 (Non Preferred Brand) $75 copay after $150 deductible

Tier 4 (Specialty)

NOT COVERED Please contact SmithRX to see if you qualify for Patience Assistance Program

90 Day Mail Order $38/$120/$225

Please note, the above information presents only the highlights of your medical plan. More detailed information can be found in the Summary Plan Description. Out of network services may result in balance billing. Please stay in network.

$2500 BUY UP PLAN

Plan Highlights

Deductible

In Network You Pay Out of Network You Pay

$2,500 Individual | $5,000 Family $5,000 Individual | $10,000 Family

Coinsurance You Pay 0%

Pay 30%

Annual Out of Pocket Maximum $7,900 Individual | $15,800 Family $15,800 Individual | $31,600 Family

Primary Care Physician Office Visit $20 copay

Deductible then 30%

Specialist Office Visit $75 copay Deductible then 30%

Preventive Care Services Plan pays 100% Deductible then 30%

Diagnostic Tests (x ray, blood work) Deductible then 0% Deductible then 30%

Imaging (CT/PET scans, MRIs) in Outpatient Facility Deductible then 0% Deductible then 30%

Imaging (CT/PET scans, MRIs) in Doctor’s office setting

Hospital Inpatient Care

$250 copay (deductible does not apply) Deductible then 30%

Deductible then 0% Deductible then 30%

Outpatient Surgery Deductible then 0% Deductible then 30%

Emergency Room $500 copay

Urgent Care $75 copay Deductible then 30%

Rx Calendar Year Deductible None

Tier 1 (Generic) $15 copay

Tier 2 (Brand) $35 copay

Tier 3 (Non Preferred Brand) $65 copay

Tier 4 (Specialty)

NOT COVERED Please contact SmithRX to see if you qualify for Patience Assistance Program

90 Day Mail Order $38/$88/$163

Please note, the above information presents only the highlights of your medical plan. More detailed information can be found in the Summary Plan Description. Out of network services may result in balance billing. Please stay in network.

Allied Member Portal

Once you are enrolled in an Allied health plan, you will have access to your own personalized member portal via AlliedBenefit.com. Allied’s online member portal allows you to navigate your benefits and proactively manage your healthcare at any time from any device.

With your Allied Member Portal, you can:

• Access your digital ID card

• Look up claims and deductible progress

• Review your benefits, copays & coinsurance amounts

• Pull up your customized Personal Health Record (PHR)

• Find in network providers through the PPO directory

Set up your Allied member account at alliedbenefit.com.

1. Go to alliedbenefit.com/Members, click “Register”

2. Enter the required information under “Website Account Request,” click “Submit.”

3. Look out for two emails from notifications@alliedbenefit.com with instructions on how to authenticate your account. Click the link in the second email to complete the registration.

Log in or register your account at alliedbenefit.com

Group number: A22223

Find a Health Care Provider

Through your Allied health plan, you have access to the PHCS provider network of doctors, hospitals, and facilities. The PHCS network offers you:

• Choice Broad access to more than 4,800 hospitals, nearly 92,000 ancillary care facilities, and 920,000 healthcare professionals.

• Savings Negotiated discounts that result in significant cost savings for you when you visit in network providers, helping you to maximize your benefits. A PHCS logo on your health insurance card tells both you and your provider that a PHCS discount applies.

• Quality MultiPlan applies rigorous criteria when credentialing providers for participation in the PHCS Network, so you can be assured you are choosing your healthcare provider from a high quality network.

How to Find a PHCS Network Provider

By Phone: Call 888 733 9582 Monday through Friday from 8 a.m. to 8 p.m. (Eastern Time) and identify yourself as a health plan participant accessing the PHCS Network.

Online: You may also search online at www.multiplan.com:

1. Click on “Find a Provider” at the top of the page.

2. After acknowledging you have read the disclaimer at the bottom of the screen, click on the green ”Select Network” button.

3. When selecting your network, choose “PHCS,” then “I don’t see any of these statements,” and “Front.”

4. Enter one of the search criteria suggested in the search box to begin your search

5. If your browser settings don’t allow your location to be detected, enter a zip code.

Before Your Appointment

It is your responsibility to confirm your providers’ continued participation in the PHCS Network and accessibility under your benefit plan. Please also be sure to follow any preauthorization procedures required by your plan (usually a telephone number on your ID card). In addition, to ensure proper handling of your claim, always present your current benefits ID card upon arrival at your appointment.

If You Need Assistance

If you have issues when scheduling appointments with PHCS Network providers, call PHCS at 888 733 9582

If you have questions about your benefits or claims status, please call Allied Member Services at 800 288 2078.

Health Reimbursement Arrangement (HRA)

• The HRA is an employee benefit that is provided by Georgia Dermatology at no cost to the employees covered under the Allied Base Medical Plan.

• Georgia Dermatology will reimburse participating employees the last $1,000 of the $5,000 deductible for the Allied Base Plan. The maximum reimbursement is two per family, if you are covering dependents.

• Please provide your Allied Explanation of Benefits (EOB) to Human Resources as proof of satisfying the $5,000 Deductible.

Key Plan Components

• Receive services from a national network of providers and facilities PHCS Network.

• You may choose any provider without having a Primary Care Physician (PCP) identified or requiring a referral from a PCP to see a specialist.

• You pay co pays for services such as doctor visits, urgent care & prescriptions.

• Preventive Care is covered at no cost on all plans.

• Deductible applies to major items like inpatient hospital, outpatient surgery & MRI/CAT/PET scans at an outpatient facility.

• All deductible, coinsurance and co pay expenses accrue toward the out of pocket maximum.

Things to consider

• Since your medical plans run on a calendar year basis, all deductible and out of pocket amounts will reset to $0 on January 1.

o 4th quarter deductible carryover feature: If you have any deductible related services that actually occur in October, November or December, those deductible amounts satisfied will automatically be applied to your 2022 calendar year deductible by Allied.

o This does NOT include any coinsurance, copays or out of pocket amounts, ONLY deductible.

• Everyone will receive new medical ID cards. Newly covered employees will receive ID cards.

• Members can view/print a copy of their ID cards via the Allied Member Portal, www.AlliedBenefit.com

DENTAL

Staying healthy includes obtaining quality dental care for you and your family. Georgia Dermatology offers a dental plan through Guardian. To search online for an in‐network dentist you can go to www.guardiananytime.com and click on Find a Provider. The plan type is PPO. Claims are paid in‐network based on a negotiated fee schedule with participating dentists. You have the freedom to use an out‐of‐network dentist, but claims are paid based on the 90th percentile of the Usual & Customary rates in your geographic area. You may be subject to balance billing when you use an out‐of‐network dentist.

*Maximum Carryover: Up to $350 of your unused $1,500 annual maximum could be rolled over to the next year as long as in network dentists are used and annual claims do not exceed $700. The Maximum Rollover Account Limit is $1,250.

Benefit In Network Out of Network

Your Deductible

$50 individual / $150 Family $50 individual / $150 Family

Calendar Year Maximum Applies to preventive, basic, and major services $1,500

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

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

Major Services Crowns, Inlays/Onlays, Dentures

How are Claims Paid?

100% (Deductible waived)

80% (After deductible)

50% (After deductible)

Negotiated Fee Schedule

90th percentile of usual & customary for network dentists in your area

Georgia Dermatology offers the choice of two vision plans through Guardian the VSP Network Plan OR the Guardian Vision Network Plan. The in network benefits are the same on both plans, so you want to make your choice based on which network has your desired provider In Network. You may choose between the VSP Network or Guardian Vision networks. To search for participating vision providers in either network, go to www.guardiananytime.com and select VSP Network OR Guardian Vision Network.

Guardian Network

VSP Network

Eye Exam:

Routine Exam

$10 Copay Up to $59 allowance $10 Copay Up to $39 allowance

Frames: Frames $130 allowance (20% discount on balance) Up to $70 allowance $130 allowance (20% discount on balance) Up to $46 allowance

Lenses:

Single $10 Copay up to $30 allowance $10 Copay up to $23 allowance

Bifocal $10 Copay up to $50 allowance $10 Copay up to $37 allowance

Trifocal $10 Copay up to $65 allowance $10 Copay up to $49 allowance

Elective contacts $130 allowance Up to $120 allowance $130 allowance Up to $100 allowance

Frequency:

Examination 1 per 12 months

Frames 1 per 12 months

Lenses (glasses OR contacts, not both) 1 per 12 months

LIFE AND AD&D

Basic Life/AD&D Insurance provided by Georgia Dermatology

Life Insurance is a key element of proper financial planning and helps provide financial stability and protection for families in case of an untimely death If you are an eligible full time associate, Georgia Dermatology provides $25,000

accident. Those interested can elect the amount that suits their needs at an affordable rate. Rates are based on age and when you enroll for this benefit, it will illustrate the cost in Beacon.

Supplemental Term Life Insurance and AD&D coverage is portable (you may take it with you when you leave Georgia Dermatology by contacting Guardian within 30 days).

Employee: Increments of $10,000 up to the lesser of 5 times base annual earnings or a maximum of $500,000 The guarantee issue amount at your initial offering of this plan is $130,000 Employees wishing to apply for coverage above $130,000 will need to seek approval for this coverage by completing an Evidence of Insurability (EOI) form, where they will answer a series of simple health questions for Guardian underwriting to review

If electing coverage for yourself, you may also elect coverage for your spouse and/or children.

Spouse : Increments of $5,000 up to $500,000 not to exceed your amount. The guarantee issue amount is $50,000, under age 65. Spouse coverage terminates at age 70. Spouse rates are based on the employee’s age.

Child (age 6 months 26): Increments of $2,000 up to $10,000. Coverage is up to age 20 (or to 26 if a full time student). All child life is guarantee issue. One monthly premium covers all dependent children.

Choose Your Beneficiary: Make sure your life and accidental death benefits will be paid as you intend. Be sure you name a beneficiary when you enroll in Life and AD&D benefits.

If you do not enroll in supplemental employee or spouse life when you are first eligible (within 30 days of your eligibility), there is no guarantee issue amount and any amounts requested are subject to Evidence of Insurability (EOI).

DISABILITY

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. Rates are based on age and basic earnings. You will be able to determine the cost in Beacon.

Short-Term Disability

Georgia Dermatology offers all full time employees the opportunity to purchase short term disability coverage through Guardian. This coverage pays up to a weekly benefit of 60% of the associate’s pre disability income (up to a maximum of $1,500 per week) during periods of disability resulting from injury, sickness, or pregnancy STD benefits begin on the 8th day after an accident, sickness, or pregnancy STD benefits pay weekly for a duration of up to 12 weeks *There is a 3/12 pre existing condition limitation which means the plan will not pay a claim anytime in the first 12 months of coverage due to a condition for which a member received medical care anytime in the 3 months prior to the effective date.

Long-Term Disability

Georgia Dermatology offers all full time employees the opportunity to purchase long term disability coverage through Guardian Long term disability pays 60% of monthly earnings to a maximum of $6,000 Benefits begin after 90 days of being disabled and can last up to Social Security Normal Retirement Age *There is a 6/24 pre existing condition limitation which means the plan will not pay a claim anytime in the first 24 months of coverage due to a condition for which a member received medical care anytime in the 6 months prior to the effective date.

*TheSTDpre existingconditionlimitationdoesapplytopregnancy(i.e.ifyouarealreadypregnantwhenyouelectSTD, youcannotmakeaclaimwhenyoudeliver.TheplanwillonlypayifyoubecomepregnantAFTERtheeffectivedateofyour STDcoverage).

ACCIDENT & CRITICAL ILLNESS

Accident Insurance

Georgia Dermatology offers an Accident plan through Guardian Benefits are paid directly to you based on a flat schedule when an accident occurs Some examples of when the plan would pay a benefit are the following: fracture, dislocation, burn, concussion, coma, torn cartilage in knee, laceration, broken tooth, eye injury, ambulance, emergency room, hospital admission, paralysis and more. If enrolling, you may also cover a spouse and/or children. The plan has a $50 annual benefit (reward) for preventive screenings. Rates are based on who you cover on the plan and can be found on page 14. This plan is portable at the same rate should you leave the company.

Critical Illness Insurance

Georgia Dermatology offers a Critical Illness plan through Guardian A lump sum benefit is paid out when diagnosed with a critical illness. Consider this plan as a way to help with your medical plan expenses and other daily living expenses if you were to be diagnosed with a critical illness. The plan pays for diagnosis of Heart Attack, Stroke, Major Organ Transplant, End Stage Renal Failure & Invasive Cancer. Select coverage for yourself in increments of $5,000 up to $20,000. $20,000 is guarantee issue (no health questions asked) Child coverage is included with your coverage If enrolling, you may also cover a spouse Spouse coverage is in increments of $2,500 up to $10,000, not to exceed 50% of your benefit $10,000 is guarantee issue for spouses The plan has a $50 annual benefit (reward) for preventive screenings Rates are based on age, tobacco use and coverage amount and can be found in Beacon This plan has a 12 month look back period for pre existing condition limitation exclusion. The plan is portable at the same rate should you leave the company.

EMPLOYEE ASSISTANCE

Your Confidential Employee Assistance Program Helping find balance between work and home life.

WorkLifeMatters provides guidance for personal issues that you might be facing and information about other concerns that affect your life, whether it’s a life event or on a day to day basis.

Unlimited free telephonic consultation with an EAP counselor available 24/7 at 800 386 7055

Referrals to local counselors up to three sessions free of charge

State of the art website featuring over 3,400 helpful articles on topics like wellness, training courses, and a legal and financial center

EMPLOYEE

Your Bi-Weekly Payroll Deductions

Allied Plans

Base Medical Plan $75.00 $360.00

Medical Plan $120.00 $440.00

Employee

Guardian Plans

Dental $16.60 $34.77 $32.00 $53.40

Vision Guardian Network $3.52 $6.16 $6.69 $10.21

Vision VSP Network $3.83 $6.70 $7.27 $11.10

Accident $7.99 $13.44 $13.65 $19.10

Basic Life/AD&D Employer paid benefit

Supplemental Life/AD&D Beacon will calculate deductions based on election and age.

Short & Long-Term Disability Beacon will calculate deductions based on election, age and annual salary.

Critical Illness Beacon will calculate deductions based on election, tobacco use and age.

Your Broker Support Contacts

JANE MURPHY

SSP SR CLIENT SERVICES ASSISTANT 404 949 1076 jane.murphy@sspins.com

EMBER FORD

SSP SR CLIENT SERVICES EXECUTIVE 404 949 1022 eford@sspins.com

IMPORTANT NOTICES

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)

PremiumAssistanceunderMedicalandCHIP

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

IMPORTANT NOTICES

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

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

PPACA Compliant Plan Notice

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

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

NOTE: If you purchase a health plan through the marketplace instead of accepting health coverage offered by your employer, then you will lose the employer contribution to the employer offered coverage Also, this employer contribution, as well as your employee contribution to employer offered coverage, is excluded from income for Federal and State income tax 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 lo continue the coverage that you (and your covered dependents, if any) had under the [Company] 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.

IMPORTANT NOTICES

Duration of USERRA Coverage

General Rule: 24 Month Maximum. When a covered employee takes a leave for service in the uniformed services, USERRA coverage for the employee (and covered dependents for whom coverage is elected) can continue until up to 24 months from the date on which the employee's leave for uniformed service began However, USERRA coverage will end earlier if one of the following events takes place:

A premium payment is not made within the required time; You fail to return to work or to apply for reemployment within the time required under USERRA (see below) following the completion of your service in the uniformed services; You lose your rights under USERRA as a result of a dishonorable discharge or other conduct specified in USERRA.

Notice of Privacy Provision

This Notice of Privacy Practices (the "Notice") describes the legal obligations of [Company] (the "Plan") and your legal rights regarding your protected health information held by the Plan under the Health Insurance Portability and Accountability Act of 1996 (HIPAA) and the Health Information Technology for Economic and Clinical Health Act (HITECH Act). Among other things, this Notice describes how your protected health information may be used or disclosed to carry out treatment, payment, or health care operations, or for any other purposes that are permitted or required by law We are required to provide this Notice of Privacy Practices to you pursuant to HIPAA

The HIPAA Privacy Rule protects only certain medical information known as "protected health information " Generally, protected health information is health information, including demographic information, collected from you or created or received by a health care provider, a health care clearinghouse, a health plan, or your employer on behalf of a group health plan, from which it is possible to individually identify you and that relates to:

• Your past, present, or future physical or mental health or condition;

• The provision of health care to you; or

• The past, present, or future payment for the provision of health care to you

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

IMPORTANT NOTICES

This guide provides a summary of you 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

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.

Loss of Other Coverage

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 othercoverage)

Medicaid or CHIP

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

To request special enrollment or obtain more information, please contact HR.

HEALTH INSURANCE MARKETPLACE

PART A: GENERAL INFORMATION

To assist you as you evaluate options for you and your family, this notice provides some basic information about the 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 runs from November 1, 2022, through December 15, 2022, for coverage starting as early as January 1, 2023.

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

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

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

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 alter tax basis.

How Can I Get More Information?

For more information about your coverage offered by your employer, please check your summary plan description or contact Human Resources.

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

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

Georgia Dermatology & Skin Cancer Center, LLC

5. Employer Address

2400 Bellevue Rd

7. City Dublin

4. Employer Identification Number (EIN) 31 1838862

6. Employer Phone Number 478 275 7202

8. State GA

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

Robyn Burney

11. Phone Number (if different from above)

12. Email Address robyn.burney@gaderm.com

Here is some basic information about health coverage offered by this employer:

As your employer, we offer a health plan to:

All employees. Eligible employees are:

Activefull timeemployeesworking30ormorehoursaweek

Some employees. Eligible employees are:

9. Zip Code 31021

With respect to dependents:

We do offer coverage. Eligible dependents are:

Childrenuptoage26

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.

IMPORTANT NOTICE ABOUT 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 Georgia Dermatology 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

• Georgia Dermatology has determined that all of the prescription drug coverage offered by the Allied plans in this Benefit Guide 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 Georgia Dermatology coverage will not be affected Please review prescription drug coverage plan provisions/options under the certificate booklet provided by Allied 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 Georgia Dermatology 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 Georgia Dermatology 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 Georgia Dermatology changes. You also may request a copy of this notice at any time

More detailed information about Medicare plans that offer prescription drug coverage is in the “Medicare & You” handbook. You’ll get a copy of the handbook in the mail every year from Medicare You may also be contacted directly by Medicare drug plans For more information about Medicare prescription drug coverage Visit www.medicare.gov. Call your State Health Insurance Assistance Program (see the inside back cover of your copy of the “Medicare & You” handbook for their telephone number) for personalized help Call 1 800 MEDICARE (1 800 633 4227) TTY users should call 1 877 486 2048 If you have limited income and resources, extra help paying for Medicare prescription drug coverage is available For information about this extra help, visit Social Security on the web at www.socialsecurity.gov, or call them at 1 800 772 1213 (TTY 1 800 325 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)