Teen Challenge - 2024 Executives Benefits Guide

EXECUTIVES

BENEFITS GUIDE 2024 PLAN YEAR

TABLE OF CONTENTS

I ntroduction . . . . . . . . . . . . . . . . . . . . . . . Employee Navigator . . . . . . . . . . . . . . . . Medical . . . . . . . . . . . . . . . . . . . . . . . . . . . HSA . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Supplemental Products . . . . . . . . . . . . . Dental . . . . . . . . . . . . . . . . . . . . . . . . . . Vision . . . . . . . . . . . . . . . . . . . . . . . . . . Basic Life AD&D. . . . . . . . . . . . . . . . . . Disability . . . . . . . . . . . . . . . . . . . . . . . . Employee Assistance Program . . . . . Member Claims Advocate . . . . . . . . . FAQ . . . . . . . . . . . . . . . . . . . . . . . . . . . . Legal Notices . . . . . . . . . . . . . . . . . . . . Medicare Part D. . . . . . . . . . . . . . . . . COBRA. . . . . . . . . . . . . . . . . . . . . . . . . Exchange Notices. . . . . . . . . . . . . . . . Contact Information. . . . . . . . . . . . . .

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Teen Challenge is proud to offer you a comprehensive benefits package for the 2024 plan year. Keep in mind that new enrollment and changes will become effective January 1st, 2024.

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About Deductions

In preparation of your enrollment, please have the following information readily available for you and your dependent(s): • Date(s) of birth • Social Security Number(s): Mandatory • Full name, relationship, and Social Security Number(s) for Life Beneficiary(ies). (Beneficiaries must be at least 18 years old or you will be required to name a guardian for him/her.) Information Needed for Enrollment Premiums for medical, dental and vision plans are all deducted on a pre-tax basis because they are covered under Section 125 of the Internal Revenue Code. Once you elect benefits you will not be approved to make changes to your election or drop coverage until the next Open Enrollment period, unless you have a qualifying event. Voluntary life, long-term disability and short-term disability insurance premiums are deducted on a post-tax basis and may be changed outside of the Open Enrollment period.

Eligibility Information

Qualifying Life Events

As an employee of Teen Challenge, you may be eligible for enrollment in a variety of insurance products. Full-time employees may participate in the benefits package on the 1st of the month following 60 days. You may enroll your eligible dependents for coverage once you are eligible. Your eligible dependents include:

Qualifying events are events that cause an individual to lose his or her group health coverage. The type of qualifying event determines who the qualified beneficiaries are for that event and the period of time that a plan must offer continuation of coverage.

Qualifying events include:

• Marriage • Divorce or legal separation • Birth or adoption of a child • Death of spouse or dependent child • Change in employment status • Loss of other coverage • Entitlement to Medicare or Medicaid • Child turning 26 years old

• Your legal spouse • Your children up to age 26 (as identified in the plan document)

*Once your elections are effective, they will remain in effect through the plan year.

You must notify Human Resources within 30 days of the qualifying life event. Depending on the type of event, you may be asked to provide proof of the event. If you do not contact Human Resources within 30 days of the qualifying event, you will have to wait until the next annual enrollment period to make changes.

TEEN CHALLENGE 2024 BENEFITS GUIDE

How to Enroll

Step 1: Creating your Employee Navigator Account

Welcome Email:

• You will receive a Welcome email from Employee Navigator • Click on the “Registration Link” in the email • Create an account with username and password of your choice

• Go to https://www.employeenavigator.com/benefits/Account/Register • Enter [First Name], then [Last Name] • Enter your Company Identifier [TeenChallenge] • PIN: Last four of your SSN • Enter your birthdate: MM/DD/YYY • Click “Next” to continue • When prompted, your username will be as follows: [First Name].[Last Name] Option 2:

Step 2: Complete HR Tasks

• Once your account is set up, you will be taken to your employee homepage.

• On the homepage, click the “Complete HR Tasks” to begin your new hire tasks first.

• The first few tasks require you to put in demographic information and e-sign for online acknowledgment.

T I P If you hit “Dismiss, complete later” you’ll be taken to your Home Page. You’ll still be able to start enrollments again by clicking “Start Enrollments”

Step 3: Benefit Elections

• To enroll dependents in a benefit, click the checkbox next to the dependent’s name under “Who am I enrolling?” If you do not click on their name(s), they will not get the insurance. • Below your dependents you can view your available plans and the cost per pay period. To elect a benefit, click Select Plan underneath the plan cost.

TEEN CHALLENGE 2024 BENEFITS GUIDE

Step 4: Forms

• If you have elected benefits that require a beneficiary designation, Primary Care Physician or completion of an Evidence of Insurability form, you will be prompted or required to complete.

Step 5: Review & Confirm Elections

• Review the benefits you selected on the enrollment summary page to make sure they are correct then click “Sign & Agree” to complete your enrollment. Print a summary of your elections for your records.

T I P If you miss a step you’ll see Enrollment Not Complete in the progress bar with the incomplete steps highlighted. Click on any incomplete steps in the drop down bar to complete them. ALL STEPS MUST BE COMPLETED! Step 6: HR Tasks (if applicable)

• To complete any required HR tasks, click “Start Tasks”. If your HR department has not assigned any tasks, you’re finished!

TEEN CHALLENGE 2024 BENEFITS GUIDE

Medical and Pharmacy Coverage

Teen Challenge offers the following Medical plans through Aetna and offers “in and out-of-network” benefits.

Insurance Carrier:

Aetna Medical Insurance

Medical Plan:

Copay Plan - $5k / 80%

HDHP w/HSA - $7k / 100%

In-Network: Office Visit Copay - Primary Care

$45

Deductible; then 100% Coinsurance

Office Visit Copay - Specialist Care

$80

Deductible; then 100% Coinsurance

Urgent Care Copay

$75

Deductible; then 100% Coinsurance

Emergency Room Care

$425 Copay; then 80% Coinsurance

Deductible; then 100% Coinsurance

Preventative Visit Copay

Diagnostic Testing (X-Ray / Blood Work)

Deductible; then 80% Coinsurance

Deductible; then 100% Coinsurance

Advanced Imaging

Deductible; then 80% Coinsurance

Deductible; then 100% Coinsurance

Coinsurance

80%

100%

Employee Deductible

$5,000

$7,000

Family Deductible

$10,000

$14,000

Employee Out-of-Pocket Max

$7,500 (includes deductible)

Family Out-of-Pocket Max

$15,000 (includes deductible)

Inpatient Hospital

Deductible; then 80% Coinsurance

Deductible; then 100% Coinsurance

Outpatient Hospital or Facility

Deductible; then 80% Coinsurance

Deductible; then 100% Coinsurance

Out-of-Network: Coinsurance

60%

30%

Employee Deductible

$10,000

Family Deductible

$20,000

Employee Out-of-Pocket Max

$20,000

Family Out-of-Pocket Max

$40,000

Prescription Drugs: ( 30 Day Supply) Rx Deductible

Combined with Medical

Tier 1 - Generic

$15

$10

Tier 2 - Preferred

$35

$30

Tier 3 - Non-Preferred

$65

$60

Tier 4 - Specialty

$250

$250 / $500

Employee Bi-Weekly Deduction Employee Only

$68.21

$57.26

Employee + Spouse

$136.43

$114.51

Employee + Child(ren)

$129.61

$108.78

Family

$204.64

$171.76

TEEN CHALLENGE 2024 BENEFITS GUIDE

Health Savings Account (HSA)

Teen Challenge Health Savings Account

Your eligibility In order to open and fund an HSA, you must meet the following requirements: • You are enrolled in Teen Challenge’s High Deductible Plan (HDHP) • Are not covered under another medical plan such as Medicare, Tricare or a spouse’s medical plan (not an HDHP) which provides similar coverage; and • Cannot be claimed as a dependent on another person’s insurance policy or tax return.

Qualified Health Care Expenses Each time you have a medical, dental or vision expense you decide if you want to pay with money from your HSA. “Qualified Medical Expenses” are determined by the US Treasury, 213(d) expenses, and detailed in IRS Publication 502. Some examples include but are not limited to:

•

Expenses that apply toward your deductible

2024 IRS Calendar Year Contribution Limit

• • •

Prescription expenses Contact lens fitting

Orthodontia • Acupuncture • Artificial teeth • Eye glasses

2024

If you cover just yourself on the plan:

$4,150 $8,300 $1,000

If you cover yourself and a spouse or dependents:

Age 55+ Catch-Up:

Whose Medical Expenses Can You Use Your HSA Funds on?

When You Can Begin Contributing You may begin funding your HSA when your medical HDHP benefits begin. You are able to contribute as little or as much (up to the IRS limit) as you wish out of each paycheck and this election may be changed at any time throughout the year. When You Cannot Contribute If you terminate HDHP medical plan coverage (or employment) with Teen Challenge, you may no longer contribute to your HSA through Teen Challenge’s payroll deduction. You own the HSA so your balance can be carried over year after year and the funds you contributed always belong to you.

Generally your:

• Legally married spouse. Domestic partners are not covered under the tax code. • Permanently and totally disabled dependent of any age. • Dependent under the age of 19

at the end of calendar year or a full-time student under the age of 24 at the end of the calendar year who also: Lived with you more than 1/2 the calendar year, and Didn’t provide over 1/2 his/her own support in the calendar year, and Didn’t file a joint tax return, other than to claim a refund

•

Benefits of an HSA

•

Tax Savings! An HSA provides triple tax savings: (1) tax deductions when you contribute to your account (2) tax-free investment earnings (3) tax-free withdrawals for qualified medical expenses

•

Qualifying relative. See IRS Publication 502 for more information.

TEEN CHALLENGE 2024 BENEFITS GUIDE

Aetna MinuteClinic

Now offering access to MinuteClinic ® at no cost * to the member

Give your employees the care they need, when and where they need it.

TEEN CHALLENGE 2024 BENEFITS GUIDE

Aetna MinuteClinic

Bringing quality care close to home The time for a solution that gives people more options to take control of their health and get the care they need — on their terms — is now.

Lower costs

Improve health

Boost satisfaction

High-quality care that’s convenient and reliable MinuteClinic ® makes it easy for your employees to get the care they need, when and where they need it. And now your employees can get access to all covered MinuteClinic services at no cost to them — not just preventive care. *

MinuteClinic is a walk-in clinic inside select CVS Pharmacy ® and Target stores and is the largest provider of retail health care in the United States — with over 1,100 locations in 33 states and the District of Columbia.

Open every day, including evenings. MinuteClinic offers both walk-in and scheduled appointment options.

MinuteClinic health care providers treat a variety of illnesses, injuries and conditions. They can also write prescriptions, when medically appropriate.

Contact your Aetna representative today to learn more.

TEEN CHALLENGE 2024 BENEFITS GUIDE Aetna and MinuteClinic, LLC (which either operates or provides certain management support services to MinuteClinic-branded walk-in clinics) are both within the CVS Health family. Aetna is not responsible or liable in any manner for services received at CVS MinuteClinic locations. For more information about Aetna plans, *Visit minuteclinic.com for age and service restrictions. This is for informational purposes only and is intended to be used only in connection with self-funded plans. It is not medical advice and is not intended to be a substitute for proper medical care provided by a physician. Information is believed to be accurate as of the production date; however, it is subject to change. Includes access to all covered services at MinuteClinic. Eligible members enrolled in high-deductible plans must meet their deductible. However, such services would be subject to negotiated contract rates. Once the deductible has been met, members will be able to access MinuteClinic services at no cost-share. Members in Aetna Whole Health ACO, APCN Plus, HMO and indemnity plans are not eligible for this benefit. Such members should refer to their benefit plan documents in order to determine coverage and applicable cost- share for walk-in clinic benefits and services, as applicable.

91.03.206.1

Aetna Member Access

A new way of looking at health care

aetna.com

95.03.124.1 (3/19)

10 TEEN CHALLENGE 2024 BENEFITS GUIDE

Aetna Member Access

Welcome to a simpler and easier way for members to manage their health plans

Members can set up an account today and manage benefits and more.

Search for care, doctors, procedures

Robert

Documents & Forms

Buscar proveedores

Home

Manage

Pharmacy

Stay Healthy

Family

Active plans

Quick tasks

Active

View Member ID cards

Medical Robert, Jack & 1 other

View coverage

Medical Christopher, Jack

Find a nearby urgent care

Assign a primary care physician

View coverage

Find a nearby ER

Dental All family members

View coverage

Spending to date Spending summary

Medical - in network

Vision Robert

View coverage

Deductible - $5,000

Other coverage All family members

View coverage

$3,000.00

$2,000.00

Spent

Remaining

Account balances

Out-of-pocket max - $10,000

Flex Spending Account

$2,091.84

Spent $3,000.00

Remaining $7,000.00

Health Savings Account

$11,302.98

What are deductibles, maximums and coinsurance? Right now your family pays 100% for all in-network medical services.

Spent $3,000.00

Remaining $7,000.00

Most recent Claims What are deductibles, maximums and coinsurance? Right now your family pays 100% for all in-network medical services.

Brookhaven Memorial Hospital Medical Center Inc, Patchogue

Unpaid $853.23

Dec 5

Robert

Unpaid $853.23

South Bedford Dental

Dec 4

Christopher

Dec 1 AT HOME Visit our member website at aetna.com . Robert South Bedford Dental Unpaid $853.23 Dec 2 Jack Comfort Dental Unpaid $853.23 Dec 3 Robert Wynkoop Imaging Center

ON THE GO Get the Aetna Health SM app by texting “ AETNA ” to 90156 for a link to download the app (message and data rates apply).*

Unpaid $853.23

View all claims

Privacy Center

Plan Disclosures

Nondiscrimination Notice

Accessibility Services

Translation Assistance

Find and compare services • Search for facilities, procedures or medications • Find in-network providers accepting new patients • Estimate and compare costs

Manage benefits • Access your medical ID card whenever you need it • Track spending and progress toward deductibles • View and pay your claims

*Terms and Conditions: bit.ly/2nlJFYG. Privacy Policy: aetna.com/legal-notices/privacy.html. Aetna is the brand name used for products and services provided by one or more of the Aetna group of subsidiary companies, including Aetna Life Insurance Company and its affiliates (Aetna).

aetna.com

TEEN CHALLENGE 2024 BENEFITS GUIDE

Aetna Access To Care

Aim high: Raise the bar on your health care

Aetna® health plans can help you raise the bar on your health and wellness goals. Get big opportunities for savings and support that fit your schedule, with programs that are part of your health plan. You can access easy-to-use in-person and online tools and resources. It’s what you need to stay happy, healthy and productive — in all parts of your life. You can access these programs and certain in-network services at low or no cost* under your medical and pharmacy plans.

Start today. Log in to your member website through Aet.Na/Health-Login. There, you can manage your benefits, connect with care, and view and pay claims.

*If the member is enrolled in a qualified high-deductible health plan, they can receive preventive services at no cost. To receive no-cost care on all covered non-preventive services, the member will first need to meet their deductible. Indemnity plans will apply the plan’s deductible and coinsurance for most services. Refer to plan documents for cost-sharing and additional plan details.

Aetna.com 1126755-01-01 (7/22)

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Aetna Access To Care

Access to care

MinuteClinic Your plan gives you access to covered MinuteClinic® services at no cost to you.* MinuteClinic is a clinic inside many select CVS Pharmacy,® CVS HealthHUB and Target® locations.** They’re open every day, even evenings and weekends. And now you can get care quickly from the comfort of your own home with virtual care visits any day of the week. If you’re in a qualified high-deductible health plan, you can get preventive care at no extra cost. And you’ll get lower-cost care for other covered minor illness and injury care at MinuteClinic. To receive no-cost care on all covered services, you will first need to meet your deductible. Find a MinuteClinic near you at CVS.com/MinuteClinic . Or log in to your Aetna Health SM app by going to Aet.Na/Health-App to set up an appointment. For a list of other providers in the network, log in to Aet.Na/Health-Login and use our search tool. Teladoc® You can connect directly with a board-certified doctor by phone or video through Teladoc. This service is best for general medical, dermatology or mental health visits at no cost to you. To start:

•Call 1-855-TELADOC (835-2362) •Visit Aet.Na/AFA-Tdoc •Download the Aetna Health app at Aet.Na/Health-App

*Includes select MinuteClinic services. Not all MinuteClinic services are covered. Please consult benefit documents to confirm which services are included. Members enrolled in qualified high-deductible health plans must meet their deductible before receiving covered non-preventive MinuteClinic services at no cost-share. However, such services are covered at negotiated contract rates. This benefit is not available in all states and on indemnity plans. Visit MinuteClinic.com for age and service restrictions. This is for informational purposes only and is intended to be used only in connection with self-funded plans. It is not medical advice and is not intended to be a substitute for proper medical care provided by a physician. **For a complete list of other participating providers, log in to your member site at Aetna.com and use our provider search tool.

13 TEEN CHALLENGE 2024 BENEFITS GUIDE

Aetna Access To Care

Mental well-being

Employee Assistance Program (Aetna Resources For Living SM ) You and your eligible household members can get help with all aspects of life, from emotional well-being, (stress management, work/life balance, depression, anxiety) to help with daily life (e.g., stress, care for children, older adults and pets). There’s even legal and financial help. You can seek personal help 24/7 with the Resources For Living mobile app. We’re here for you, 24/7. Give us a call at 1-866-326-7172, TTY: 711 . Or check out Aet.Na/AFA-RFL (Username: SGEAP Password: EAP).

Behavioral Telehealth/Virtual providers and services In addition to in-person counseling, these services offer another way to get help. You can

also choose between multiple providers. Check out Aet.Na/AFA-BH to get started.

Managing health

Aetna One® Essentials Your health — both physical and mental — is everything. Whether you’re managing an acute issue or dealing with other complex health challenges, our nurses can help. If you’re identified for care management, a nurse can work with you to set up a care plan, help you understand your benefits and answer your health questions. You can start using these resources today. Go to Aet.Na/Health-Login to log in to your member website or call the number on your member ID card. Enhanced Maternity Program Going through a maternity journey is unique for each person. So whether you need support for family planning or postpartum care, we’ll be right there as a trusted, reliable resource. To learn more and sign up, call us at 1-800-272-3531 (TTY: 711) weekdays from 8 AM to 7 PM ET. Or log in to your member website at Aetna.com and look under “Stay Healthy.” Diabetic Meter Program Looking for an easier way to monitor your levels? Here you go: We offer no-cost* meters to eligible plan members. Regular blood glucose testing is vital to successful diabetes management. That’s why your prescription plan includes this helpful program. Call the number on your member ID card to learn more. Order your new meter today by going to Aet.Na/AFA-DMP and filling out the form.

*Blood glucose meters are funded by the manufacturer. Choice of meters is subject to change. Meters will be shipped to members within 7 to 10 days of order. Additional requirements or limitations may apply.

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Aetna Access To Care

Wellness and discount programs

Attain by Aetna® app Attain® * helps you follow your own path to better health. It combines your unique health history with your wearable activity device. The result: personalized goals, ** achievable actions and motivating rewards. Download on the App Store® or Google Play.™ Or text “ATTAINAPP” to 37046 for a link to download (message and data rates may apply). *** Explore more at Aet.Na/AFA-Attain. Peerfit Peerfit helps you stay active with monthly credits † you can redeem for group fitness classes. These include virtual classes at any gym or fitness center that participates in the Peerfit network. Fitness classes include yoga, barre, CrossFit, kickboxing and more. Get active on your own terms with Peerfit. Visit Aet.Na/AFA-Peerfit. Wellness tools You can access a health assessment and online health programs to help you meet your goals. You choose the goals to work on and your pace. You can also get helpful details about procedures, conditions and treatments. To start using these tools, log in to your member website on Aet.Na/Health-Login. Discount program The Aetna Discount Program helps you save on health products and services. You’ll get discounts on things like eyewear, hearing exams, healthy lifestyle services and natural health offerings. To start, log in to your member website on Aet.Na/Health-Login. **Goals and suggested health actions should not replace your doctor’s advice. If you have a medical condition that prevents you from meeting your goals, or if your doctor advises you not to take part in physical activity, there may be an opportunity for you to earn the same rewards by different means. Please contact 1-866-820-3731 (TTY: 711). ***Terms and Conditions: Aet.na/2IyZvfc Privacy Policy: Aet.na/2GqxsuN. iPhone is a trademark of Apple Inc., registered in the U.S. and other countries. App Store is a service mark of Apple Inc. Google Play and Android are trademarks of Google LLC. † Employees are provided with 40 monthly credits that can be exchanged for classes from studios in the Peerfit network. Credits reset each month. The number of credits required per class varies based on studio and class type. DISCOUNT OFFERS ARE NOT INSURANCE. They are not benefits under your insurance plan. You get access to discounts off the regular charge on products and services offered by third party vendors and providers. Aetna makes no payment to the third parties — you are responsible for the full cost. Check any insurance plan benefits you have before using these discount offers, as those benefits may give you lower costs than these discounts. Peerfit, Inc., is an independent provider of fitness and wellness technologies, empowering individuals to live healthy and active lifestyles by making wellness accessible and enjoyable through the power of choice and community-driven motivation. Aetna Resources For Living SM is the brand name used for products and services offered through the Aetna group of companies. The EAP is administered by Aetna Behavioral Health, LLC; and in California, for Knox-Keene plans, by Aetna Health of California, Inc. and Health and Human Resources Center, Inc. All EAP calls are confidential, except as required by law. This material is for informational purposes only. It contains only a partial, general description of programs and services and does not constitute a contract. EAP instructors, educators and network participating providers are independent contractors and are neither agents nor employees of Aetna. Aetna does not direct, manage, oversee or control the individual services provided by these persons and does not assume any responsibility or liability for the services they provide and, therefore, cannot guarantee any results or outcomes. The availability of any particular provider cannot be guaranteed and is subject to change. Information is believed to be accurate as of the production date; however, it is subject to change. For more information about Aetna plans, refer to Aetna.com. Aetna, CVS Pharmacy® and MinuteClinic, LLC (which either operates or provides certain management support services to MinuteClinic-branded walk-in clinics) are part of the CVS Health® family of companies. Aetna Funding Advantage℠ plans are self-funded, meaning the benefits coverage is provided by the employer. Aetna Life Insurance Company provides administrative services to the employer. Not all services are covered. See plan documents for a complete description of benefits, exclusions and limitations of coverage. Aetna.com ©2022 Aetna Inc. 1126755-01-01 (7/22) *The Attain by Aetna® app is available now on the App Store or Google Play store. You need to be at least 18. You need a compatible iPhone® or Android™ device, and a compatible wearable device.

15 TEEN CHALLENGE 2024 BENEFITS GUIDE

Sun Life Accident Insurance

Once your coverage goes into effect, you can file a claim for covered accidents that occur after your insurance plan’s effective date. Unless otherwise specified, benefits are payable only once for each covered accident, as applicable. The full list of benefits is listed here.

16 TEEN CHALLENGE 2024 BENEFITS GUIDE

Sun Life Accident Insurance

Employee Bi-Weekly Deduction Employee Only

$5.85 $8.80 $9.90

Employee + Spouse Employee + Child(ren)

Family

$12.84

17 TEEN CHALLENGE 2024 BENEFITS GUIDE

Sun Life Critical Illness Insurance

18 TEEN CHALLENGE 2024 BENEFITS GUIDE

Sun Life Critical Illness Insurance

*Critical Illness Rates are Age-Banded. Refer to Employee Navigator for amounts.

19 TEEN CHALLENGE 2024 BENEFITS GUIDE

Sun Life Hospital Indemnity Insurance

20 TEEN CHALLENGE 2024 BENEFITS GUIDE

Sun Life Hospital Indemnity Insurance

Employee Bi-Weekly Deduction Employee Only

$13.55 $28.28 $22.59 $37.32

Employee + Spouse Employee + Child(ren)

Family

21 TEEN CHALLENGE 2024 BENEFITS GUIDE

Dental Coverage

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

Insurance Carrier:

Unum Dental Insurance

Plan Type:

Basic Plan

Enhanced Plan

Calendar Year Deductible Calendar Year Maximum

$50 Individual / $150 Family

$1,000

$2,000

Preventive Services

100%

Basic Services Major Services Endo / Perio

80% 50% 50% N/A

90% 60% 90%

Orthodontia (dependent children only) Out-of-Network Reimbursement Employee Bi-Weekly Deduction Employee Only

$2,000

90th UCR

$13.33 $26.25 $37.79 $50.70

$21.48 $42.06 $55.21 $75.79

Employee + Spouse Employee + Child(ren)

Family

22 TEEN CHALLENGE 2024 BENEFITS GUIDE

Vision Coverage

You can help protect your eyesight by visiting an eye doctor regularly. Vision insurance includes an annual comprehensive eye exam with an eye care doctor. Taking care of your eyes today can lead to a better quality of life later. Seeing an in-network eye care provider can reduce your expenses with savings on frames, lenses, contacts, eye exams and more. You can find vision providers at unumvisioncare.com

Insurance Carrier:

Unum Vision Insurance

Plan Type:

VSP

In-Network $10 Copay $25 Copay $25 Copay $25 Copay $25 Copay

Out-of-Network

Exam Copay

Up to $40 Up to $30 Up to $50 Up to $70 Up to $70 Up to $105

Lenses - Single lined Lenses - Bifocal lined Lenses - Trifocal Lenses - Lenticular

Frames

$ 150 Allowance

Elective Contact Lenses (in place of lenses & frame)

$40 Contact Lens exam $150 Allowance

Up to $150; Medically Necessary up to $210

Frequency for Exam / Lenses / Frames Employee Bi-Weekly Deduction Employee Only

12 months / 12 months / 24 months

$3.38 $5.37 $7.57

Employee + Spouse Employee + Child(ren)

Family

$11.83

23 TEEN CHALLENGE 2024 BENEFITS GUIDE

Basic Life and AD&D Insurance Coverage

Teen Challenge provides all Full Time employees with Basic Life and Accidental Death & Dismemberment at no cost to employees.

Insurance Carrier: Basic Life w/ AD&D Eligibility Requirement Life Insurance Benefit

OneAmerica Basic Life w/AD&D Insurance

All Full Time Employees

$25,000

Guarantee Issue

Yes

Accidental Death & Dismemberment Benefit (AD&D)

Same as Basic Life Amount

Voluntary Term Life Insurance Coverage

As a supplemental benefit, Teen Challenge allows eligible employees to purchase additional life insurance coverage for yourself and your dependents. This coverage is paid for by you and is offered through OneAmerica. Rates for the voluntary term life insurance are based on age, and volume, and benefits are subject to applicable age reductions.

Insurance Carrier:

OneAmerica Voluntary Life w/AD&D Insurance

Voluntary Life w/ AD&D Eligibility Requirement Employee Benefit Amounts Employee

All Full Time Employees

5x Annual Earnings up to $300k in increments of $10k

Spouse

100% of Employee Amount up to $150k

Child(ren)

Flat $10k

Guarantee Issue Employee

$100k

Dependent Child(ren)

$25k $10k

24 TEEN CHALLENGE 2024 BENEFITS GUIDE

OneAmerica Life Insurance Needs

Protecting Your Loved Ones — No Matter What

“Will my loved ones be OK when I’m gone?” It’s a difficult question to ask yourself, but an important one all the same.

If you were to pass away unexpectedly, how would your loved ones cope financially? Would they be taken care of? Or would they find themselves struggling to make ends meet while still in the midst of their grief? A Growing Gap for Families Across the country, American families face a growing insurance gap. In early 2020, 46% of U.S. adult consumers didn’t own life insurance. 1 Yet, 44% also stated that their families would begin to feel the financial effects within six months of a primary wage earner passing away — and 28% would do so within just a month. 1 But life insurance isn’t just about protecting your loved ones in the short term. It can also be a way of providing for them for decades to come, by keeping them on track for their long-term goals, whether they be college education, home ownership or even retirement. 1. Source: https://lifehappens.org/blog/is-life-insurance-tomorrows- problem-findings-from-the-2020-insurance-barometer-study/ June 16, 2020.

46% of U.S. adult consumers don’t own life insurance. 44% state that their families would begin to feel the financial effects within six months of a primary wage earner passing away.

To learn more, or if you have questions about the life insurance options available through your employer, contact your human resources department today.

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Disability Coverage

The goal of Teen Challenge’s Disability Insurance Plan is to provide you with income replacement should you be unable to work due to a non-work-related illness or injury. The company provides employees with the option to purchase voluntary “Short and Long Term Disability” income benefits.

Both Short-Term and Long-Term Disability Coverage is offered through OneAmerica.

Insurance Carrier:

Short-Term Disability Insurance

Plan Type:

Voluntary

Eligibility Requirement Benefit Percentage

All Full Time Employees

60% $100

Increments

Maximum Weekly Benefit

$1,000

Benefit Duration

13 Weeks

Waiting Period - Injury Waiting Period - Sickness Pre-Existing Condition

7 Days 7 Days

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Insurance Carrier:

Long-Term Disability Insurance

Plan Type:

Voluntary

Eligibility Requirement

All Full Time Employees

Waiting Period

90 Days

Benefit Percentage

60% $100

Increments

Maximum Monthly Benefit

$5,000 2 Years 12 / 12

Benefit Duration

Pre-Existing Condition

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OneAmerica Disability Insurance Needs

Protect Your Income with Disability Insurance

You probably have insurance for the things you depend on most. That could include protecting your home against fire or flood and protecting your vehicle in case of an accident.

You may even have life insurance to make sure that your loved ones are taken care of after you die. But have you ever considered insuring your income? It’s an important question. Your income is the cornerstone of your financial stability. It’s how you afford that home’s mortgage, your car’s monthly payments and the food and other necessities your household needs. That stability is threatened, however, if you experience a severe injury or illness that leaves you unable to work. Worker’s Compensation Might Not Be Enough Although worker’s compensation does offer some protections, it only covers injuries that happen on the job. To qualify for coverage, you also must meet certain eligibility requirements. If you have medical insurance, that can help too, but only to cover your actual medical costs. It still won’t replace your lost income while you’re unable to work.

16% of American workers had disability insurance coverage 1 . 50% of working Americans would have to tap into their savings if they couldn’t work due to an injury or illness. 2

Ready to learn more? Reach out to your human resources department today to get started.

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Employee Assistance Program (EAP)

Call Your ComPsych ® GuidanceResources ® program anytime for confidential assistance.

Call: 855.387.9727

TDD: 800.697.0353

Go online: guidanceresources.com

Your company Web ID: ONEAMERICA3

Personal issues, planning for life events or simply managing daily life can affect your work, health and family. Your GuidanceResources program provides support, resources and information for personal and work-life issues. The program is company-sponsored, confidential and provided at no charge to you and your dependents. This flyer explains how GuidanceResources can help you and your family deal with everyday challenges.

Confidential Counseling 3 Session Plan

GuidanceResources ® Online Knowledge at your fingertips.

This no-cost counseling service helps you address stress, relationship and other personal issues you and your family may face. It is staffed by GuidanceConsultants SM —highly trained master’s and doctoral level clinicians who will listen to your concerns and quickly refer you to in-person counseling (up to 3 sessions per issue per year) and other resources for: › Stress, anxiety and depression › Job pressures › Relationship/marital conflicts › Grief and loss › Problems with children › Substance abuse Financial Information and Resources Discover your best options. Speak by phone with our Certified Public Accountants and Certified Financial Planners on a wide range of financial issues, including: › Getting out of debt › Retirement planning › Credit card or loan problems › Estate planning › Tax questions › Saving for college

GuidanceResources Online is your one stop for expert information on the issues that matter most to you...relationships, work, school, children, wellness, legal, financial, free time and more. › Timely articles, HelpSheets SM , tutorials, streaming videos and self-assessments › “Ask the Expert” personal responses to your questions › Child care, elder care, attorney and financial planner searches Free Online Will Preparation Get peace of mind. EstateGuidance ® lets you quickly and easily write a will on your computer. Just go to www.guidanceresources.com and click on the EstateGuidance link. Follow the prompts to create and download your will at no cost. Online support and instructions for executing

and filing your will are included. You can: › Name an executor to manage your estate › Choose a guardian for your children › Specify your wishes for your property › Provide funeral and burial instructions

Legal Support and Resources Expert info when you need it.

Talk to our attorneys by phone. If you require representation, we’ll refer you to a qualified attorney in your area for a free 30-minute consultation with a 25% reduction in customary legal fees thereafter. Call about: › Divorce and family law › Real estate transactions › Debt and bankruptcy › Civil and criminal actions › Landlord/tenant issues › Contracts Work-Life Solutions Delegate your “to-do” list. Our Work-Life specialists will do the research for you, providing qualified referrals and customized resources for: › Child and elder care › College planning › Moving and relocation › Pet care › Making major purchases › Home repair

Your ComPsych ® GuidanceResources ® Program

CALL ANYTIME Call: 855.387.9727 TDD: 800.697.0353 Online: guidanceresources.com Your company Web ID: ONEAMERICA3

ONEAMERICA ® is the marketing name for the companies of OneAmerica. OneAmerica markets ComPsych services. ComPsych is not an affiliate of OneAmerica and is not a OneAmerica company.

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Employee Benefit Assistants You Can Count on M ember C laims A dvocate

Teen Challenge provides you and your family members a complimentary member claims service to help with claims, billing, missing ID cards and more. give member claims advocate a call if : • You received a provider bill or EOB and feel the claim was processed incorrectly • You are at the doctor or pharmacy and having trouble with your coverage • You need to confirm if a provider is In-Network • You are missing your ID card Y ou can reach the M ember C laims A dvocate team by phone or email

Monday through Friday, 8:30 AM EST - 5:00 PM EST

Charlie McDaniel - cmcdaniel@yatesins.com Resa Carter - rcarter@yatesins.com

(706) 323-1600

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Frequently Asked Questions

What is included in the Medical Out-of-Pocket maximum? What is included in the Pharmacy Out- of-Pocket maximum? The Medical Out-of-Pocket maximum is the maximum amount a member must pay during the policy year for covered essential health benefits. The OOP includes a member’s deductible and any coinsurance member responsibility. The Pharmacy OOP includes only pharmacy co-pays. The Medical OOP does NOT include monthly premiums, or billing from out-of-network providers. What is an in-network vs out-of-network provider? Aetna contracts with a wide range of doctors, as well as specialists, hospitals, labs, radiology facilities and pharmacies. These are the providers that are considered “in your network”. Specifically, each of these providers has agreed to accept Aetna’s contracted rate for your medical care and services rendered. The contracted rate includes both Aetna’s share of the cost, and the member’s. Your share may be in the form of a co-payment, deductible, or co-insurance. For example, Aetna’s contracted rate for a primary care visit might be $125. The Plan has a $25 co-payment for the visit; the member will pay $25 of the cost and your insurance plan will pay the remaining $100. An “out-of-network” provider is a medical doctor or facility that is not in contract with Aetna. This means that the provider may charge members higher rates for medical services and care, outside of the standard “in-network” rates. For example, a out-of- network provider may charge $200 for a primary care visit. Aetna may pay an adjustment of an out-of-network benefit of $80 dollars to the provider, so the member may be balance-billed for the remaining $120 cost of the visit.

When can I change my beneficiary information for my Basic Life Insurance? Any time! It is important that all beneficiary information be kept up-to-date. You may need to change it after a marriage, divorce, or birth of a child. You can go into Employee Navigator at anytime to update your beneficiary.

Term

Definition

Network Office Visit (PCP) The “per visit” co-pay cost for a primary care or standard network doctor.

The “per visit” co-pay cost for a specialized doctor (cardiologist, OB/GYN,

Specialist Office Visit

orthopedic, gastrointestinal, etc.)

The amount of money a member owes for any In-network health care services before co-insurance coverage begins. These are generally services that are NOT covered under a standard co-pay (inpatient surgery, outpatient surgery, MRI, etc.) Deductibles run on a calendar year basis. After any applicable deductible is met, the remaining cost of any in-network health care service is divided between the insurance carrier and the member. A 70% / 30% network co-insurance would divide the cost of a service with 70% paid by the insurance carrier and 30% paid by the member. These are generally services that are NOT covered under a standard co-pay (inpatient surgery, outpatient surgery, MRI, etc.) The maximum amount a member must pay during the policy year for covered essential health benefits. The OOP includes a member’s deductible, any co-insurance member responsibility, primary care and specialist office visit co-pays, ER or Urgent Care co-pays, and prescription co-pays / costs. The OOP does NOT include monthly premiums, billing from out-of-network providers, or spending for non-essential health benefits. The cost of a one month supply of a prescription drug. All covered drugs are designated into tiered levels based on drug usage, cost, and clinical effectiveness. Tier 1 usually includes generics, while Tier 2 generally includes preferred brand name medications. Tier 3 typically includes non-preferred brand name medications, Tier 4 usually includes higher cost drugs and Specialty Drugs are covered under a separate tier.

Network Deductible

Co-Insurance

Network Out-of-Pocket Maximum (OOP)

Prescription Drug Tiers and Monthly Co-Pays

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Legal Notices

Medicaid and the Children’s Health Insurance Program (CHIP) Offer Free or Low-Cost Health Coverage to Children and Families 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 following states, you may be eligible for assistance paying your employer health plan premiums. The following list of states is current as of January 31, 2022. Contact your State for more information on eligibility –

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: Customer Service@MyAKHIPP.com Medicaid Eligibility: http://dhss.alaska.gov/dpa/Pages/medicaid/default. aspx ARKANSAS - Medicaid Website: http://myarhipp.com/ Phone: 1-855-MyARHIPP (855-692-7447) COLORADO - Medicaid Website: http://www.colorado.gov/hcpf Customer Contact Center: 1-800-221-3943 KANSAS - Medicaid Website: http://www.kdheks.gov/hcf/ Phone: 1-785-296-3512 KENTUCKY - Medicaid Website: http://chfs.ky.gov/dms/default.htm Phone: 1-800-635-2570 LOUSIANA - Medicaid Website: http://dhh.louisiana.gov/index.cfm/ subhome/l/n/331 Phone: 1-888-695-2447

FLORIDA - Medicaid Website: http://flmedicaidtplrecovery.com/hipp/ Phone: 1-877-357-3268 GEORGIA - Medicaid Website: http://dch.georgia.gov/medicaid - click on Health Insurance Premium Payment (HIPP) Phone: 404-656-4507 INDIANA - Medicaid Healthy Indiana Plan for Low-Income Adults 19-64 Website: http://www.hip.in.gov Phone: 1-877-438-4479 All other Medicaid Website: http://www.indianamedicaid.com Phone: 1-800-403-0864 IOWA - Medicaid Website: http://www.dhs.state.ia.us/hipp/ Phone: 1-888-346-9562 MAINE - Medicaid Website: http://maine.gov/dhhs/ofi/public-assistance/ index.html Phone: 1-800-442-6003 TTY: Maine relay 711

MASSACHUSETTS - Medicaid and CHIP Website: http://www.mass.gov/MassHealth

Phone: 1-800-462-1120 MINNESOTA - Medicaid Website: http://mn.gov/dhs/ma/ Phone: 1-800-657-3739

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Legal Notices

MISSOURI - Medicaid Website: http://www.dss.mo.gov/mhd/participants/pages/hipp.htm

RHODE ISLAND - Medicaid Website: http://www.eohhs.ri.gov/ Phone: 401-462-5300 SOUTH CAROLINA - Medicaid Website: http://www.scdhhs.gov Phone: 1-888-549-0820 SOUTH DAKOTA - Medicaid

Phone: 573-751-2005 MONTANA - Medicaid Website: http://dphhs.mt.gov/ MontanaHealthcarePrograms/HIPP

Phone: 1-800-694-3084 NEBRASKA - Medicaid

Website: http://www.dhhs.ne.gov/Children_Family_ Services/AccessNebraska/Pages/accessnebraska_ index.aspx Phone: 1-855-632-7633 NEVADA - Medicaid Website: http://dwss.nv.gov/ Phone: 1-800-992-0900 NEW HAMPSHIRE - Medicaid Website: http://www.dhhs.nh.gov/oii/documents/hippapp.pdf Phone: 603-271-5218 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: http://www.nyhealth.gov/health_care/medicaid/ Phone: 1-800-541-2831 NORTH CAROLINA - Medicaid Website: http://www.ncdhhs.gov/dma Phone: 919-855-4100 NORTH DAKOTA - Medicaid 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://oregonhealthcare.gov/index-es.html Phone: 1-800-699-9075 PENNSYLVANIA - Medicaid Website: http://www.dhs.pa.gov/hipp Phone: 1-800-692-7462

Website: http://dss.sd.gov Phone: 1-888-828-0059 TEXAS - Medicaid Website: http://www.dhs.state.ia.us/hipp/ Phone: 1-888-346-9562 UTAH - Medicaid and CHIP Medicaid Website: http://health.utah.gov/medicaid CHIP Website: http://health.utah.gov/chip

Phone: 1-877-543-7669 VERMONT - Medicaid Website: http://www.greenmountaincare.org Phone: 1-800-250-8427 VIRGINIA - Medicaid and CHIP Medicaid & CHIP Website: http://www.coverva.org/programs_premi- um_assistance.cfm Medicaid Phone: 1-800-432-5924 CHIP Phone: 1-855-242-8282 WASHINGTON - Medicaid Website: http://www.hca.wa.gov/free-or-low-costhealth-care/pro- gram-administration/premiumpayment- program Phone: 1-800-562-3022 ext. 15473 WEST VIRGINIA - Medicaid Website: http://www.dhhr.wv.gov/bms/Medicaid%20Expansion/Pages/ default.aspx Phone: 1-877-598-5820, HMS Third Party Liability WISCONSIN - Medicaid and CHIP Website: http://www.dhs.wisconsin.gov/publications/p1/p10095.pdf

Phone: 1-800-362-3002 WYOMING - Medicaid Website: http://wyequalitycare.acs-inc.com/ Phone: 307-777-7531

To see if any more States have added a premium assistance program since January 31, 2022, or for more information on special enrollment rights, you can contact either:

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 Centers for Medicare & Medicaid Services www.cms.hhs.gov 1-877-267-2323, Menu Option 4, Ext. 61565

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