good2grow 2022 Benefit Guide

2022-2023

BENEFIT GUIDE June 1, 2022 – May 31, 2023

TABLE OF CONTENTS

At good2grow 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(s) and/or Summary of Coverage. In the case of a discrepancy the plan specific documents will prevail.

Page 2

A Smarter Way to Better Health

Page 3

Eligibility & Enrolling

Page 4

Benefit Basics- Who pays for What?

Page 5-7

Medical Networks

Page 8-9

Traditional Cigna Medical Plans

Page 10-11

Flexible Spending Account (FSA)

Page 12

High Deductible (HSA) Plan

Page 13

Health Savings Account (HSA)

Page 14

Where to go for care

Page 15

Dental Plan

Page 16

Vision Plan

Page 17

Employer Paid Life & AD&D Insurance, Supplemental Voluntary Life Insurance

Page 18

Employer Paid Disability Insurance and Life Assistance Program (LAP)

Page 19

Voluntary Accident and Legal Shield

Page 20

Employee Monthly Contributions, Quick Guide to Enrollment

Page 21

Key Contacts

Page 22-30

Model Notices

good2grow Benefit Guide | 1

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 please 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: 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

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 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. good2grow Benefit Guide | 2

ELIGIBILITY & ENROLLMENT Who is Eligible to Join the Benefit Plan?

Qualifying Event Changes

You and your dependents are eligible to join the good2grow 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 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 or domestic partner

•

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

*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.

IRS-approved qualifying life status changes include: •

Marriage, divorce or legal separation

•

Birth of your child or your domestic partner’s child 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, domestic partner or a dependent

•

Change in work schedule, including switching between full-time and part-time status, by you, your spouse, domestic partner 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

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.

When Do Benefits Become Effective?

You are eligible for benefits if you work at least 30 hours per week. Your benefits are effective on 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. To find out when the annual Open Enrollment Period occurs, contact Human Resources.

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 31 days of the other 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.

!

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. good2grow Benefit Guide | 3

BENEFIT BASICS good2grow pays the cost of some benefits and you share the costs of others, as shown below.

Who Pays

Tax Treatment

Medical

good2grow & You

Pretax

Dental

good2grow & You

Pretax

Vision

You

Pretax

Group Life/AD&D

good2grow

n/a

Voluntary Life/AD&D

You

After-tax

Disability Coverage

good2grow

Pretax

New - Accident

You

After-tax

New - Legal Services

You

After-tax

Health Savings Account (HSA)

good2grow/You

Pretax

Employee Assistance Program (EAP)

good2grow

na/

For more information about your benefits, please contact your HR Team: Leah.Rainwater@good2grow.com Online: https://access.paylocity.com

good2grow Benefit Guide | 4

CIGNA MEDICAL NETWORKS good2grow has 4 medical plan options. Three use the Open Access Plus (OAP) and one uses the Local Plus.

Open Access Plus (OAP) – National Network • Available on the Buy-Up, Mid & HDHP • Broadest coverage • No Primary Care Provider selection required • No specialist referrals required Local Plus – New Plan with Special Network • High quality and efficiency providers • Strong focus on Piedmont & Children’s • Primary Care Provider selection encouraged but not required • No specialist referrals required • Access national network of labs (Quest & LabCorp), convenience care clinics & virtual care services • In-Network “Away From Home Care” in Local Plus • Always In-Network nationwide coverage for emergencies

good2grow Benefit Guide | 5

LOCAL PLUS NETWORK

Georgia Areas with Local Plus

Major Hospitals in Atlanta area Piedmont, Piedmont Fayette/Henry/ Mountainside/Newnan/ Rockdale/Newton/ Walton Children’s Egleston/Hughes Spalding/Scottish Rite Eastside Medical Cartersville Medical

U.S. Areas with Local Plus

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PROVIDER SEARCH Follow these steps at www.cigna.com to search for providers in the Cigna Open Access Plus (OAP) or Local Plus Networks 1

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good2grow Benefit Guide | 7

MEDICAL PLANS Traditional Plans: Open Access Plus (OAP) Network Plan Highlights

OAP BUY-UP $1000/20%

OAP MID PLAN $2000/20%

In-Network

Out-of-Network

In-Network

Out-of-Network

$1,000/$3,000

$2,000/$6,000

$2,000/$6,000

$4,000/$12,000

20%

40%

20%

40%

$6,000/$12,000

$12,000/$24,000

$7,150/$14,300

$14,300/$28,600

Virtual Care Office Visit

$0 copay

Ded., then 40%

$0 copay

Ded., then 40%

Primary Care Physician Office Visit

$30 copay

Ded., then 40%

$25 copay

Ded., then 40%

Mental Health Office Visit

$30 copay

Ded.,then 40%

$25 copay

Ded., then 40%

Specialist Office Visit

$60 copay

Ded., then 40%

$70 copay

Ded, then 40%

Preventive Care Services

Plan pays 100%

Ded., then 40%

Plan pays 100%

Ded., then 40%

Laboratory Diagnostics & X-Ray

Ded., then 20%

Ded., then 40%

Ded., then 20%

Ded., then 40%

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

Ded., then 20%

Ded., then 40%

Ded., then 20%

Ded., then 40%

Hospital Inpatient Care

Ded., then 20%

Ded., then 40%

Ded., then 20%

Ded., then 40%

Outpatient Surgery

Ded., then 20%

Ded., then 40%

Ded, then 20%

Ded, then 40%

Individual/Family Deductible

4th quarter carry over included

Coinsurance Annual Out-of-Pocket Maximum

Emergency Room Urgent Care Prescription Drugs

$500 copay $50 copay

Ded., then 40%

$500 copay $50 copay

Ded., then 40%

You pay either a copay &/or coinsurance per the assigned prescription drug tier which can be found in the prescription drug formulary. This plan meets the CMS standard for creditable prescription drug coverage.

Quantity Limits: Mail-Order=90-day supply

Prescription Deductible

None

Tier 1 — Generic Drugs

Retail: $10 copay

Retail: $10 copay (Rx deductible WAIVED)

Tier 2 — Preferred Brand-Name

Retail: $35 copay

Retail: $50 copay, after Rx Deductible

Tier 3 — Non-Preferred Brand-Name

Retail: $60 copay

Retail: $75 copay, after Rx Deductible

20% to $250 max per Rx

20% to $250 max per Rx, after Rx Deductible

Tier 4—Specialty Drugs

Individual: $100

Family: $200

90-Day Mail Order 3 x 30-day Retail Cost 3 x 30-day Retail Cost Important Notes This is a summary only of your coverage. In-network services are based on negotiated charges; out-of-network services are based on maximum reimbursable charges. The Out-of-Pocket Maximum includes deductibles and copays. You could be balanced billed by providers and/or facilities when using an out-of-network facility.

!

The prescription drug coverage provided by this medical plan 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. good2grow Benefit Guide | 8

NEW - MEDICAL PLAN LOCAL PLUS Plan Network– Traditional Plan Plan Highlights

LOCAL PLUS $2000/20% In-Network (Local Plus only)

Out-of-Network

$2,000/$6,000

$4,000/$12,000

20%

40%

$7,150/$14,300

$14,300/$28,600

Virtual Care Office Visit

$0 copay

Ded., then 40%

Primary Care Physician Office Visit (including Mental Health)

$25 copay

Ded., then 40%

Specialist Office Visit

$70 copay

Ded, then 40%

Preventive Care Services

Plan pays 100%

Ded., then 40%

Laboratory Diagnostics & X-Ray

Ded., then 20%

Ded., then 40%

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

Ded., then 20%

Ded., then 40%

Hospital Inpatient Care

Ded., then 20%

Ded., then 40%

Outpatient Surgery

Ded, then 20%

Ded, then 40%

Individual/Family Deductible

4th quarter carry over included

Coinsurance

Annual Out-of-Pocket Maximum

Emergency Room Urgent Care

Prescription Drugs

Prescription Deductible Tier 1 — Generic Drugs

$500 copay $50 copay

Ded., then 40%

You pay either a copay &/or coinsurance per the assigned prescription drug tier which can be found in the prescription drug formulary. This plan meets the CMS standard for creditable prescription drug coverage.

Quantity Limits: Mail-Order=90-day supply Individual: $100

Family: $200

Retail: $10 copay (Rx deductible WAIVED)

Tier 2 — Preferred Brand-Name

Retail: $50 copay, after Rx Deductible

Tier 3 — Non-Preferred Brand-Name

Retail: $75 copay, after Rx Deductible

Tier 4—Specialty Drugs 90-Day Mail Order

20% to $250 max per Rx, after Rx Deductible 3 x 30-day Retail Cost

Important Notes This is a summary only of your coverage. In-network services are based on negotiated charges; out-of-network services are based on maximum reimbursable charges. The Out-of-Pocket Maximum includes deductibles and copays. You could be balanced billed by providers and/or facilities when using an out-of-network facility.

!

The prescription drug coverage provided by this medical plan 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. good2grow Benefit Guide | 9

FLEXIBLE SAVINGS ACCOUNT (FSA) Available each January only (and for new hires): As an employee of good2grow, you have the option to participate in a Flexible Savings Account (FSA) through WEX each open enrollment every January. An FSA allows you to set aside pre-tax money from your paycheck to pay for a variety of eligible health care and dependent care expenses. A separate enrollment email will be sent to you in December regarding calendar year enrollment.

Current Annual Maximum: Medical FSA: $2,850

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Current Annual Maximum: Dependent Care FSA: $5,000 (or $2,500 if married, filed separately)

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MEDICAL PLANS High Deductible HSA Plan $3000/20% with Open Access Plus (OAP) Network Plan Highlights

In Network – You Pay

Out-of-Network – You Pay

$3,000 /$6,000

$6,000/$12,000

20% after deductible

40% after deductible

$6,350/$12,700

$12,700 /$25,400

Virtual Care Visit

Deductible, then 20%

Deductible, then 40%

Primary Care Physician Office Visit

Deductible, then 20%

Deductible, then 40%

Mental Health Visit

Deductible, then 20%

Deductible, the 40%

Specialist Office Visit

Deductible, then 20%

Deductible, then 40%

Plan pays 100%

Deductible, then 40%

Laboratory Diagnostics & X-Ray

Deductible, then 20%

Deductible, then 40%

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

Deductible, then 20%

Deductible, then 40%

Hospital Inpatient Care

Deductible, then 20%

Deductible, then 40%

Outpatient Surgery

Deductible, then 20%

Deductible, then 40%

Emergency Room

Deductible, then 20%

Plan pays as In-network

Urgent Care

Deductible, then 20%

Deductible, then 40%

Deductible Individual/Family Coinsurance Annual Out-of-Pocket Maximum

Preventive Care Services

Prescription Drugs

You pay either a copay &/or coinsurance per the assigned prescription drug tier which can be found in the prescription drug formulary. This plan does NOT meet the CMS standard for creditable prescription drug coverage.

Prescription Deductible

Medical Deductible Applies

Tier 1 — Generic Drugs

Deductible, then Retail $10 copay

Tier 2 — Preferred Brand-Name

Deductible, then Retail $35 copay

Tier 3 — Non-Preferred BrandName

Deductible, then Retail $60 copay

Tier 4 - Specialty Drugs 90-Day Mail Order

Deductible, then Retail 20% to $250 Deductible, then 3 x 30-day Retail Copay

**You could be balanced billed by providers and/or facilities when using an out-of-network facility. good2grow will be utilizing HSA Bank through Cigna for its HSA administration. To request additional HSA cards, call Cigna OneGuide customer service at 866-494-2111. Remember to register on myCigna.com to access the HSA Bank website to create your login.

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The prescription drug coverage provided by this medical plan is not 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. good2grow Benefit Guide | 12

HEALTH SAVINGS ACCOUNT (HSA) The Health Savings Account (HSA) is a tax-advantaged, interest-bearing account used to pay for eligible health care expenses. You can open and contribute to an HSA if you are enrolled in the Cigna High Deductible HSA $3,000 Plan. Additionally, you are not required to take distributions. Your money can continue to grow in your account until you need it. Unlike flexible spending accounts which work on a “use it or lose it” principle, HSA’s are use it or keep it! You maintain complete control over how and when to make payments for qualified medical expenses from your account. You can make contributions to the HSA and all money in the account is yours to keep — even if you leave good2grow. You can withdraw your funds to pay for current qualified medical, dental and vision care expenses, or you can keep your money in the HSA to pay for future expenses. At the end of the year, any money in the HSA rolls over to the next year. You never lose it. New this year—good2grow will be contributing $250 annually to each employee’s HSA and $500 annually to each employee + dependent level HSA.

Coverage Level

IRS Maximum Allowable Calendar Year Contribution for 2022 (including good2grow’s contribution)

good2grow Annual contribution

Employee Only

$3,650

$250

Employee + Spouse, Employee + Children, Employee + Family

$7,300

$500

If age 55 or older

Additional $1,000 contribution permitted

N/A

good2grow Benefit Guide | 13

WHERE TO GO FOR CARE

good2grow Benefit Guide | 14

DENTAL Cigna is our dental carrier. The plan has two networks from which to choose –the Cigna DPPO Advantage network or the Cigna DPPO network. The plan features will vary based on weather or not your dentist is in the network. Keep in mind you will always save money by using an in-network provider. Out-of-network benefits mirror in-network benefits however the out-of-network provider may balance bill the member for services.

Dental Plan Highlights

Cigna DPPO Advantage

Cigna DPPO & Out-of-Network

Your Deductible

$50 individual / $150 Family

$50 individual / $150 Family

$1,500

$1,500

Plan pays 100%

Plan pays 100%

100% after deductible

80% after deducible

60% after deductible

50% after deductible

50%; $1,500 lifetime max

50%; $1,500 lifetime max

Calendar Year Maximum Applies to preventive, basic, and major services 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, Bridgework, Dentures, Bridges

Orthodontia (Child only up to age 19)

Dental Plan Reimbursement Levels

Additional Member Responsibility in excess of Coinsurance

Based on contracted fees

None

Cigna DPPO: Based on contracted fees; Out-ofNetwork: 90th percentile of submitted charges Yes, the difference between the member’s dentist’s billed charges and the dental plan reimbursement level good2grow Benefit Guide | 15

VISION Cigna is our vision carrier. good2grow offers a voluntary vision plan which provides coverage for routine eye exams and pays for all or a portion of the cost of glasses or contact lenses. You can see in– or out-of-network providers; however, you will always save money if you see in-network providers. To find in-network vision providers, please go to myCigna.com or call Cigna OneGuide at 866-494-2111.

VISION PLAN HIGHLIGHTS Services

In Network

Out Of Network

$10 Copay

Plan reimburses up to $45

$130 frame allowance

Plan reimburses up to $71

Eye Exam: (Once every 12 months) Routine Exam with dilation Frames: (Once every 24 months) Any available frame at provider location

Standard Plastic Lenses: (Once every 12 months) Single

Plan pays 100% after $25 Copay

Plan reimburses up to $32

Bifocal

Plan pays 100% after $25 Copay

Plan reimburses up to $55

Trifocal

Plan pays 100% after $25 Copay

Plan reimburses up to $65

Contact Lenses: (Material Only; in lieu of eyeglasses) (Once every 12 months) Elective contact lenses: Medically Necessary

$130 allowance

Plan reimburses up to $105

Covered in full

Plan reimburses up to $210

Frequency: Examination

12 months

Frames

24 months

Eyeglass Lenses

12 months

Contact Lenses

12 months good2grow Benefit Guide | 16

LIFE INSURANCE AND AD&D 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 employee, good2grow provides Employer Paid Basic Life insurance 1 times your salary to a maximum of $100,000 of basic group term life insurance and an additional matching amount of accident death and dismemberment (AD&D) to you at no cost through Cigna. Coverage is reduced by 35% at age 65, by 60% at age 70, by 75% at age 75 and by 85% at age 80. All amounts are guaranteed issue which means there are no medical questions.

Supplemental Voluntary Life and AD&D Insurance Employees have the option of purchasing Supplemental Life Insurance, on top of their employer-paid life insurance through Cigna.

Supplemental Life Insurance and Accidental Death and Dismemberment (AD&D) are intended to provide additional protection to full-time employees. AD&D provides additional protection in the event of accidental death. It also covers loss of limb or eye due to accident.

Those interested can elect the amount that suits their needs at an affordable rate.

Employees: This coverage is available in increments of $10,000 to a maximum of $500,000. The guarantee issue amount is $100,000. If you apply for more than $100,000 you will need to seek approval for this coverage by completing an Evidence of Insurability form, where you will answer a series of simple health questions for Cigna underwriting to review.

If enrolling you may also elect coverage for your spouse or children.

Spouse/Domestic Partner: Increments of $5,000 to the lesser of $250,000 or 100% of your amount. The guaranteed issue amount is $50,000.

Choose Your Beneficiary

Child: Elect either $5,000 or $10,000 and one rate will cover all dependent children. All child life is guarantee issue.

→Make sure your life and accident

death benefits will be paid as you intend.

Voluntary Life Guarantee Issue Schedule

→Be sure you name a beneficiary when

• • •

you enroll in Life and AD&D benefits during open enrollment.

Employee: $100,000 Spouse: $50,000 Child: $10,000

→Then, continue to review your

beneficiary designations as you experience life changes.

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DISABILITY INSURANCE Disability insurance provides income replacement should you become disabled and unable to work due to a non-work-related illness or injury. good2grow provides eligible employees with disability income benefits as shown below at no cost to you. Coverage is automatic. You do not need to enroll.

Short-Term Disability (Employer Paid) good2grow provides full-time employees with Short Term Disability coverage through Cigna. You will receive 60% of your weekly earnings to a maximum of $2,000. Benefits begin on the 15th day after an accident or illness and can last for up to 11 weeks depending on the illness or accident. There are two weeks to subtract being paid a disability benefit. For example, a standard pregnancy delivery is 6 weeks with a benefit payment of 4 weeks.

Long-Term Disability

(Employer Paid)

good2grow provides Long-Term Disability (LTD) coverage through Cigna which offers income protection if you become disabled and cannot work for an extended period of time. The LTD benefit begins after 90 Days and pays 60% of your monthly salary. Benefits are paid as long as you remain disabled, in general until you reach age 65 or the Social Security Normal Retirement Age.

Life Assistance Program (LAP) Life Assistance Program (LAP) is complimentary and confidential. Receive expert support services to assist you and your family with a variety of life issues from family care, stress, depression or addiction. In today’s environment, we acknowledge that addressing work-life balance issues is more important than ever. If you find yourself in need of some professional support to deal with personal, work, financial or family issues, your LAP can help. LAP includes 3 face-to-face sessions. To speak with an advocate or request a referral to a counselor at any time (24/7), please call 800-538-3543, or online at cignalap.com. You and your immediate family (spouse or domestic partner, dependent children, parents and parents-in-law) can use the LAP for help with: • Marriage and family concerns

• Parent and child relationships

• Identity theft counseling

• Job-related issues

• Legal and financial counseling

• Various other related issues

• Stress, anxiety and depression

• Financial planning

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ACCIDENT INSURANCE You can’t always avoid accidents ─ but you can protect yourself from accident-related costs that can strain your budget.

Accident insurance from Cigna pays a benefit directly to you if you have a covered injury and need treatment. You can get coverage for your spouse and dependents, too. As medical costs continue to rise, accident insurance provides a necessary layer of financial protection.

Based on which plan level you choose, Cigna has a Wellness Reimbursement where you receive $50 per year (or $75 per year) benefit by simply having a preventive visit with a screening.

Payroll Deductions for the Accident Insurance are available in the Paylocity enrollment portal.

LEGAL SERVICES Expected and unexpected legal issues arise every day. With a $21.95 monthly fee, LegalShield provides you with access to advice and counsel on an unlimited number of personal legal issues from lawyers with an average of 22 years’ experience. (Employees located in MA, pricing is $20.95.)

• • • • • • • • •

Advice for any personal legal matter—even prior issues Letters – Phone calls on your behalf Contract and Document Review (up to 15 pages) 24/7 Emergency Assistance Standard Will Preparation Non-criminal moving traffic violation assistance Uncontested Adoption Representation Trial Defense Services – civil suit action filed in court 25% Discount to use your provider’s law firm for legal situations extending beyond the plan coverage

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CONTRIBUTIONS Please refer to the chart below for your bi-weekly payroll deductions. Payroll deductions for other lines of coverage which vary by age and/or amount will be found in Paylocity.

Employee Only

Cigna Buy-Up OAP Network $1000/20% $84.44

Employee + Spouse

$289.74

$217.55

$181.61

$145.87

Employee + Children

$262.44

$197.06

$164.49

$132.13

Employee + Family

$426.89

$320.51

$267.57

$214.91

Level of Coverage

Cigna Mid Plan Cigna Local Plus HDHP with HSA OAP Network Network OAP Network $2000/20% $2000/20% $3000/20% $61.73 $49.87 $40.65

Level of Coverage

Dental

Vision

Employee Only

$8.06

$1.46

Employee + Spouse

$25.60

$3.98

Employee + Children

$36.66

$4.29

Employee + Family

$54.06

$6.59

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KEY CONTACTS & RESOURCES Your Broker Support Contacts

JANE MURPHY SSP SR ACCOUNT ANALYST 404-949-1076 jane.murphy@sspins.com EMBER FORD SSP SR CLIENT SERVICES EXECUTIVE 404-949-1022 eford@sspins.com

KEY CONTACTS & RESOURCES Benefit

Company

Phone

Website

Medical Coverage

Cigna

866-494-2111

www.myCigna.com

Flexible Spending Account (FSA)

WEX/Discovery

866-451-3399

www.wexinc.com or email customerservice@wexhealth.com

Health Savings Account (HSA)

HSA Bank/Cigna

866-494-2111

www.myCigna.com

Telemedicine (AmWell Health/MDLive)

Cigna

MD Live: 888-726-3171 AmWell: 855-667-9722

https://MDLiveforCigna.com Https://AmwellforCigna.com

Dental, Vision, Life/AD&D

Cigna

866-494-2111

www.myCigna.com

Voluntary Life, STD & LTD

Cigna

866-494-2111

www.myCigna.com

Life Assistance Program (LAP)

Cigna

800-538-3543

www.cignalap.com

Accident Insurance

Cigna

800-244-6224

www.cigna.com

Legal Services Coverage

LegalShield

800-654-7757 (general) Or 770-853-2925 (Beth Fincher LegalShield Rep)

www.legalshield.com

Online Enrollment

Paylocity

Benefits/Human Resources

Leah Rainwater

https://access.paylocity.com/ 404-936-8137

Leah.rainwater@good2grow.com good2grow Benefit Guide | 21

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 employersponsored 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 1877-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 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.

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IMPORTANT INFORMATION Duration of USERRA Coverage General Rule: 24-Month Maximum. When a covered employee takes a leave for service in the uniformed services, USERRA coverage for the employee (and covered dependents for whom coverage is elected) can continue until up to 24 months from the date on which the employee's leave for uniformed service began. However, USERRA coverage will end earlier if one of the following events takes place: A premium payment is not made within the required time; You fail to return to work or to apply for reemployment within the time required under USERRA (see below) following the completion of your service in the uniformed services; You lose your rights under USERRA as a result of a dishonorable discharge or other conduct specified in USERRA. Notice of Privacy Provision This Notice of Privacy Practices (the "Notice") describes the legal obligations of [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.

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IMPORTANT INFORMATION 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

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.

To request special enrollment or obtain more information, please contact HR. good2grow Benefit Guide | 25

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. good2grow Benefit Guide | 26

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.

1. Employer Name good2grow, LLC

2. Employer Identification Number (EIN) 26-0769570

3. Employer Address 2859 Paces Ferry Rd, SE Suite 2100

4. Employer Phone Number 770-356-7074

5. City Atlanta

6. State GA

7. Zip Code 30339

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

Leah Rainwater 9. Phone Number (if different from above)

10. Email Address Leah.rainwater@good2grow.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:

X

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:

X

Spouses, domestic partners and children up to age 26.

We do not offer coverage.

X

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. good2grow Benefit Guide | 27

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 good2grow 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.

•

good2grow has determined that the prescription drug coverage offered by the Cigna Traditional Buy Up, Cigna Mid and Cigna Local Plus 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 good2grow coverage will not be affected. Please review prescription drug coverage plan provisions/options under the certificate booklet provided by Cigna. 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 good2grow 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 good2grow 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 good2grow 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).

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IMPORTANT NOTICE ABOUT YOUR PRESCRIPTION DRUG COVERAGE & MEDICARE NON-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 good2grow 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. good2grow has determined that the prescription drug coverage offered by the Cigna HDHP HSA Plan is, on average for all plan participants, NOT expected to pay out as much as standard Medicare prescription drug coverage pays.

Therefore, your coverage is considered NonCreditable Coverage. This is important because, most likely, you will get more help with your drug costs if you join a Medicare drug plan, than if you only have prescription drug coverage from the Cigna Plan. This also is important because it may mean that you may pay a higher premium (a penalty) if you do not join a Medicare drug plan when you first become eligible.

You can keep your current coverage from the Cigna HDHP HSA plan. However, because your coverage is non-creditable, you have decisions to make about Medicare prescription drug coverage that may affect how much you pay for that coverage, depending on if and when you join a drug plan. When you make your decision, you should compare your current coverage, including what drugs are covered, with the coverage and cost of the plans offering Medicare prescription drug coverage in your area. Read this notice carefully - it explains your options.

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.

EMPLOYER GROUP PLAN

If you decide to drop your current coverage with good2grow, you will be eligible for a two (2) month Special Enrollment Period (SEP) to join a Medicare drug plan. However you also may pay a higher premium (a penalty) because you did not have creditable coverage under HDHP. When Will You Pay A Higher Premium (Penalty) To Join A Medicare Drug Plan?

Since the coverage under Cigna HDHP HSA plan, is not creditable, depending on how long you go without creditable prescription drug coverage you may pay a penalty to join a Medicare drug plan. Starting with the end of the last month that you were first eligible to join a Medicare drug plan but didn’t join, if you go 63 continuous days or longer without prescription drug coverage that’s creditable, 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 (penalty) as long as you have Medicare prescription drug coverage. In addition, you may have to wait until the following October to join.

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IMPORTANT NOTICE ABOUT YOUR PRESCRIPTION DRUG COVERAGE & MEDICARE NON-CREDITABLE (CONT.) When Will You Pay A Higher Premium (Penalty) To Join A Medicare Drug Plan?

If you decide to join a Medicare drug plan, your current good2grow coverage may be affected. Please review prescription drug coverage plan provisions/options under the certificate booklet provided by Cigna HSA Plan.

See pages 7- 9 of the CMS Disclosure of Creditable Coverage To Medicare Part D Eligible Individuals Guidance (available at http:// www.cms.hhs.gov/CreditableCoverage/), 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 good2grow coverage, be aware that you and your dependents may not be able to get this coverage back. drug plan. When you make your decision, you should compare your current coverage, including what drugs are covered, with the coverage and cost of the plans offering Medicare prescription drug coverage in your area. Read this notice carefully - it explains your options.

For more information about this notice or your current prescription drug coverage contact human resources.

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