Pilot Bank 2019 Benefits

Benefits at a Glance

Plan Year: January 1, 2019 through December 31, 2019

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CONTENTS & CONTACT INFORMATION

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

BROKER

M.E. Wilson Company Katie Reeves Miller 813-229-8021 Ext. 132 kmiller@mewilson.com

MEDICAL

page 3-5

Florida Blue (Policy # 69973) 800-583-9072 www.bcbsfl.com

DENTAL

page 6

MetLife (Policy # 5343653) 800-275-4638 www.metlife.com/mybenefits

VISION

page 7

MetLife (Policy # 5343653) 800-275-4638 www.metlife.com/mybenefits

BASIC & VOLUNTARY LIFE

page 8

Mutual of Omaha 800-769-7159 www.mutualofohama.com

SHORT TERM & LONG TERM DISABILITY

page 9

Mutual of Omaha 800-769-7159 www.mutualofohama.com

EAP & LIFELOCK & IDENTITY THEFT

page 10

ONLINE ENROLLMENT

page 11

DISCLOSURE NOTICES

page 13

BENEFIT INFORMATION

Benefit

Who pays the cost?

YOUR BENEFITS PLAN

Pilot Bank pays the majority of the employee portion of the medical plan. You may enroll your eligible dependents for an additional cost.

Medical

Insurance

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

You may elect dental coverage for yourself and your eligible dependents on a voluntary basis and you will be responsible for the cost.

Dental

Insurance

You may elect vision coverage for yourself and your eligible dependents on a voluntary basis and you will be responsible for the cost.

Vision

Insurance

Basic Life

Pilot Bank pays the entire cost.

Insurance

You may elect additional life coverage for yourself and your eligible dependents on a voluntary basis and you will be responsible for the cost.

Voluntary Life Insurance

Short and Long Term Insurance

Pilot Bank pays the entire cost.

ELIGIBILITY

All Regular full-time employees are eligible to join the Pilot Bank Benefits Plan on the 1st of the month following 30 days. You may also enroll your dependents in the Benefits Plan when you enroll.

Eligible dependents include:

Your legal spouse

•

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

Under 26 years of age

►

WHEN CAN YOU ENROLL?

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

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

If you do not enroll at one of the above times, you must wait for the next annual open enrollment period.

BENEFIT INFORMATION

CHOOSING YOUR BENEFITS

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

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

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

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

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

MAKING CHANGES

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

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

Your marriage

•

Your divorce or legal separation

•

• Birth or adoption of an eligible child

• Death of your spouse or covered child

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

WHEN COVERAGE ENDS

• Change in your work status that affects your benefits

Coverage will stop on the last day of the month in which employment with the company ends. Life insurance ends the last day of employment.

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

• Change in your child’s eligibility for benefits

• Receiving Qualified Medical Child Support Order (QMCSO)

KEY BENEFIT TERMS

COBRA – A Federal law that allows workers and dependents who lose their medical, dental, or vision coverage to continue any of these coverages for a specified length of time by electing and paying for continuation benefits. Copayment – A flat fee that you pay for medical services, regardless of the actual amount charged by your doctor or another provider. This generally applies to physicians’ office visits and prescription drugs. Deductible – The amount you pay toward medical and dental expenses each year before the plan begins paying benefits. Out of Pocket Maximum – The maximum amount you will pay in deductibles, copayments and coinsurance during the year.

MEDICAL INSURANCE

Pilot Bank offers five medical plans through Florida Blue. To find participating providers go to www.bcbsfl.com and click on “Find a Doctor”, choose the appropriate plan type (BlueOptions or BlueCare), and click continue. Then, narrow down your search based on location and provider type.

HDHP Plan Options, compatible with a Health Savings Account (H.S.A)

Pilot Bank is offering the same plans as current. Though these are the same plans you will notice a change in the plan names. The current and new plan names are shown in the chart below.

BlueCare 126/127 HMO H.S.A

BlueOptions 0314/0315 PPO H.S.A.

BlueOptions 0212/0213 PPO H.S.A.

FBA 201/202

FBA 105/106

FBA 103/104

New plan names:

IN-NETWORK

Deductible (Individual / Family)

$1,500 / $3,000

$2,500 / $5,000

$1,350 / $2,700

Maximum Out-of-Pocket (Individual / Family)

$3,000 / $6,000

$5,800 / $11,600

$5,000 / $5,000

Out-of-Pocket Includes

Deductible, Coinsurance, & Copays

Coinsurance

90% / 10%

80% / 20%

Routine Preventive Services Wellness, Immunizations, & Mammography/Colonoscopy

Covered 100%

CO-PAYS

TelaDoc

$40 Copay

Office Visits for Illness / Injury

Deductible & Coinsurance

Specialist Visits

Deductible & Coinsurance

Inpatient Hospital

Deductible & Coinsurance

Outpatient Surgery

Deductible & Coinsurance

Emergency Room

Deductible & Coinsurance

Urgent Care

Deductible & Coinsurance

OUTPATIENT DIAGNOSTIC SERVICES Lab Services (Freestanding Lab)

Deductible & Coinsurance

X-Ray Services (Freestanding Lab)

Deductible & Coinsurance

Complex Diagnostic

Deductible & Coinsurance

PRESCRIPTIONS

(After Deductible)

Retail (30 day supply)

$10 / $50 / $80 / $125

Mail Order (90 day supply)

2.5 x retail

OUT-OF-NETWORK Deductible

$5,000 / $10,000

$2,500 / $5,000

Maximum Out-of-Pocket

$11,600 / $23,200

$10,000 / $10,000

Not available

Coinsurance

60% / 40%

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

MEDICAL INSURANCE

Copay Plan Options

Pilot Bank is offering the same plans as current. Though these are the same plans you will notice a change in the plan names. The current and new plan names are shown in the chart below.

BlueCare 0402 HMO

BlueOptions 0307 PPO

New plan names:

FBA 305

FBA 004

IN-NETWORK Deductible (Individual / Family)

$3,500 / $5,000

$750 / $2,250

Maximum Out-of-Pocket (Individual / Family)

$6,350 / $12,700

$3,250 / $6,750

Out-of-Pocket Includes

Deductible, Coinsurance, Copays, & Prescriptions

Coinsurance

70% / 30%

80% / 20%

Routine Preventive Services Wellness, Immunizations, & Mammography/Colonoscopy

Covered 100%

CO-PAYS

TelaDoc

$0 Copay

Office Visits for Illness / Injury

$40 Copay

$30 copay

Specialist Visits

$65 Copay

$60 Copay

Inpatient Hospital

Deductible & Coinsurance

Outpatient Surgery

Deductible & Coinsurance

Emergency Room

$300 Copay

Urgent Care

$85 Copay

$65 Copay

OUTPATIENT DIAGNOSTIC SERVICES

Lab Services (Freestanding Lab)

100% Covered

X-Ray Services (Freestanding Lab)

$65 Copay

$50 Copay

Complex Diagnostic

$200 Copay

Deductible & Coinsurance

PRESCRIPTIONS

Retail (30 day supply)

$10 / $40 / $80 / $125

Mail Order (90 day supply)

2.5 x retail

OUT-OF-NETWORK Deductible

$1,750 / $5,250

Maximum Out-of-Pocket

Not Available

$6,000 / $12,000

Coinsurance

50% / 50%

MEDICAL CONTRIBUTION SCHEDULE

HDHP Plan Options, compatible with a Health Savings Account (H.S.A)

BlueCare 126/127 FBA 201/202 HMO H.S.A

Employee Pays Semi-Monthly

Employee Only

$46.47

Employee + Spouse

$216.57

Employee + Child(ren)

$160.80 $335.08

Family

BlueOptions 0314/0315 FBA 105/160 PPO H.S.A.

Employee Pays Semi-Monthly

Employee Only

$49.94

Employee + Spouse

$149.56 $104.62 $245.07

Employee + Child(ren)

Family

BlueOptions 0212/0213 FBA 103/104 PPO H.S.A.

Employee Pays Semi-Monthly

Employee Only

$57.60

Employee + Spouse

$226.10 $197.40 $412.09

Employee + Child(ren)

Family

Employer Health Savings Account (H.S.A) Contribution

Employee Only

$750.00

Employee & Dependent(s)

$1,500.00

Copay Plan Options

BlueOptions 0307 FBA 004 PPO

Employee Pays Semi-Monthly

Employee Only

$71.20

Employee + Spouse

$331.80 $246.36 $513.36

Employee + Child(ren)

Family

BlueCare 0402 FBA 305 HMO

Employee Pays Semi-Monthly

Employee Only

$46.47

Employee + Spouse

$216.55 $160.78 $335.04

Employee + Child(ren)

Family

DENTAL INSURANCE

Pilot Bank offers dental coverage through MetLife. The Dental PPO Plans allow you to use in-network or out-of-network benefits. If out-of-network dentists are used, you will be responsible for paying the difference between MetLife’s allowed amount and what the dentist may charge, also known as “balance billing”. The charts below provides a brief overview of the plans.

Met 1000

Met 1500

Met 3000

Out-of- Network*

Network

In- Network

Calendar Year Deductible Individual

$50

$150

Family

Annual Maximum

$1,000

$1,500

$3,000

Diagnostic & Preventive Exams Cleanings Fluoride X-Rays Sealants Regular Restorative Services Amalgam Fillings Extractions - Single Tooth Endodontics (Root Canal) Periodontics (Gum Disease) Major Services Crowns

100%

80%

100%

80%

100%

80%

60%

80%

60%

80%

50%

40%

50%

40%

50%

Bridges Dentures Orthodontia Services Adult & Child Lifetime Maximum

50% $1,500

Not Covered

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

Met 1000 Employee Cost Semi-Monthly

Met 1500 Employee Cost Semi-Monthly

Met 3000 Employee Cost Semi-Monthly

Employee Only

$14.46 $29.46 $31.97 $50.69

$19.98 $40.70 $44.15 $70.02

$24.78 $50.42 $58.78 $90.42

Employee + Spouse

Employee + Child(ren)

Family

VISION INSURANCE

Pilot Bank offers vision coverage through MetLife. The MetLife vision network consists of optometrists, ophthalmologist opticians and optical retailers. You have the option of visiting any provider, however by choosing a participating provider, you receive the highest level of benefits.

Vision VSP Network

In-Network

Out-of-Network

Routine Eye Exams

$10 Copayment

Reimbursed up to $35

$15 Copayment $30-$100 allowance $15 copay Up to $55 allowance $15 copay Up to $120 allowance

Lenses*

$15 Copayment

$15 copay Up to $120 allowance

Frames

$15 copay Up to $120 allowance (elective) 100% after copay (necessary)

Contact Lenses

Frequency Exam

Once every 12 months

Lenses or contact lenses

Once every 12 months

Frame

Once every 24 months

• Covered lenses include single vision, bifocal, trifocal and lenticular. • Lenses, Frames & Contacts are limited to either one pair of contacts or frames/lenses per calendar year.

Employee Cost Semi-Monthly

Employee Only

$3.46 $6.92 $7.12 $9.86

Employee + Spouse

Employee + Child(ren)

Family

BASIC AND VOLUNTARY LIFE INSURANCE

BASIC LIFE

Pilot Bank provides all full-time employees working 30 or more hours per week are automatically enrolled in Basic Life and AD&D with a benefit of 1x your annual salary, to a maximum of $500,000. Officers of the bank receive 2x annual salary.

**The Basic Life insurance is paid 100% by Pilot Bank.**

VOLUNTARY LIFE

Pilot Bank provides all full-time employees working 30 or more hours per week the option to purchase voluntary life insurance coverage. If you elect additional life insurance for yourself you may also elect coverage for your spouse and/or child(ren). The chart below provides an overview of the plan.

Employee

Benefit is available in increments of:

$25,000

Maximum Benefit:

Up to a maximum of 7x salary or $500,000, whichever is less.

Spouse

Benefit is available in increments of:

$25,000

Maximum Benefit:

Up to a maximum of 50% of employee amount or $250,000, whichever is less

Child(ren)

Benefit:

$10,000

Refer to Mutual of Omaha summary for voluntary life insurance pricing.

Benefit Reduction Schedule

Age

Benefits reduced by:

Late entrants, benefit elections and increases during open enrollment will require evidence of insurability (EOI).

35%

Additional 35%

SHORT TERM DISABILITY

Pilot Bank provides all full-time employees working 30 or more hours per week Short Term Disability coverage. This insurance can help protect your income in the event of a disability by providing you a benefit for injuries and sickness that are not work related.

**This coverage is 100% paid for by Pilot Bank. **

31 st Day

Benefits Begin

Benefits Payable

Maximum of 9 weeks

Percentage of Income Replaced

60% of Basic Earnings

Maximum Benefit

$1,615 per week

LONG TERM DISABILITY

Pilot Bank provides all full-time employees working 30 or more hours per week Long Term Disability coverage. This insurance can help protect your income in the event of a disability by providing you a benefit for injuries and sickness that are not work related.

**This coverage is 100% paid for by Pilot Bank.**

91 st Day

Benefits Begin

Benefits Payable

Until Social Security Retirement Age

Percentage of Income Replaced

60% of Basic Earnings

Maximum Benefit

$10,000 per month

EMPLOYEE ASSISTANCE PROGRAMS

The Employee Assistance Program is offered to all full-time benefit eligible employees and immediate family members of Pilot Bank through MehraVista Health. It is a completely confidential counseling program that covers issues such as marital and family concerns, depression, substance abuse, grief and loss, financial entanglements, and other personal stressors.

You can contact MehraVista Health toll free at 866-684-2007, or you can visit their website at www.mehravista.com

LIFELOCK & INDENTITY THEFT

LifeLock Benefit Elite ™ Identity Theft Protection LifeLock Benefit Elite identity theft protection helps proactively safeguard your credit, your finances and your good name with vigilant services that alert you of potential threats before the damage is done. If identity thieves steal your personal information, they could take out a mortgage, commit tax fraud, open new credit accounts and a whole lot more. LifeLock Benefit Elite Includes:

• Identity Theft Detection and Alerts • Lost Wallet Protection • Address Change Verification • Black Market Website Surveillance • Reduced Pre-Approved Credit Card Offers • Credit, Checking & Savings Account Activity Alerts • Court Records Scanning

LifeLock Ultimate Plus ™ Identity Theft Protection The leading identity theft protection from the industry leader.

You’ve worked hard. You’ve sacrificed and you’ve saved. Now you want to do everything you can to protect your finances, your family and your future.

Today’s modern criminals don’t care if you’re the lifeline for your family. To them, you’re just another goldmine. And remember, the more digitally connected you are, the more connected they are. Get the protection and convenience of LifeLock Ultimate Plus ™ membership so you can get on with your life. LifeLock Ultimate Plus Includes:

• Checking and Savings Account Application Alerts • Bank Account Takeover Alerts • Investment Account Activity Alerts • Credit Inquiry Activity • Monthly Credit Score Tracking • File Sharing Network Search • Lost Wallet Protection • Data Breach Notification • And so much more…

LifeLock Benefit Elite Semi-Monthly

LifeLock Ultimate Plus Semi-Monthly

Employee Only

$4.25 $8.49 $7.43

$12.75 $25.49 $18.06 $30.81

Employee + Spouse

Employee + Child(ren)

Family

$11.68

ONLINE ENROLLMENT

ONLINE ENROLLMENT, Continued

REQUIRED ANNUAL EMPLOYEE DISCLOSURE NOTICES

Required Annual Employee Disclosure Notices

THE NEWBORNS’ AND MOTHERS’ HEALTH PROTECTION ACT OF 1996 The Newborns’ and Mothers’ Health Protection Act of 1996 prohibits group and individual health insurance policies from restricting benefits for any hospital length of stay for the mother or newborn child in connection with childbirth; (1) following a normal vaginal delivery, to less than 48 hours, and (2) following a cesarean section, to less then 96 hours. Health insurance policies may not require that a provider obtain authorization from the health insurance plan or the issuer for prescribing any such length of stay. Regardless of these standards an attending health care provider may, in consultation with the mother, discharge the mother or newborn child prior to the expiration of such minimum length of stay. Further, a health insurer or health maintenance organization may not: 1. Deny to the mother or newborn child eligibility, or continued eligibility, to enroll or to renew coverage under the terms of the plan, solely to avoid providing such length of stay coverage; 2. Provide monetary payments or rebates to mothers to encourage such mothers to accept less than the minimum coverage; 3. Provide monetary incentives to an attending medical provider to induce such provider to provide care inconsistent with such length of stay coverage; 5. Restrict benefits for any portion of a period within a hospital length of stay described in this notice. These benefits are subject to the plan’s regular deductible and co-pay. For further details, refer to your Summary Plan Description. Keep this notice for your records and call Human Resources for more information. Effective January 1, 2009 group health plans are required by Federal government to comply with Section 111 of the Medicare, Medicaid, and SCHIP Extensions of 2007’s new Medicare Secondary Payer regulations. The mandate is designed to assist in establishing financial liability of claims assignments. In other words, it will help establish who pays first. The mandate requires group health plans to collect additional information, more specifically Social Security numbers for all enrollees, including dependents 6 months of age or older. Please be prepared to provide this information on your benefits enrollment form when enrolling into benefits. 4. Require a mother to give birth in a hospital; or SECTION 111

WOMEN’S HEALTH AND CANCER RIGHTS ACT OF 1998

The Women’s Health and Cancer Rights Act of 1998 requires Pilot Bank to notify you, as a participant or beneficiary of the Pilot Bank Health and Welfare Plan, of your rights related to benefits provided through the plan in connection with a mastectomy. You, as a participant or beneficiary, have rights to coverage to be provided in a manner determined in consultation with your attending physician for: 1. All stages of reconstruction of the breast on which the mastectomy was performed; 2. Surgery and reconstruction of the other breast to produce a symmetrical appearance; and 3. Prostheses and treatment of physical compilations of the mastectomy, including lymphedema. These benefits are subject to the plan’s regular deductible and co-pay. For further details, refer to your Summary Plan Description. Keep this notice for your records and call Human Resources for more information. The law allows for continued coverage for dependent children who are covered under your group health plan as a student if they lose their student status because of a medically necessary leave of absence from school. This law applies to medically necessary leaves of absence that begin on or after January 1, 2010 If your child is no longer a student, as defined in your Certificate of Coverage, because he or she is on a medically necessary leave of absence, your child may continue to be covered under the plan for up to one year from the beginning of the leave of absence. This continued coverage applies if your child was (1) covered under the plan and (2) enrolled as at student at a post-secondary educational institution (includes colleges, universities, some trade schools and certain other post-secondary institutions). Your employer will require a written certification from the child’s physician that states that the child is suffering from a serious illness or injury and that the leave of absence is medically necessary. MICHELLE’S LAW

REQUIRED ANNUAL EMPLOYEE DISCLOSURE NOTICES

Required Annual Employee Disclosure Notices continued continued

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

PATIENT PROTECTION:

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

I. No access to protected health information (PHI) except for summary health information for limited purpose and enrollment / dis-enrollment information. Neither the group health plan nor the plan sponsor (or any member of the plan sponsor’s workforce) shall create or receive protected health information (PHI) as defined in 45 C.F.R. §160.103 except for (1) summary health information for purpose of (a) obtaining premium bids or (b) modifying, amending, or terminating the group health plan, and (2) enrollment and dis-enrollment information. The group health plan is a fully-insured group health plan sponsored by the “Plan Sponsor”. The group health plan and the plan sponsor intend to comply with the requirements of 45 C.F.R. §164.530 (k) so that the group health plan is not subject to most of HIPAA’s privacy requirements.

II. Insurer for group health plan will provide privacy notice

The insurer for the group health plan will provide the group health plan’s notice of privacy practices and will satisfy the other requirements under HIPAA related to the group health plan’s PHI. The notice of privacy practices will notify participants of the potential disclosure of summary health information and enrollment / dis-enrollment information to the group health plan and the plan sponsor.

III. No intimidating or retaliatory acts

The group health plan shall not intimidate, threaten, coerce, discriminate against, or take other retaliatory action against individuals for exercising their rights , filing a complaint, participating in an investigation, or opposing any improper practice under HIPAAA.

IV. No Waiver

The group health plan shall not require an individual to waive his or her privacy rights under HIPAA as a condition of treatment, payment, enrollment or eligibility. If such an action should occur by one of the plan sponsor’s employees, the action shall not be attributed to the group health plan.

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

continued

When will you pay a higher premium (penalty) to join a Medicare drug Plan? You should also know that if you drop or lose your current coverage with Florida Blue and don’t join a Medicare drug plan within 63 continuous days after your current coverage ends, you may pay a higher premium (a penalty) to join a Medicare drug plan later. If you go 63 continuous days or longer without creditable prescription drug coverage, your monthly premium may go up at least 1% of the Medicare base beneficiary premium per month for every month that you did not have that coverage. For example, if you go nineteen months without creditable coverage, your premium may consistently be at least 19% higher than the Medicare base beneficiary premium. You may have to pay this higher premium (a penalty) as long as you have Medicare prescription drug coverage. In addition, you may have to wait until the following October to join. For more information about this notice or your current prescription drug coverage… Contact our office for further information (see contact information below). NOTE: You’ll get this notice each year. You will also get it before the next period you can join a Medicare drug plan, and if this coverage through Florida Blue changes. You also may request a copy of this notice at any time. For more information about your options under Medicare prescription drug coverage… More detailed information about Medicare plans that offer prescription drug coverage is in the “Medicare & You” handbook. You’ll get a copy of the handbook in the mail every year from Medicare. You may also be contacted directly by Medicare drug plans. For more information about Medicare prescription drug coverage: • Call your State Health Insurance Assistance Program (see your copy of the Medicare & You handbook for their telephone number) for personalized help, • Call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048. If you have limited income and resources, extra help paying for Medicare prescription drug coverage is available. For information about this extra help, visit Social Security on the web at www.socialsecurity.gov, or call them at 1-800-772-1213 (TTY 1-800-325-0778). Remember: Keep this notice. If you enroll in one of the new plans approved by Medicare which offer prescription drug coverage, you may be required to provide a copy of this notice when you join to show that you are not required to pay a higher premium amount. • Visit www.medicare.gov

MEDICARE PART D

This notice applies to employees and covered dependents who are eligible for Medicare Part D. Please read this notice carefully and keep it where you can find it. This notice has information about your current prescription drug coverage with Florida Blue and about your options under Medicare’s prescription drug Plan. If you are considering joining, you should compare your current coverage including which drugs are covered at what cost, with the coverage and costs of the plans offering Medicare prescription drug coverage in your area. Information about where you can get help to make decisions about your prescription drug coverage is at the end of this notice. 1. Medicare prescription drug coverage became available in 2006 to everyone with Medicare through Medicare prescription drug plans and Medicare Advantage Plan (like an HMO or PPO) that offer prescription drug coverage. All Medicare prescription drug plans provide at least a standard level of coverage set by Medicare. Some plans may also offer more coverage for a higher monthly premium. 2. Florida Blue has determined that the prescription drug coverage offered by the Welfare Plan for Employees of Pilot Bank under the Florida Blue option are, on average for all plan participants, expected to pay out as much as the standard Medicare prescription drug coverage pays and is therefore considered Creditable Coverage. Because your existing coverage is Creditable Coverage, you can keep this coverage and not pay a higher premium (a penalty) if you later decide to join a Medicare drug plan. You should also know that if you drop or lose your coverage with Florida Blue and don’t enroll in Medicare prescription drug coverage after your current coverage ends, you may pay more (a penalty) to enroll in Medicare prescription drug coverage later. _______________________________________________________ You can join a Medicare drug plan when you first become eligible for Medicare and each year from October 15 th to December 7 th . However, if you lose your current creditable prescription drug coverage, through no fault of your own, you will also be eligible for a two (2) month Special Enrollment Period (SEP) to join a Medicare drug plan. What happens to your current coverage if you decide to join a Medicare Drug Plan? If you decide to join a Medicare drug plan, your current Florida Blue coverage will not be affected. You can keep this coverage if you elect part D and this plan will coordinate with Part D coverage. If you decide to join a Medicare drug plan and drop your current Florida Blue coverage, be aware that you and your dependents will be able to get this coverage back. When can you join a Medicare Drug Plan?

Date: 01/01/2019 Name of Entity/Sender: Pilot Bank Contact--Position/Office: Ellen Rozalski

12471 West Linebaugh Avenue Tampa, Florida 33626

Phone Number:

813-342-4792

HEALTHCARE REFORM AND YOU

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

If you obtain coverage through an Exchange:

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

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

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

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

GENERAL NOTICE OF COBRA RIGHTS Continued

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

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

New Health Insurance Marketplace Coverage Options and Your Health Coverage

Form Approved OMB No. 1210-0149 (expires 5-31-2020)

PART A: General Information When key parts of the health care law take effect in 2014, there will be a new way to buy health insurance : the Health Insurance Marketplace. To assist you as you evaluate options for you and your family, this notice provides some basic information about the new Marketplace and employment-based health coverage offered by your employer. What is the Health Insurance Marketplace? The Marketplace is designed to help you find health insurance that meets your needs and fits your budget. The Marketplace offers "one-stop shopping" to find and compare private health insurance options. You may also be eligible for a new kind of tax credit that lowers your monthly premium right away. Open enrollment for health insurance coverage through the Marketplace begins in October 2013 for coverage starting as early as January 1, 2014.

Can I Save Money on my Health Insurance Premiums in the Marketplace? You may qualify to save money and lower your monthly premium, but only if your employer does not offer coverage, or offers coverage that doesn't meet certain standards. The savings on your premium that you're eligible for depends on your household income.

Does Employer Health Coverage Affect Eligibility for Premium Savings through the Marketplace? Yes. If you have an offer of health coverage from your employer that meets certain standards, you will not be eligible for a tax credit through the Marketplace and may wish to enroll in your employer's health plan. However, you may be eligible for a tax credit that lowers your monthly premium, or a reduction in certain cost-sharing if your employer does not offer coverage to you at all or does not offer coverage that meets certain standards. If the cost of a plan from your employer that would cover you (and not any other members of your family) is more than 9.5% of your household income for the year, or if the coverage your employer provides does not meet the "minimum value" standard set by the Affordable Care Act, you may be eligible for a tax credit. 1 Note: If you purchase a health plan through the Marketplace instead of accepting health coverage offered by your employer, then you may lose the employer contribution (if any) to the employer-offered coverage. Also, this employer contribution -as well as your employee contribution to employer-offered coverage- is often excluded from income for Federal and State income tax purposes. Your payments for coverage through the Marketplace are made on an after-tax basis.

How Can I Get More Information? For more information about your coverage offered by your employer, please check your summary plan description or contact:

Ellen Rozalski813-342-4792

The Marketplace can help you evaluate your coverage options, including your eligibility for coverage through the Marketplace and its cost. Please visit HealthCare.gov for more information, including an online application for health insurance coverage and contact information for a Health Insurance Marketplace in your area.

PART B: Information About Health Coverage Offered by Your Employer This section contains information about any health coverage offered by your employer. If you decide to complete an application for coverage in the Marketplace, you will be asked to provide this information. This information is numbered to correspond to the Marketplace application.

3. Employer Name

4. Employer Identification Number (EIN)

Pilot Bank

59-2689717

5. Employer Address

6. Employer Phone Number

12471 West Linebaugh Avenue

813-342-4792

7. City

8. State

9. Zip Code

Tampa

33626

10. Who can we contact about employee health coverage at this job?

Ellen Rozalski

11. Phone Number (if different from above)

12. E-mail address

erozalski@pilotbank.com

1 An employer-sponsored health plan meets the "minimum value standard" if the plan's share of the total allowed benefit costs covered by the plan is no less than 60 percent of such costs

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