Creative Sign Designs Benefits at a Glance 2019-19

2018 - 2019

Benefits at a Glance

CONTENTS & CONTACT INFORMATION

Refer to this list when you need to contact one of your benefit vendors. For general information contact Human Resources.

BROKER Provider Name

M.E. Wilson Company

Broker Contact

Amanda Sands

Provider Phone Number

813-229-8021 Ext. 139

Provider Email Address

asands@mewilson.com

MEDICAL

page 3

Provider Name

Cigna

Provider Phone Number

866-494-2111

Provider Web Address

www.cigna.com

DENTAL

page 5

Provider Name

Guardian

Provider Phone Number

800-541-7846

Provider Web Address

www.guardiananytime.com

VISION

page 6

Provider Name

Guardian

Provider Phone Number

800-541-7846

Provider Web Address

www.guardiananytime.com

BASIC AND VOLUNTARY LIFE page 7 Provider Name Guardian Provider Phone Number 800-541-7846 Provider Web Address www.guardiananytime.com SHORT-TERM AND LONG-TERM DISABILITY page 8 Provider Name Guardian Provider Phone Number 800-541-7846 Provider Web Address www.guardiananytime.com EMPLOYEE ASSISTANCE PROGRAM page 9 Provider Name Guardian WorkLife Matters Provider Phone Number 800-386-7055 Provider Web Address www.ibhworklife.com

SUPPLEMENTAL BENEFITS

page 10

HOW TO ENROLL

page 12

DISCLOSURE NOTICES

page 16

BENEFIT INFORMATION

Benefit

Who pays the cost?

Creative Sign Design pays the majority of the employee portion of the medical plan. You may enroll your eligible dependents for an additional cost. You may elect dental coverage for yourself and your eligible dependents on a voluntary basis and you will be responsible for the cost. You may elect vision coverage for yourself and your eligible dependents on a voluntary basis and you will be responsible for the cost.

Medical Insurance

YOUR BENEFITS PLAN

Creative Sign Designs offers a variety of benefits allowing you the opportunity to customize a benefits package that meets your personal needs. In the following pages, you’ll learn more about the benefits offered. You’ll also see how choosing the right combination of benefits can help protect you and your family’s health and finances – and your family’s future.

Dental Insurance

Vision Insurance

Basic Life

Creative Sign Designs pays the entire cost.

Voluntary Life Insurance

The employee pays the entire cost.

Short Term Disability

The employee pays the entire cost.

Long Term Disability

Creative Sign Designs pays the entire cost.

ELIGIBILITY

All Regular full-time employees are eligible to join the Creative Sign Designs Benefits Plan on the 1st of the month following 60-Days. “Regular Full-Time Employees” must be regularly scheduled and working at least 30 hours per week.

You may also enroll your dependents in the Benefits Plan when you enroll.

Eligible dependents include:

Your legal spouse

•

• Your married or unmarried natural children, step- children living with you, legally adopted children and any other children for whom you have legal guardianship, who are:

WHEN CAN YOU ENROLL?

You can sign up for Benefits at any of the following times:

► Under 26 years of age;

► A dependent who is older than 26 years of age, but less than 30 years of age may be eligible for medical benefits. To be eligible, a Dependent must:

• After completing your initial eligibility period; • During the annual open enrollment period (after completing initial eligibility period); • Within 30 days of a qualified family-status change.

• Be unmarried and not have dependents of his or her own; AND

Be a resident of Florida or a student; AND

•

If you do not enroll at one of the above times, you may enroll during the next annual open enrollment period.

Not have coverage of their own, or covered under any other plan, including Medicare

•

BENEFIT INFORMATION

CHOOSING YOUR BENEFITS

You must actively choose any benefit that you pay for, or share in the cost with Creative Sign Designs. Your part of the cost is automatically taken out of your paycheck. There are two ways that the money can be taken out:

WHY DO I PAY FOR BENEFITS WITH BEFORE-TAX MONEY?

There is a definite advantage to paying for some benefits with before-tax money:

• BEFORE YOUR TAXES ARE CALCULATED – medical and dental • AFTER YOUR TAXES ARE CALCULATED – vision, voluntary life and accidental death & dismemberment

Taking the money out before your taxes are calculated lowers the amount of your pay that is taxable. Therefore, you pay less in taxes.

MAKING CHANGES

Generally, you can only change your benefit choices during the annual benefits enrollment period. However, you may be able to change your benefit choices during the plan year if you have a change in status including:

If you fail to notify Human Resources within 30 days of a family status change, you will be required to wait until the next annual enrollment period to make benefit changes unless you have another family status change.

Your marriage

•

Your divorce or legal separation

•

• Birth or adoption of an eligible child

• Death of your spouse or covered child

• Change in your spouse’s work status that affects his or her benefits

WHEN COVERAGE ENDS

• Change in your work status that affects your benefits

Coverage will stop on the last day of the month in which employment with the company ends. Disability coverage will end on the day of termination.

• Change in residence or work site that affects your eligibility for coverage

• Change in your child’s eligibility for benefits

• Receiving Qualified Medical Child Support Order (QMCSO)

KEY BENEFIT TERMS

Copayment – A flat fee that you pay for medical services, regardless of the actual amount charged by your doctor or another provider. This generally applies to physicians’ office visits and prescription drugs. Deductible – The amount you pay toward medical and dental expenses each year before the plan begins paying benefits. Out of Pocket Maximum – The maximum amount you will pay in deductibles, coinsurance and copayments during the year. Coinsurance – The percentage of costs of a covered health care service you pay (20%, for example) after you've paid your deductible.

MEDICAL INSURANCE

Creative Sign Designs offers three medical plans through Cigna. To find participating providers go to www.mycigna.com and click on “Find a Doctor”, choose the appropriate provider type. In Step 2: Plan Name, choose “LocalPlus”. Complete the remaining information and click Search.

The chart below provides a brief overview of the medical plans. This chart is intended only to highlight the benefits available and should not be relied upon to fully determine your coverage. If the below illustration of benefits conflicts in any way with the Summary Plan Description (SPD), the SPD shall prevail. It is recommended that you review your exact description of services and supplies that are covered, those which are excluded or limited, and other terms and conditions of coverage .

(Base Plan) LocalPlus 70%

(Mid Plan) LocalPlus 80%

(High Plan) LocalPlus 100%

IN-NETWORK: Plan Year or Calendar Year Basis

Calendar Year

Deductible (Individual / Family)

$4,500 / $9,000

$3,000 / $6,000

$1,000 / $2,000

Coinsurance

70% / 30%

80% / 20%

100%

Maximum Out-of-Pocket (Individual/Family)

$7,150 / $14,300

$6,500 / $13,000

$4,000 / $8,000

Deductible, Coinsurance & Copayments

Maximum Out-of-Pocket Includes

Lifetime Maximum

Unlimited

PREVENTIVE CARE:

Wellness Immunizations Mammography/Colonoscopy COPAYMENTS: Referral Required Office Visits Consultations for Illness/Injury

Covered 100%

$40 Copayment

$25 Copayment

Specialist Visits

$65 Copayment

$40 Copayment

Inpatient Hospital

Deductible & Coinsurance

$500 Deductible

Outpatient Surgery

Deductible & Coinsurance

$500 Deductible

Emergency Room Urgent Care

$350 Copayment $75 Copay

$350 Copayment $100 Copay

$250 Copayment $75 Copay

OUTPATIENT DIAGNOSTIC SERVICES: Independent/Freestanding Lab Complex Diagnostic (MRI, CT, PET, Etc.) – Freestanding Facility

Covered 100%

$300 Copay

$250 Copay

PRESCRIPTIONS:

Tier 1: $10 copay Tier 2: $45 Copay Tier 3: $90 Copay

Tier 1: $10 copay Tier 2: $40 copay Tier 3: $70 copay

Tier 1: $10 copay Tier 2: $45 copay Tier 3: $90 copay

Retail (30 day supply)

OUT-OF-NETWORK 2 Deductible (Individual / Family)

$9,000 / $18,000

$5,000 / $10,000

Maximum Out-of-Pocket (Individual/Family)

$14,300 / $28,600

$13,000 / $26,000

$10,000 / $20,000

Coinsurance

50% / 50%

70% / 30%

MEDICAL CONTRIBUTION SCHEDULE

(Base Plan) LocalPlus 70%

Employee Pays (Bi-Weekly)

Employee Only

$ 60.48 $323.11 $227.58 $482.21

Employee + Spouse

Employee + Child(ren)

Family

(Mid Plan) LocalPlus 80%

Employee Pays (Bi-Weekly)

Employee Only

$ 73.30 $353.18 $251.20 $522.27

Employee + Spouse

Employee + Child(ren)

Family

(High Plan) LocalPlus 100%

Employee Pays (Bi-Weekly)

Employee Only

$116.61 $453.54 $330.89 $657.40

Employee + Spouse

Employee + Child(ren)

Family

DENTAL INSURANCE

Creative Sign Designs offers dental coverage through Guardian. The Dental PPO Plan allows you to use in-network or out-of-network benefits. If out-of-network dentists are used, you will be responsible for paying the difference between Guardian’s allowed amount and what the dentist may charge, also known as “balance billing”. The chart below provides a brief overview of the plan.

DHMO

PPO

Calendar Year Deductible

In-Network

Out-of-Network

Individual

$50

$75

Family

$150

$225

Annual Maximum

Unlimited

$1,500

Diagnostic & Preventative

Exams & X-rays

Fee Schedule

100%

80%

Cleanings

Fee Schedule

Regular Restorative Services

Amalgam Fillings

Fee Schedule

Extractions – Single Tooth

Fee Schedule

80% after deductible

Endodontics (Root Canal)

Fee Schedule

Peridontics (Gum Disease)

Fee Schedule

Major Services Crowns

Fee Schedule

Bridges

Fee Schedule

50% after deductible

Dentures

Fee Schedule

Orthodontia

Child

$1,895

50%

Adult

$2,195

Not Covered

Lifetime Max

N/A

$1,000

Age Limit

N/A

1 Subject to balance billing. Please refer to your plan document for specific details.

Employee Contributions (Bi-Weekly)

DHMO

PPO

Employee Only

$ 5.30

$10.75

Employee + Spouse

$ 9.77

$22.17

Employee + Child(ren)

$11.92

$30.88

Family

$18.30

$42.29

VISION INSURANCE

Creative Sign Designs offers vision coverage through Guardian. The Vision PPO Plan allows you to use in-network or out-of-network benefits. If out-of-network vision providers are used, you will be responsible for paying the difference between Guardian’s allowed amount and what the provider may charge, also known as “balance billing”.

Vision Davis/Full Feature – Designer B

In-Network

Out-of-Network

Routine Eye Exams

No Charge

Up to $50 reimbursement

Standard Lenses: $48 - $126 reimbursement, depending on lens type

Standard Lenses: No Charge

Lenses *

Additional costs apply for specialty materials and/or lens coating*

Up to $150 allowance, plus 20% off balance over $150, plus an additional $50 allowance if purchased at Vision Works

Frames

Up to $48 reimbursement

Contact Lenses Fitting & Follow-up Exam

Included, when contacts are purchased

Not Included

Conventional Lenses: Up to $150 allowance, plus 15% off balance over $150 (copay waived)

Elective

Up to $105 reimbursement (Copay waived)

Medically Necessary:

No Charge (Copay waived)

Up to $210 reimbursement (Copay waived)

Frequency Exam

• Lenses, Frames & Contacts are limited to either one pair of contacts or frames/lenses per calendar year.

Once every 12 months

Lenses or contact lenses

Once every 12 months

Frame

Once every 24 months

* Please refer to your plan document for specific details.

Employee Contributions (Bi-Weekly)

Vision

Employee Only

$ 2.88 $ 5.54 $ 5.08 $ 8.31

Employee + Spouse

Employee + Child(ren)

Family

BASIC LIFE AND AD&D & VOLUNTARY LIFE INSURANCE

BASIC LIFE INSURANCE

Creative Sign Designs provides life insurance to all active full time employees at no cost to the employee. The chart below provides an overview of the plan.

Basic Life Insurance

Employee Benefit Amount

$20,000

Age Reduction Schedule

35% at age 65; 50% at age 70; 75% at age 75

Accidental Death & Dismemberment (AD&D)

Included - Equal to basic life

VOLUNTARY LIFE INSURANCE

Creative Sign Designs provides all active employees working 30 or more hours per week the option to purchase life insurance coverage through a group plan, at the employee’s cost. The chart below provides an overview of the plan. Please note that anyone enrolling outside of their initial open enrollment period is considered a late entrant and will be subject to medical underwriting.

Voluntary Life Insurance

Employee Life

Increments of $10,000 up to $500,000

Employee Guarantee Issue

$100,000 (for timely entrants under age 65 only)

Spouse Life

Increments of $5,000 up to $250,000 (not to exceed 50% of Employee’s amount)

Spouse Guarantee Issue

$25,000 (for timely entrants under age 65 only)

Dependent Life

Increments of $1,000 up to $10,000 (not to exceed 50% of Employee’s amount)

Accidental Death & Dismemberment (AD&D)

Included - Equal to Voluntary Life amount

Age Reduction Schedule

35% at age 65; 50% at age 70

Age

Employee

Spouse

Child

VOLUNTARY LIFE Life Rates per $1,000 of benefit Includes AD&D Cost

<24

$.07

$.23

25-29

$.07

30-34

$.09

COST CALCULATION:

35-39

$.15

_____________________ Benefit Amount / 1,000 x____________________ Monthly Rate (from chart) = ____________________ x12 /26 =____________________ Approximate Bi-Weekly Cost

40-44

$.22

45-49

$.35

50-54

$.56

55-59

$.86

60-64

$1.32

65-69

$2.34

70-74

$4.17

SHORT TERM DISABILITY INSURANCE

Creative Sign Designs provides all active employees working 30 or more hours per week the option to purchase short term disability insurance coverage through a group plan, at the employee’s cost.

Short Term Disability

Benefit Percentage

60% of basic earnings

Maximum Weekly Benefit

$1,000 per week

Benefits commence on the 15th day for an accident Benefits commence on the 15th day for a sickness

Elimination Period

Duration of Benefit

24 weeks

Definition of Earnings

Salary prior to disability

Voluntary STD Premium Calculation:

STEP 1

Enter your basic weekly pay (divide you annual pay by 52) rounded to the nearest dollar. Multiply the amount in Step 1 by 60% and enter the result (rounded to the next higher dollar). This is your weekly benefit. Do not enter more than $1,000.

1. _________

STEP 2

2. _________

STEP 3

Divide the amount in Step 2 by 10 and enter that amount.

3. _________

STEP 4

Premium factor

4. .60__

STEP 5

Multiply the amount in Step 3 by the amount in Step 4 and then enter it here. This is your approximate monthly premium. Multiply the amount in Step 4 by 12 and then divide by 26 and then enter it here. This is your approximate bi-weekly cost.

5. _________

STEP 6

6. _________

LONG TERM DISABILITY INSURANCE

Creative Sign Designs provides Long Term Disability to all active full time employees at no cost to the employee. The chart below provides an overview of the plan.

Long Term Disability

Benefit % of Monthly Covered Payroll

60% of basic earnings

Monthly Maximum

$6,000 per month

Benefits commence on the 181 st day

Elimination Period

Benefit Duration

Social Security Normal Retirement Age (SSNRA)

Definition of Earnings

Salary prior to disability

EMPLOYEE ASSISTANCE PROGRAM (EAP)

When it is difficult to cope with problems, we often turn to family or friends for support. Unfortunately, sometimes that is not enough. Sometimes we need the ear of an experienced professional, one who will keep our concerns confidential and help guide us in the right direction.

Guardian’s WorkLife Matters Comprehensive Employee Assistance Program (EAP) has trained professionals to work with you as you search for solutions to personal and workplace issues.

Your EAP is paid for in full by Creative Sign Designs and is available 24 hours a day and 7 days a week to help guide you in the right direction when dealing with:

Depression

• • • • • • • • •

Marital and Family Conflicts

Alcohol and Drug Use

Resiliency

Gambling Problems

Grief and Loss

Divorce and Family Law

Financial Issues

Stress and/or Anxiety

In addition to unlimited phone counseling, you are also entitled to up to 3 face to face visits with a referred counselor, psychologist or other behavioral health professional.

To contact EAP hotline directly and confidentially, call toll free at 1-800-386-7055 anytime.

If you would benefit from speaking with a professional face to face, the EAP staff can put you in touch with local experts and resources. If you prefer, you can access online resources at www.ibhworklife.com. This website is available when you need trusted, expert information, resources, referrals, or answers to everyday questions.

EAP HOTLINE: 1-800-386-7055

SUPPLEMENTAL BENEFITS

Creative Sign Designs offers you the opportunity to purchase supplement benefits with Guardian. These plans are designed to compliment the group medical, dental, life and disability coverage. This benefit is 100% paid for by the employee.

Accident Insurance

Because accidents can happen at any time and any place, often times individuals are not prepared for the repercussions, particularly the cost. Accident insurance helps pay for unexpected healthcare expenses due to accidents. It provides benefits to cover the initial care, durable medical equipment and follow up visits; however, benefits are paid directly to you, the member. See Guardian benefit summary for more details.

Some examples of the benefit you may receive as a result of a covered accident are:

Occupational or Physical Therapy - $35/day up to 10 days

• • •

Hospital Confinement – $250/day, up to 1 year

Hospital ICU Confinement – $500 per day, up to 15 days

• Initial Physician’s office/Urgent Care Facility Treatment - $100

Employee Contributions (Bi-Weekly)

Accident

Employee Only

$ 6.92

Employee + Spouse

$11.58

Employee + Child(ren)

$14.82

Family

$19.48

Hospital Coverage

Guardian’s Hospital plan pays specific benefits for qualified expenses incurred at the hospital. The benefits are paid directly to you, when you need it most, and can be used to help fill the gaps caused by most major medical plans (copays, deductibles, etc.). It can also be used to pay for non-medical expenses related to your hospital stay such as childcare and transportation.

Some examples of the benefit you may receive as a result of a covered hospital stay are:

• Hospital/ICU Admission: $1,000 per admission/per year/per insured • Hospital/ICU Confinement: $100 per day (to a max of 31 days per year)/per insured • Health Screenings: $50 per day of screening (to a max of 1 day per year)/per insured • Treatments covered: sickness and injury

Employee Contributions (Bi-Weekly)

Hospital

Employee Only

$ 9.39

Employee + Spouse

$21.15

Employee + Child(ren)

$15.14

Family

$26.90

SUPPLEMENTAL BENEFITS (Continued)

Critical Illness

Guardian’s Critical Illness plan allows you the ability to receive a lump sum benefit upon first and second diagnosis of any qualified Critical Illnesses listed under the covered conditions. Benefits are paid directly to you, when you need it most, and can be used for medical expenses, childcare, transportation, copays and deductibles related to your illness. Additionally, Wellness Benefits pay when you complete specific preventive

screenings such as mammograms and colonoscopies. See Guardian benefit summary for more details.

Some examples of qualified Critical Illnesses are:

Cancer

• • • •

Heart Attack Organ failure

Stroke

Bi-Weekly Costs

Employee Only

Employee + Spouse

Employee Age to Policy Issue

$5,000 Benefit

$10,000 Benefit

$5,000 / $2,500 Benefit

$10,000 /$ 5,000 Benefit

<30

$1.96

$3.35

$3.18

$5.26

30-39

$3.01

$5.41

$4.77

$8.37

40-49

$6.11

$11.51

$9.47

$17.57

50-59

$11.54

$22.18

$17.71

$33.67

60-69

$17.94

$34.77

$27.43

$52.67

70+

$33.36

$65.26

$50.74

$98.58

Notes: • Costs listed are for Issue Age and will not increase due to a change in age • Spouse’s age is based on Employee’s Age • Spouse’s benefit cannot exceed 50% of Employee’s benefit • A Child(ren) benefit of 25% of the Employee’s amount is included in the Employee’s election

HOW TO ENROLL IN BENEFITS

2 Enrolling in Benefits – During open enrollment, all benefits that are available to you will be displayed on the Enrollments page. Select a category, such as Medical, to compare information, such as benefit costs, for the available options. You can select another category, or click the Forward To arrow in the upper-right corner of the screen to move to another benefit category. Please note, if you select “Walk me through my Benefit Options.” you can only view benefits in the order displayed.

ENROLLING IN BENEFITS CONTINUED.

If you selected a plan to change, the plan information is displayed. Click Enroll in This Plan.

On the Enrollment page, you choose your coverage level. If you would like additional coverage, you can select it at this time. You will also choose the dependents for coverage under this plan. When finished, click Enroll. .

ENROLLING IN BENEFITS CONTINUED

5 Your enrollment details are displayed. You can remove an enrollment if needed, or edit the plan if you need to make changes to your selections. When finished, click Review & Complete.

6 Review your benefit elections. If you need to make a change, click Return to Choose Plans. After reviewing your elections, click Complete Enrollment.

ENROLLING IN BENEFITS CONTINUED

7 Your enrollment confirmation is displayed. A list of your benefits appears. If a benefit election requires practitioner approval, you will see a pending approval indicator below the Your Changes Have Been Submitted message.

REQUIRED ANNUAL EMPLOYEE DISCLOSURE NOTICES

Required Annual Employee Disclosure Notices

THE NEWBORNS’ AND MOTHERS’ HEALTH PROTECTION ACT OF 1996 The Newborns’ and Mothers’ Health Protection Act of 1996 prohibits group and individual health insurance policies from restricting benefits for any hospital length of stay for the mother or newborn child in connection with childbirth; (1) following a normal vaginal delivery, to less than 48 hours, and (2) following a cesarean section, to less then 96 hours. Health insurance policies may not require that a provider obtain authorization from the health insurance plan or the issuer for prescribing any such length of stay. Regardless of these standards an attending health care provider may, in consultation with the mother, discharge the mother or newborn child prior to the expiration of such minimum length of stay. Further, a health insurer or health maintenance organization may not: 1. Deny to the mother or newborn child eligibility, or continued eligibility, to enroll or to renew coverage under the terms of the plan, solely to avoid providing such length of stay coverage; 2. Provide monetary payments or rebates to mothers to encourage such mothers to accept less than the minimum coverage; 3. Provide monetary incentives to an attending medical provider to induce such provider to provide care inconsistent with such length of stay coverage;

WOMEN’S HEALTH AND CANCER RIGHTS ACT OF 1998

The Women’s Health and Cancer Rights Act of 1998 requires Creative Sign Designs to notify you, as a participant or beneficiary of the Creative Sign Designs Health and Welfare Plan, of your rights related to benefits provided through the plan in connection with a mastectomy. You, as a participant or beneficiary, have rights to coverage to be provided in a manner determined in consultation with your attending physician for: 1. All stages of reconstruction of the breast on which the mastectomy was performed;Surgery and reconstruction of the other breast to produce a symmetrical appearance; and

2. Prostheses and treatment of physical compilations of the mastectomy, including lymphedema.

These benefits are subject to the plan’s regular deductible and co-pay. For further details, refer to your Summary Plan Description. Keep this notice for your records and call Human Resources for more information.

MICHELLE’S LAW

The law allows for continued coverage for dependent children who are covered under your group health plan as a student if they lose their student status because of a medically necessary leave of absence from school. This law applies to medically necessary leaves of absence that begin on or after January 1, 2010 If your child is no longer a student, as defined in your Certificate of Coverage, because he or she is on a medically necessary leave of absence, your child may continue to be covered under the plan for up to one year from the beginning of the leave of absence. This continued coverage applies if your child was (1) covered under the plan and (2) enrolled as at student at a post-secondary educational institution (includes colleges, universities, some trade schools and certain other post-secondary institutions). Your employer will require a written certification from the child’s physician that states that the child is suffering from a serious illness or injury and that the leave of absence is medically necessary.

4. Require a mother to give birth in a hospital; or

5. Restrict benefits for any portion of a period within a hospital length of stay described in this notice.

SECTION 111

Effective January 1, 2009 group health plans are required by Federal government to comply with Section 111 of the Medicare, Medicaid, and SCHIP Extensions of 2007’s new Medicare Secondary Payer regulations. The mandate is designed to assist in establishing financial liability of claims assignments. In other words, it will help establish who pays first. The mandate requires group health plans to collect additional information, more specifically Social Security numbers for all enrollees, including dependents 6 months of age or older. Please be prepared to provide this information on your benefits enrollment form when enrolling into benefits.

REQUIRED ANNUAL EMPLOYEE DISCLOSURE NOTICES

Required Annual Employee Disclosure Notices continued continued

HIPAA PRIVACY POLICY FOR FULLY- INSURED PLANS WITH NO ACCESS TO PHI

PATIENT PROTECTION:

If the Group Health Plan generally requires the designation of a primary care provider who participates in the network and who is available to accept you or your family members. For children, you may designate a pediatrician as the primary care provider. You do not need prior authorization from the carrier or from any other person (including a primary care provider) in order to obtain access to obstetrical or gynecological care from a health care professional in the network who specializes in obstetrics or gynecology. The health care professionals, however, may be required to comply with certain procedures, including obtaining prior authorization for certain services, following a pre-approved treatment plan or procedures for making referrals. For a list of participating health care professionals who specialize in obstetrics or gynecology, or for information on how to select a primary care provider, and for a list of the participating primary care providers, contact the Plan Administrator or refer to the carrier website. It is your responsibility to ensure that the information provided on your application is accurate and complete. Any omissions or incorrect statements made by you on your application may invalidate your coverage. The carrier has the right to rescind coverage on the basis of fraud or misrepresentation. CHILDREN’S HEALTH INSURANCE PROGRAM REAUTHORIZATION ACT (CHIPRA) OF 2009 Effective April 1, 2009, a special enrollment period provision is added to comply with the requirements of the Children’s Health Insurance Program Reauthorization Act (CHIPRA) of 2009. If you or a dependent is covered under a Medicaid or CHIP plan and coverage is terminated as a result of the loss of eligibility for Medicaid or CHIP coverage, you may be able to enroll yourself and/or your dependent(s). However, you must enroll within 60 days after the date eligibility is lost. If you or a dependent becomes eligible for premium assistance under an applicable State Medicaid or CHIP plan to purchase coverage under the group health plan, you may be able to enroll yourself and/or your dependent(s). However, you must enroll within 60 days after you or your dependent is determined to be eligible for State premium assistance. Please note that premium assistance is not available in all states.

I. No access to protected health information (PHI) except for summary health information for limited purpose and enrollment / dis-enrollment information. Neither the group health plan nor the plan sponsor (or any member of the plan sponsor’s workforce) shall create or receive protected health information (PHI) as defined in 45 C.F.R. §160.103 except for (1) summary health information for purpose of (a) obtaining premium bids or (b) modifying, amending, or terminating the group health plan, and (2) enrollment and dis-enrollment information. requirements of 45 C.F.R. §164.530 (k) so that the group health plan is not subject to most of HIPAA’s privacy requirements. The insurer for the group health plan will provide the group health plan’s notice of privacy practices and will satisfy the other requirements under HIPAA related to the group health plan’s PHI. The notice of privacy practices will notify participants of the potential disclosure of summary health information and enrollment / dis-enrollment information to the group health plan and the plan sponsor. The group health plan shall not intimidate, threaten, coerce, discriminate against, or take other retaliatory action against individuals for exercising their rights , filing a complaint, participating in an investigation, or opposing any improper practice under HIPAAA. III. No intimidating or retaliatory acts The group health plan shall not require an individual to waive his or her privacy rights under HIPAA as a condition of treatment, payment, enrollment or eligibility. If such an action should occur by one of the plan sponsor’s employees, the action shall not be attributed to the group health plan. The group health plan is a fully-insured group health plan sponsored by the “Plan Sponsor”. The group health plan and the plan sponsor intend to comply with the II. Insurer for group health plan will provide privacy notice IV. No Waiver

Required Annual Employee Disclosure Notices - Continued REQUIRED ANNUAL EMPLOYEE DISCLOSURE NOTICES

continued

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 Cigna 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 at least 1% of the Medicare base beneficiary premium per month for every month that you did not have that coverage. For example, if you go nineteen months without creditable coverage, your premium may consistently be at least 19% higher than the Medicare base beneficiary premium. You may have to pay this higher premium (a penalty) as long as you have Medicare prescription drug coverage. In addition, you may have to wait until the following October to join. For more information about this notice or your current prescription drug coverage… Contact our office for further information (see contact information below). 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 Cigna 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: • Call your State Health Insurance Assistance Program (see 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 notice. If you enroll in one of the new plans approved by Medicare which offer prescription drug coverage, you may be required to provide a copy of this notice when you join to show that you are not required to pay a higher premium amount. • Visit www.medicare.gov

MEDICARE PART D

This notice applies to employees and covered dependents who are eligible for Medicare Part D. Please read this notice carefully and keep it where you can find it. This notice has information about your current prescription drug coverage with Cigna and about your options under Medicare’s prescription 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. 1. Medicare prescription drug coverage became available in 2006 to everyone with Medicare through Medicare prescription drug plans and Medicare Advantage Plan (like an HMO or PPO) that offer prescription drug coverage. All Medicare prescription 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. Cigna has determined that the prescription drug coverage offered by the Welfare Plan for Employees of Creative Sign Designs under the Cigna option are, on average for all plan participants, expected to pay out as much as the 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. You should also know that if you drop or lose your coverage with Cigna and don’t enroll in Medicare prescription drug coverage after your current coverage ends, you may pay more (a penalty) to enroll in Medicare prescription drug coverage later. _______________________________________________________ You can join a Medicare drug plan when you first become eligible for Medicare and each year from October 15 th to December 7 th . 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 Cigna coverage will not be affected. You can keep this coverage if you elect part D and this plan will coordinate with Part D coverage. If you decide to join a Medicare drug plan and drop your current Cigna coverage, be aware that you and your dependents will be able to get this coverage back. When can you join a Medicare Drug Plan?

Date: 11/1/18 Name of Entity/Sender: Creative Sign Designs Contact--Position/Office: Debbie Brunton 128021 Commodity Place Tampa, FL 33626 Phone Number: 813-749-2304

HEALTHCARE REFORM AND YOU

The Patient Protection and Affordable Care Act & The Health Care and Education Affordability Reconciliation Act of 2010, together, create the most comprehensive health insurance reform ever under taken in recent history by our Country. Many of the new law’s required changes have already been incorporated into company health plans across the country since the effective date in September of 2010. However, there will be many more changes taking place in the months to come, as more guidance is issued by the government to employers, insurance carriers and individuals. One of the key requirements of the new law beginning in 2014, is the mandate that all U.S. citizens & legal residents either carry health insurance or pay an income tax penalty. While the tax penalty is not too severe in the first year, it becomes progressively more costly each year thereafter. In 2014, the greater of $95 or 1% of taxable income; In 2015, the greater of $325 or 2% of taxable income; In 2016, the greater of $695 or 2.5% of taxable income; and After 2016, the penalty is indexed for inflation. However, there are two ways to avoid the tax penalty: You can buy coverage for you and your family through your place of employment, if your employer offers such coverage. That coverage must meet certain standards set by the law in order for you and the employer to escape respective tax penalties. The coverage must meet certain minimum coverage standards (Generally pays at least 60% of your covered medical expenses) and must be considered “affordable” (Employer cannot charge you a premium for single or employee only coverage greater than 9.5% of your W-2 earnings for the year). The 9.5% would apply to annual salaries of up to about $45,000. Or, you can provide coverage for you and your family through a Federally run Insurance Exchange that is supposed to be up and running by 1/1/2014. Essentially, an Exchange is an interactive site where an individual can go to research, evaluate and buy health plans. The State of Florida chose not to set up a state run exchange, so the Federal government will take over that responsibility. Penalties for failing to buy coverage Tax penalties for failing to buy coverage are phased in according to the following schedule:

If you obtain coverage through an Exchange:

The Exchange will eventually sell insurance policies at certain levels of coverage: • Bronze level – a medical plan designed to pay 60% of covered medical benefits; • Silver level – a medical plan designed to pay 70% of covered medical benefits; • Gold level – a medical plan designed to pay 80% of covered medical benefits; • Platinum level – a medical plan designed to pay 90% of covered medical benefits; • Catastrophic – available to young adults up to age 30 or those exempt from the individual mandate (additional requirements may apply) If you satisfy certain low income thresholds and do not have medical coverage through an employer, or have employer- provided coverage that is considered “unaffordable” or pays benefits that are below the “Bronze” plan discussed above, there are tax credits available to help you pay the premiums for coverage purchased through the Exchange. The credits also help pay for expenses like deductibles and co pays. More information on these credits will be provided to you later. If you and your family are below 133% of the Federal Poverty Level in 2014, you may qualify for Medicaid. Other changes to take effect in 2014 are: The health plan may no longer exclude coverage of a pre- existing condition; The health plan may not impose more than a 90-day waiting period for coverage; Your plan may no longer place an annual limit on key benefits in the plan; Your health plan must allow dependent children up to age 26 to enroll in coverage, regardless of the availability of employer-sponsored coverage where they work. You may only obtain coverage through an Exchange if you are not participating in your employer’s plan.

GENERAL NOTICE OF COBRA RIGHTS *Continuation coverage rights under cobra**

Introduction You’re getting this notice because you recently gained coverage under a group health plan (the Plan). This notice has important information about your right to COBRA continuation coverage, which is a temporary extension of coverage under the Plan. This notice explains COBRA continuation coverage, when it may become available to you and your family, and what you need to do to protect your right to get it. When you become eligible for COBRA, you may also become eligible for other coverage options that may cost less than COBRA continuation coverage. The right to COBRA continuation coverage was created by a federal law, the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA). COBRA continuation coverage can become available to you and other members of your family when group health coverage would otherwise end. For more information about your rights and obligations under the Plan and under federal law, you should review the Plan’s Summary Plan Description or contact the Plan Administrator. You may have other options available to you when you lose group health coverage. For example, you may be eligible to buy an individual plan through the Health Insurance Marketplace. By enrolling in coverage through the Marketplace, you may qualify for lower costs on your monthly premiums and lower out-of-pocket costs. Additionally, you may qualify for a 30-day special enrollment period for another group health plan for which you are eligible (such as a spouse’s plan), even if that plan generally doesn’t accept late enrollees. What is COBRA continuation coverage? COBRA continuation coverage is a continuation of Plan coverage when it would otherwise end because of a life event. This is also called a “qualifying event.” Specific qualifying events are listed later in this notice. After a qualifying event, COBRA continuation coverage must be offered to each person who is a “qualified beneficiary.” You, your spouse, and your dependent children could become qualified beneficiaries if coverage under the Plan is lost because of the qualifying event. Under the Plan, qualified beneficiaries may elect COBRA continuation coverage, but they may be required to pay for the coverage. If you’re an employee, you’ll become a qualified beneficiary if you lose your coverage under the Plan because of the following qualifying events: • Your hours of employment are reduced, or • Your employment ends for any reason other than your gross misconduct.

If you’re the spouse of an employee, you’ll become a qualified beneficiary if you lose your coverage under the Plan because of the following qualifying events: • Your spouse dies; • Your spouse’s hours of employment are reduced; • Your spouse’s employment ends for any reason other than his or her gross misconduct; • Your spouse becomes entitled to Medicare benefits (under Part A, Part B, or both); or • You become divorced or legally separated from your spouse. Your dependent children will become qualified beneficiaries if they lose coverage under the Plan because of the following qualifying events: • The parent-employee dies; • The parent-employee’s hours of employment are reduced; • The parent-employee’s employment ends for any reason other than his or her gross misconduct; • The parent-employee becomes entitled to Medicare benefits (Part A, Part B, or both); • The parents become divorced or legally separated; or • The child stops being eligible for coverage under the Plan as a “dependent child.” When is COBRA continuation coverage available? The Plan will offer COBRA continuation coverage to qualified beneficiaries only after the Plan Administrator has been notified that a qualifying event has occurred. The employer must notify the Plan Administrator of the following qualifying events: • The end of employment or reduction of hours of employment; • Death of the employee; • The employee’s becoming entitled to Medicare benefits (under Part A, Part B, or both). For all other qualifying events (divorce or legal separation of the employee and spouse or a dependent child’s losing eligibility for coverage as a dependent child), you must notify the Plan Administrator within 60 days after the qualifying event occurs. You must provide this notice to the employer sponsoring the Plan.

GENERAL NOTICE OF COBRA RIGHTS Continued

How is COBRA continuation coverage provided? Once the Plan Administrator receives notice that a qualifying event has occurred, COBRA continuation coverage will be offered to each of the qualified beneficiaries. Each qualified beneficiary will have an independent right to elect COBRA continuation coverage. Covered employees may elect COBRA continuation coverage on behalf of their spouses, and parents may elect COBRA continuation coverage on behalf of their children. COBRA continuation coverage is a temporary continuation of coverage that generally lasts for 18 months due to employment termination or reduction of hours of work. Certain qualifying events, or a second qualifying event during the initial period of coverage, may permit a beneficiary to receive a maximum of 36 months of coverage. Disability extension of 18-month period of COBRA continuation coverage: If you or anyone in your family covered under the Plan is determined by Social Security to be disabled and you notify the Plan Administrator in a timely fashion, you and your entire family may be entitled to get up to an additional 11 months of COBRA continuation coverage, for a maximum of 29 months. The disability would have to have started at some time before the 60th day of COBRA continuation coverage and must last at least until the end of the 18-month period of COBRA continuation coverage. Second qualifying event extension of 18-month period of continuation coverage If your family experiences another qualifying event during the 18 months of COBRA continuation coverage, the spouse and dependent children in your family can get up to 18 additional months of COBRA continuation coverage, for a maximum of 36 months, if the Plan is properly notified about the second qualifying event. This extension may be available to the spouse and any dependent children getting COBRA continuation coverage if the employee or former employee dies; becomes entitled to Medicare benefits (under Part A, Part B, or both); gets divorced or legally separated; or if the dependent child stops being eligible under the Plan as a dependent child. This extension is only available if the second qualifying event would have caused the spouse or dependent child to lose coverage under the Plan had the first qualifying event not occurred. There are also ways in which this 18-month period of COBRA continuation coverage can be extended:

Are there other coverage options besides COBRA Continuation Coverage? Yes. Instead of enrolling in COBRA continuation coverage, there may be other coverage options for you and your family through the Health Insurance Marketplace, Medicaid, or other group health plan coverage options (such as a spouse’s plan) through what is called a “special enrollment period.” Some of these options may cost less than COBRA continuation coverage. You can learn more about many of these options at www.healthcare.gov. If you have questions Questions concerning your Plan or your COBRA continuation coverage rights should be addressed to the contact or contacts identified below. For more information about your rights under the Employee Retirement Income Security Act (ERISA), including COBRA, the Patient Protection and Affordable Care Act, and other laws affecting group health plans, contact the nearest Regional or District Office of the U.S. Department of Labor’s Employee Benefits Security Administration (EBSA) in your area or visit www.dol.gov/ebsa. (Addresses and phone numbers of Regional and District EBSA Offices are available through EBSA’s website.) For more information about the Marketplace, visit www.HealthCare.gov. Keep your Plan informed of address changes To protect your family’s rights, let the Plan Administrator know about any changes in the addresses of family members. You should also keep a copy, for your records, of any notices you send to the Plan Administrator.

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