2023/2024 RightSourcing Enrollment Guide: US Contractors

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2023/2024

Enrollment Guide

U.S. RightSourcing Contractor Edition

Plan Year: 9/1/2023 to 8/31/2024

The company values our employees and works diligently to provide superior benefits that meet our employees’ needs. The benefits offered include healthcare, wellness, financial and employee discounts, to assist in all aspects of our employees’ well-being. The company continues to invest in quality benefits, providing our employees with a selection of plans to meet their personal and financial needs.

Table of Contents

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Your Enrollment Your Virtual Benefit Fair Eligibility Preparing for Enrollment Making Your Elections Health Benefits Health Insurance Terms to Know Medical Services Medical Plans Lyric Health Benefit Health Savings Account (HSA) Dental Plans Vision Plan Unum Employee Assistance Program Financial Benefits Travel Assist for Personal Travel Will Preparation Services Health Advocate Medical Bill Saver Group Life Insurance Short & Long-Term Disability Group Accident Insurance Hospitalization Insurance Critical Illness Insurance 401(k) Retirement Benefit 529 Plan College Savings Legal Benefit Whole Life Insurance with LTC Rider Long Term Care Travel Guard for Business Travel 3 4 6 7 8 9 10 12 14 16 17 18 19 19 19 20 21 22 22 23 24 24 24 24 25 25 26 26 27 27 27 27 27 27 27 27 27 27 27 28 31 34 Employee Discounts & Memberships PerkSpot Discount Program TripBeat: Travel and Leisure Benefit
Pet Insurance
Mutual Home & Auto Insurance
Financial Credit Union
Technologies Member Purchase Program
LifeLock Wellcard Rx
Cellular Service Noom Invite Fitness International Medical Coverage Cigna Wellness Webinars Legal Notices Legal Disclosures COBRA Medicaid and CHIP Contacts Contact the Benefits Department at Phone: 800.813.7946 Online: Global Support Center
Introduction Benefits highlighted in this guide are governed by the RightSourcing plan contracts and policies, applicable state and federal laws, including company policy. If there is a conflict between the wording of this guide relative to the group policies and contracts, the policies, contracts and applicable laws govern. The company reserves the right to alter, amend, or terminate any of the benefits described in this guide at any time.
Nationwide
Liberty
iThink
Dell
Norton
Verizon

Virtual Benefits Fair

For more information about the benefits outlined in this guide, you can visit your Virtual Benefits Fair via your Employee Portal, HRconnection. Within this portal, you will find a series of valuable resources including detailed plan summaries, carrier brochures, provider links, and an extensive video library, offering education on a series of topics and specific plan offerings.

Access your Virtual Benefits Fair

Click Here, or visit HRconnection.com

Enter Guest Key: Sourcingcontractors1

The Evolution of Work™

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Eligibility

Eligibility Policy

You are eligible to participate in our health and ancillary benefits on the first of the month, following 30 days of full-time (30+ hours per week) employment. Elections must be made by the last day of your eligibility month. Late enrollments will be retroactive to the 1st of the month. Missed contributions will be collected in arrears. If you enroll, you must maintain full-time (30+ hours per week) status. If your status changes to part-time your benefits may be subject to cancelation. A monthly hours audit is conducted to ensure compliance of the eligibility policy. If your status has changed to part-time you will be notified prior to cancellation to confirm that change is due to a reduction of work hours. If you are missing time due to sick leave or personal time off, please complete the Supplemental Payroll Deduction (SPD) Form and submit to the Global Support Center . Sick leave and personal time off is not considered when determining status, only reductions in work hours are considered.

Coverage Options

You can enroll in any combination of medical, dental, and/ or vision plans based on your needs. For example, you can enroll in the company medical and dental plan and decline the vision plan. You can also enroll in a combination of coverage options. For example, you can enroll only yourself in the company medical and vision and enroll your spouse in the dental plan.

The only requirement is that you must elect coverage for yourself in order to elect any dependent coverage.

Qualified Dependents

Medical, Dental, and Vision Insurance

Company employees may enroll qualified dependents, as defined by the IRS, into the healthcare coverage. The Dependent Policy requires that proof of dependency be submitted for each dependent enrolling, to ensure compliance with IRS guidelines. If proof is not provided by the last day of your eligibility month, the dependent will be removed from coverage.

Eligible dependents include:

• Your legal spouse

• Your domestic partner

• You or your spouse’s children (including birth children, step-children, legally adopted children, children placed for adoption or children for whom you or your spouse are the legal guardian) as follows:

• Up to age 26 regardless of student or marital status (30 for Cigna Medical)

• Unmarried children age 26 or over who are incapable of self-support because of a total physical or mental disability

Date of Hire

• Employee Assistance Program (EAP)

• Employee Discounts & Memberships

First of month following 30 days of full-time employment

• Medical, Dental, and Vision

• Life: Employee, Spouse & Child

• Short and Long Term Disability

• Legal

• Ancillary and Supplemental Benefits

Date of Termination

• Benefits Eligibility and Coverage ends on last day of employment.

• If you are enrolled in medical, dental and vision, Cobra documents will be sent within 30 days of termination.

Coverage Options Include:

Employee Only

Employee + 1 Dependent Family

Make sure you have the Social Security Numbers and birth dates of your dependents. You won’t be able to enroll your dependents without this information!

Please Note: Under Magnit’s Dependent Policy, dependent proof is required for all dependents enrolled in healthcare coverage. To complete the enrollment of your dependents, documentation is needed to show they are valid dependents under IRS guidelines. Failure to provide valid dependent proof, by the last day of your eligibility period, will result in the dependent’s removal from coverage. The cancellation will be backdated to your coverage effective date.

Section 125 defined: Under a cafeteria, or Section 125 plan, you pay for your employer-sponsored benefits with pretax dollars. Your employer deducts your payments from your wages before withholding certain taxes. Your employer doesn’t include your pretax payments in your taxable wages on your annual W-2.

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Annual Renewal

Plans renew on September 1st every year and are subject to coverage and rate changes.

Open Enrollment and Life Events

The plan year runs from September 1st to August 31st. Each August, during Open Enrollment, you will have the opportunity to make changes to your benefit elections for yourself and your covered dependents. Outside of Open Enrollment, you must experience a qualifying event that satisfies federal regulations outlined below:

• Gain or Loss of health coverage

• Married, legal separation or divorce

• Birth or adoption of a child

• Becoming a U.S. Citizen

• Moving

• Death of a dependent family member

• Dependents no longer eligible to be a named dependent on a parent’s plan

What is a Qualifying Life Event?

You will need to submit supporting documentation to process your life event.

What happens if I don’t enroll?

• Remember, you have until the last day of your eligibility month to enroll.

• If you do not enroll within this time frame, you will have 100% employer-paid benefits only.

• Outside of Open Enrollment, you must experience a qualifying event that satisfies federal regulations in order to enroll at a later date.

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Preparing For Enrollment

Preparing for Enrollment

It’s important to read over the benefit descriptions for the plans offered. Additionally, make sure you understand all the terms and definitions used in the descriptions—this guide can help. Not knowing something now could cost you later in the year.

Which Plans are Right for You?

Do you need healthcare, financial, or ancillary benefits for you or your family? Ask yourself:

• Do you or your dependents have any chronic health conditions?

• Are you saving enough for retirement or college?

• How much healthcare coverage and what type of care do you need this year?

• Do you expect your needs to change in the near future?

• Do you prefer to pay less from your paycheck or less out of your pocket when you need care?

• If something happened to you and you couldn’t work – could you still pay your bills?

Answering these questions will help you determine what coverage you need.

Have You Considered a High Deductible Health Plan?

High deductible health plans have lower premiums and may result in lower annual medical costs. These plans offer several advantages to reward you for taking an active role in your health care spending.

• Lower paycheck costs – allowing you to keep control over more of your money

• Tax-advantaged savings account – enrolling in a Health Savings Account (HSA) helps you pay your deductible and out-of-pocket costs

• Comparable benefits – these plans use the same networks that other plans offer, and in-network preventive care is still 100% covered

Need More Coverage?

Are you interested in a high-deductible plan with a lower premium? You may want additional coverage that pays benefits directly to you to help cover deductibles and out-of-pocket expenses.

Consider combining your medical coverage with supplemental insurance. These plans are a great complement to your medical plan choice and can help reduce the financial risk associated with illness and injury.

Depending on your situation, you may be able to save money by purchasing a lower-cost medical plan and adding one or more supplemental plans to achieve effective protection at a lower plan cost. Refer to the supplemental insurance section on page 22 for more information.

Critical Illness Accident Hospital Indemnity
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Making your elections

Cost of Coverage

The company is committed to offering you a competitive benefits program that offers the flexibility to select coverage that best fits your needs and your budget. The company Coverage is in compliance with the ACA affordability guidelines. You will be responsible for any remaining costs for the benefits you select, which will be provided as you enroll in the Employee Hub.

Making Your Elections

Employees eligible for medical insurance and all other benefits will receive an email offering them the opportunity to elect coverage. Employees will receive the email two weeks prior to their eligibility date.

How to Enroll

Enrollment for most health and financial benefits is completed in Dayforce Click here for more information and training resources on how to access and use Dayforce. If you have not setup your Dayforce account access, you will need to setup your security access first. Security access is completed on Okta Click here for Okta registration instructions.

Enrollment for 401(k), 529 plan, Wellness, Voluntary Whole Life, Long Term Care, and employee perks are handled directly with the provider. Enrollment details are listed in the benefits guide.

New Hires & Conversions

All new hires and conversions are required to complete enrollment, even if they are waiving all coverage.

Active Employees

If you are an active employee and do not enroll in benefits during the annual open enrollment period your current benefit elections will automatically carry over to the next plan year, excluding any plans no longer offered. This feature is designed to make the enrollment process as easy as possible for employees who want to keep current coverage for another year. However, we will require you to complete an annual confirmation or declination of coverage to ensure you have reviewed the new plan year offering.

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Health Insurance Terms to Know

Coinsurance

After your deductible is met, the percentage of eligible expenses you are required to pay for covered health services.

Copayment

A fixed dollar amount you pay for healthcare services, such as doctor’s visits, urgent care or emergency room services. Copayments track towards your Out-of-Pocket Maximum, but do not apply towards the deductible.

Deductible

The amount you pay for certain covered healthcare services before your insurance plan starts to pay on your behalf. See your full plan summary for additional details.

High-deductible health plan (HDHP)

High Deductible Health (HDHP) plans, a type of Consumer Directed Health Plan (CDHP) or Consumer Health Plan (CHP), are becoming increasingly popular for those who don’t need to see the doctor very often. These plans may behave like an HMO or PPO plan, but have higher deductibles to meet in exchange for lower monthly cost.

Health savings account (HSA)

A bank account that lets you put money aside, tax-free, to save and pay for health care expenses. Any remaining money at the end of the calendar year rolls over to the next year. Taxes are never paid on the funds if used for qualified health care services. Funds can be invested to grow on a pre-tax basis.

Preventive Care

Routine healthcare services like check-ups, immunizations, and screenings for adults, women, and children. For a list of Preventive Care service mandates, click here

Reasonable & Customary

Going rate for a procedure based on your geographic location.

Network Hospitals and providers who have a contracted agreement with our benefit providers to make covered services available to members at a discounted rate.

Out-of-Pocket Maximum (OOPM)

The most you will pay for healthcare services during the calendar year. After you spend this amount on deductibles, copayments, and coinsurance, your health plan pays 100% of the costs for covered benefits (with minimal exceptions).

Premium

This is the cost you will pay to participate in the employer health plan. Your Premium is separate from your Deductible and Out-of-Pocket Max.

Qualifying Life Event (QLE)

A status or life change that allows you to make changes to your benefits mid-year.

Who pays for your healthcare?

You

Once

You pay your portion after your employers contribution Preventive Care Your plan pays Copay You pay Deductible You pay Coinsurance
Premium
and your plan each pay a % after your deductible has been met Out-of-Pocket Maximum Your deductible, copays, and coinsurance track toward your Out-of-pocket maximum
Other Covered Expenses
All
your plan will pay for any charged services covered
your plan.
you have reached your OOPM,
by
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Medical Services

Preventive Care

The company offers a series of ACA compliant medical plans, in partnership with Cigna, providing you with access to quality and comprehensive healthcare coverage with a selection of varying plan designs so you can choose the coverage that best meets your and your family’s needs. Additionally, Cigna offers a host of Preventive Care services at no cost to members. Examples of this are as follows:

• Well-woman checkups including mammograms

• Well-child checkups & immunizations

• Annual physicals

• Blood pressure tests

• $0 Copay Preventive Care/Maintenance Drugs

• Cholesterol tests and more…

Cigna Online Provider Directory

www.cigna.com/hcpdirectory

Cigna Telehealth

Click Here to learn more, and be directed to the Cigna Virtual Care (telehealth) Website.

Cigna Express Scripts Pharmacy

Express Scripts® Pharmacy (a Cigna company), our home delivery pharmacy, is a convenient option if you’re taking a medication on a regular basis to treat an ongoing health condition.

Benefits of using Express Scripts® Pharmacy

Express Scripts® Pharmacy helps make it easy for you to get your medication. With just a few simple clicks of your mobile phone, tablet or computer, your important medications will be on their way to your door (or location of your choice).

• Easily order, manage, track and pay for your medications on your phone or online

• Standard shipping at no extra cost

• Fill up to a 90-day supply at one time

• Helpful pharmacists available 24/7

• Automatic refills and refill reminders so you don’t miss a dose

• Flexible payment options

Click Here to learn more!

Cigna also covers other routine services, but those services may require you to pay out of your pocket.

Click Here for additional information & reference on our ACA mandated preventive care coverage.

Cigna Employee Assistance Program

Brightline: Behavioral Health for your Family Connect+

On-the-go access to personalized content, group classes, interactive exercises, and chat with coaches for tips and guidance

Coaching

Programs to help tackle everyday common challenges with expert behavioral health coaches in as few as four sessions

Care

Personalized behavior therapy and medication evaluation & support from licensed Brightline clinicians

Click Here to get started

9 NEW FOR 2023/2024: Click Here for information on how to to access your Cigna Digital ID card, or Click Here for a video explanation!

Medical plans

The information on the following pages reflects what the covered individual/family will be required to pay out-of-pocket, until the Annual Out-of-Pocket Maximum (OOPM) is reached. This handout is provided as an overview of medical benefits offered. For specific coverage information, please refer to your Summary of Benefits & coverage (SBC) documentation provided at HRconnection.com

Alternative rates with restrictive abortion coverage available for employees located in TX, OK, and MO.

Please note: The above coverage is not available in Hawaii and Puerto Rico, due to local regulations. Alternate coverage will be offered in those areas.

**Individuals enrolled in Employee +1 or Family level coverage will have an Individual Out-of-Pocket Maximum of $6,900 In-Network & $14,000 (HSA) or $13,800 (MVP) Out-of-Network. Please note out of network coverage is limited to customary and reasonable charges.

Major Medical Plan In-Network Out-of-Network In-Network Out-of-Network Annual Deductible Individual $3,000 $7,000 $5,000 $10,000 Family $6,000 $14,000 $6,900 $13,800 Annual Out-of-Pocket Max (includes deductible) Individual $5,000** $11,000** $6,900** $13,800** Family $10,000 $22,000 $13,800 $27,600 Coinsurance 30% 50% 30% 50% Lifetime Maximum Carrier coverage is unlimited Carrier will pay 150% of customary & reasonable Charges Carrier coverage is unlimited Carrier will pay 150% of customary & reasonable Charges Preventive Care Covered at 100% Deductible and Coinsurance Covered at 100% Deductible and Coinsurance Primary Care Physician (Office Visit) Specialist (Office Visit) Advanced Radiology (Outpatient) Plan pays 70% Plan pays 50% Plan pays 70% Plan pays 50% Urgent care Deductible and Coinsurance Deductible and Coinsurance Deductible and Coinsurance Deductible and Coinsurance Emergency Room Deductible and Coinsurance Deductible and Coinsurance Deductible and Coinsurance Deductible and Coinsurance Hospital Inpatient Deductible and Coinsurance Deductible and Coinsurance Deductible and Coinsurance Deductible and Coinsurance Outpatient Services Deductible and Coinsurance Deductible and Coinsurance Deductible and Coinsurance Deductible and Coinsurance Prescription Drugs (Cigna RX Formulary - Value Tier 3) Preventive Generic $0 Copay 40% $0 Copay 40% Generic $10 Copay 40% $10 Copay 40% Brand Name Preferred $40 Copay 40% $40 Copay 40% Brand Name Non-Preferred $80 Copay 40% $80 Copay 40% Specialty $200 Copay 40% $200 Copay 40% Mail Order 2x retail Not Covered 2x retail Not Covered Employee Employee + 1 Dependent Family Plan Year Runs September 1st, 2023 to August 31st, 2024 Deductible and OOPM Run Calendar Year January 1st to December 31st Weekly Deduction Benefits Plans HSA OAP MVP OAP Deductible and Coinsurance Deductible and Coinsurance Deductible and Coinsurance Deductible and Coinsurance $391.06 $351.02 Cigna $136.16 $122.20 $276.36 $248.05 After Deductible After Deductible
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Satisfies individual mandate under health care reform providing Minimum Essential Coverage (MEC), with limited medical coverage from Transamerica. Plan limitations do exist, so please review the summaries provided to ensure you understand the level of coverage you would receive when electing this benefit option.

• Low out-of-pocket premium

• Section 125 qualified plan

• Mental Health

• Prescription Coverage

• Reimbursement for a variety of services

• Wellness Coverage

• Hospitalization and Surgical Coverage

Limited Coverage Plan MEC Preferred MEC Preferred Plus Covered Benefits In-Network In-Network Deductible (single/family) $0/$0 $0/$0 Coinsurance 100% 100% Out-of-Pocket Maximum (single/family) $0/$0 $0/$0 PPO Network Open Access Solution* Open Access Solution* ACA Required Preventive Care/ Screening/Immunization Benefits (MEC) Covers 100% of the government's listed Preventive and Wellness Benefits Covers 100% of the government's listed Preventive and Wellness Benefits Telemedicine Unlimited Calls Unlimited Calls Geo Fencing ER and Rx Unlimited Access Unlimited Access RealTime Choices Transparency Program Unlimited Access Unlimited Access RealTime Behavioral Health N/A N/A Fully Insured Indemnity Benefits Inpatient Hospital $100 daily benefit, 180 maximum days $200 daily benefit, 180 maximum days Inpatient Surgery & Anesthesia Daily Indemnity Benefit $500 per day/$100 Anesthesia, 1 day maximum per benefit period $1,000 per day/$200 Anesthesia, 1 day maximum per benefit period Outpatient Surgery & Anesthesia Daily Indemnity Benefit $250 per day/$50 Anesthesia, 1 day maximum per benefit period $500 per day/$100 Anesthesia, 1 day maximum per benefit period Outpatient Physician Office Visit Daily Indemnity Benefit $40 per day, 6 day maximum per benefit period $60 per day, 6 day maximum per benefit period Outpatient Diagnostic X Ray and Lab Daily indemnity Benefit $50 per day with a 3 day maximum per benefit period $50 per day with a 3 day maximum per benefit period Outpatient Prescription Drug Indemnity Benefit $15 per day, 12 day maximum per benefit period $15 per day, 12 day maximum per benefit period Initial Hospital Admission Daily Indemnity Benefit $500 per day,1 day maximum with 1 Admission per benefit period $1,000 per day,1 day maximum with 1 Admission per benefit period Emergency Room Visit Daily Indemnity Benefit (covers illness and accident) $100 daily benefit with a max of 3 days per benefit period $100 daily benefit with a max of 3 days per benefit period Ambulance Service Daily Indemnity Benefit $100 per day, 3 day maximum per benefit period $100 per day, 3 day maximum per benefit period Weekly Deduction Employee $31.29 $36.43 Employee + 1 Dependent $56.69 $67.59 Employee + Children $73.17 $82.93 Family $103.61 $122.22 Plan
Runs September 1st, 2023 to August 31st, 2024 Deductible and OOPM Run Calendar Year January 1st to December 31st
unique Open Access Solution ensures all providers are paid at the "in network" benefit level. The Open Access Solution leverages the best national network contracts available along with the pre-negotiated pricing for providers that fall outside of those national network contracts. The Open Access Solution ultimately provides better unlimited access to the members and better pricing for the plan. RealTimeTelemed
Year
*Our
MEC/Limited Plan Coverage
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LYRIC TELEHEALTH

This year, the company is excited to announce the addition of Lyric Telehealth benefits. Employees and their dependents can have access to telehealth services for wellness, urgent care, mental health counseling and dermatology for only $10 per month. Lyric Health is an award-winning virtual care service provider that powers access to modern remote care, reducing costs and improving satisfaction and outcomes.

Head-to-toe healthcare that fits in your pocket!

Schedule Consultation: Call, Click, or Tap to schedule your consultation

Talk to a Provider: A doctor will call you directly or join on video from the website or our app

Access your Treatment Plan: See your diagnoses, prescriptions, and doctors’ notes as directed

Feel Better: Stay healthier! Use the app to keep track of your personal health records anytime from anywhere

Comprehensive suite of Virtual Care services.

Urgent Care - $0 Copay

24/7/365 on-demand access to licensed physicians to help with non-emergency needs.

Primary Care - $0 Copay

Get ongoing, personalized care from a provider comitted to your complete health.

Virtual Counseling - $0 Copay

Virtual visits with caring mental health professionals.

Dermatology - $0 Copay

Get a treatment plan for Acne, Eczema, or other conditions.

Advanced Mental Healthcare Available - $100 Copay

Visit with an advanced mental healthcare pro for depression, anxiety, and other concerns.

Care Navigation

Guidance and Navigation to make healthcare easy to access, understand, and use.

Virtual MSK

Physical therapists deliver care plans proven to prevent injuries and guide members to pain relief.

Labs

Leveraging data to determine potential risk factors in order to manage special conditions.

Specialty Referral

Get a quick and easy specialist referral for any condition your doctor can’t treat.

Download the Lyric app and get instant access to integrated virtual care designed to treat the complete you.

Website: GetLyric.com

Phone: 1.866.223.8831

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Access Your Virtual Urgent Care

Doctors can be hard to reach, illnesses can occur in the middle of the night, and sometimes you just have a question. Get on-demand care when you need it.

Multiple Cost Savings

Healthcare Cost Savings: Redirecting unnecessary doctor, urgent and ER visits can reduce healthcare spending significantly.

Productivity: A typical doctors appointment can take half of the work day. Lyric gives employees easy access to a physician wherever they are located.

Access Your Virtual Behavioral Health

Therapy from the privacy of your home or office

Common Conditions

In some cases, a visit to the doctor’s office can be avoided, saving time and money.

• Flu Symptoms

• Ear infection

• Urinary Tract Infection

• Pink eye

• Rashes

• Acne

• Sinus Problems

• Allergies

• Nausea

• Stomach Viruses

• Sore Throat

• and Much More...

Whether it’s stress, anxiety, depression, or sudden loss, we can help. Speak with a licensed therapist anytime from anywhere.

Our suite of mental health services includes:

Virtual Counseling - $0 Copay

Consult with a Master-level therapist/counselor. The amount of counseling sessions will be clinically appropriate based on the issue.

• Substance Abuse

• Relationship Issues

Virtual Psychologist - $100 Copay

• Depression

• Stress and Anxiety

• Death of a loved one

• Parenting Issues

Speak with a licensed psychologist, one-to-one, to assess your symptoms and evaluate your medical, psychological, and family history to determine a productive treatment plan.

• Depression

• Life changes

Virtual Psychiatrist - $100 Copay

• Addiction

• Grief and Loss

• Stress Management

• Relationship

Connect with a U.S. based, board-certified Psychiatrist who can diagnose, treat and prescribe medications for a range of mental health disorders, as necessary.

• Anxiety • Depression

• Panic Disorders

Required notices for Lyric Health

• Bipolar Disorder

• Trauma & PTSD

• Addictive Behaviors

Emergency Services Notice: Client understands and will inform members that if in the providers sole medical judgement, the consult involves a life threatening emergency, provider may direct the member to the nearest emergency facility.

Provider/Patient Relationship: Client understands and will inform members that in order to receive any services, member is required to complete the necessary steps to create a provider/patient relationship via telephone or video, in accordance with applicable state and federal laws. Those steps include:

1. Completing a medical history disclosure, within the member’s health portal or by telephone with a designated care coordinator,

2. Agreement to informed patient consent and release form confirming an understanding that the provider is not obligated to accept the member as a patient, and that the member’s participation in the program may be cancelled at any time without recourse by the member; and,

3. Acknowledgement and understanding of additional MTM policies and disclosures.

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Health Savings Account (HSA)

A Health Savings Account (HSA) is a powerful savings tool. You can start setting aside money in a tax-free account to save for future qualified healthcare expenses.

Health Savings Accounts are administered by HSA Bank.

Eligibility

You are eligible to open and contribute to a Health Savings Account if:

• You are enrolled in a company High Deductible Medical Plan

• You are not covered by your spouse/domestic partner’s health plan, health care flexible spending account or health reimbursement account

• You are not eligible to be claimed as dependent on someone else’s tax return

• You are not enrolled in Medicare or TRICARE

Benefits of an HSA

• You choose how much to set aside for healthcare expenses - start, stop or change your contributions at any time

• Reduces taxable income - your HSA is deducted from your paycheck, so the tax benefits are immediate

• Grows tax-free - you can invest excess balances over $2,000 into mutual funds and the earnings are tax-free

• If you switch to a non-HDHP you can continue to use your HSA to pay for eligible medical expenses, you just won’t be able to make any more contributions

• Your HSA is portable if you change jobs

• At age 65, distributions from your HSA on non-qualified medical expenses are taxed as income with no penalty

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Eligible Expenses

You can always use your HSA for any contributions towards your deductible, but did you know you can use your HSA for expenses that are not covered by insurance?

Click here to check out the full list of eligible expenses.

How To Use

Once you’ve enrolled in a Health Savings Account, HSA Bank will mail you a debit card that you can use to pay for your eligible expenses or you can continue to pay upfront for expenses and file for reimbursement.

You can use the accounts to pay for your own expenses, or those of an eligible dependent. In general, an eligible dependent under this plan is anyone you list as a dependent on your federal income tax return. This includes immediate family members, a close relative or other person whose primary residence is your home and for whom you provide over 50% support.

HSA Bank will never ask you for any records or receipts, but the IRS could. Make sure you keep all of your records! If you take a distribution from your HSA for non-eligible expenses there is a 20% excise tax plus any applicable income taxes.

Click Here to learn more!

HSA Bank Contacts

Email: askus@hsabank.com

Phone: (800)357.6246

Fax Number: (877)851.5274

Individual $4,150 Family $8,300 Catch-up (Age 55+) $1,000 2024 Contribution Maximums
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Cigna dental

Not only does good dental hygiene prevent tooth decay, gum disease and bad breath - it can also prevent more serious health consequences such as heart disease and stroke. To provide employees and their families with the most suitable coverage, the company offers dental coverage through Cigna.

The Cigna Dental plans offer you the option to enroll in a DPPO or DHMO. Plan coverage includes preventive services covered at 100%, including routine cleanings twice a year. All plans are linked to a national network of providers.

What is a DPPO?

With the Dental Preferred Provider Organization plan (DPPO), you can see any licensed dentist or specialist. You do not have to choose a primary care dentist or get specialist referrals. Preventive Services are covered at 100%. Two levels of coverage are available with either $2,000 or $1,000 in annual coverage, once a small deductible is met.

• You choose a licensed dentist for routine, preventive, diagnostic, and emergency care. You’ll pay less for many covered services if you use in-network dentists. Out-of-network services will cost you more.

• When you meet your annual deductible and satisfy any waiting periods, you pay a coinsurance (a portion of covered charges), and the plan pays the rest (up to the yearly dollar limit of the plan).

What is a DHMO Plan?

The Cigna Dental Care (DHMO) plan requires you to select a general dentist for routine, preventive, diagnostic, and emergency care. They will refer you to specialists as needed.

• This plan covers preventive services at 100%.

• Cigna Dental Care (DHMO) plans do not have a deductible or a yearly dollar limit.

• No coverage waiting period.

• This plan includes orthodontia for adults & children.

• This plan does not cover out-of-network services.

Easily search for Cigna DPPO or DHMO network providers in the directory on cigna.com or mycigna.com.

DHMO In-Network Out-of-Network In-Network Out-of-Network In-Network Deductible (Individual/Family) $50 / $150 $50 / $150 $50 / $100 $100 / $300 $0 Calendar Year Benefits Maximum $2,000 $2,000 $1,000 $1,000 $0 Class I: Diagnostic & Preventive No Charge No Charge No Charge 20%, No Ded No Charge Class II: Basic Restorative 20% After Ded 20% After Ded 20% After Ded 30% After Ded Class III: Major Restorative 50% After Ded 50% After Ded 50% After Ded 60% After Ded Class IV: Orthodontia Lifetime Maximum: $1,000 50% After Class IV $50 Ded 50% After Class IV $50 Ded N/A N/A Weekly deduction Employee $3.65 Employee + 1 Dependent $9.30 Family $11.30 Plan Year Runs September 1st, 2023 to August 31st, 2024 Deductible and OOPM Run Calendar Year January 1st to December 31st $29.29 $19.33 $41.94 $27.71 Plan Highlights PPO - High PPO - Low Please refer to Dental Fee overview for a summary of covered services and patient charges $13.82 $9.08 16
Dental Plan Comparison
17 Eyemed vision Magnit Global Solutions SUMMARY OF BENEFITS IN-NETWORK MEMBER COST OUT-OF-NETWORK MEMBER REIMBURSEMENT $0 copay Up to $40 $10 copay Up to $40 Up to $39 Not covered W-UP Up to $40; contact lens fit and two follow-up visits Not covered 10% off retail price Not covered $0 copay; 20% off balance over $200 allowance Up to $105 $0 copay; 20% off balance over $150 allowance Up to $105 $10 copay Up to $30 $10 copay Up to $50 $10 copay Up to $70 $10 copay Up to $70 $65 copay Up to $50 $95 - 185 copay Up to $50 Anti Reflective Coating - Standard $45 copay Up to $23 Anti Reflective Coating - Premium Tier 1 - 3 $57 - 85 copay Up to $23 $75 Not covered $40 Not covered Polycarbonate - Standard < 19 years of age $0 copay Up to $20 Scratch Coating - Standard Plastic $15 Not covered $15 Not covered $15 Not covered 20% off retail price Not covered $0 copay; 15% off balance over $150 allowance Up to $105 $0 copay; 100% of balance over $150 allowance Up to $105 $0 copay; paid-in-full Up to $300 Hearing Care from Amplifon Network Discounts on hearing aids; call 1.877.203.0675 Not covered Lasik or PRK from U.S. Laser Network 15% off retail or 5% off promo price; call 1.800.988.4221 Not covered ALLOWED FREQUENCY –ADULTS ALLOWED FREQUENCY –KIDS Once every plan year Once every plan year Once every other plan year Once every other plan year Once every plan year Once every plan year Once every plan year Once every plan year (Plan allows member to receive either contacts and frame, or frame and lens services) QL-0000088411 the right to make changes to the products available on each tier. All providers are not required to carry all brands on all tiers. For current listing of brands by tier, call 866-939-3633. No benefits will be paid for services or materials connected with or charges arising from: medical or surgical treatment, services or supplies for the treatment of the eye, eyes or supporting structures; Refraction, when not provided as part of a Comprehensive Eye Examination; services provided as a result of any Workers’ Compensation law, or similar legislation, or required by any governmental agency or program orthoptic or vision training, subnormal vision aids and any associated supplemental testing; Aniseikonic lenses; any Vision Examination or any corrective Vision Materials required by a Policyholder as a condition of employment; safety eyewear; solutions, cleaning products or frame cases; non-prescription sunglasses; plano (non-prescription) lenses; plano (nonprescription) contact lenses; two pair of glasses in lieu of bifocals; electronic vision devices; services rendered after the date an Insured Person ceases to be covered under the Policy, except when Vision Materials ordered before coverage ended are delivered, and the services rendered to the Insured Person are within 31 days from the date of such order; or lost or broken lenses, frames, glasses, or contact lenses that are replaced before the next Benefit Frequency when Vision Materials would next become available. Fees charged by a Provider for services other than a covered benefit and any local, state or Federal taxes must be paid in full by the Insured Person to the Provider. Such fees, taxes or materials are not covered under the Policy. Allowances provide no remaining balance for future use within the same Benefit Frequency. Some provisions, benefits, exclusions or limitations listed herein may vary by state.. Plan discounts cannot be combined with any other discounts or promotional offers. In certain states members may be required to pay the full retail rate and not the negotiated discount rate with certain participating providers. Please see online provider locator to determine which participating providers have agreed to the discounted rate. Employee Employee + Spouse Employee + Child(ren) Family $1.79 $3.40 $3.44 $5.48 Weekly Vision deduction Visit EyemedVirtualBenefitFair.com to learn more! Enter Password: GQ52WGXJ

Employee Assistance Program

Your EAP has great online information at your fingertips!

Log on and Learn! Check out our online offerings such as trainings, articles, webinars, courses and more to help make your job and life easier and less stressful.

Log onto your member website at Unum.com/lifebalance and click on “Access Your EAP Benefits” to access these EAP + Work/Life resources.

Here are just a few ways you can take advantage of your Employee Assistance Program:

Financial Information

Topics covering Contracts, Bankruptcy, Divorce, Custody, Real Estate, Wills & Estates, and more. Get access to some of the most commonly used financial forms.

Parenting Resources

Information for personal development, managing work and family, communicating effectively, and more! View topics covering Adoption, Bullying, Child care and development, children with disabilities, and more!

Relationships

We offer a variety of resources to help you improve your relationships with friends, family, coworkers, and spouses/partners; further improving your communication skills, personal and professional development, leadership, and interpersonal skill.

Education

Webinars from leading experts on a host of Work/Life topics.

Counseling Support

HealthAdvocate can connect you to the right confidential counseling support.

Turn to us, when you don’t know where to turn.

Toll-free 24/7 access to EAP and Work/Life Balance

Phone: 1.800.854.1446

Website: Unum.com/lifebalance

Up to 3 sessions per issue per year are available to you and your household members.

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Help when you need it most!

With your Employee Assistance Program and Work/Life Balance Services, confidential assistance is as close as your phone or computer.

Employee Assistance Program (EAP)

Your EAP is designed to help you lead a happier and more productive life at home and at work. Call for confidential access to a Licensed Professional Counselor* who can help you.

A Licensed Professional Counselor can help with:

• Stress, Depression, Anxiety

• Relationship issues, Divorce

• Job stress, Work conflicts

• Family and Parenting Problems

• Anger, Grief, and Loss

• and more

*The counselors must abide by federal regulations regarding duty to warn of harm to self or others. In these instances, the consultant may be mandated to report a situation to the appropriate authority.

Work/Life Balance

You can also reach out to a specialist for help with balancing work and life issues. Just call and one of our Work/Life Specialists can answer your questions and help you find resources in your community.

Ask our Work/Life Specialists about:

• Child care

• Elder care

• Legal questions

• Financial Services, Debt Management

• Even reducing your Medical/Dental Bills!

• and more

• Identity Theft Emergency Travel Assistance

If you experienced a medical emergency while traveling (business or personal), would you know who to call? Whenever you travel 100 miles or more from home — to another country or just another city — be sure to pack your worldwide emergency travel assistance phone number! Travel assistance speaks your language, helping you locate hospitals, embassies and other unexpected travel destinations. Add the number to your cell phone contacts, so it’s always close at hand! Just one phone call connects you and your family to medical and other important services 24 hours a day.

Will Preparation Services

Preparing a will doesn’t have to be complicated — or expensive. Your employee assistance program includes simple tools that can help you create a basic will in no time.

Always by your side

• Expert Support 24/7

• Convenient Website

• Short-term Help

• Referrals for additional care

• Monthly Webinars

• Medical Bill Saver

Who is covered?

Unum’s EAP services are available to all eligible employees, their spouses or domestic partners, dependent children, parents and parents-in-law.

Help is easy to Access.

• Online Support

• Phone Support

• In-Person Support

Medical Bill Saver

Medical Bill Saver is one more way the Unum Employee Assistance Program helps employees manage the stresses of modern life.

When a covered employee has a medical or dental bill totaling over $400 in out-of-pocket costs, our skilled negotiating team works with the provider(s) to get a discount. Successful negotiations can save employees hundreds, and sometimes thousands of dollars.

Our experts can also show employees how to keep bills lower in the future — for example, by using in-network providers.

By helping reduce employees’ out-of-pocket costs, Medical Bill Saver can make consumer-driven health plans (CDHPs) more attractive — and more effective.

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Life Insurance

Voluntary Term Life and AD&D Insurance

The company offers all benefits eligible employees with Voluntary Term Life Insurance, up to a maximum of $500,000, with Term Life and Accidental Death & Dismemberment benefits through Unum. This coverage provides financial protection during your working years. Your spouse and children are also eligible for coverage.

Voluntary Term Life and AD&D insurance gives you the opportunity to purchase additional life insurance for you and your eligible dependents, if you are enrolled.

Evidence of Insurability (EOI) is required when electing coverage over the guaranteed issue amount. Coverage will not become effective until your EOI is approved by Unum. You choose the coverage that’s right for you and your beneficiary(ies). And you keep that coverage for a set period of time or “term”.

To get an accurate representation of your payroll deduction, please visit HRconnection to utilize the rate calculator.

Increments $10,000 Maximum Benefit $500,000 Guaranteed Issue Amount $200,000 Increments $10,000 Maximum Benefit $250,000 Guaranteed Issue Amount $50,000 Increments $5,000 policy Level 1 Maximum Benefit $5,000 Level 2 Maximum Benefit $10,000 At age 65 Reduces by 35% At age 75 Reduces by 75% Age Monthly cost/$10,000 Under 30 $0.51 30-34 $0.67 35-39 $0.76 40-44 $0.84 45-49 $1.26 50-54 $1.94 55-59 $3.62 60-64 $5.56 65-69 $10.71 Over 70 $17.37 Dependent Monthly cost/$10,000 Spouse* $1.86 Dependent Monthly cost/$5,000 Child* $0.64 UNUM Supplemental Life in increments of $10,000 UNUM Spouse Supplemental Life in increments of UNUM Child Supplemental Life in increments of $5,000 Get up to $10,000 of coverage in $5,000 increments. One policy covers all of your children. Employee Spouse Dependent Child(ren) Age Reduction Schedule Monthly Cost *Dependent Life coverage is only available to those who enroll in Employee Life coverage. 20

Disability Insurance

Income Protection

Disability insurance protects your income in the event of a short-term or long-term illness or injury. The company offers short-term and long-term disability coverage through Unum. Disability coverage is voluntary for all benefit eligible employees. Both plans are established so you can use the money however you choose; to help pay for rent or mortgage, groceries, out of pocket medical expenses and more.

That’s why having disability insurance is so important. Our disability plans are designed to help protect your financial security by providing replacement income if you are ever disabled due to a non-work-related injury or illness.

Please review your plan information brochure for further coverage details.

The Unum Voluntary STD and LTD Insurance are only available to those enrolled in a Cigna Medical Plan. If you are not enrolled in a Unum Medical Plan and still are interested in these types of programs you may consider the options available with Unum Benefits. For more information and rates on the Unum Benefits offerings you can call 1.800.346.3620.

Short-Term Disability

When you are unable to work for a period of time due to a disabling illness or injury, short term disability insurance can replace a percentage of your lost income (up to a maximum weekly benefit) for a period of time as defined by the policy.

Long-Term Disability

When you are unable to work for an extended period of time due to a disabling illness or injury, long term disability insurance can replace a percentage of your lost income (up to a maximum monthly benefit) for a period of time as defined by the policy. To

rates
the Dayforce System at Enrollment 21 Weekly Benefit Percentage 60% Weekly Benefit Maximum Up to $2,000 Benefits Begin After 0 days if you become disabled due to an injury; After 7 days if you become disabled due to an illness Benefit Duration Up to 26 weeks Age Rate 0-39 $0.31 40-44 $0.32 45-49 $0.37 50-54 $0.44 55-59 $0.53 60-64 $0.62 65-69 $0.81 70-100 $0.81 Benefit Amount Monthly Rate per $10 of covered weekly benefit Monthly Benefit Percentage 60% Monthly Benefit Maximum Up to $10,000 Benefits Begin After a 180-day elimination period Benefit Duration Up to SSNRA Age Rate 0-39 $0.14 40-49 $0.36 50-99 $0.81 Benefit Amount Monthly Rate per $100 of covered monthly benefit Click Here to access the Unum Premium Rate Calulcator.
get an accurate representation of your payroll deduction, you can view
in

Supplemental Benefits

Get valuable financial protection now.

The company is offering Supplemental benefits from Unum. These benefits are Guaranteed Issue at initial eligibility, late entries will be subject to evidence of insurability. Take a moment to learn how these benefits can help protect your finances when you need it most. This information below will help guide you through the benefits Unum has to offer as well as important information to keep in mind while making your selections.

Click Here to learn more about these benefits.

Accident Insurance

Accident Insurance pays a set benefit amount based on the type of injury you have and the type of treatment you need. It covers accidents that occur on and off the job. And it includes a range of incidents, from common injuries to more serious events.

Why is this coverage so valuable?

It can help you with out-of-pocket costs that your medical plan doesn’t cover, like copays and deductibles. You’ll have base coverage without medical underwriting. The cost is conveniently deducted from your paycheck. You can keep your coverage if you change jobs or retire. You’ll be billed directly.

Click Here to view the detailed Accident Insurance flyer.

Hospital Insurance

Hospital Insurance helps covered employees and their families cope with the financial impacts of a hospitalization. You can receive benefits when you’re admitted to the hospital for a covered accident, illness or childbirth.

Why is this coverage so valuable?

• The money is paid directly to you — not to a hospital or care provider. The money can also help you pay the out-of-pocket expenses your medical plan may not cover, such as coinsurance, copays and deductibles.

• You get affordable rates when you buy this coverage at work.

• The cost is conveniently deducted from your paycheck.

• The benefits in this plan are compatible with a Health Savings Account (HSA).

• You may take the coverage with you if you leave the company or retire, without having to answer new health questions. You’ll be billed directly.

• Wellness Benefit Available

Click Here to view the detailed Hospital Insurance flyer.

Who Can Get Coverage for Accident Insurance, and Hospital Insurance?

You:

If you’re actively at work

Your Spouse*:

Can get coverage as long as you have purchased coverage for yourself.

Your Children*:

Dependent Children from birth until their 26th birthday, regardless of marital or student status.

*Employee must purchase coverage for themselves in order to purchase spouse or child coverage.

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Election ACCIDENT Insurance HOSPITAL Insurance Employee $2.29 $2.62 Employee + Spouse $3.97 $5.01 Employee + Child(ren) $5.45 $3.74 Family $7.13 $6.13 Weekly Payroll Deduction

Critical Illness Insurance

If you’re diagnosed with an illness that is covered by this insurance, you can receive a lump sum benefit payment. You can use the money however you want.

Why is this coverage so valuable?

• The money can help you pay out-of-pocket medical expenses, like copays and deductibles.

• You can use this coverage more than once. Even after you receive a payout for one illness, you’re still covered for the remaining conditions and for the reoccurrence of any critical illness with the exception of skin cancer. The reoccurrence benefit can pay 100% of your coverage amount. Diagnoses must be at least 180 days apart or the conditions can’t be related to each other.

• Wellness Benefit Available

Why should I buy coverage now?

• It’s more affordable when you buy it through your employer and the premiums are conveniently deducted from your paycheck.

• Coverage is portable. You may take the coverage with you if you leave the company or retire. You’ll be billed at home.

Click Here to view the detailed Critical Illness Insurance Flyer.

You:

Choose $10,000, $20,000 or $30,000 of coverage with no medical underwriting to qualify if you apply during this enrollment.

Your Spouse:

Spouses can only get 50% of the employee coverage amount as long as you have purchased coverage for yourself.

Your Children: Children from live birth to age 26 are automatically covered at no extra cost. Their coverage amount is 50% of yours. They are covered for all the same illnesses plus these specific childhood conditions: cerebral palsy, cleft lip or palate, cystic fibrosis, Down syndrome and spina bifida. The diagnosis must occur after the child’s coverage effective date.

23
Employee Spouse Employee Spouse Employee Spouse Under 25 $0.66 $0.51 $1.33 $1.03 $1.99 $1.54 25 - 29 $0.78 $0.57 $1.56 $1.14 $2.34 $1.72 30 - 34 $0.96 $0.66 $1.93 $1.33 $2.89 $1.99 35 - 39 $1.22 $0.79 $2.44 $1.58 $3.66 $2.37 40 - 44 $1.56 $0.96 $3.13 $1.93 $4.69 $2.89 45 - 49 $2.07 $1.22 $4.14 $2.44 $6.22 $3.66 50 - 54 $2.76 $1.56 $5.53 $3.13 $8.29 $4.69 55 - 59 $3.76 $2.06 $7.51 $4.12 $11.27 $6.18 60 - 64 $5.26 $2.81 $10.51 $5.62 $15.77 $8.43 65 - 69 $7.50 $3.93 $14.99 $7.86 $22.49 $11.79 70 - 74 $15.41 $7.89 $30.82 $15.78 $46.23 $23.66 75 - 79 $15.41 $7.89 $30.82 $15.78 $46.23 $23.66 80 - 84 $15.41 $7.89 $30.82 $15.78 $46.23 $23.66 85+ $15.39 $7.88 $30.78 $15.75 $46.16 $23.63
Age Option 1 Employee coverage: $10,000 Spouse coverage: $5,000 Be Well benefit: $50 Option 2 Employee coverage: $20,000 Spouse coverage: $10,000 Be Well benefit: $75 Option 3 Employee coverage: $30,000 Spouse coverage: $15,000 Be Well benefit: $100
Weekly Payroll Deduction
Can Get Coverage for Critical Illness Insurance?
Who

Financial Planning

401(k)

Retirement - Administered by Principal

This qualified, pre-tax program allows for immediate enrollment with no waiting period for all company employees, regardless of status. Auto-enrollment occurs on the 45th day of full-time employment. Auto-enrollment can be waived by calling Principal at 800.986.3343 or online at www.principal.com

• Enroll, change, or cease contribution at anytime

• Contribute up to 70% of your earnings, up to the IRS annual mandate or HCE limitations

• Catch-up benefit available for employees over 50

• Comprehensive fund portfolio

Principal Account Access Guide

Magnit 401(k) Plan Summary

Principal Website At-A-Glance

Auto-enrollment Permissible Withdrawal

Note: Employees defined as Highly Compensated Employees (HCE) under IRS regulations will be restricted to $10,000 in annual contributions due to plan testing requirements. Magnit uses a “look-back” year to determine HCE status. HCE status is reviewed annually. HCEs that are 50 years old or older are still eligible for the Catch-up contribution and their annual limit will be increased accordingly. Learn more about HCE status by clicking here .

529 Plans - Offered by College America

A 529 plan is a tax-advantaged investment vehicle in the United States designed to encourage saving for the future higher education expenses of a designated beneficiary. Beneficiary can attend any school nationwide. For more information contact John Fischer at john.fischer@wealthbfinancial.com for an individual consultation.

Legal Plan - Administered by ARAG

Enjoy life with fewer worries with legal insurance from ARAG, available to company employees via a simple payroll deduction! Legal insurance provides its members a place to turn for help when facing life’s unexpected legal and financial issues. Two plan options are available to select from to best suit your needs. Click Here to learn more about Legal Insurance from ARAG, and view a comparison of the two plans available to you!

Voluntary Whole Life Insurance with Long Term Care Rider

The company offers permanent, and portable whole life insurance to all of our benefits eligible employees, provided by Unum. This product also includes a long-term care rider!

You can purchase from $10,000 up to $300,000 of coverage. This plan is portable with coverage that does not decrease. Individual coverage for your spouse and your children is available even if you don’t purchase coverage for yourself. Please refer to your plan information for more details.

Please note: You may only enroll in the Unum Whole Life benefit at the time of hire or during the annual Open Enrollment period. Guarantee issue limits are only available to employees at the time of hire. All other employees will need to complete an Evidence of Insurability form.

Have questions, or need more information on the offerings by Unum?

Reach out to our call center at 1.800.346.3620 or Click Here to enroll!

UltimateAdvisor $4.21 UltimateAdvisor Plus $5.08 Weekly Deduction Phone: Website: Access Code: 800.247.4184 ARAGLegal.com/myinfo 18294mag 24

Group Long Term Care Insurance - Offered by Genworth Life Insurance Company

Do you know who would provide care if you needed extended assistance with everyday activites like bathing and dressing because of an accident, chronic illness, or due to aging? Where would the money to pay for that care come from? Long Term Care insurance can play an important role in addressing your own and your family’s long-term care needs.

Click Here to access the Genworth Portal or Call 800.416.3624 , Monday - Friday 7am-7pm, Central Time.

Reference Group Policy number: 18640

• Reduced/limited medical review for eligible employees.*

• Coverage available up to a lifetime maximum benefit pool of $288,000

• Coverage is available for employees and their family members at group rates, including spouses, parents, and others.

• Fully portable; Coverage goes with you when your employment ends.

*Eligible Full-time Employees 65 and under during their new hire enrollment period, excluding Alaska residents. The insurance program is underwritten by Genworth Life Insurance Company with Administrative Offices in St. Paul, MN. Coverage under this plan is not available to residents of Vermont. Insurance is provided under a group policy 18640 issued to Magnit Global Solution Inc. using policy forms 7053POL-CA and 7053CRT-CA. Coverage is intended to be tax qualified under IRS code 7702(B).

Travel Guard for Business Travel - Administered by AIG

Traveling requires attention to a number of unique details. A study from the Travel Leaders Corporate survey shows that travelers’ top concerns are travel logistics. You are covered with business travel accident insurance along with travel assistance services to help you with travel mishaps or emergencies during your trip. This insurance coverage is provided by your employer. Whether it’s a medical emergency, flight delay or lost luggage, we are here 24 hours a day, 7 days a week to support you. For support with the U.S., just call 1.877.244.6871, or outside of the U.S., call +1.715.346.0859 (Collect/Reverse Charge call).

Click Here to access the AIG Portal; Your policy number is 9155849.

Click Here to view the AIG Business Travel Summary

Medical Assistance

• Medical evacuation and repatriation assistance

• Out-of-Country Medical Coverage up to $200,000

• Hospital and provider assistance

• Emergency prescription replacement assistance

• Assistance with the renting and/or replacement of medical equipment

Travel Assistance

• Lost/stolen baggage assistance

• Lost passport/travel documents assistance

• ATM locator

• Emergency telephone interpretation coordination

• Legal/bail bond referrals

• Embassy and consulate information

Concierge Services

• Restaurant referrals and reservations

• Event ticketing

• Ground transportation coordination

• Wireless device assistance

Identity Theft Assistance**

• Account activity monitoring assistance

• Financial account investigation assistance

• Credit review and fraud detector assistance

• Social Security personal earnings and benefits statement assistance

• Collaborate with law enforcement

Assistance Website and Mobile App

• Travel Security Awareness Training - online instruction modules

• Country reports

• Travel alerts

Security Assistance

• Security evacuation assistance with on-the-ground physical response

• Security and safety advisories

• 24-hour response services to assist employees and their families during an incident

• Online access to up-to-date security intelligence

**Identity theft services are not available for residents in New York or outside the United States.

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Increasing Purchasing Power

PerkSpot - Your Discount Program

PerkSpot is a one-stop-shop for exclusive discounts at many of your favorite national and local merchants. It is completely free and optimized for use on any device: desktops, tablets and phones. Enjoy access to thousands of discounts in dozens of categories, updated daily. Take advantage of online offers from popular national retailers, and discover discounts in your neighborhood with PerkSpot’s streamlined Local Map. Filter your map results by categories like restaurants, health and fitness, retail and more.

Opt in to PerkSpot’s weekly email to receive a curated selection of discounts. Each week’s email features both new and popular deals, as well as seasonal and thematic groupings of offers. The PerkSpot weekly email is a particularly great resource for your holiday shopping.

Start saving today by signing up or logging in at: MagnitGlobal .PerkSpot.com

Need Some Help? Reach Out To Us!

PerkSpot’s customer service team works tirelessly to help you access your Discount Program and redeem deals easily. Below are some important details regarding customer service availability.

Hours: 9am - 6pm, Monday - Friday

Phone: 866.606.6057

Email: cs@perkspot.com

Support*: support.perkspot.com

*If you’ve still got some questions, visit support.perkspot.com to submit a request. Our bilingual Customer Service team will reach out and can answer any questions in both English and Spanish.

TripBeat

Join Tripbeat, Save Big, and Travel the World!

We are delighted to announce that Tripbeat is now available to all Magnit employees.

Magnit has partnered with Tripbeat, powered by Travel + Leisure Co., to bring you exclusive access to incredible savings on your future travels. Tripbeat is easy-to-use online platform that offers a wide range of travel deals, from savings on resorts and hotels to car rentals and tours, all at incredible prices. TripBeat brings you unparalleled savings and benefits. Whether you are dreaming of relaxing on breathtaking beaches, indulging in delicious cuisine, or delving into rich historical landmarks, the platform has you covered.  Magnit is providing all employees a complimentary 12-month premium membership. You will have access to the deepest discounts on the website, allowing you to save in time for your upcoming summer travels.

HOTELS: Deeper discounts on 600,000+ hotels worldwide at up to 60% off*

RESORTS: $389 week-long resort stays

CAR RENTALS: Up to 20% off at major rental companies

AIRFARE: Book popular airlines for domestic and international flights

ACTIVITIES: Access to 345,000+ tours and activities

*CRUISES: Premium Member Exclusive – Sail away with up to $1,500 in onboard credits

*VACATION HOMES: Premium Member Exclusive – Rentals with special member pricing

*TICKETS: Premium Member Exclusive – Enjoy special member pricing on theme parks, concerts, movie tickets, and more

After the 12-months, the company will provide employees a complimentary standard membership. Employees may maintain their premium membership for $9.95 per month. Consider signing up today, and begin booking hotels, resorts, car rentals, cruises and more.

Click Here to sign up for FREE today with activation code: Magnit12

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Nationwide® Pet Insurance

You work hard to provide your family with everything they need. So whether your family includes kids with two feet or kids with four paws, you know what responsibility looks like.

Pets are unpredictable. While it is hard to anticipate accidents and illnesses, Nationwide® Pet Insurance makes it a little easier to be prepared for them. Nationwide® provides coverage for unexpected and significant medical incidents by providing protection for your pets when you need it.

Nationwide® policies cover a multitude of medical problems and conditions related to accidents and illnesses, including cancer. You are free to use any veterinarian worldwide—even specialists and emergency care providers.

Click Here for more information and to be redirected to the company’s Nationwide® Pet Insurance website.

Liberty Mutual Home and Auto Insurance

Liberty Mutual has partnered with the company to offer employees special savings on quality auto and home insurance and with benefits such as Multi-Policy Discount, Personal Property Replacement, and 24-Hour Claims Assistance, you’ll worry less and save more. Call 800.699.4378 or visit LibertyMutual.com/MagnitGlobal to learn more or get a free quote.

iThink Financial Credit Union Membership Financial services

include:

• No-fee checking

• Online banking

• No-fee VISA credit cards

• Financial planning services

• Auto and consumer loans

• Mortgages and home equity loans

• IRAs and money market accounts

Click Here to learn more about iThink Financial. Click here to learn how to join iThink Financial today!

Dell Technologies Member Purchase Program

Now available to Magnit Employees Exclusive Savings on Dell products and services. Click here to learn more or go to www.dell.com/mpp/magnit to access the savings.

Employee Perks

Norton Lifelock - Identity Theft Protection

Now available via payroll deduction.

Identity Theft Protection

Proprietary technology monitors for fraudulant use of your Social Security Number, Name, Address, and date of birth in applications for credit and services.

Device Security

Multi-layered, advanced security helps protect devices against existing and emerging malware threats, including ransomware.

Parental Control

Employees can take action to monitor their child’s online activity and identify potential dangers to help keep children safe when exploring online.

Online Privacy

Protect devices on vulnerable connections through bank-grade encryption to keep information private.

This benefit is subject to closed enrollment.

Click Here to learn more about Norton LifeLock benefit plans.

Wellcard RX Discount

Save up to 65% on prescription medication costs and wide range of other health services.

Click Here for more information.

Verizon Cellular Services

Employees can receive a 15% discount on wireless services from Verizon, additionally, the Disney bundle is now included with select Unlimited Plans.*

Click Here for more information and *Terms.

And More!

• Access Noom at a discount - Use code: NOOM20

• Fitness discount store with Invite Fitness Use Code: msg23

• International Medical Coverage

• Cigna Wellness Webinars , for those enrolled in medical

For information on the discounts listed above, please visit the Global Support Center , or visit HRconnection

27
Benefit Election Essential Premier Employee Only (18+) $7.99 $11.49 Employee + Family $15.98 $21.98 Monthly Cost

Legal Information

Special Enrollment Rights

This notice is being provided to ensure that you understand your right to apply for group health insurance coverage. You should read this notice even if you plan to waive coverage at this time.

Loss of Coverage

If you are declining coverage for yourself or your dependents (including your spouse) because of other health insurance or group health plan coverage, you may be able to enroll yourself and your dependents in this plan if you or your dependents lose eligibility for that other coverage (or if the employer stops contributing toward your or your dependents’ 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).

Example: You waived coverage because you were covered under a plan offered by your spouse’s employer. Your spouse terminates their employment. If you notify your employer within 30 days of the date coverage ends, you and your eligible dependents may apply for coverage under our health plan.

CHIP/Medicaid

If you or your dependent(s) lose coverage under a state Children’s Health Insurance Program (CHIP) or Medicaid, you may be able to enroll yourself and your dependents. However, you must request enrollment within 60 days after the loss of CHIP or Medicaid coverage.

If you or your dependent(s) become eligible to receive premium assistance under a state CHIP or Medicaid, you may be able to enroll yourself and your dependents. However, you must request enrollment within 60 days of the determination of eligibility for premium assistance from state CHIP or Medicaid.

Marriage, Birth, or Adoption

If you have a new dependent as a result of a marriage, birth, adoption or placement for adoption, you may be able to enroll yourself and your dependents. However, you must request enrollment within 30 days after the marriage, birth, adoption, or placement for adoption.

Newborns’/Mothers’ Health Protection Act

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 child 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).

Genetic Information Nondiscrimination Act of 2008

The Genetic Information Nondiscrimination Act of 2008 (“GINA”) protects employees against discrimination based on their genetic information. Unless otherwise permitted, your Employer may not request or require any genetic information from you or your family members.

Click Here for the entire disclosure notice.

Summary of Benefits Coverage

A Summary of Benefits Coverage (SBC) for each of the employer-sponsored medical plans is available on your portal at HRconnection.com

28

Women’s Health and Cancer Rights Act

Under the Women’s Health and Cancer Rights Act, group health plans must make certain benefits available to participants of health plans who have undergone a mastectomy. In particular, a plan must offer mastectomy patients benefits for:

• Reconstruction of the breast on which the mastectomy was performed;

• Any necessary surgery and reconstruction of the other breast to produce a symmetrical appearance.

• Prostheses

• Treatment of physical conditions related to the mastectomy including lymphedema

Our medical plans comply with these requirements. Benefits for these items are similar to those provided under the plan for similar types of medical plan services and supplies.

HIPAA Regulations help to Protect Your Privacy

The privacy provisions of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) help to ensure that your healthcare-related information stays private. New employees will receive a Privacy Practice notice which outlines the ways in which the medical plan may use and disclose protected health information (PHI). The notice also describes your rights. For more information, please visit the Global Support Center .

Dependent Coverage Extension to Age 26

The Medical Plan will cover eligible dependent children of an employee to age 26 regardless of student status, marital status, residence or financial dependence on the employee, if not eligible to access coverage through his/her employer’s plan.

Mental Health Parity and Addiction Equity Act (MHPAEA) Disclosure

The Mental Health Parity and Addiction Equity Act of 2008 generally requires group health plans and health insurance issuers to ensure that financial requirements (such as copays and deductibles) and treatment limitations (such as annual visit limits) applicable to mental health or substance use disorder benefits are no more restrictive than the predominant requirements or limitations applied to substantially all medical/surgical benefits. For information regarding the criteria for medical necessity determinations made under the plan with respect to mental health or substance use disorder benefits, please visit the Global Support Center .

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Legal Information

Your Rights and Protections Against Surprise Medical Bills

When you get emergency care or get treated by an out-of-network provider at an in-network hospital or ambulatory surgical center, you are protected from surprise billing or balance billing.

What is “balance billing” (sometimes called “surprise billing”)?

When you see a doctor or other health care provider, you may owe certain out-of-pocket costs, such as a copayment, coinsurance, and/or a deductible. You may have other costs or have to pay the entire bill if you see a provider or visit a health care facility that isn’t in your health plan’s network.

“Out-of-network” describes providers and facilities that haven’t signed a contract with your health plan. Out-of-network providers may be permitted to bill you for the difference between what your plan agreed to pay and the full amount charged for a service. This is called “balance billing.” This amount is likely more than in-network costs for the same service and might not count toward your annual out-of-pocket limit.

“Surprise billing” is an unexpected balance bill. This can happen when you can’t control who is involved in your care—like when you have an emergency or when you schedule a visit at an in-network facility but are unexpectedly treated by an out-of-network provider.

You are protected from balance billing for: Emergency services

If you have an emergency medical condition and get emergency services from an out-of-network provider or facility, the most the provider or facility may bill you is your plan’s in-network cost-sharing amount (such as copayments and coinsurance). You can’t be balance billed for these emergency services. This includes services you may get after you’re in stable condition, unless you give written consent and give up your protections not to be balanced billed for these post-stabilization services.

When you get emergency care or are treated by an out-of-network provider at an in-network hospital or ambulatory surgical center, you are protected from balance billing. In these cases, you shouldn’t be charged more than your plan’s copayments, coinsurance and/or deductible.

Certain services at an in-network hospital or ambulatory surgical center

When you get services from an in-network hospital or ambulatory surgical center, certain providers there may be out-of-network. In these cases, the most those providers may bill you is your plan’s in-network cost-sharing amount. This applies to emergency medicine, anesthesia, pathology, radiology, laboratory, neonatology, assistant surgeon, hospitalist, or intensivist services. These providers can’t balance bill you and may not ask you to give up your protections not to be balance billed.

If you get other services at these in-network facilities, out-of-network providers can’t balance bill you, unless you give written consent and give up your protections. You’re never required to give up your protections from balance billing. You also aren’t required to get care out-of-network. You can choose a provider or facility in your plan’s network.

When balance billing isn’t allowed, you also have the following protections:

• You are only responsible for paying your share of the cost (like the copayments, coinsurance, and deductibles that you would pay if the provider or facility was in-network). Your health plan will pay out-of-network providers and facilities directly.

• Your health plan generally must:

o Cover emergency services without requiring you to get approval (prior authorization) for services in advance.

o Cover emergency services by out-of-network providers.

o Base what you owe the provider or facility (cost-sharing) on what it would pay an in-network provider or facility and show that amount in your explanation of benefits.

o Count any amount you pay for emergency services or out-of-network services toward your deductible and out-of-pocket limit.

If you believe you’ve been wrongly billed, you may contact the No Surprises Helpdesk, operated by the U.S. Department of Health and Human Services, at 1.800.985.3059

Click Here for more information about your rights under federal law.

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COBRA

If you or one of your dependents experience a COBRA qualifying event resulting in a loss of coverage under one of the company’s group health insurance plans, you and your eligible dependents may have the right to continue your medical, dental, or vision coverage through COBRA for at least 18 months or more at your (or your dependents’) expense.

Examples of COBRA qualifying events include but are not limited to:

• Termination of employment with the company for reasons other than gross misconduct

• Reduction in hours resulting in the loss of group health coverage

• Divorce or Legal Separation

• Dependent child ceases to be dependent child under the group health plan

General FMLA Notice

The United States Department of Labor Wage and Hour Division Leave Entitlements

Eligible employees who work for a covered employer can take up to 12 weeks of unpaid, job protected leave in a 12-month period for the following reasons:

• The birth of a child or placement of a child for adoption or foster care;

• To bond with a child (leave must be taken within 1 year of the child’s birth or placement);

• To care for the employee’s spouse, child, or parent who has a qualifying serious health condition;

• For the employee’s own qualifying serious health condition that makes the employee unable to perform the employee’s job;

• For qualifying exigencies related to the foreign deployment of a military member who is the employee’s spouse, child, or parent.

An eligible employee who is a covered servicemember’s spouse, child, parent, or next of kin may also take up to 26 weeks of FMLA leave in a single 12-month period to care for the servicemember with a serious injury or illness.

An employee does not need to use leave in one block. When it is medically necessary or otherwise permitted, employees may take leave intermittently or on a reduced schedule.

Employees may choose, or an employer may require, use of accrued paid leave while taking FMLA leave. If an employee substitutes accrued paid leave for FMLA leave, the employee must comply with the employer’s normal paid leave policies.

Benefits & Protections

While employees are on FMLA leave, employers must continue health insurance coverage as if the employees were not on leave.

Upon return from FMLA leave, most employees must be restored to the same job or one nearly identical to it with equivalent pay, benefits, and other employment terms and conditions.

An employer may not interfere with an individual’s FMLA rights or retaliate against someone for using or trying to use FMLA leave, opposing any practice made unlawful by the FMLA, or being involved in any proceeding under or related to the FMLA.

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Provider TASC Phone #
Website tasconline.com Cobra
800.422.4661

Legal Information

General FMLA Notice (Continued)

Eligibility Requirements

An employee who works for a covered employer must meet three criteria in order to be eligible for FMLA leave. The employee must:

• Have worked for the employer for at least 12 months;

• Have at least 1,250 hours of service in the 12 months before taking leave;* and

• Work at a location where the employer has at least 50 employees within 75 miles of the employee’s worksite.

*Special “hours of service” requirements apply to airline flight crew employees.

Requesting Leave

Generally, employees must give 30-days’ advance notice of the need for FMLA leave. If it is not possible to give 30-days’ notice, an employee must notify the employer as soon as possible and, generally, follow the employer’s usual procedures.

Employees do not have to share a medical diagnosis, but must provide enough information to the employer so it can determine if the leave qualifies for FMLA protection. Sufficient information could include informing an employer that the employee is or will be unable to perform his or her job functions, that a family member cannot perform daily activities, or that hospitalization or continuing medical treatment is necessary. Employees must inform the employer if the need for leave is for a reason for which FMLA leave was previously taken or certified.

Employers can require a certification or periodic recertification supporting the need for leave. If the employer determines that the certification is incomplete, it must provide a written notice indicating what additional information is required.

Employer Responsibilities

Once an employer becomes aware that an employee’s need for leave is for a reason that may qualify under the FMLA, the employer must notify the employee if he or she is eligible for FMLA leave and, if eligible, must also provide a notice of rights and responsibilities under the FMLA. If the employee is not eligible, the employer must provide a reason for ineligibility. Employers must notify its employees if leave will be designated as FMLA leave, and if so, how much leave will be designated as FMLA leave.

Enforcement

Employees may file a complaint with the U.S. Department of Labor, Wage and Hour Division, or may bring a private lawsuit against an employer. The FMLA does not affect any federal or state law prohibiting discrimination or supersede any state or local law or collective bargaining agreement that provides greater family or medical leave rights.

For more information, or to file a complaint, call 1.866.4.USWAGE (1.866.487.9243)

TTY: 1.877.889.5627

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Important Notice from Magnit Global About Your Prescription Drug Coverage and Medicare

The purpose of this notice is to advise you that the prescription drug coverage listed under the Magnit medical plans is expected to pay out, on average, at least as much as the standard Medicare prescription drug coverage will pay in the plan year. This is known as “creditable coverage.”

Please read this notice carefully and keep it where you can find it. This notice has information about your current prescription drug coverage with Rightsourcing, 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:

1. 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.

2. Magnit Global has determined that the prescription drug coverage offered by the 2023-2024 Plan Year is, 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 Rightsourcing, Inc. coverage will not be affected. Medicare eligible employees who are on the benefit plan, will have the same access as non-Medicare employees.

If you do decide to join a Medicare drug plan and drop your current Rightsourcing, Inc. coverage, be aware that you and your dependents will 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 Rightsourcing, 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.

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Legal Information

Important Notice from Magnit Global About Your Prescription Drug Coverage and Medicare (Continued)

For More Information About This Notice or Your Current Prescription Drug Coverage

For further information, visit the Global Support Center

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 Rightsourcing, Inc. changes. You also may request a copy of this notice at any time.

For More Information About Your Options Under Medicare Prescription Drug Coverage

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).

Premium Assistance Under Medicaid and the Children’s Health Insurance Program (CHIP)

If you or your children are eligible for Medicaid or CHIP and you’re eligible for health coverage from your employer, your state may have a premium assistance program that can help pay for coverage, using funds from their Medicaid or CHIP programs. If you or your children aren’t eligible for Medicaid or CHIP, you won’t be eligible for these premium assistance programs but you may be able to buy individual insurance coverage through the Health Insurance Marketplace. For more information, visit www.healthcare.gov.

If you or your dependents are already enrolled in Medicaid or CHIP and you live in a State listed below, 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, contact your State Medicaid or CHIP office or dial 1.877.KIDS.NOW or www.insurekidsnow.gov to find out how to apply. If you qualify, ask your state if it has a program that might help you pay the premiums for an employer-sponsored plan.

If you or your dependents are eligible for premium assistance under Medicaid or CHIP, as well as eligible under your employer plan, your employer must allow you to enroll in your employer plan if you aren’t already enrolled. This is called a “special enrollment” opportunity, and you must request coverage within 60 days of being determined eligible for premium assistance. If you have questions about enrolling in your employer plan, contact the Department of Labor at www.askebsa.dol.gov or call 1-866-444-EBSA (3272).

If you live in one of the states on the following pages, you may be eligible for assistance paying your employer health plan premiums. The following list of states is current as of January 31, 2023. Contact your State for more information on eligibility –

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Alabama - Medicaid

Website: http://myalhipp.com/

Phone: 1-855-692-5447

Alaska - Medicaid

The AK Health Insurance Premium Payment Program

Website: http://myakhipp.com/

Phone: 1-866-251-4861

Email: CustomerService@myakhipp.com

Medicaid Eligibility: https://health.alaska.gov/dpa/Pages/default.aspx

Arkansas - Medicaid

Website: http://myarhipp.com/

Phone: 1-855-692-7447

California - Medicaid

Health Insurance Premium Payment (HIPP) Program

Website: http://dhcs.ca.gov/hipp

Phone: 916-445-8322

Fax: 916-440-5676

Email: hipp@dhcs.ca.gov

Colorado - Health First Colorado (Colorado’s Medicaid Program) & Child Health Plan Plus (CHP+)

Health First Colorado Website: https://www.healthfirstcolorado.com/

Health First Colorado Member Contact Center: 1-800-221-3943/ State Relay 711

CHP+: https://hcpf.colorado.gov/child-health-plan-plus

CHP+ Customer Service: 1-800-359-1991/ State Relay 711

Health Insurance Buy-in Program (HIBI): https://www.mycohibi.com/

HIBI Customer Service: 1-855-692-6442

Florida - Medicaid

Website:

https://www.flmedicaidtplrecovery.com/hipp/index/html

Phone: 1-877-357-3268

Georgia - Medicaid

GA HIPP Website:

https://medicaid.georgia.gov/health-insurance-premium-payment-program-hipp

Phone: 678-564-1162, press 1

GA CHIPRA Website:

https://medicaid.georgia.gov/programs/third-party-liability/children-health-insurance-program-reauthorization-act-2009-chipra

Phone: 678-564-1162, press 2

Indiana - Medicaid

Healthy Indiana Plan for low-income adults 19-64 Website: http://www.in.gov/fssa/hip/

Phone: 1-877-438-4479

All other Medicaid

Website: https://www.in.gov/medicaid

Phone: 1-800-457-4584

Iowa - Medicaid and Chip (Hawki)

Medicaid Website:

https://dhs.iowa.gov/ime/members

Medicaid Phone: 1-800-338-8366

Hawki Website: http://dhs.iowa.gov/hawki

Hawki Phone: 1-800-257-8563

HIPP Website:

https://dhs.iowa.gov/ime/members/medicaid-a-to-z/hipp

HIPP Phone: 1-888-346-9562

Kansas - Medicaid

Website: https://www.kancare.ks.gov/ Phone: 1-800-792-4884

HIPP Phone: 1-800-766-9012

Kentucky - Medicaid

Kentucky Integrated Health Insurance Premium Payment Program (KI-HIPP) Website: https://chfs.ky.gov/agencies/dms/member/Pages/ kihipp.aspx

Phone: 1-855-459-6328

Email: KIHIPP.PROGRAM@ky.gov

KCHIP Website:

https://kidshealth.ky.gov/pages/index.aspx

Phone: 1-877-524-4718

Kentucky Medicaid Website: https://chfs.ky.gov

Louisiana - Medicaid Website: www.medicaid.la.gov or www.ldh.la.gov/lahipp

Phone: 1-888-342-6207 (medicaid hotline) or 1-855-618-5488 (LaHIPP)

Maine - Medicaid

Enrollment Website:

https://www.mymaineconnection.gov/benefits

Phone: 1-800-442-6003

TTY: Maine Relay 711

Private Health Insurance Premium Webpage:

https://www.maine.gov/dhhs/ofi/applications-forms

Phone: 1-800-977-6740

TTY: Maine relay 711

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Massachusetts - Medicaid and CHIP

Website: https://www.mass.gov/masshealth/pa

Phone: 1-800-862-4840

TTY: 617-886-8102

Minnesota - Medicaid

Website:

https://mn.gov/dhs/people-we-serve/children-and-families/health-care/health-care-programs/ programs-and-services/other-insurance.jsp

Phone: 1-800-657-3739

Missouri - Medicaid

Website:

http://www.dss.mo.gov/mhd/participants/pages/hipp.htm

Phone: 573-751-2005

Montana - Medicaid

Website:

http://dphhs.mt.gov/MontanaHealthcarePrograms/HIPP

Phone: 1-800-694-3084

Email: HHSHIPPProgram@mt.gov

Nebraska - Medicaid

Website: http://www.ACCESSNebraska.ne.gov

Phone: 1-855-632-7633

Lincoln: 402-473-7000

Omaha: 402-595-1178

Nevada - Medicaid

Medicaid Website: http://dhcfp.nv.gov

Medicaid Phone: 1-800-992-0900

New Hampshire - Medicaid

Website: https://www.dhhs.nh.gov/programs-services/ medicaid/health-insurance-premium-program

Phone: 603-271-5218

Toll Free Number for the HIPP program: 1-800-852-3345, ext. 5218

New Jersey - Medicaid and CHIP

Medicaid Website:

http://www.state.nj.us/humanservices/dmahs/clients/ medicaid/

Medicaid Phone: 609-631-2392

CHIP Website: http://www.njfamilycare.org/index.html

CHIP Phone: 1-800-701-0710

New York - Medicaid

Website:

health.ny.gov/health_care/medicaid/

Medicaid Phone: 1-800-541-2831

North Carolina - Medicaid

Website: https://medicaid.ncdhhs.gov/

Phone: 919-855-4100

North Dakota - Medicaid and CHIP

Website:

http://www.nd.gov/dhs/services/medicalserv/medicaid/

Phone: 1-844-854-4825

Oklahoma - Medicaid and CHIP

Website: http://www.insureoklahoma.org

Phone: 1-888-365-3742

Oregon - Medicaid

Website: http://healthcare.oregon.gov/Pages/index.aspx

http://www.oregonhealthcare.gov/index-es.html

Phone: 1-800-699-9075

Pennsylvania - Medicaid and CHIP

Website:

https://www.dhs.pa.gov/Services/Assistance/Pages/ HIPP-Program.aspx

Phone: 1-800-692-7462

Chip Website: pa.gov

CHIP Phone: 1-800-986-KIDS (5437)

Rhode Island - Medicaid and CHIP

Website: http://www.eohhs.ri.gov/

Phone: 1-855-697-4347, or 401-462-0311 (Direct Rite Share Line)

South Carolina - Medicaid

Website: https://www.scdhhs.gov

Phone: 1-888-549-0820

South Dakota - Medicaid

Website: http://dss.sd.gov

Phone: 1-888-828-0059

Texas - Medicaid

Website: http://gethipptexas.com/

Phone: 1-800-440-0493

Utah - Medicaid and CHIP

Medicaid Website: https://medicaid.utah.gov/

CHIP Website: http://health.utah.gov/chip

Phone: 1-877-543-7669

Vermont - Medicaid

Website: https://dvha.vermont.gov/members/medicaid/ hipp-program

Phone: 1-800-250-8427

Virginia - Medicaid and CHIP

Website: https://www.coverva.org/en/famis-select

https://www.coverva.org/en/hipp

Medicaid/CHIP Phone: 1-800-432-5924

Washington - Medicaid

Website: https://www.hca.wa.gov/

Phone: 1-800-562-3022

West Virginia - Medicaid and CHIP

Website: https://dhhr.wv.gov/bms/

http://mywvhipp.com/

Medicaid Phone: 304-558-1700

CHIP Toll-free phone: 1-855-MyWVHIPP (1-855-699-8447)

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Wisconsin - Medicaid and CHIP

Website:

https://www.dhs.wisconsin.gov/badgercareplus/p-10095.htm

Phone: 1-800-362-3002

Wyoming - Medicaid

Website:

https://health.wyo.gov/healthcarefin/medicaid/programs-and-eligbility/

Phone: 1-800-251-1269

For more information on special enrollment rights, you can contact one of the below resources:

U.S. Department of Labor

Employee Benefits Security Administration

www.dol.gov/ebsa

1.866.444.EBSA (3272)

U.S. Department of Health and Human Services

Center for Medicare and Medicaid Services

www.cms.hhs.gov

1.877.267.2323, Menu Option 4, Ext. 61565

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040424 0447 Updated:
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