Passion, Inc. 2026_Print - FINAL

Enrollment + Eligibility Who is Eligible to Join the Benefit Plan?

You and your dependents are eligible to join the health and our company welfare 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.

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. The change to your benefit elections must be consistent with and on account of the change in life status.

IRS-approved qualifying life status changes include:

Who is an Eligible Dependent?

•

Your spouse to whom you are legally married

•

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

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

A totally disabled child who is physically or mentally disabled prior to age 26 may remain on the 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 first day of hire as a full-time employee with Passion, Inc.

•

Marriage, divorce or legal separation

•

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

•

Death of a dependent

•

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

•

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

•

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

•

If you or your dependents lose eligibility for Medicaid or the Children’s Health Insurance Program (CHIP) coverage

•

If you or your dependents become eligible for a state’s premium assistance subsidy under Medicaid or CHIP

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

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.

This guide provides a basic overview of benefits. Please see plan documentation for full detail.

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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.

Preventative 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

Immunizations

Understanding What’s Covered

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

Some immunizations and vaccinations are also considered preventive care services.

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

Generally speaking, if a service is considered preventive care, it will be covered at 100%. If it’s not, it may still be covered subject to a copay, deductible or coinsurance. The Affordable Care Act (ACA) requires that services considered preventive care be covered by your health plan at 100% 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.

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Medical Ameriben / Anthem Buy-Up Plan Plan Highlights Deductible – Individual | Family

Base Plan

In Network

Out-of-Network

In Network

Out-of-Network

$1,500 | $3,000

$3,000 | $6,000

$2,500 | $5,000

$5,000 | $10,000

Coinsurance – You pay

0% after deductible

30% after deductible 20% after deductible 40% after deductible

Annual Out-of-Pocket Maximum Individual | Family

$5,000 | $10,000

$10,000 | $20,000

$5,000 | $10,000

$10,000 | $20,000

Primary Care Physician Office Visit

$30 copay

30% after deductible

$50 copay

40% after deductible

Specialist Office Visit

$60 copay

30% after deductible

$75 copay

40% after deductible

Preventive Care Services

Plan pays 100%

30% after deductible

Plan pays 100%

40% after deductible

Laboratory Diagnostics & X-Ray

Plan pays 100%

30% after deductible

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

Plan pays 100%

30% after deductible

Hospital Inpatient Care

0% after deductible

30% after deductible

Outpatient Surgery

0% after deductible

30% after deductible

Emergency Room

$350 copay

$350 copay

$350 copay

$350 copay

Urgent Care

$50 copay

$50 copay

$50 copay

$50 copay

Deductible, then 20% Deductible, then 20% Deductible, then 20% Deductible, then 20%

40% after deductible 40% after deductible 40% after deductible 40% after deductible

Prescription Drugs

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

Tier 1 — Generic Drugs

Retail: $10 copay Mail Order: $25 copay

Retail: $10 copay Mail Order: $25 copay

Tier 2 — Preferred Brand-Name

Retail: $35 copay Mail Order: $88 copay

Retail: $50 copay Mail Order: $125 copay

Tier 3 — Non-Preferred Brand-Name

Retail: $75 copay Mail Order: $188 copay

Retail: $100 copay Mail Order: $250 copay

Tier 4 - Specialty Drugs

Retail: $150 copay Mail Order: $150 copay – 30-day supply

Retail: 25% to a max of $300 Mail Order: 25% to a max of $300 – 30day supply

Buy-Up Plan

Base Plan

Employee Only

$15.00

$0.00

Employee + Spouse

$338.02

$248.50

Employee + Child(ren) Employee + Family

$288.31 $587.88

$205.19 $457.86

Medical Contributions (pretax) Per Pay Period – 24 per year

This is only a summary of your plans. This summary shows in-network coverage only for illustrative purposes. For more information about your coverage, or to view a copy of the complete terms of coverage, please reference your plan summaries and SBCs. These documents will govern over this benefit guide illustration.

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Telemedicine AVAILABLE TO THOSE ENROLLED IN ANTHEM MEDCIAL COVERAGE

SAVE TIME. SAVE MONEY! When you use LiveHealth Online to treat an injury, illness or to get the advice you need, the cost is simple with a $0 copay per visit!

24/7 + ACCESS TO A DOCTOR Don’t wait weeks for an appointment and skip the trip to urgent care. LiveHealth Online connects you with the right care — right now.

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

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

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

DOCTORS LOCATED ALL 50 STATES

THE RIGHT CARE WHEN YOU MOST NEED IT EVERYDAY CARE

MEDICAL EXPERTS

MENTAL HEALTH

WELLNESS & PREVENTION

SET UP YOUR ACCOUNT IN MINUTES Most people download the app or get started online. You can also call 1-888-LiveHealth. Then fill out a brief medical history like you would at a doctor’s office.

ACROSS

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Introducing

AmeriBen Engage A new enhanced member experience There’s nothing more important than your health, and AmeriBen Engage guide you through your healthcare journey every step of the way.

Find quality, innetwork providers near you

Compare estimated costs for care before you go

Understand your health plan

is the new way to

Take your digital member ID card onthe-go

AmeriBen Engage connects you to everything you need to easily manage your healthcare, meet your goals and live healthier.

AmeriBen EngageTM app and website are available 7/01/2025!

Visit engage.ameriben.com.

• Download the AmeriBen Engage app.

•

AmeriBen is a separate and independent company providing medical benefits administration services on behalf of self-funded group health plans.

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Receive virtual care and support When you aren’t feeling your best — physically, mentally, or emotionally — or you need guidance managing a health condition, help is available. You can connect to the care you need by logging in to engage.ameriben.com. You can have a video visit with a doctor 24/7 for common health issues and annual wellness visits. Care for mental and emotional health is available by appointment.1

Visit with a doctor for common medical concerns Doctors are available anytime, with no long wait times and no appointments needed. They can help you with health issues, such as a cold or the flu, allergies, sore throat, migraines, or skin rashes. During your private and secure video visit, the doctor will assess your condition, provide a treatment plan, and send prescriptions to the pharmacy of your choice, if needed.2

Receive care for your behavioral health If you’re feeling anxious or depressed, or having trouble coping, you can set up a video visit with a therapist, psychologist, or psychiatrist.3 Appointments can be scheduled within one to two weeks.1 Psychiatrists help manage medications; they do not provide counseling or talk therapy.4

What people say about virtual care visits5

92% were able to book a virtual visit sooner than an in-person visit

89% said the doctor they saw was professional and helpful

92% thought the doctor understood their concerns

Log in to engage.ameriben.com to get started.

1 Appointments subject to availability.

2 The doctor will determine what medications should be prescribed or refilled.

3 Online counseling is not appropriate for all kinds of problems. If you are in crisis or having suicidal thoughts, it’s important that you seek help immediately. Please text, chat, or call 988 (Suicide and Crisis Lifeline), or 911 for help.

If your issue is an emergency, call 911 or go to your nearest emergency room. Emergency services are not provided through virtual care on anthem.com.

4 Prescriptions determined to be a “controlled substance” (as defined by the Controlled Substances Act under federal law) cannot be prescribed through virtual care on anthem.com.

5 Based on SydneySM Health utilization trends from top national clients.

In addition to using a telehealth service, you can receive in-person or virtual care from your own doctor or another healthcare provider in your plan’s network. If you receive care from a doctor or healthcare provider not in your plan’s network, your share of the costs may be higher. You may also receive a bill for any charges not covered by your health plan.

Anthem Blue Cross and Blue Shield is the trade name of: In Colorado: Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc. In Connecticut: Anthem Health Plans, Inc. In Indiana: Anthem Insurance Companies, Inc. In Georgia: Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. and Community Care Health Plan of Georgia, Inc. In Kentucky: Anthem Health Plans of Kentucky, Inc. In Maine: Anthem Health Plans of Maine, Inc. In Missouri (excluding 30 counties in the Kansas City area): RightCHOICE® Managed Care, Inc. (RIT), Healthy Alliance® Life Insurance Company (HALIC), and HMO Missouri, Inc. RIT and certain affiliates administer non-HMO benefits underwritten by HALIC and HMO benefits underwritten by HMO Missouri, Inc. RIT and certain affiliates only provide administrative services for self funded plans and do not underwrite benefits. In Nevada: Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc., dba HMO Nevada. In New Hampshire: Anthem Health Plans of New Hampshire, Inc. HMO plans are administered by Anthem Health Plans of New Hampshire, Inc. and underwritten by Matthew Thornton Health Plan, Inc. In 17 southeastern counties of New York: Anthem HealthChoice Assurance, Inc., and Anthem HealthChoice HMO, Inc. In these same counties Anthem Blue Cross and Blue Shield HP is the trade name of Anthem HP. LLC. In Ohio: Community Insurance Company. In Virginia: Anthem Health Plans of Virginia, Inc. trades as Anthem Blue Cross and Blue Shield, and its affiliate HealthKeepers, Inc. trades as Anthem HealthKeepers providing HMO coverage, and their service area is all of Virginia except for the City of Fairfax, the Town of Vienna, and the area east of State Route 123. In Wisconsin: Blue Cross Blue Shield of Wisconsin (BCBSWI), underwrites or administers PPO and indemnity policies and underwrites the out-of-network benefits in POS policies offered by Compcare Health Services Insurance Corporation (Compcare) or Wisconsin Collaborative Insurance Corporation (WCIC). Compcare underwrites or administers HMO or POS policies; WCIC underwrites or administers Well Priority HMO or POS policies. Independent licensees of the Blue Cross and Blue Shield Association. Anthem is a registered trademark of Anthem Insurance Companies, Inc. AmeriBen is a separate and independent company providing medical benefit plan administration services on behalf of self-funded group health plans. Engage is the trade name of Castlight, Inc., a separate and independent company offering care management services on behalf of your health plan.

1076001CAMENABS 10/24

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AmeriBen

Customer Care Helping employees understand benefits, claims, and billing details.

AmeriBen Engage Portal You can also access engage.ameriben.com, our digital portal 24 hours, seven days a week for benefit information, claims status and digital ID cards.

AmeriBen’s representatives are available from 8 a.m. to 8 p.m. Eastern time.

Customer Care is available 8 a.m. - 8 p.m. ET

Precertification Services Some medical services require precertification. To submit forms or to find out if your medical procedure or service requires precertification, please call your dedicated AmeriBen Medical Management Services line at 855-258-2653.

AmeriBen is a separate and independent company providing medical benefits administration services on behalf of self-funded group health plans.

Call 855-778-9044 Visit: engage.ameriben.com

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Flexible Spending Account (FSA) Provided by Flores Passion offers employees the opportunity to participate in the Healthcare Flexible Spending Account (FSA) and Dependent Care FSA (DCFSA). These programs may provide you with significant tax advantages as they allow you to pay for eligible out-of-pocket expenses with pre-tax dollars through payroll deductions.

Healthcare Flexible Spending Account You may defer up to $3,300 to your Healthcare FSA to fund eligible out-of-pocket healthcare, dental and/or vision expenses. The following list provides examples of expenses eligible for reimbursement under the IRS guidelines: • • • • • •

Non-covered medical expenses that quality under Section 217 of the IRS code Deductibles Office visit copays Prescription medication Over-the-counter medications Hearing and dental expenses not covered by insurance

Examples of non-eligible expenses include: cosmetic surgery, electrolysis, toiletries, vitamins, health club dues.

Dependent Care FSA You may defer up to $5,000 to your Dependent Care FSA to fund eligible out-of-pocket expenses for childcare and eldercare. Funds remaining in the Dependent Care FSA do not rollover. To be eligible for reimbursement, expenses must meet the following criteria established by the IRS: o o o o o

The person cared for must be under age 13, or if older, physically or mentally incapable of self-care.

Day care must be necessary in order for you and your spouse to work.

The person cared for must be claimed as a dependent on your federal tax return and must reside in your home at least eight hours per day.

Payment for care cannot be made to anyone you claim as a dependent on your income tax return, to your spouse or to a child under age 19.

If care is provided by a center that cares for more than six individuals, it must be licensed.

The FSA contributions require an enrollment each year. If there are funds remaining in the Health FSA at the end of 2025 – and you choose not to enroll in the Health FSA for 2026 – you will be able to file for reimbursement of available funds for 90 days post 12/31/2025. If you enroll in the Health FSA in 2026 – your 2025 remaining funds up until $660 will rollover for use.

For a complete list of eligible medical and dependent care expenses, you may access publications #502 (healthcare) and #503 (dependent care) on the web at www.irs.gov.

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Healthcare (FSA) YOUR STEPS TO SAVINGS!

1 2 3

REALIZE THE TAX SAVINGS You can set aside pre-tax money into an account to be reimbursed for eligible medical expenses. Savings will depend on your tax bracket. For example, if you are taxed at 25% and you enroll for $3,050 you would save $762.50 in taxes.

ESTIMATE YOUR EXPENSES Plan for your upcoming expenses and include your spouse and dependents, if eligible. A brief list of expenses can be found to the right. A comprehensive list of allowable expenses and an expense worksheet can be found at www.flores247.com.

ENROLL AND MANAGE YOUR ACCOUNT Contact your Human Resources Department to find out how to enroll for this benefit. Flores will send a custom Participant ID number via mail or email to help you manage your account. Contact information can be found on the back of this flyer.

THE HEALTH CARE FLEXIBLE SPENDING ACCOUNT (FSA) CAN REIMBURSE YOU FOR ELIGIBLE EXPENSES YOU OR YOUR ELIGIBLE DEPENDENTS INCUR THAT ARE NOT PAID BY YOUR EXISTING HEALTH CARE PLAN.

ELIGIBLE EXPENSES • Medical co-payments, co-insurance and deductibles • Routine wellness visits • Prescription expenses • Vision expenses (including eye exams, eyeglasses and contact lenses) • LASIK surgery • Dental expenses (excluding cosmetic procedures) • Orthodontia payments • Hearing expenses • Over-the-counter Medications • Menstrual Care Items • COVID-19 Related PPE

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Health Care FSA FAQs FREQUENTLY ASKED QUESTIONS HOW CAN I SUBMIT A CLAIM? Claims may be uploaded to your account on our participant Flores247 Web Portal, www.flores247.com, or using our Flores Mobile app. You may also submit your request for reimbursement via fax or mail, if you prefer. Please note that all claims must be received by the filing deadline for the applicable plan year in which your expenses were incurred.

WHAT MUST BE INCLUDED ON RECEIPTS? All receipts for reimbursement must include the following information: Date of service, Description of Service, Outof-Pocket Cost, Provider Name, and Patient Name.

WILL I HAVE A DEBIT CARD? Yes. Your plan offers a debit card. You are able to use your Flores Benefits Card at the point of purchase. Remember to keep all of your receipts in case they are requested for review.

DO I NEED TO RE-ENROLL IN THE HEALTH CARE FSA EACH YEAR? Yes, you must re-enroll with each new plan year. Elections do not rollover from year to year.

WHEN WILL I HAVE ACCESS TO THE FUNDS IN MY HEALTH CARE FSA? After your first Health Care FSA contribution to the plan, you will have access to the total amount you have elected for the plan year, regardless of the current balance in your flexible spending account.

HOW WILL REIMBURSEMENTS BE ISSUED? Reimbursements will be mailed as a check to your home address. If you would like to have your reimbursement issued as a direct deposit, you may add your direct deposit information on the participant website (www.flores247.com) or submit a completed Direct Deposit Information Form. If your plan offers the debit card, you may use this card at the point of purchase to access your FSA dollars.

CAN I CHANGE MY ELECTION DURING THE PLAN YEAR? You may only change your annual election during the plan year if you experience a qualifying status change event. You must notify your employer within 30 days of any status change event in order to change your election. See the Allowable Status Changes Guide on our website (www.flores247.com) for further information.

WHAT HAPPENS TO MY HEALTH CARE FSA IF I TERMINATE FROM THE COMPANY? Any expenses submitted for reimbursement must be incurred prior to your termination date or the benefit end date specified by your company. Claims must be submitted prior to the claims filing deadline for the plan year during which you terminated. In certain situations you may be eligible to continue your participation in the Health Care FSA through the election of COBRA. Please contact your Human Resource Department for further information.

CAN I SUBMIT MY SPOUSE’S / DEPENDENT’S MEDICAL EXPENSES TO MY HEALTH CARE FSA? Regardless of who is covered on your medical insurance, the Health Care FSA may reimburse expenses for your spouse or any qualifying tax or adult dependent.

WILL UNUSED FUNDS ROLLOVER TO THE NEXT YEAR? Yes. Your employer offers the Health FSA carryover, any unused balance up to $660 that remains in your account as of the last day of the plan year will roll into the new plan year for you to be able to use towards eligible expenses you incur during the new plan year.

HOW DO I OBTAIN MY ACCOUNT DETAILS?

HOW DO I SUBMIT DOCUMENTS TO FLORES?

WEBSITE Visit www.flores247.com and log in using Participant ID or User Name and password

MOBILE APP Download our mobile app from your app store

PID & PASSWORD ASSISTANCE Dial 800.840.7684

ONLINE Visit www.flores247.com and upload documents securely MOBILE Download Flores Mobile app Available for Apple or Android devices MAIL Flores & Associates, LLC PO Box 31397 Charlotte, NC 28231 FAX 800.726.9982 or 704.335.0818

CUSTOMER SERVICE 1.800.532.3327

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ACCESS BENEFITS WHEREVER. WHENEVER.

FEATURES View your account balances right on the home screen Submit Supporting Documentation Request for Reimbursement Upload documents from your camera roll Download Flores Mobile today

HOW TO USE Capture for Debit Card Documentation or Claim Submissions To submit a claim, select “Upload” from the main screen then select the type of claim to upload. You can then photograph your documentation, upload up to 10 images from your camera roll, and add claim details.

Once your claim is submitted you will receive the standard e-Status messages as the document is processed by Flores.

Viewing Account Information You are also able to access your Flores Account Information using this mobile app. By selecting one of your accounts, you will be taken to the responsive Flores247.com website without a need for an additional login. Through this portal you can view account history, plan documents, add Authorized Users, add/edit Direct Deposit information, and access helpful guides.

www.flores247.com

800.532.3327

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Dental Good dental care is critical to your overall well-being. With Unum Dental insurance, you can get the attention your teeth need — at a cost you can afford. Unum Dental allows you to see any dentist you choose. To get the most from your benefits and reduce out-of-pocket costs, choose an in-network provider by utilizing our large national network. These providers have agreed to file your claims and uphold the highest quality standards. You can find in-network providers at https://www.unumdentalcare.com/.

In-Network

Unum DENTAL – Plan Highlights Your Deductible

$50 individual / $150 Family

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

$1,000 combined In-network and Out-of-Network

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

100% (Deductible waived)

Basic Services: Filings, Simple Extractions, Oral Surgery, Emergency Treatment, Repair of Crown, Denture, or Bridge

80% After Deductible

Major Services: Crowns, Bridgework, Full & Partial Dentures, Implants, Inlays and Onlays, Endodontics, Periodontal Maintenance.

50% After Deductible

Orthodontics (Children up to age 19)

50%

Lifetime Orthodontia Maximum

$1,000

Dental Contributions (pretax) Per Pay Period – 24 per year Employee Only

$0.00

Employee + Spouse

$10.19

Employee + Child(ren) Employee + Family

$11.04 $16.79

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Vision EyeMed’s Vision Care, offers easy access to thousands of conveniently located vision care providers. By having access to a nationwide network, it offers convenient, accessible options for eye care including optometrists, ophthalmologists, opticians and many leading optical retailers, such as Private Practitioners, LensCrafters, Target Optical, most Sears Optical, Pearl Vision and JC Penny Optical locations.

EyeMed Vision- Plan Highlights Services

Providers Plus

In Network

Out Of Network

$0 Copay

$10 Copay

Up to $39

$180 allowance + 20% off balance

$130 frame allowance + 20% balance

Up to $91

Single

$20 Copay

$20 Copay

$30

Bifocal

$20 Copay

$20 Copay

$50

Trifocal

$20 Copay

$20 Copay

$70

$180 allowance + 15% off balance

$130 allowance + 15% off Balance

Up to $91

Paid in full

$210 allowance

Routine Exam Frames: Any available frame at provider location Standard Plastic Lenses:

Contact Lenses: (Material Only) Conventional Medically Necessary

Frequency: Exam | Frames | Lenses | Contact

12 | 24 | 12 | 12

Vision Contributions (pretax) Per Pay Period – 24 per year Employee Only

$0.00

Employee + Spouse

$1.41

Employee + Child(ren) Employee + Family

$1.53 $2.33

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Life and Accidental Death + Dismemberment (AD+D) BASIC LIFE AND AD&D Basic Term Life means that you keep the coverage for a set period of time, or “term.” If you die during that term, the money can help your family pay for basic living expenses, final arrangements, tuition and more.

AD&D Insurance is also available, which can pay a benefit if you survive an accident but have certain serious injuries. It can pay an additional amount if you die from a covered accident. Your employer is offering this coverage at no cost to you.

Company Paid Basic Life | Unum Benefit Amount

1x Annual Salary up to $200,000

AD&D Coverage

Included

Cost

100% Employer Paid

VOLUNTARY LIFE AND AD&D You choose the amount of coverage that’s right for you, and you keep coverage for a set period of time, or “term.” If you die during that term, the money can help your family pay for basic living expenses, final arrangements, tuition and more. AD&D Insurance is also available, which pays a benefit if you survive an accident but have certain serious injuries. It pays an additional amount if you die from a covered accident. With Voluntary and AD&D you (pretax) are able toPer select coverage and / or child(ren). You must elect VisionLife Contributions Pay Periodfor– your 24 spouse per year coverage for yourself before adding coverage for a dependent.

Employee Paid Voluntary Life | Unum Benefit Amount - Employee

5x annual salary up to a max of $500,000 | increments of $10,000

Benefit Amount – Spouse

Cannot exceed 100% of EE amount up to a max of $250,000 | increments of $5,000

Benefit Amount – Child (age 6 months – 26 years)

Cannot exceed 100% of EE amount up to a max of $10,000 | increments of $1,000

AD&D Coverage

Included

Guarantee Issue - Employee

$150,000

Guarantee Issue - Spouse

$50,000

Guarantee Issue - Child

$10,000

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Life and Accidental Death + Dismemberment (AD+D) continued Voluntary Em ployee and Spouse Term Life and AD&D Calculations Benefit Amount / $1,000 x Rate from Table = Monthly Cost Monthly Cost x 12 / 24 = Per Pay Period Deduction

Voluntary Child Term Life and AD&D Benefit Amount / $1,000 x 0.24 = Monthly Cost Monthly Cost x 12 / 24 = Per Pay Period Deduction

Voluntary Term Life and A D&D Rates ( Spous e Term Life and A D&D is bas ed on employ ee age) Age Rates / $1,000

< 29 30-34 0.062 0.080

35-39 40-44 0.090 0.108

45-49 50-54 55-59 60-64 65-69 70-74 75-79 0.163 0.259 0.300 0.660 1.270 2.384 4.816

EOI (evidence of insurability) is required if your election for you or your eligible dependent(s) exceeds the guaranteed issue maximum or if you add or increase coverage for you or your eligible dependents after your initial eligibility period. Coverage will not be effective until approved by the carrier.

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Disability Insurance Disability coverage provides the financial security of knowing that you will continue to receive income if you are unable to work due to illness or injury.

SHORT-TERM DISABILITY (STD) Company Paid Even a few weeks away from work can make it difficult to manage household expenses. Short-Term Disability is available to you through Unum. This coverage will pay up to 60% of your weekly salary up to a maximum of $1,000 for accidents, sickness, or pregnancy, so you can focus on getting better, and worry less about keeping up with your bills. Benefits begin on the 8th day of disability for sickness and pregnancies. Benefits are payable up to a maximum of 13 weeks.

LONG-TERM DISABILITY (LTD) Company Paid Serious illnesses or accidents can come out of nowhere. They can interrupt your life and your ability to work for months ─ even years. Long-Term Disability coverage is available to you through Unum. This benefit pays 60% of your monthly earnings in the event of a disability after 90 days for accidents and illness up to a maximum monthly benefit of $6,000. The Long-Term Disability benefit pays up to the Social Security Normal Retirement Age (SSNRA).

Plan Highlights

STD

Definition of Disability

LTD Accident | Illness

Elimination Period

7 days

90 days

Benefit Percentage

60%

60%

Benefit Maximum

$1,000 weekly

$6,000 monthly

Benefit Duration

12 weeks

SSNRA

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Questions on your benefits or need assistance with Claims, contact Pritchard & Jerden:

Key Contacts & Resources Kristie Mercer Client Support Specialist PHONE # 770-635-2293 EMAIL: kmercer@sspins.com

Your Employee Support Contact

NEED HELP WITH A CLAIM BE SURE TO HAVE THE FOLLOWING INFORMATION WHEN CALLING: Subscriber ID # Date of Service Name of Patient Name of Doctor, Facility or Hospital Copy of Bill or Explanation of Benefits (EOB)

Benefit

Company

Phone

Website

Medical

Ameriben

1.855.778.9044

engage.ameriben.com

Vision

EyeMed

1.866.939.3633

member.eyemedvisioncare.com

Dental

Unum

1.800.858.6843

www.unum.com

Life and Disability

Unum

1.800.858.6843

https://www.unum.com/employers/ employee-benefits/dentalinsurance

Flexible Spending Account (FSA)

Flores

800.532.3327

www.flores247.com

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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 Passion, Inc. 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 purposed.

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 Passion, Inc. 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 Passion, Inc. (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 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 Passion, Inc. 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.

•

Passion, Inc. has determined that the prescription drug coverage offered by the Ameriben/ Anthem 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 Passion, Inc. coverage will not be affected. Please review prescription drug coverage plan provisions/options under the certificate booklet provided

by Ameriben / Anthem. 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 Passion, Inc. 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 Passion, Inc. 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 Passion, Inc. 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).

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Notes

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