Hi-Tech Utility - 2024 Benefits Guide

2024 EMPLOYEE BENEFITS GUIDE

WELCOME TO YOUR BENEFIT ENROLLMENT GUIDE 2024 - 2025 PLAN YEAR

Hi Tech Utility is proud to offer you a comprehensive benefits package for the upcoming plan year. This enrollment guide will assist you in determining the coverage levels that will provide you and your family with the protection that gives you peace of mind. We encourage you to take the time to review the enrollment guide prior to enrollment. The Open Enrollment period will begin on December 11 th and end on December 23 rd . Keep in mind that the benefits you select during this enrollment will be effective January 1 st , 2024 and will continue through December 31 st , 2024.

Please note: This benefit guide contains the basic information about your benefits program. It does not cover every detail; but it does provide a general description of each benefit plan. Every effort has been made to ensure that the information is accurate. However, this guide is not an insurance policy. If there is any question as to coverage, benefit eligibility, or interpretation, the insurance contract and the Certificate of Coverage you receive from the insurance carrier will govern the administration of your benefits. If you would like additional or specific information, please contact the Human Resources Department.

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 Hi Tech Utility, 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.

HI TECH UTILITY 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 [HTUC2022] • 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.

HI TECH UTILITY 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!

HI TECH UTILITY 2024 BENEFITS GUIDE

Medical and Pharmacy Coverage

Hi Tech Utility offers the following Medical plans through Aetna and offers “in and out-of-network” benefits. Please review as each plan has different benefits which are highlighted. Insurance Carrier: Aetna Medical Insurance Medical Plan:

$2,500 / 80% Copay Plan $5,000 / 100% Copay Plan $6,750 / 100% IRx Plan

In-Network: Office Visit Copay - Primary Care

$35

$25

Office Visit Copay - Specialist Care

$70

Deductible; then 100% Coinsurance

Urgent Care Copay

$75

$50

Emergency Room Care

Deductible; 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

$500 Copay; (applies to deductible)

Coinsurance

80%

100%

Employee Deductible

$2,500

$5,000

$6,750

Family Deductible

$5,000

$10,000

$13,500

Employee Out-of-Pocket Max

$6,000 (includes deductible)

$7,150 (includes deductible)

$8,150 (includes deductible)

Family Out-of-Pocket Max

$12,000 (includes deductible)

$14,300 (includes deductible)

$16,300 (includes deductible)

Inpatient Hospital

Deductible; then 80% Coinsurance

Deductible; then 100% Coinsurance $1,000 Copay; (applies to deductible)

Outpatient Hospital or Facility

Deductible; then 80% Coinsurance

Deductible; then 100% Coinsurance $1,000 Copay; (applies to deductible)

Out-of-Network: Coinsurance

50%

N/A

Employee Deductible

$5,000

$10,000

N/A

Family Deductible

$15,000

$30,000

N/A

Employee Out-of-Pocket Max

$15,000

$25,000

N/A

Family Out-of-Pocket Max

$45,000

$75,000

N/A

Prescription Drugs: ( 30 Day Supply) Tier 1a / 1b - Generic

$3 / $10

$2 / $15

Tier 2 - Preferred

$50

$85 (after deductible)

Tier 3 - Non-Preferred

$80

$125 (after deductible)

Tier 4 - Specialty - Preferred

20% to a $250 max

$275 (after deductible)

Tier 4 - Specialty - Non-Preferred

40% to a $500 max

$575 (after deductible)

Employee Weekly Deduction Employee Only

$54.03

$45.97

$24.61

Employee + Spouse

$172.23

$157.53

$115.49

Employee + Child(ren)

$158.32

$144.81

$104.38

Family

$267.00

$247.61

$187.54

HI TECH UTILITY 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.

HI TECH UTILITY 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)

HI TECH UTILITY 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

HI TECH UTILITY 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)

10 HI TECH UTILITY 2024 BENEFITS GUIDE

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.

HI TECH UTILITY 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.

12 HI TECH UTILITY 2024 BENEFITS GUIDE

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.

13 HI TECH UTILITY 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:

Base Plan

Buy-Up 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% 80% N/A

80% 50% 80%

Orthodontia (for everyone)

$1,500

Out-of-Network Reimbursement Employee Weekly Deduction Employee Only

90th UCR

$6.86

$8.23

Employee + Spouse Employee + Child(ren)

$13.52 $18.27 $27.04

$16.26 $21.39 $31.85

Family

14 HI TECH UTILITY 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:

EyeMed

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

Out-of-Network

Exam Copay

Up to $45 Up to $30 Up to $50 Up to $65 Up to $100

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

$ 150 Allowance; then 20% off remaining balance

Frames

Up to $70

Elective Contact Lenses (in place of lenses & frame)

Up to $105; Medically Necessary up to $210

$150 Allowance

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

12 months / 12 months / 12 months

$1.40 $3.10 $3.25 $5.32

Employee + Spouse Employee + Child(ren)

Family

15 HI TECH UTILITY 2024 BENEFITS GUIDE

Basic Life and AD&D Insurance Coverage

Hi Tech Utility 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

Unum 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, Hi Tech Utility 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 Unum. Rates for the voluntary term life insurance are based on age, and volume, and benefits are subject to applicable age reductions.

Insurance Carrier:

Unum Voluntary Life w/AD&D Insurance

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

All Full Time Employees

Up to $300k in increments of $10k

Spouse

100% of Employee Amount up to $100k

Child(ren)

Flat $10k

Guarantee Issue Employee

$70k $20k

Dependent Child(ren)

N/A

16 HI TECH UTILITY 2024 BENEFITS GUIDE

Disability Coverage

The goal of Hi Tech Utility’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-Term Disability” income benefits. Short-Term Disability Coverage is offered through Unum.

Insurance Carrier:

Short-Term Disability Insurance

Plan Type:

Voluntary

Eligibility Requirement

All Full Time Employees

Benefit Percentage

60%

Maximum Weekly Benefit

$1,500

Benefit Duration

12 Weeks

Waiting Period - Injury

7 Days

Waiting Period - Sickness

7 Days

Pre-Existing Condition

3 / 12

17 HI TECH UTILITY 2024 BENEFITS GUIDE

Unum Accident Insurance

HI TECH UTILITY CONSTRUCTION INC.

Accident Insurance

What’s included? Be Well Benefit

How does it work? Accident Insurance pays a set benefit amount based on the type of injury you have and the type of treatment you need. It covers accidents that occur off the job. And it includes a range of incidents, from common injuries to more serious events. Why is this coverage so valuable? It can help you with out-of-pocket costs that your medical plan doesn’t cover, like co-pays and deductibles. You’ll have base coverage without medical underwriting. The cost is conveniently deducted from your paycheck. You can keep your coverage if you change jobs or retire. You’ll be billed directly.

Every year, each family member who has Accident coverage can also receive $50 for getting a covered Be Well screening test, such as: • Annual exams by a physician include sports physicals, well-child visits, dental and vision exams • Screenings for cancer, including pap smear, colonoscopy • Cardiovascular function screenings • Screenings for cholesterol and diabetes • Imaging studies, including chest X-ray, mammography • Immunizations including HPV, MMR, tetanus, influenza Organized Sports Benefit Each family member that has Accident coverage is eligible for a 10% increase in payable benefits within the Injury and Treatment schedule of benefit categories. See disclosures and schedule of benefits for more information.

Who can get coverage?

If you’re actively at work*

You

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

Your spouse

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

Your children

*Employees must be legally authorized to work in the United States and actively working at a U.S. location to receive coverage. See Schedule of benefits for a complete listing of what is covered.

How much does it cost?

Your monthly premium

Option 1

$10.43

You

$19.30

You and your spouse

$27.52

You and your children

$36.39

Family

18 HI TECH UTILITY 2024 BENEFITS GUIDE

Unum | Accident Insurance

EN-2073

FOR EMPLOYEES

(10-22)

Unum Critical Illness Insurance

HI TECH UTILITY CONSTRUCTION INC.

Critical Illness Insurance

How does it work? If you’re diagnosed with an illness that is covered by this insurance, you can receive a lump sum benefit payment. You can use the money however you want. Why is this coverage so valuable? • The money can help you pay out-of-pocket medical expenses, like co-pays and deductibles. • You can use this coverage more than once. Even after you receive a payout for one illness, you’re still covered for the remaining conditions and for the reoccurrence of any critical illness with the exception of skin cancer. The reoccurrence benefit can pay 100% of your coverage amount. Diagnoses must be at least 180 days apart or the conditions can’t be related to each other.

Why should I buy coverage now? • It’s more affordable when you buy it through your employer and the premiums are conveniently deducted from your paycheck. • Coverage is portable. You may take the coverage with you if you leave the company or retire. You’ll be billed at home. Be Well Benefit Every year, each family member who has Critical Illness coverage can also receive $50 for getting a covered Be Well Benefit screening test, such as:

• Annual exams by a physician include sports physicals, well- child visits, dental and vision exams • Screenings for cancer, including

• Screenings for cholesterol and diabetes • Imaging studies, including chest X-ray, mammography • Immunizations including HPV, MMR, tetanus, influenza

pap smear, colonoscopy • Cardiovascular function screenings

What’s covered?

Critical illnesses • Heart attack • Stroke • Major organ failure • End-stage kidney failure

• Coronary artery disease Major (50%): Coronary artery bypass graft or valve replacement Minor (10%): Balloon angioplasty or stent placement

Who can get coverage?

Choose $15,000 of coverage with no medical underwriting to qualify if you apply during this enrollment. Spouses can only get 50% of the employee coverage amount as long as you have purchased coverage for yourself. Children from live birth to age 26 are automatically covered at no extra cost. Their coverage amount is 50% of yours. They are covered for all the same illnesses plus these specific childhood conditions: cerebral palsy, cleft lip or palate, cystic fibrosis, Down syndrome and spina bifida. The diagnosis must occur after the child’s coverage effective date.

You:

Your spouse:

Cancer conditions • Invasive cancer — all breast cancer is considered invasive

• Non-invasive cancer (25%) • Skin cancer — $500

Your children:

Progressive diseases

Supplemental conditions

• Amyotrophic Lateral Sclerosis (ALS) • Dementia, including Alzheimer’s disease • Multiple Sclerosis (MS) • Parkinson’s disease • Functional loss

• Loss of sight, hearing or speech • Benign brain tumor • Coma • Permanent Paralysis • Infectious Diseases (25%)

Please refer to the certificate for complete definitions about these covered conditions. Coverage may vary by state. See exclusions and limitations.

19 HI TECH UTILITY 2024 BENEFITS GUIDE

Unum | Critical Illness Insurance

EN-2050

FOR EMPLOYEES

(8-22)

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

Hi Tech Utility 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

Seth Knight - sknight@yatesins.com Resa Carter - rcarter@yatesins.com Charlie McDaniel - cmcdaniel@yatesins.com (706) 323-1600

20 HI TECH UTILITY 2024 BENEFITS GUIDE

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

21 HI TECH UTILITY 2024 BENEFITS GUIDE

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

22 HI TECH UTILITY 2024 BENEFITS GUIDE

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

23 HI TECH UTILITY 2024 BENEFITS GUIDE

Legal Notices

Important Notices about Medical Coverage

HIPAA Special Enrollment Rights If you are declining enrollment for yourself or your dependents (including your spouse) because of other health insurance or group health plan coverage, you may be able to enroll yourself or your dependents in this plan if you or your dependents lose eligibility for that other coverage (or if the employer stops contributing towards your or your dependents’ other coverage). However, you must request enrollment within 30 days after your or your dependents’ other coverage ends (or after the employer stops contributing toward the other coverage). In addition, if you have a new dependent as result of marriage, birth, adoption, or placement for adoption, you may be able to enroll yourself and your dependents. However, you must enroll within 30 days after the marriage, birth, adoption, or placement for adoption. Effective April 1, 2009 special enrollment rights also exist in the following circumstances: • If you or your dependents experience a loss of eligibility for Medicaid or your State Children’s Health Insurance Program (SCHIP) coverage; or • If you or your dependents become eligible for premium assistance under an optional state of Medicaid or SCHIP program that would pay the employee’s portion of the health insurance premium. NOTE: In the two above listed circumstances only, you or your dependents will have sixty (60) days to request special enrollment in the group health plan coverage. An individual must request this special enrollment within sixty (60) days of the loss of coverage described at bullet one, and within sixty (60) days of when eligibility is determined as described in bullet two. Women’s Health and Cancer Rights Act of 1998 Annual Notice If you have had or are going to have a mastectomy, you may be entitled to certain benefits under the Women’s Health and Cancer Rights Act of 1998 (WHCRA). For individuals receiving mastectomy-related benefits, coverage will be provided in a manner determined in consultation with the attending physician and the patient, for all stages of reconstruction of the breast on which the mastectomy was performed; surgery and reconstruction of the other breast to produce a symmetrical appearance; prostheses; and treatment of physical complications of the mastectomy, including lymphedema.

These benefits will be provided subject to the same deductibles and co-insurance applicable to other medical and surgical benefits provided under this plan. Our plan complies with these requirements. Benefits for these items generally are compatible to those provided under our plan for similar types of medical services and supplies. Of course, the extent to which any of these items is appropriate following mastectomy is a matter to be determined by consultation between the attending physician and the patient. Our plan neither imposes penalties (for example, reducing or limiting reimbursements) nor provides incentives to induce attending providers to provide care inconsistent with these requirements. If you would like more information on WHCRA benefits, call Yates LLC at (706) 323-1600.

Paperwork Reduction Act Statement

According to the Paperwork Reduction Act of 1995 (Pub. L. 104-13) (PRA), no persons are required to respond to a collection of information unless such collection displays a valid Office of Management and budget (OMB) control number. The Department notes that a Federal agency cannot conduct or sponsor a collection of information unless it is approved by OMB under the PRA, and displays a currently valid OMB control number, and the public is not required to respond to a collection of information unless it displays a currently valid OMB control number. See 44 U.S.C. 3507. Also, not withstanding any other provisions of law, no person shall be subject to penalty for failing to comply with a collection of information if the collection of information does not display a currently valid OMB control number. See 44 U.S.C. 3512. The public reporting burden for this collection of information is estimated to average approximately seven minutes per respondent. Interested parties are encouraged to send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the U.S. Department of Labor, Employee Benefits Security Administration, Office of Policy and Research, Attention: PRA Clearance Officer, 200 Constitution Avenue, N.W., Room N-5718, Washington, DC 20210 or email ebsa.opr@dol.gov and reference the OMB Control Number 1210-0137.

24 HI TECH UTILITY 2024 BENEFITS GUIDE

Page 1 Page 2 Page 3 Page 4 Page 5 Page 6 Page 7 Page 8 Page 9 Page 10 Page 11 Page 12 Page 13 Page 14 Page 15 Page 16 Page 17 Page 18 Page 19 Page 20 Page 21 Page 22 Page 23 Page 24 Page 25 Page 26 Page 27 Page 28 Page 29 Page 30 Page 31 Page 32

yatesknightrawls.employeenavigator.com

Made with FlippingBook - professional solution for displaying marketing and sales documents online