MetroDerm, P.C. Benefit Guide

2022

BENEFITS GUIDE January 1, 2022 – December 31, 2022

WELCOME! Our employees are our greatest resource. That's why MetroDerm, P.C. is continuing to provide you with health plans, wellness enhancements, and benefits that make sense for you and your family, your busy lifestyle, and your wallet.

Please take the time to carefully review the information, carrier changes and all the benefits offered to you, to ensure you get the best value based on your needs. We hope the benefits offered will inspire you and your dependents to take charge of your health and continue making wellness a priority.

OPEN ENROLLMENT Open Enrollment is your opportunity to add, cancel, or make changes to your benefits. This year, open enrollment will be Monday, November 29th – Friday, December 3rd.

Once you elect your benefits, the elections remain in effect for the plan year, January 1st, 2022 – December 31st, 2022. You may only change coverage due to an IRS qualified “life event” and must do so within 30 days of the event. A qualifying event is a significant change in a person’s life that creates the need to add, cancel, increase, or change coverage. We encourage you to review all your benefits and make selections wisely.

This year we will be using Employee Navigator to make our benefits elections. You must elect or decline coverage through Employee Navigator no later than Friday, December 3rd.

ELIGIBILITY

QUALIFYING EVENTS

New hires are eligible for benefits on the first of the month following 60 days from your date of hire. You may enroll yourself and eligible dependents for coverage. You must enroll yourself in benefits in order to enroll your dependents. Eligible dependents include your spouse, dependent children, legally adopted children and stepchildren. Spouses and dependent children are eligible for: Medical, Dental, Vision, Accident, Critical Illness, and Voluntary Life.

Once you have made your elections, you are NOT eligible to change or drop coverage until the next Open Enrollment period unless you have a qualifying event. If you experience a qualifying life event, contact the Human Resources Department within 30 days of your qualifying event. If you fail to do so, you will have to wait until the next open enrollment period to make any changes to your coverage. Qualifying life events include, but are not limited to:

Dependent children are eligible for the group health plan until their 26th birthday regardless of whether they are a full-time student.

•

Marriage

•

Divorce

• •

Birth or adoption Employment changes from Part-time to Full-time Change in dependent status (i.e.

Dependent child reaches age 26 limit)

•

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HOW TO ENROLL All employees are required to login to Employee Navigator to make elections or waive coverage. To begin, visit www.employeenavigator.com and use the steps below to login or you can click here to watch an instructional video.

1. Click "Login" at the top right-hand corner of the page.

2. Click on Register as a new user. For the 2022 Open Enrollment, all employees will need to register as a NEW USER. Prior Employee Navigator logins will not be active.

3.

Create your account by entering: • Your first and last name as they appear in payroll.

• The MetroDerm P.C. company identifier – MetroDerm-PC • The last 4 digits of your SSN. • Your date of birth.

If you encounter a login error, please reach out to Marie Volk at Sterling Seacrest Pritchard – mvolk@sspins.com.

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MEDICAL

Medical benefits are available through Aetna.

In-Network

EHDHP

AETNA HNOption 3000/100 HNOption

Coinsurance

0%

0%

0%

0%

Deductible - EE/Fam

$5,000 / $10,000

$3,000 / $6,000

$5,000 / $10,000

$2,000 / $4,000

Out-of-Pocket - EE/Fam

$6,900 / $13,800

$6,000 / $12,000

$7,900 / $15,800

$8,000 / $16,000

Covered in Full

Covered in Full

Covered in Full

Covered in Full

Office Copay - PCP Office Copay – Specialist

Deductible + 0%

$30 $60

$30 $60 after Deductible

$40 $75

Diagnostic Lab (x-ray, blood work)

Deductible + 0%

Deductible + 0%

Deductible + 0%

Deductible + 0%

Urgent Care ER

Deductible + 0%

$60 $500

$75 $500 after Deductible

$75 $500

Telemedicine

Deductible + 0%

PCP Copay

PCP Copay

PCP Copay

Inpatient Hospital & Services

Deductible + 0%

Deductible + 0%

Deductible + 0%

Deductible + 0%

Complex Imaging

Deductible + 0%

Deductible + 0%

Deductible + 0%

Deductible + 0%

Outpatient Surgery Hospital

Deductible + 0%

Deductible + 0%

Deductible + 0%

Deductible + 0%

Shared with Medical Ded.

None

Shared with Medical Ded.

None

$10 / $30 / $60 $250 / $500

$15 / $35 / $65 $250 / $500

$15 / $35 / $65 / $250

$15 / $35 / $65 $250/$500

70%

70%

70%

70%

Deductible - EE/Fam

$10,000 / $20,000

$6,000/$12,000

$5,000 / $10,000

$10,000 / $30,000

Out-of-Pocket - EE/Fam

$20,000 / $40,000

$12,000/$24,000

$23,700 / $47,400

$20,000 / $40,000

$98.02

$173.23

$63.62

$206.73

Employee & Spouse

$414.69

$581.65

$338.33

$656.02

Employee & Child(ren)

$323.84

$464.48

$259.51

$527.12

Family

$596.38

$815.99

$495.94

$913.80

AETNA EHDHP 5000/100

Wellcare

AETNA OAMC 5000/100

AETNA OAMC 2000/100

OAMC

OAMC

Prescription Drugs Rx Deductible Pref Rx Copays Tiers 1a / 1 / 2 / 3 / 4 Out-of-Network Coinsurance

Bi-Weekly Deductions Employee

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Teladoc.com/Aetna | 1-855-Teladoc(835-2362) ©Teladoc Health, Inc. All rights reserved. Teladoc and the Teladoc logo are registered trademarksof Teladoc Health, Inc. For a complete descriptionof the Teladoc program and the limitationsof Teladoc services, visitTeladoc.com/Aetna. 442274160_04202021

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H E A LT H S AV I N G S AC C O U N T Employees electing the Aetna EHDHP 5000/100 plan have the option to enroll in a Health Savings Account

WHAT IS AN HSA? A Health Savings Account (HSA) is like a 401(k) for healthcare.

It is a tax advantaged personal savings or investment account that you can use to save and pay for qualified health expenses, now or in the future.  Funds contributed to the HSA are not subject to federal income tax at the time of deposit.  Withdrawals for qualified medical expenses are also taxfree.  HSA funds may be used to pay for qualified medical expenses at any time without federal tax liability or penalty.  HSAs are portable, which means you keep your HSA, even if you leave MetroDerm, P.C. or are unemployed.  Funds roll over and accumulate year to year if not spent.

CONTRIBUTIONS Maximum contributions for the 2022 plan year are listed below. This amount includes employer contributions.

• $3,650 for Individual coverage • $7,300 for Family coverage • Additional $1,000 for “Catch-Up” age 55 and older

WHAT ARE QUALIFIED MEDICAL EXPENSES? Examples of HSA eligible expenses are copays, deductibles, qualifying prescriptions, and qualifying medical equipment. A full description of qualified HSA expenditures can be found in IRS Publication 502 and is located on the web at www.irs.gov/pub/irs-pdf/p502.pdf.

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D E N TA L Dental benefits are available through Aetna.

Your Network is

PPO/PDN with PPO II

Annual Deductible (Waived for Preventative) Individual / Family

$50 / $150

Yearly Maximum Benefit per Person

$1,500

Preventative Services (Oral Exams, Cleanings, X-rays)

100%

Basic Services (Fillings, Simple Extractions, etc.)

80%

Major Services (Crowns, Endodontics, Periodontics, etc.)

50%

Out-of-Network UCR

90th

COST PER PAYCHECK (26) Employee Only

$17.14

Employee Spouse

$34.26

Employee + Child(ren)

$47.61

Family

$65.59

VISION Aetna offers easy access to thousands of conveniently located vision care providers Network Exam (1x per calendar year) Frames (once every 24 months)

Aetna Network Vision $10 $160 retail max + 15% off balance

Lenses (once every 12 months) Single

$25

Bifocal

$25

Trifocal

$25

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

$160 max

COST PER PAYCHECK (26) Employee Only

$3.14

Employee Spouse

$5.96

Employee + Child(ren)

$6.27

Family

$9.22

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M e t r o D e r m , P. C . O F F E R S : Voluntary Life Insurance and AD&D – Employees are offered the option to purchase additional life insurance through Unum. Rates will vary based on age and the benefit you select. All rates can be found in your Employee Navigator portal.

Plan Highlights Employee: Spouse: Child(ren):

Increments of $10,000 up to a maximum of $500,000 subject to medical eligibility. At your initial enrollment, you are eligible for up to a $150,000 with no medical questions asked.

Increments of $5,000 up to a maximum of $500,000 (not to exceed 100% of employee’s amount).

Subject to medical eligibility. At your initial enrollment, your spouse is eligible for up to a $15,000 with no medical questions ask.

Increments of $2,000 up to a maximum of $10,000. Coverage begins at 15 days.

Voluntary Short-Term Disability – Provided through Unum Benefit Amount: Up to 60% of monthly salary up to a maximum of $5,000 for non-work-related accidents or sickness.

Waiting Period: 14 days Benefit Period: up to 3 months

Supplemental Benefit – Through Unum, Employees can purchase Accident Insurance or Critical Illness insurance to offset medical cost.

Identity Protection (NEW) – Employees have the option to purchase Identity Protection through Allstate. Coverage includes identity monitoring, credit monitoring, full remediation and up to $1 million expense coverage and stolen funds reimbursement. Bi-Weekly - Employee Only Coverage - $4.61 / Family Coverage - $8.28

Pet Benefit Solutions (NEW) – pet care bundle includes everyday savings on veterinary care and pet products, and access to other pet care services. Bi-Weekly – One Pet- $5.42 / Family (2+ pets) - $8.54

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

Your Employee Support Contacts Claims Questions?

Benefit Questions?

Kristie Mercer 770.635.2293 kmercer@sspins.com

Marie Volk 770.635.0451 mvolk@sspins.com

BE SURE TO HAVE THE FOLLOWING INFORMATION WHEN CALLING:

Garry Hill 678.424.6593 ghill@sspins.com

Subscriber ID # Date of Service Name of Patient Name of Doctor, Facility or Hospital Copy of Bill or Explanation of Benefits (EOB)

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

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

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

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

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

SPECIAL ENROLLMENT NOTICES

NEWBORNS' & MOTHERS' HEALTH PROTECTION ACT

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

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

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

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

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

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