DVF Benefit Guide

2018 BENEFIT GUIDE

1

Benefit Basics

ELIGIBILITY You are eligible for benefits if you work at least 30 hours per week. Most of your benefits are effective on the first day of the month following your date of hire. Your dependents can also enroll for coverage, including:

• Your legal spouse • Your domestic partner • Your children up to age 26

Your benefit elections are for the 2018 plan year through December 31st. Remember that you may only change coverage if you experience a qualifying life event, as described here. Your domestic partner is eligible for benefits if he or she is not a relative and has lived with you for at least six months in a committed relationship and you intend to continue living together indefinitely. A declaration will be required. For more information about domestic partner benefits, contact the Human Resources Department. QUALIFYING LIFE EVENTS Generally, you may only make or change your existing benefit elections during the open enrollment window. However, you may change your benefit elections during the year if you experience an event such as:

• Marriage • Divorce or legal separation • Birth of your child or your domestic partner’s child • Death of your spouse, domestic partner or dependent child • Adoption of or placement for adoption of your child

• Change in employment status of employee, spouse/domestic partner or dependent child • Qualification by the Plan Administrator of a child support order for medical coverage • New entitlement to Medicare or Medicaid

You must notify Human Resources within 30 days following the date of a qualifying life event. Depending on the type of event, you may need to provide proof of the event, such as a marriage license. Human Resources will let you know what documentation you should provide. If you do not contact Human Resources within 30 days following the qualified event, you will have to wait until the next open enrollment window to make changes (unless you experience another qualifying life event).

For more information about your benefits, please contact

Human Resources or visit the Online benefits portal: www.dvfbenefits.com

2018 BENEFIT OVERVIEW

Health Reimbursement Account

You have a choice of three medical plans through Cigna Healthcare:

• • •

HSA

HRA EPO HRA OAP

Each medical plan features individual and family deductibles; copays; coinsurance; and out-of-pocket maximums.

HEALTH REIMBURSEMENT ACCOUNT (HRA) An HRA is an employer provided account. You can use your HRA to help pay for current qualified expenses. DVF will contribute $500 for single employees and $1,000 for families into the HRA for 2018. DVF will also contribute $250 for deductible expenses into your HRA for 2018. This amount will be used to help fund your initial out-of-pocket expenses that apply towards your annual deductible. There are three concepts that make up this plan:

• Your Health Reimbursement Account • Your Responsibility • The Health Coverage

YOUR HEALTH REIMBURSEMENT ACCOUNT (HRA) Each year, DVF may add a certain amount to your Health Reimbursement Account (HRA) balance. As long as a balance is available in the account, your HRA provides coverage for medical and pharmacy expenses (e.g., deductible and copays) that would normally require a payment from you. If you exhaust your HRA, you now move into the Your Respon- sibility portion of the plan. You are not eligible to contribute into the HRA. Only DVF can contribute on your behalf into the HRA. YOUR RESPONSIBILITY If you use your entire HRA balance, you are then responsible for additional health care expenses outlined on page 7. This amount pertains to the remaining medical deductible and any applicable copays. Your remaining deductible will be the deductible minus the employer HRA contribution of $500 for single employees and $1,000 for families. THE HEALTH COVERAGE Once you meet “Your Responsibility” amount – as detailed above, then the Cigna Medical portion of the plan begins to cover your expenses for the remainder of the plan year. For more information on the Cigna HRA plan, see page 7 of the benefits guide.

2018 BENEFIT OVERVIEW

Health Savings Account

HIGH DEDUCTIBLE HEALTH PLAN (HDHP) An HDHP provides coverage after you meet the Plan’s deductible. To qualify as an HDHP under IRS guidelines, the plan must satisfy certain deductible and out-of-pocket amounts which may change each year. HEALTH SAVINGS ACCOUNT (HSA) An HSA is a tax-advantaged health savings account for participants enrolled in an HDHP. You can use funds in an HSA to help pay for qualified expenses, or save for the future. You may contribute funds to your HSA up to the annual contribution limit (with an additional catch-up contribution for participants age 55 and over) regardless of your HDHP annual deductible amount. You are entitled to 1/12th of the maximum contribution for each month in which you are an HSA-eligible individual. (Special rules may apply for individuals who become newly eligible during the year.) Your contributions can be made on a pre-tax basis through the convenience of salary deferral or by a direct contribution to the HSA Administrator (tax deduction obtained when you file your federal tax return). Once you reach age 65 and enroll in Medicare Part A or B, you cannot continue to make contributions to an HSA; however, you can still make withdrawals. For 2018, the annual contribution limit is $3,450 for single coverage / $6,900 for family coverage. The “catch-up” contribution limit is $1,000. Any funds in your account at the end of the plan year accumulate and earn non-taxable interest or investment return over the life of the account. The dollars in your HSA are your money and remain your money even if you leave DVF or retire. After you have incurred a qualified expense, there are several options available for accessing HSA funds. Discovery Benefits will provide you with a debit card to access your funds. You can also request additional debit cards and a check book - please note charges may apply. If you enroll in the HSA you are not eligible to participate in the Medical Flexible Spending Account. You can put aside additional money into your HSA to pay for these eligible expenses and the unused funds roll-over. DVF will contribute $700 for single employees and $1,200 for families into the HSA for 2018.

Additional information on banking options will be provided to you after you enroll.

2018 BENEFIT OVERVIEW

Your Dental Plan

It’s important to have regular dental exams and cleanings so problems are detected before they become painful—and expensive. Keeping your teeth and gums clean and healthy will help prevent most tooth decay and periodontal disease, and is an important part of maintaining your medical health. You have a choice of two dental plans: the Cigna DMO plan and the Cigna DPPO plan. This chart shows what the plans pay:

Provision

DMO Plan

DPPO Plan

In-Network Only

In-Network

Out-of-Network

$50 individual $150 family

Annual Deductible

n/a

n/a

Annual Maximum Per Individual

$1,650*

Unlimited

Preventative Dental Services (cleanings, fluoride treatments, sealants and x-rays) Basic Dental Services (fillings, periodontics, scaling and root planning, oral surgery) Major Dental Services (crowns, bridges, full and partial dentures)

Plan pays 100%

Plan pays 100%, no deductible

Copay based off procedure

Plan pays 80% You pay 20%

Plan pays 50% You pay 50%

Copay based off procedure

$2,184 for children up to 19; $2,904 for adults

Orthodontia Services (Services up to 24 months)

Not Covered

*The annual maximum dollar amount increases (up to the maximum) in following years if preventative care was received in the first and subsequent plan years to $1,800 in year 2, $1,950 in year 3 and $2,100 in year 4.

2018 BENEFIT OVERVIEW

5

Your vision plan is provided through Vision Service Plan. It provides coverage for routine eye exams and pays for all or a portion of the cost of glasses or contact lenses. You can see in- or out-of-network providers; however, you always save money if you see in-network providers. VSP also offers a Lasik discount. For more information, please contact the Human Resources Department. Your Vision Plan

Frequency is 12 months for exams, 12 months for lenses, 12 months for contact lenses and 24 months for frames.

Benefit

In-Network

Out-of-Network Reimbursement

Eye Exam

$10 copay

$50 allowance

Hardware

$20 copay

Reimbursement Varies

Covered at 100% up to $130 - 20% discount on amounts over $130

Frames*

$70 allowance

$20 copay

$50 allowance

Single Vision Lenses

$20 copay

$75 allowance

Bifocal Lenses

Trifocal Lenses

$20 copay

$75 allowance

$50 copay

Standard Progressive Lenses**

$75 allowance

$80-90 copay

Premium Progressive Lenses**

$75 allowance

$120-160 copay

Custom Progressive Lenses**

$75 allowance

Medically Necessary Contact Lenses

Covered at 100%

$210 allowance

Elective Contact Lenses In Lieu of Glasses

$130 allowance

$105 allowance

*The Hardware Copay applies to frames and lenses.

**Lens Enhancements.

2018 BENEFIT OVERVIEW

Medical Plan Comparison

HRA-EPO

HRA-OAP

HSA

In-Network Only In-Network Only

Out-of-Network

In-Network

Plan Provision

Individual $500 Family $1,000 + $250 for deductible expenses

Individual $500 Family $1,000 + $250 for deductible expenses

Company Contribution to HRA/HSA

Individual $700 Family $1,200

$15/$30/$60, after deductible is met Plan pays 80%, you pay 20% after deductible is met $30/$60/$120, after deductible is met Plan pays 80%, you pay 20% after deductible is met Plan pays 80%, you pay 20% after deductible is met Plan pays 80%, you pay 20% after deductible is met Plan pays 80%, you pay 20% after deductible is met Plan pays 80%, you pay 20% after deductible is met Plan pays 80%, you pay 20% after deductible is met Individual $2,000 Family $4,000

Individual $3,000 Family $6,000

Individual $3,000 Family $6,000

$40 copay after deductible is met you pay 30% after deductible is met Plan pays 70%, you pay 30% after deductible is met Plan pays 70%, Individual $3,000 Family $6,000

Annual Deductible

Primary Care Visit

$25 copay

$25 copay

Specialist Office Visit

$40 copay

$40 copay

$40 copay after deductible is met

$40 copay after deductible is met

Urgent Care Visit

Prescription Drugs Retail

n/a

$15/$30/$60

$15/$30/$60

Prescription Drugs Mail Order

n/a

$30/$60/$120

$38/$75/$150

$100 copay after deductible is met Plan pays 80%, you pay 20% after deductible is met Plan pays 80%, you pay 20% after deductible is met

$100 copay after deductible is met Plan pays 80%, you pay 20% after deductible is met Plan pays 80%, you pay 20% after deductible is met

$100 copay after deductible is met Plan pays 60%, you pay 40% after deductible is met Plan pays 60%, you pay 40% after deductible is met Plan pays 70%, you pay 30% after deductible is met

Emergency Room

Inpatient Services

Outpatient Services

Outpatient Lab and X-ray

Plan pays 100% Plan pays 100%

Plan pays 70%, you pay 30% after deductible is met

Plan pays 80%, you pay 20% after deductible is met

Plan pays 100% Plan pays 100%

Radiology

70%

80%

80%

80%

Coinsurance

Unlimited per individual

Unlimited per individual

Unlimited per individual

Unlimited per individual

Lifetime Maximum

Annual Out-of -Pocket Maximum

Individual $3,000 Family $6,000

Individual $5,000 Family $10,000

Individual $5,000 Family $10,000

Individual $5,000 Family $10,000

UCR

150% of Medicare

n/a

n/a

n/a

*Please use overview as reference only. Please refer to SBC for specific benefits.

2018 BENEFIT OVERVIEW

Benefit Costs

Bi-weekly Employee Contributions* $44.39

Plan Name

Coverage Type

Employee

CIGNA MEDICAL HSA PLAN

Employee + Child(ren) Employee + Spouse Employee + Family

$136.51 $128.74 $228.63

$70.57

Employee

CIGNA MEDICAL HRA EPO PLAN

Employee + Child(ren) Employee + Spouse Employee + Family Employee + Child(ren) Employee + Spouse Employee + Family Employee Employee + Child(ren) Employee + Spouse Employee + Family Employee + Child(ren) Employee + Spouse Employee + Family Employee Employee

$111.78 $286.19 $242.91 $309.52 $431.37 $4.81 $9.46 $10.14 $14.80 $20.11 $39.06 $43.08 $62.06 $190.18 $174.30

CIGNA MEDICAL HRA OAP PLAN

CIGNA DENTAL DMO PLAN

CIGNA DENTAL DPPO PLAN

$4.67 $7.47 $7.63 $12.29

Employee

Employee + Child(ren) Employee + Spouse Employee + Family

VSP VISION PLAN

*These deductions are taken twice a month from your paycheck.

2018 BENEFIT OVERVIEW

Flexible Spending Accounts

Eligible Expenses Limits

Eligible Expenses

Benefit

Saves on eligible expenses not covered by insurance; reduces your taxable income

Medical Care FSA Most medical, dental and vision

care expenses that are not covered by your health plan (such as co-payments, coinsurance, deductibles, eyeglasses and doctor-prescribed over the counter medications) Dependent Care FSA Dependent care expenses (such as day care, after school programs for eligible dependents under age 13, or over age 13 if he or she spends at least eight hours a day in your home and is physically or mentally incapable of caring for himself or herself or elder care programs) so you and your spouse can work or attend school full-time

Maximum contribution is $2,650 per year

A Flexible Spending Account (FSA) is a program that helps you pay for health care and dependent care costs using tax free dollars. Each pay period, you decide how much money you would like to contribute to one or both accounts. Your contribution is deducted from your paycheck on a pretax basis and is put into the Medical FSA, the Dependent Care FSA, or both. When you incur expenses, you can access the funds in your account to pay for eligible health care or dependent care expenses. This chart shows the eligible expenses for each FSA; how much you can contribute to each FSA each year, and how you benefit by using an FSA. You are not eligible to participate in the Medical Flexible Spending Account if you enroll in the HDHP with Health Savings Account (HSA). Your Flexible Spending Account (FSA) elec- tions are effective from January 1 through December 31. Please plan your contributions carefully. Our Medical FSA allows you to carry over $500 in unused funds to the 2019 plan year. Any money remaining in your Medical Care FSA over $500 and any amount in your Dependent Care FSA as of December 31, 2018 will be forfeited. This is known as the “use it or lose it” rule and it is governed by IRS regulations. Note that FSA elections do not automatically continue from year to year; you must actively enroll each year. IMPORTANT INFORMATION ABOUT FSA’s

Maximum contribution is $5,000 per year ($2,500 if married and filing separate tax returns)

Reduces your taxable income

EXAMPLE Here’s a look at how much you can save when you use an FSA to pay for your health care and dependent care expenses.

With FSA

Without FSA

$50,000

$50,000

Your taxable income

Pretax contribution to Health Care and Dependent Care FSA

$2,000

$0

$11,701

$12,355

Federal and Social Security taxes*

After-tax dollars spent on eligible expenses

$0

$2,000

Spendable income after expenses and taxes Tax savings with the Medical and Dependent Care FSA

$36,300

$35,645

$655

N/A

*This is an example only. It assumes a 25% Federal income tax rate marginal rate and a 7.7% FICA marginal rate. State and local taxes vary, and are not included in this example. However, you will also save on any state and local taxes.

2018 BENEFIT OVERVIEW

Your Life/AD&D, BTA and Disability Plans

DISABILITY INSURANCE Disability insurance provides income replacement should you become disabled and unable to work due to a non-work-related illness or injury. The company provides eligible employees with disability income benefits at no cost as shown below. Coverage is automatic. You do not need to enroll.

LIFE INSURANCE Life insurance is an important part of your financial security, especially if you support a family. The company provides Basic Life Insurance to all eligible employees at no cost equal to one times your annual basic earnings, up to a maximum benefit of $500,000. Coverage is automatic. You do not need to enroll. This benefit reduces by 35% at age 65 and to 50% at age 70. Conversion of this policy is available if you leave DVF. AD&D INSURANCE Accidental Death & Dismemberment (AD&D) insurance is designed to provide a benefit in the event of accidental death or dismemberment. The company provides AD&D Insurance to all eligible employees at no cost equal to one times your annual basic earnings, up to a maximum benefit of $500,000. Coverage is automatic. You do not need to enroll.

Coverage

Benefit

• Covers 60% of your base weekly earnings, to a $2,500 weekly maximum • Maximum of 12 weeks • Benefits begin on

Short-Term Disability/Salary Continuation

the 8 th day for Accident and Sickness

BUSINESS TRAVEL ACCIDENT INSURANCE (BTA)

• Covers 60% of your base monthly earnings, to a $15,000 monthly maximum • Benefit begins after 13 weeks of disability • Maximum duration is to age 65 if

Business Travel Accident Insurance helps out if you are seriously ill or experience accidental death or dismemberment when you travel for business. The coverage is paid for by the company and includes: • 24-hour worldwide business travel protection • Travel assistance services • Emergency medical evacuation

Long-Term Disability

disabled prior to age 60 – limited benefit available after age 60.

Coverage is automatic. You do not need to enroll.

2018 BENEFIT OVERVIEW

2018 BENEFIT GUIDE

Supplemental Life Insurance

EMPLOYEE SUPPLEMENTAL LIFE/AD&D INSURANCE In addition to the Basic Life and Accidental Death & Dismemberment Insurance provided by DVF, you can purchase additional protection under the Employee Supplemental Life / AD&D Benefit. This benefit is available in $10,000 increments up to the lesser amount of 5 times your salary or $500,000. When you are initially eligible you are guaranteed up to $150,000 without Evidence of Insurability (EOI). After your initial eligibility, all amounts will be subject to EOI, unless you enroll for at least $10,000 during the open enrollment period. For the Employee and Dependent Spouse Supplemental Life, age reductions will apply. Benefits will reduce by 35% at age 65 and an additional 15% at age 70. These polices are portable upon termination.

DEPENDENT SUPPLEMENTAL LIFE/AD&D INSURANCE Your dependent spouse and dependent child(ren) also have the option to purchase Life / AD&D Insurance through DVF. If you are enrolled in supplemental life: Your spouse is eligible for a benefit in $5,000 increments up to the lesser of 100% of the Employee amount or $500,000. Your spouse is guaranteed $25,000 in coverage without EOI at initial eligibility. Your dependent child(ren) are eligible for the following: • Birth to 6 months: $1,000 • 6 months to 19 years (26 if a full time student): $2,000 increments up to $10,000 All dependent child(ren) amounts are guarantee issue and not subject to EOI. No health questions required for the AD&D. Please refer to the Summary Plan Description for additional details.

Employee (Per $1,000)

Spouse (Per $1,000)

Child (Per $1,000)

Employee (Per $1,000)

Spouse (Per $1,000)

Age

Age

-24

$0.056

$0.056

$0.035

50-54

$0.432

$0.432

Ineligible

$0.062

$0.062

$0.618

$0.618

25-29

55-59

30-34

60-64

Ineligible

$0.083

$0.083

$0.795

$0.795

Ineligible

35-39

65-69

$0.123

$0.123

$1.131

$1.131

$0.188 $0.293

$0.188 $0.293

$2.140 $6.613

$2.140 $6.613

Ineligible Ineligible

40-44 45-49

70-74 75+

Child Life rate is $0.35 per $1,000 of coverage, per month. AD&D rate is $0.03/$1,000 of coverage, per month.

EXAMPLE OF CALCULATING YOUR MONTHLY COST:

Age

Life Volume

Benefit Unit

Unit Rate

Cost

24 @

$100,000

/

$1,000

X

$0.0560

=

$5.60

$0.35

$10,000

$1,000

10

$0.035

@

/

X

=

2018 BENEFIT OVERVIEW

401(k) Retirement Plan

DVF’s 401(k) Retirement Plan gives you an easy way to save for your future through payroll deductions.

EMPLOYER CONTRIBUTIONS The Company will match $0.65 for every $1 up to 6% of your eligible compensation. VESTING Vesting refers to your right of ownership to the money in your account. You are immediately vested in all of your contributions. Vesting of the employer contributions and profit sharing is as follows:

ELIGIBILITY You are eligible to participate in the plan immediately on your Date of Hire with the company. EMPLOYEE CONTRIBUTIONS Contributions from your pay are made on a pretax basis—up to the IRS annual limit of $18,500 for 2018. If you are 50 years of age or older, (or if you will reach age 50 by the end of the year), you may make a catch-up contribution up to $6,000 in addition to the normal IRS annual limit.

• Year 1: 33% • Year 2: 66% • Year 3: 100%

MORE INFORMATION Your account will be available immediately upon termination. Various tax laws will apply – please contact Human Resources directly. Loans and Hardship withdrawals are available. For additional details about the DVF 401(k) Retirement Plan through Fidelity or to enroll or change your contribution rates or investment elections, please visit www.netbenefits.com or call Fidelity at 1-800-294-4015.

With Company match

Without Company match

Current Age: 28

Eligible Compensation 401 (k) salary reduction as a % 401 (k) salary reduction as a dollar amount Company Match $0.65 for $1 up to 6% of pay

$100,000

$100,000

10%

10%

$10,000

$10,000

$3,900

NO MATCH ($0)

Total Annual Contribution

$13,900

$10,000

Assumed rate of Return

5%

5%

Retirement Age

65

65

Total Account Balance at age 65

$1,450,601

$1,043,596

2018 BENEFIT OVERVIEW

Additional Benefits

EMPLOYEE ASSISTANCE PROGRAM If you find yourself in need of some professional support to deal with personal, work, financial or family issues, your Employee Assistance Program (EAP) can help. You and your immediate family (spouse or domestic partner and dependent children) can use the EAP for help with: • Marriage and family problems • Job-related issues • Stress, anxiety and depression • Legal and financial counseling • Financial planning – tax, retirement, credit & debt management • Assistance with Child Care or Elder Care resources • Pet Care/Veterinary Services Members can receive up to 3 face-to-face visits with a counselor in the Cigna Life Assistance Network and unlimited telephonic and web access – 24 hours a day – 7 days a week Members can receive a free 30 minute consultation with an attorney or seasoned financial professional and Certified Public Accountant (CPA). Referrals are available for complex legal issues or financial issues – you will receive up to a 25% discount on select fees. If you need help or guidance, call a Cigna Life Assistance counselor at 800-538-3543 or visit Online: www.cignabehavioral.com/CGI

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2018 BENEFIT OVERVIEW

Additional Benefits

PET ASSURE INSURANCE Enroll to receive a 25% discount on ALL in-network veterinary services. All pets are eligible regardless of age, health conditions or pre-existing conditions. One plan covers all of your mini family members. For more information, call 1-888-789-7387 or visit www.petassure.com.

GROUP HOME/RENTERS AND AUTO INSURANCE Liberty Mutual is offering voluntary group coverage for auto insurance, homeowners insurance and renters insurance. This benefit is optional and you can enroll individually at any time throughout the year. You will receive up to a 10% discount on auto insurance and a 5% on homeowners and renters insurance. You can choose to pay for this benefit through automatic payroll deductions or in a lump sum. For more information, call 212-398-2480 ext. 50499 or visit www.LibertyMutual.com/DVF.

2018 BENEFIT OVERVIEW

What about Wellness?

DVF is committed to your health and personal well-being. Every time you make the decision to eat healthy, exercise, and get your preventative exams you are protecting your health and the corporation’s overall wellbeing. Our priority is to provide you access to meaningful benefits with tools and resources that assist you in becoming a more informed healthcare consumer. Throughout 2018, DVF encourages you to continue to participate in the Wellness events: FLU SHOTS DVF will continue to partner with a Third Party Medical Professional to deliver on-site flu shots at no cost to you. BIOMETRIC SCREENINGS DVF will continue working with a Third Party Vendor to bring onsite biometric screenings and seminars to DVF employees. Free on-site screening services will provide each participant with an individualized health report. These screenings include cholesterol, glucose level, blood pressure, height, weight and Body Mass Index (BMI). The results are immediately available following the screening and discussed during a one-on-one confidential coaching session with a credentialed health care professional. Further education and information can help participants take immediate action to improve their health. ON-SITE SEMINARS Highly-trained and certified educators will deliver hour long seminars on various topics. These topics include fitness, stress, weight management and much more! The interactive and educational seminars provide employees with information regarding company wide health concerns. Stay tuned throughout the upcoming plan year to learn more about opportunities to participate in wellness activities. MOTIVATE ME Starting 1/1/2018, employees enrolled in a Cigna medical plan will be able to earn incentives for achieving certain wellness criteria: getting your yearly physical, taking Cigna’s Online Health Assessment, and participating in DVF’s onsite biometric screening. Employees can earn up to $100 in rewards!

CIGNA HEALTHY REWARDS All Benefit Eligible Employees have access to additional tools and resources through Cigna Healthy Rewards. Any dependents enrolled in the Medical or Dental plans also have access to these resources.

These tools and resources include:

• Weight Management and Nutrition • Tobacco Cessation • Fitness • Mind/Body • Vision & Hearing Care • Alternative Medicine • Healthy Lifestyle Products • Dental Care • Vitamins, Health & Wellness Products

To access these tools and resources register on http://www.myCIGNA.com or call 1-800-870-3470.

CRUNCH FITNESS Diane Von Furstenberg offers a discount program through Crunch Fitness. • Special rates just for Employees of Diane von Furstenberg. • All employees may enroll with Crunch Fitness at a special discounted corporate rate. • New enrollees will receive one free personal training session. • Club Amenities include: awesome classes, month-to-month membership, shiny machines, tons of weights, personal training, ride studio, yoga, studio, TRX, Bliss spa products, full service locker rooms, sauna, steam room, weekly DJ (amenities vary by club). • To Join/Renew: www.onlineccs.com (password: DVFstudioEMP) OR stop by Crunch Fitness and ask for your Corporate Deal.

2018 BENEFIT OVERVIEW

Contact Information

Plan

Administrator

Website

Phone #

Medical Benefits

www.mycigna.com

Cigna

1-800-244-6224

Health Reimbursement Account (HRA)

www.discoverybenefits.com

Discovery Benefits

1-866-451-3399

Health Savings Account (HSA)

www.discoverybenefits.com

Discovery Benefits

1-866-451-3399

Dental

www.mycigna.com

Cigna

1-800-244-6224

Vision

www.vsp.com

VSP

1-800-877-7195

Flexible Spending Accounts

www.discoverybenefits.com

Discovery Benefits

1-866-451-3399

Life and Disability

www.unum.com

Unum

1-800-858-6843

Employee Assistance Program (EAP) Auto/Home/Renters Insurance

Cigna Behavioral Health

www.cignabehavioral.com/CGI

1-800-538-3543

212-398-2480 ext. 50499

www.LibertyMutual.com/DVF

Liberty Mutual

401(k) Retirement Plan

1-800-294-4015

www.netbenefits.com

Fidelity

2018 BENEFIT OVERVIEW

16

Health Insurance Glossary

On occasion, there are questions about what a specific word or term means in the context of health insurance. This glossary is intended to serve as a tool to assist you in understanding some of the most common terms.

A

Affordable Care Act (ACA): The comprehensive health care reform law enacted in March 2010. Affordable Coverage: An employer-sponsored health plan covering only the employee, and whose cost cannot exceed a set annual percentage of the employee’s household income. Allowed Amount: The maximum amount a plan will pay for a covered health care service. If a provider charges more than the plan’s allowed amount, the plan participant may have to pay the difference through a process called balance billing. Annual Limit: A cap on the benefits an insurance company will pay in a year while a plan participant is enrolled in a particular health insurance plan. Annual limits are sometimes placed on particular services such as prescriptions or hospitalizations, on the dollar amount of covered services, or on the number of visits that will be covered for a particular service. After an annual limit is reached, the plan participant must pay all associated health care costs for the rest of the year. Balance Billing: When a provider bills a patient for the difference between the provider’s charge and the patient's insurance plan's allowed amount. For example, if the provider’s charge is $100 and the patient's insurance plan's allowed amount is $70, the provider might bill the patient for the remaining $30. Brand-Name Drug: A drug sold by a drug company under a specific name or trademark and that is protected by a patent. Brand-name drugs may be available by prescription or over the counter. B C CHIP (Children’s Health Insurance Program): Insurance program that provides low-cost health coverage to children in families that earn too much money to qualify for Medicaid, but not enough money to buy private insurance. Claim: A request for a benefit (including reimbursement of a health care expense) by a plan participant to the insurer for items or services the participant believes are covered by the plan. COBRA (Consolidated Omnibus Budget Reconciliation Act): A federal law that in some cases allows a plan participant to temporarily keep health coverage after his or her employment ends, he or she loses coverage as a dependent of the covered employee, or another qualifying event.

Health Insurance Glossary

C

17

D Deductible: The amount the plan participant pays for covered health care services before his or her insurance plan starts to pay. Dental Coverage: Benefits that help pay for the cost of visits to a dentist. Dependent: A child or other individual for whom a parent, relative, or other person may claim a personal exemption that reduces their tax obligation. Diagnostic Test: Test to figure out what the plan participant’s health problem is. For example, an x-ray can be a diagnostic test to diagnose a broken bone. Disability: A limit in a range of major life activities. This includes activities like seeing, hearing, and walking, and tasks such as thinking and working. Drug List: See Formulary. after having paid his or her deductible. Coverage: See Health Insurance . Cost Sharing: The share of costs covered by insurance that a plan participant pays out of his or her own pocket. Cost sharing generally includes deductibles, coinsurance, and copays. Emergency Medical Condition: An illness, injury, symptom (including severe pain), or condition severe enough to risk serious danger to a person’s health if he or she does not receive medical attention right away. Emergency Medical Transportation: Ambulance services for an emergency medical condition. Emergency Services: Services to check for or treat an emergency medical condition. Employer Mandate: Provision of the Affordable Care Act that requires certain employers with at least 50 full-time employees (or full-time equivalents) to offer health insurance coverage to its full-time employees (and their dependents) that meets certain affordability and minimum value standards or pay a penalty tax. The employer mandate is often referred to as "pay or play." Coinsurance: The percentage of costs of a covered health care service the participant pays after having paid his or her deductible. Co-op Plan: A health plan offered by a non-profit organization in which the same people who own the company are insured by the company. Copay (also known as copayment): A fixed amount the participant pays for a covered health care service E

Employer Shared Responsibility Provision: See Employer Mandate .

Health Insurance Glossary

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F Flexible Spending Arrangement (FSA): See Health Flexible Spending Arrangement. Formulary: A list of prescription drugs covered by a prescription drug plan or another insurance plan offering prescription drug benefits. A formulary is also often called a drug list. Fully Insured Plan: A health plan purchased by an employer from an insurance company. G Generic Drug: A drug that has the same active-ingredient formula as a brand-name drug. The U.S. Food and Drug Administration (FDA) rates generic drugs to be as safe and effective as brand-name drugs. Grandfathered Health Plan: A group health plan that was created—or an individual health insurance policy that was purchased—on or before March 23, 2010. Grandfathered health plans are exempted from many changes required under the Affordable Care Act. Plans or policies may lose their “grandfathered” status if they make certain significant changes that reduce benefits or increase costs to consumers. A health plan must disclose in its plan materials whether it considers itself to be a grandfathered plan and must also advise consumers how to contact the U.S. Department of Labor or the U.S. Department of Health and Human Services with questions. Group Health Plan: In general, a health plan offered by an employer or employee organization that provides health coverage to employees and their families. Essential Health Benefits: A set of 10 categories of services health insurance plans must cover under the Affordable Care Act. These include doctors’ services, inpatient and outpatient hospital care, prescription drug coverage, pregnancy and childbirth, mental health services, and more. Exchange: See Health Insurance Marketplace . Excluded Services: Health care services that a plan does not cover. H Health Care Provider: An individual or facility that provides health care services. Examples include a doctor, nurse, chiropractor, physician assistant, hospital, surgical center, skilled nursing facility, and rehabilitation center. Health Flexible Spending Arrangement (Health FSA): An arrangement an individual establishes through his or her employer to pay for out-of-pocket medical expenses with tax-free dollars. These expenses include insurance copays and deductibles, and qualified prescription drugs, insulin, and medical devices. The maximum contribution to an FSA is subject to annual inflation adjustment. Health Insurance: A contract that requires a health insurance company to pay some or all of a plan participant’s health care costs in exchange for a premium.

Health Insurance Glossary

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Health Insurance Marketplace: A service that helps people shop for and enroll in health insurance. The federal government operates the Marketplace, available at HealthCare.gov, for most states. Some states run their own Health Insurance Marketplaces. Health Maintenance Organization (HMO): A type of health insurance plan that usually limits coverage to care from doctors who work for or contract with the HMO. There are two main types of HMOs: ▪ Traditional HMO : This type of HMO provides no benefits for services obtained outside of a network. ▪ Open-Access HMO : This type of HMO allows enrollees to receive services from an out-of- network provider at a higher cost than the enrollee would pay at an in-network provider. The additional costs may be in the form of higher deductibles, copays, or coinsurance. Health Reimbursement Arrangement (HRA): Employer-funded group health plans from which employees are reimbursed tax-free for qualified medical expenses up to a fixed dollar amount per year. Unused amounts may be rolled over to be used in subsequent years. Health Savings Account (HSA): A type of savings account that allows an individual to set aside money on a pre-tax basis to pay for qualified medical expenses, if he or she has a high deductible health plan. The maximum contribution to an HSA is subject to annual inflation adjustment. High Deductible Health Plan (HDHP): A plan with a higher deductible than a traditional insurance plan. The minimum deductible and maximum out-of-pocket limits for HDHPs are subject to annual inflation adjustment. High-Risk Pool Plan: A state-subsidized health plan that provides coverage for individuals with expensive pre- existing health care conditions. Home Health Care: Health care services and supplies an individual receives in his or her home under doctor’s orders. Services may be provided by nurses, therapists, social workers, or other licensed health care providers. Hospice Services: Services to provide comfort and support for persons in the last stages of a terminal illness. Hospitalization: Care in a hospital that requires admission as an inpatient and usually requires an overnight stay. I Individual Health Insurance Policy: Insurance policy for an individual who is not covered under an employer- sponsored plan. Individual Mandate: Provision of the Affordable Care Act that requires every individual to have minimum essential coverage for each month, qualify for an exemption, or make a penalty payment when filing his or her federal income tax return. Individual Shared Responsibility Provision: See Individual Mandate. In-Network: Health care providers (e.g., specialists, hospitals, laboratories) that have accepted contracted rates with the insurer in order to participate in the insurer’s network. The insured person typically pays a lower price for using services within the network. Inpatient Care: Health care that an individual receives when formally admitted as a patient to a health care facility, like a hospital or skilled nursing facility, on a doctor’s order. Internal Limit: Limitation that applies to individual categories of care—for example, a $250-per- procedure deductible for inpatient surgery.

Health Insurance Glossary

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Lifetime Limit: A cap on the total lifetime benefits a plan participant may receive from his or her insurance company. After a lifetime limit is reached, the insurance plan will no longer pay for covered services. M Mail-Order Drugs: Prescription drugs that can be ordered through the mail. Marketplace: See Health Insurance Marketplace. Medicaid: A joint state and federal insurance program that provides free or low-cost health coverage to some low-income people, families, children, pregnant women, the elderly, and people with disabilities. Medical Care: Services rendered by a hospital or qualified medical care provider. Medical Loss Ratio (MLR): A basic financial measurement used in the Affordable Care Act to encourage health plans to provide value to enrollees. If an insurer uses 80 cents out of every premium dollar to pay its customers' medical claims and activities that improve the quality of care, the company has a medical loss ratio of 80%. A medical loss ratio of 80% indicates that the insurer is using the remaining 20 cents of each premium dollar to pay overhead expenses, such as marketing, profits, salaries, administrative costs, and agent commissions. The Affordable Care Act sets minimum medical loss ratios for different markets, as do some state laws. Medicare: A federal health insurance program for people aged 65 and older, certain younger people with disabilities, and people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD). Medicare consists of four parts: ▪ Medicare Part A : A program within Medicare that covers hospital, skilled nursing, nursing home, hospice, and home health care services. ▪ Medicare Part B : A program within Medicare that covers medically necessary and preventive services. ▪ Medicare Part C (Medicare Advantage) : A type of Medicare health plan offered by a private company that contracts with Medicare to provide the beneficiary with all of his or her Part A and Part B benefits. ▪ Medicare Part D : A program that helps pay for prescription drugs for people with Medicare who join a plan that includes Medicare prescription drug coverage. There are two ways to get Medicare prescription drug coverage: through a Medicare Prescription Drug Plan or a Medicare Advantage Plan that includes drug coverage, both of which are offered by insurance companies and other private companies approved by Medicare. Minimum Essential Coverage (MEC): Any insurance plan that meets the Affordable Care Act requirement for having health coverage. Individuals without minimum essential coverage may be subject to the individual mandate. Minimum Value: A standard of minimum coverage that applies to employer-sponsored health plans. N Network: The facilities, providers, and suppliers a health insurer or plan has contracted with to provide health care services.

Health Insurance Glossary

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Obamacare: See Affordable Care Act . Open-Access HMO: A type of HMO that allows enrollees to receive services from an out-of-network provider at a higher cost than the enrollee would pay at an in-network provider. The additional costs may be in the form of higher deductibles, copays, or coinsurance. Open Enrollment Period: The yearly period when people can enroll in a health insurance plan. Out-of-Network: Services received outside an insurer’s network. These services typically carry a higher cost to the insured person. Out-of-Pocket Costs: Expenses for medical care that are not reimbursed by insurance. Out-of-pocket costs include deductibles, coinsurance, and copays for covered services, plus all costs for services that are not covered. Out-of-Pocket Limit: The most a plan participant can be required to pay for covered services in a plan year. An out-of-pocket limit is also often called an “out-of-pocket maximum.” Out-of-Pocket Maximum: See Out-of-Pocket Limit. Outpatient Care: Care that typically does not require an overnight hospital stay. P “Pay or Play”: See Employer Mandate. Physician Services: Health care services a licensed medical physician provides or coordinates. Plan Year: A 12-month period of benefits coverage under a group health plan. This 12-month period need not align with the calendar year. Preauthorization: A decision by a health plan that a health care service or product is medically necessary. A health plan may require preauthorization for certain services before they are provided (except in an emergency), though preauthorization is not a promise by a health plan to cover the cost. Pre-Existing Condition: A health problem an individual had before the date that his or her new health coverage starts. Pre-Existing Condition Exclusion Period: The period during which an insurance policy will not pay for care relating to a pre-existing condition. Preferred Provider Organization (PPO): A type of health plan that contracts with medical providers, such as hospitals and doctors, to create a network of participating providers. Under a PPO, a plan participant pays less in out-of-pocket costs if he or she uses providers that belong to the PPO’s network. Premium: The amount a plan participant pays for his or her health insurance every month. Premium Tax Credit: A tax credit an individual can use to lower his or her premium when he or she enrolls in a plan through the Health Insurance Marketplace. The Premium Tax Credit is based on the income estimate and household information the individual provides on his or her Health Insurance Marketplace application. Prescription Drugs: Drugs and medications that, by law, require a prescription.

Health Insurance Glossary

Prescription Drug Coverage: Health plan that helps pay for prescription drugs and medications. Preventive Services: Routine health care that includes screenings, check-ups, and patient counseling to prevent health problems. Primary Care: Health services that cover a range of prevention, wellness, and treatment programs for common illnesses. Primary Care Provider: A physician, nurse practitioner, clinical nurse specialist, or physician assistant who provides, coordinates, or helps an individual access a range of primary care services. P Q Qualified Health Plan: An insurance plan that is certified by the Health Insurance Marketplace, provides essential health benefits, follows established limits on cost sharing (like deductibles, copays, and out- of-pocket limits), and meets other requirements under the Affordable Care Act. All qualified health plans meet the minimum essential coverage requirement. R Referral: A written order from a primary care provider directing a patient to see a specialist or receive certain health care services. Under many health plans, a plan participant must obtain a referral before he or she can receive health care services from anyone except his or her primary care provider. Rehabilitation Services: Health care services that help an individual keep, get back, or improve skills and functioning for daily living that have been lost or impaired because he or she was sick, hurt, or disabled. These services may include physical and occupational therapy, speech therapy, and psychiatric rehabilitation services in a variety of inpatient and outpatient settings. Rescission: The retroactive cancellation of a health insurance policy. Insurance companies will sometimes retroactively cancel an entire individual health insurance policy if an individual made a mistake on his or her application for the policy that amounts to fraud or an intentional misrepresentation of material fact. S Screening: A type of preventive service that includes tests or exams to detect the presence of a health issue, usually performed when an individual has no symptoms, signs, or prevailing medical history of a disease or condition. Self-Insured Plan: Type of plan where the employer itself collects premiums from enrollees and takes on the responsibility of paying employees’ and dependents’ medical claims. These employers often contract with a third-party administrator for services such as enrollment, claims processing, and provider networks. Skilled Nursing Care: Services performed or supervised by licensed nurses in an individual’s home or in a nursing home. Special Enrollment Period: A time outside the yearly Open Enrollment Period when an individual can sign up for health insurance. An individual typically qualifies for a Special Enrollment Period as a result of a certain life event, such as losing other health coverage, moving, getting married, having a baby, or adopting a child. By law, special enrollment periods must last at least 30 days. Specialist: A health care provider focusing on a specific area of medicine or group of patients to diagnose, manage, prevent, or treat certain types of symptoms and conditions.

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Health Insurance Glossary

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Specialty Drugs: Prescription drugs that, in general, require special handling or ongoing monitoring and assessment by a health care provider, or that are relatively difficult to dispense. Summary of Benefits and Coverage (SBC): An easy-to-read summary that allows an individual to make apples-to-apples comparisons of costs and coverage between health plans. An individual most commonly receives an SBC when he or she shops for coverage or renews or changes coverage. T Traditional HMO: A type of HMO that provides no benefits for services obtained outside of a network. TRICARE: A health care program for active-duty and retired uniformed service members and their families. U Urgent Care: Care for an illness, injury, or condition serious enough that a reasonable person would seek care right away, but not so severe that it requires emergency room care. Usual, Customary, and Reasonable Charge (UCR): The amount paid for a medical service in a geographic area based on what providers in the area usually charge for the same or similar medical service. The UCR amount is sometimes used to determine the allowed amount. V Vision Coverage: A health benefit that at least partially covers vision care, such as eye exams and glasses. W Waiting Period: The time that must pass before coverage can become effective for an employee or dependent who is otherwise eligible for coverage under an employer-sponsored health plan. Well-Baby Care: Routine doctor visits for comprehensive preventive health services that occur when a child is 2 years of age or younger. Services include physical exams and measurements, vision and hearing screenings, and oral health risk assessments.

Health Insurance Glossary

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