Philips & Jordan 2020 Benefit Guide 2019-10.29.PRINT

2020 BENEFITS OVERVIEW

ELIGIBILITY All full-time, non-union employees working at least 30 hours per week are eligible to participate in benefit plans on the first day of the month following 60 days of continuous active employment. ENROLLMENT CHANGES Changes to your benefits may be made during open enrollment each year which typically occurs in the fourth quarter. Changes may bemade outside of open enrollment for qualifying events including, but not limited to: marriage/divorce, birth/adoption, or change in job status. Other qualifying events may apply. When you have a qualifying event, you must immediately notify Human Resources and submit the appropriate form(s) within 30 days after the qualifying event. In the event that you experience a change in Medicaid/Children’s Health Insurance Program (CHIP) eligibility, appropriate form(s) must be submitted to Human Resources within 60 days after the eligibility change. QUESTIONS Once you have reviewed your benefit options, complete the appropriate form(s) and return them to Human Resources. If you have any questions about your Phillips & Jordan benefits, please contact Human Resources at pjbenefits@pandj.com or (865) 392-3093 or (865) 392-3022. Medical Benefits - HDHP with HSA �� 2 Medical Benefits - PPO Plan �� 3 Medical Benefits Comparison�� 3 Dental Benefits�� 4 Vision Benefits�� 4 Telemedicine �� 5 Wellness Program�� 6 Flexible Spending Accounts �� 7 Disability Benefits �� 8 Paid Maternity Leave �� 8 Basic and Supplemental Life Insurance�� 9 Voluntary Aflac Products��10 Employee Assistance Program��11 401(k) Retirement Plan ��12 Annual Notices�� 13-16 Table of Contents

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Phillips & Jordan offers access to medical benefits through Cigna Health and Life Insurance Company. You may choose between two different medical plans: High Deductible Health Plan (HDHP) and Preferred Provider Organization (PPO) Plan. The HDHP offers lower premiums and generally covers 100% of medical expenses after the annual deductible has been met. Due to the higher out-of-pocket costs associated with the HDHP, Phillips & Jordan offers employees a Health Savings Account (HSA), which we will explain in more detail below. To receive the maximum benefit from your chosen plan, make sure your medical provider is a member of the network. • In-network providers will file your claims for you. • By using an out-of-network physician or facility, you will be subject to a higher deductible and responsible for a larger percentage of the charges. You may also have to pay for charges over the usual and customary rate. To find an in-network provider, download the MyCigna app or go to the online directory at www.cigna.com and click on the “Find a Doctor” button to begin your search. Please be sure to carefully review the online directory or call Cigna to confirm that your provider participates in the network. HDHPWeekly Premiums Non-Wellness Wellness Employee Only $62.81 $49.37 EMP + Spouse $119.59 $106.16 EMP + Child(ren) $104.78 $91.34 EMP + Family $161.56 $148.12 Medical Benefits - HDHP with HSA Ci gna - Open Access P l us Ne twor k 1-800-244-6224 www.myc i gna. com Group Number : 3332287

Heal th Savings Account HSA Bank 1-855-731-5225

If you are enrolled in the HDHP, you are eligible to participate in a Health Savings Account (HSA) through HSA Bank. A HSA is established to pay for future qualified medical, dental and vision expenses that are incurred by you or your dependents enrolled in the plan. Phillips & Jordan contributes to the HSA quarterly on your behalf, so it is to your advantage to make the most of your HSA. Youmaymake tax-free payroll contributions to the account topay for subsequent future qualifiedmedical expenses.Your

contributions to the HSA will be payroll deducted and the funds deposited into your HSA. You may change the amount you contribute to your HSA at any time during the plan year. When a qualified expense is incurred, you simply use your HSA debit card or request reimbursement for the expense from the custodial account. Unused account dollars are yours to keep, even if you retire or leave the company. Also, if you are 55 years of age or older you may contribute an additional $1,000 catch up contribution to your HSA.

Annual Maximum Contributions to your HSA

Total Amount You May Contribute

IRS Annual Maximum Contribution

Phillips & Jordan's Contribution $225 Quarterly, $900 Annually $400 Quarterly. $600 Annually $400 Quarterly. $600 Annually $500 Quarterly, $2,000 Annually

Employee Only

$2,650

$3,550

Emp + Spouse

$6,500

$7,100

Emp + Child(ren)

$6,500

$7,100

Emp + Family

$5,100

$7,100

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Medical Benef i ts - PPO Plan Ci gna - Open Access P l us Ne twor k 1-800-244-6224 www.myc i gna. com Group Number : 3332287 PPO PlanWeekly Premiums Employee Only

Non-Wellness Wellness

$72.20

$58.95

EMP + Spouse

$139.98 $126.73

Phillips & Jordan offers access to medical benefits through Cigna Health and Life Insurance Company. You may choose between two different medical plans: HDHP and PPO Plan. The PPO Plan offers higher premiums, but a lower deductible and out-of-pocket maximum. After reaching your annual deductible, medical expenses will be covered at 80%. By choosing the PPO Plan, you are eligible to set aside money in a Flexible Spending Account (FSA). To receive the maximum benefit from your chosen plan, make sure your medical provider is a member of the network. • In-network providers will file your claims. • By using an out-of-network physician or facility, you will be subject to a higher deductible and responsible for a larger percentage of the charges. You may also have to pay for charges over the usual and customary rate. To find an in-network provider, download the MyCigna app or go to the online directory at www.cigna.com and click on the “Find a Doctor” button to begin your search. Please be sure to carefully review the online directory or call Cigna to confirm that your provider participates in the network. The PPO Plan is not eligible for HSA contributions due to IRS regulations. EMP + Child(ren) $122.27 $109.05 EMP + Family $190.09 $176.84

Medical Benef i ts Compar ison

MEDICAL BENEFITS 1 (All benefits shown In-Network)

HDHP with HSA

PPO Plan

Deductible: Individual / Family

$3,000 / $6,000 (Shared) 2 $2,000 / $4,000 (Embedded) 3

Out-of-Pocket Maximum: Individual / Family SERVICES RECEIVED AT A PRACTITIONER’S OFFICE Preventive Care

$3,000 / $6,000

100%

Office Visit For sick visits, please consider Teladoc first SERVICES RECEIVED AT A FACILITY Emergency Room

100% after deductible

80% after deductible

100% after deductible 100% after deductible

80% after deductible 80% after deductible

MOST OTHER SERVICES

PHARMACY Retail Preventive Generics Generics / Preferred Brand / Non-Preferred Brands Mail Order 4 Preventive Generics Generics / Preferred Brand / Non-Preferred Brands

Plan pays 100% 100% after deductible

$10 / $35 / $60

Plan pays 100% 100% after deductible 100% after deductible

3x Retail copay

Specialty Drugs n/a / $35 / $60 1. See your Evidence of Coverage for Out-of-Network Benefits, prior authorization, visit limits and more. 2. Shared Family Deductible - entire family deductible must be met before the plan will pay. 3. Embedded Deductible - each individual is only responsible for the individual deductible amount before the plan will pay (maximum two deductibles).

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Your Phillips & Jordan dental benefits are administered by Cigna Health and Life Insurance Company. The plan works like a PPO plan in that you can visit any dentist that you choose. However, if your provider is not in-network, he/ she may charge more than the usual and customary rate, and you may be responsible for the additional charges. To find an in-network provider, go to the online directory at www.cigna.com. Please be sure to carefully review the online directory or call Cigna to confirm that your provider participates in the network. Dental Benef i ts Ci gna 1-800-244-6224 www.myc i gna. com Group Number : 3332287

Dental Weekly Premiums Employee Only EMP + Spouse EMP + Child(ren)

Base Plan Buy-Up Plan

$2.43 $5.35 $4.87 $6.81

$3.71 $8.16 $7.43

EMP + Family

$10.39

DENTAL PLAN BENEFITS

Base Plan $50 / $150

Buy-Up Plan

Individual / Family Deductible Calendar Year Maximum (per enrolled person) Preventive Services (Deductible does not apply)

$25 / $75

$1,500

$2,500

100%

80% after deductible 60% after deductible

80% after deductible 70% after deductible

Basic Services

Major Restorative Services

Orthodontic Services (Deductible does not apply) Orthodontic Lifetime Maximum (Covers children up to age 19, lifetime max per child)

50%

$1,500

$2,500

Vision Benef i ts Ci gna 1-800-244-6224 www.myc i gna. com Group Number : 3332287

VisionWeekly Premiums

Employee Only EMP + Spouse EMP + Child(ren)

$1.59 $3.20 $3.18 $5.05

EMP + Family

Your Phillips & Jordan vision benefits are administered by Cigna Health and Life Insurance Company. When using in- network providers, this PPO plan covers most exams, eyeglasses, and medically necessary contacts in full. Discounts are available for upgrades on covered frames and lenses. Should you choose to see an out-of-network provider, Cigna will reimburse you up to a specified amount. The out-of-network reimbursement schedule is summarized in the Vision Plan Benefits table below.

To find an in-network provider or surgery center, review out- of-network benefits, and other plan details, go to the online directory at cigna.vsp.com and click on the “Find a Cigna Vision Network Eye Care Professional” button to begin your search. Please be sure to carefully review the online directory or call Cigna to confirm that your provider participates in the network.

VISION BENEFITS

In-Network $10 Copay

Out-of-Network $45 Allowance

Vision Exam

Lenses (once per year) Single / Bifocal / Trifocal / Lenticular Frames (once every 2 years) Contacts in lieu of eyeglasses (once per year) Medically Necessary Elective

$10 Copay / covered in full

Up to $80 Allowance depending on type

$140 Allowance

$77 Allowance

$10 Copay

Covered in full Up to $150

$210 Allowance $120 Allowance

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Telemedicine Te l adoc

1-800-835-2362 www. te l adoc . com

No cost for you or your household to call! Phillips & Jordan is proud to offer Teladoc to all employees and dependents enrolled in themedical plan. Teladoc is a national network of board certified physicians providing telephonic consultations 24/7. Teladoc doctors are U.S. board certified in Internal Medicine, Family Practice, or Pediatrics. They average 15 years practice experience, are licensed in your state, and incorporate Teladoc into their day-to-day practice as a way to provide people with convenient access to quality medical care.

Teladoc does not replace your primary care physician. Teladoc should be used when you need immediate care for non-emergency medical issues. It is an affordable, convenient alternative to Urgent Care and ER visits. You can talk with aTeladoc doctor via a phone consult, video consult within the secure member portal, or video consult within the Teladoc mobile app. To request a consult, visit the Teladoc website, log into your account and click “Request a Consult”. You can also call Teladoc to request a consult by phone, or request a consult through the Teladoc mobile app. Teladoc doctors can prescribe short term medication for a wide range of conditions when medically appropriate. Teladoc doctors do not prescribe substances controlled by the DEA, nontherapeutic and/or certain other drugs which may be harmful because of their potential abuse. When you go to your pharmacy of choice to pick up the prescription, you may use your health/prescription insurance card to help pay for the medication. You will be responsible for the co-pay based on the type of medication and your plan benefits. Setting up your account is a quick and easy process . Visit www.teladoc.com and click "Set up account." (You may also use the mobile app or call 1-800-Teladoc to set up your account.) You'll provide your medical history, add dependents, provide dependent medical history, and more. Once you're account is set up, Teladoc is quick and easy to use!

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Ci gna Mo t i va t eMe 1-800-244-6224 ww.myc i gna. com

The Phillips & JordanWellness for Life Program, administered by the Cigna MotivateMe Program, offers employees best- in-class wellness services and a discount on weekly medical benefit premiums. Through theWellness for Life Program, all your health andwellness benefits will be integrated into one place and provide you with easy access to your plans, programs, and wellness resources. Most wellness activities will automatically be tracked for you. When you elect to participate in the program, the weekly medical benefit premium discount is automatically applied to your paycheck. To stay in the Wellness for Life Program you must earn at least 100 points by participating in wellness activities in the 2020 program year. Here’s how you earn points:

Wellness Activity

Points

Annual Physical Well Woman Exam

100 100 100 100 100 100

Colon Cancer Screening Prostate Cancer Screening Cervical Cancer Screening

Mammogram

Complete the Cigna on-line Health assessment

50 25

Receive a flu shot

Complete an online coaching program • Nutrition • Exercise • Positive Mood • Weight • Stress • Tobacco one and six month programs Self-reported goals: • I made smart and delicious food choices • I took part in physical activity • I’m managing my weight Participate in Apps & Activities

25 (maximum of 50)

DID YOU KNOW? The preferred way to get the 100 points is to complete an annual physical .

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Flexible Spending Account Bene f i t sAss i s t 1-865-769-2800 www.mywea l thcareon l i ne. com/benef i t sass i s t

Phillips & Jordan offers employees the option to defer money on a pre-tax basis for use on approved medical and dependant care expenses. This is NOT insurance. This is simply a way for you to save on your healthcare or daycare expenses by setting money aside from your gross income, pre-tax for expenses that you anticipate for the plan year. Healthcare FSA: With the healthcare FSA, the total dollar amount set aside for the plan year is eligible for withdrawal from the account on day one of your first payroll deduction towards the account. The maximum healthcare FSA annual contribution amount is $2,700. If you are a new hire and enroll in the plan midyear, your contributions will be prorated for the annual amount you select. Dependent Care Account (DCA): You may elect to set money aside to use for your approved childcare services, provided at a daycare facility, in your home, or in someone else’s residence through a DCA. Certain requirements must be satisfied for the services to be approved for reimbursement. The maximum DCA annual contribution amount is $5,000 per family (if you are head of household or married and file a joint tax return) or $2,500 (if you are married and file a separate tax return). Limited FSA: If you enroll in the HDHP with HSA, you are only eligible for the Limited FSA. This account may be used on qualified dental and vision expense only, not medical expenses (you will use your HSA for medical expenses). The maximum annual contribution is $2,700. By setting aside money pre-tax into either a FSA or DCA, you save on taxes and take home more spendable income! Please contact BenefitsAssist or Human Resources for a list of eligible medical and dependent care expenses.

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Disabi l i ty Benef i ts Gua rd i an

1-800-268-2525 Shor t -Term Di sab i l i t y 1-800-538-4583 Long-Term Di sab i l i t y www.guard i anany t ime. com Disability insurance can help support you and your family should you become disabled for a short period of time or for an extended period of time. Short-Term Disability (STD) STD provides you financial support in the event that you become temporarily disabled. STD coverage provides 60% of your weekly earnings up to a maximum of $1,000 per week. Benefit payments begin after an eight day waiting period if the disability is illness-related, or the first day if the disability is injury-related, and ends after 26 weeks of continuous disability. Long-Term Disability (LTD) LTD insurance protects your income in the event of a long-term illness or injury. LTD coverage provides 60% of your monthly earnings up to a maximum of $5,000 per month for hourly employees and a maximum of $10,000 per month for salaried employees. Benefit payments begin after you have been deemed to be disabled for 180 days, and ends when you are no longer disabled or reach Social Security Normal Retirement Age. Premium information may be found on your enrollment form. Phillips & Jordan is proud to offer up to 8 weeks of paid maternity leave to its employees following the birth of a child. This benefit is eligible to employees that meet the following criteria: • Be a full-time, regular employee • Have been employed with the company for at least 12 months or • Have worked at least 1,250 hours during the 12 consecutive months immediately preceding the date the leave would begin. Paid Materni ty Leave Human Resour ces 865-392-3093

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Basic Li fe Insurance Gua rd i an 1-888-600-1600 www.guard i anany t ime. com

Phillips & Jordan provides you with Basic Life and Accidental Death & Dismemberment (AD&D) insurance at no cost through Guardian. All full-time hourly and salaried employees receive: • $50,000 of coverage for yourself, • $10,000 of coverage for your spouse, and • $2,000 of coverage for child(ren) ages 6 months to 26 years, or $1,000 of coverage for child(ren) live birth to 6 months. You will need a beneficiary for this policy. Contact Human Resources to update your beneficiaries anytime during the year. Salaried Employees Buy-Up Option Salaried employees may increase their Basic Life and AD&D coverage up to three times their annual salary (up to $300,000). Additional coverage premiums are based on your annual salary and only costs between $2.00 and $5.15 per week! Phillips & Jordan pays 65% of the cost, and you only pay 35% of the additional coverage amount.

Supplemental Li fe Insurance Gua rd i an 1-888-600-1600 www.guard i anany t ime. com

Employee and Spouse Rates - Monthly Cost per $1,000 of Coverage Age Rate <30 $0.08 30-34 $0.09 35-39 $0.13 40-44 $0.21 45-49 $0.35 50-54 $0.62 55-59 $1.02 60-64 $1.36 65-69 $2.12 70+ See Plan Details Dependent Children $0.08 per $1,000

In addition to the Basic Life insurance provided by Phillips & Jordan, you have the option to purchase Supplemental Life/AD&D insurance through Guardian. You may purchase: • Employee coverage in increments of $20,000 up to a maximum of $500,000. Newly hired employees may purchase the first $200,000 without Evidence of Insurability. • Spousal coverage may be purchased in increments of $1,000 up to $100,000, but must not exceed 50% of the employee purchase amount. Newly hired employees may purchase the first $50,000 without Evidence of Insurability. • Child(ren) coverage • $500 of coverage on child(ren) age birth to 6 months.

Example of Voluntary Term Life Premium Calculations Age Monthly Rate Per $1,000 Benefit in $1,000’s Monthly Premium

Yours

$0.13 $0.09 $0.08

X 100 = $13.00 X 50 = $4.50 X 10 = $0.80

• $10,000 of coverage on child(ren) age 6 months to 26 years (if a full-time student). • The full amount is available without Evidence of Insurability.

Spouse 32

Child(ren)

Total

$18.30

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Voluntary Af lac Products Af l ac 1-865-318-3141 ke l l y_went z@us .af l ac . com Phillips & Jordan offers 3 different Aflac policies through payroll deductions at a Group Payroll Rate! Aflac pays cash directly to you when you need it most. Your health insurance pays doctors and hospitals, Aflac pays you! Aflac is the financial safety net for you and your family! Aflac Accident Insurance Insurance Accident Treatment: $125 Employee & Spouse, $75 child. Hospital Admission benefit of $1,000. Hospital Confinement benefit of $200 per day. Accident specific lump sumbenefits $25 to $10,000. Follow-up treatment benefit & physical therapy benefits $25 each. Coverage for crutches and wheelchairs: $100. Dismemberment $100 - $25,000. Ambulance Ground: $100 / Air Ambulance $500. Accidental Death Life Insurance: $5,000 - $50,000. Annual Wellness Benefit after 12 months of paid premiums of $60 per covered person. Plus a lot more benefits! Aflac Hospital Indemnity Aflac's Hospital Indemnity policy covers costs associated with a hospital stay, such as: • Hospital Emergency Room / Physician Benefit (Medical Fees): $25 - $50 • Well Baby Care: $25 per visit, (four visits per covered person per year) • Out-of-Hospital PrescriptionDrugBenefit: $10witha 5prescriptionmaximum per year • Hospital Admission: $300 • Hospital Confinement: $200 per day • Hospital Intensive Care: $200 per day up to 30 days Covered Critical Illnesses include: Cancer, Heart Attack, Stroke, Major Organ Transplant, Renal Failure (end Stage), Carcinoma in Situ, Coronary Artery Bypass Surgery. The First-Occurrence benefit amounts for the employee ranges from $5,000 - $50,000. Spouse coverage is also available in benefit amounts of $5,000 - $25,000. Eachdependent child is covered at 50%of theprimary insured (Employee) amount at NO ADDITIONAL CHARGE! This policy also has a $50 wellness benefit per covered person, per year after the 30 day waiting period. Rates are based on age. Aflac has approved for all Phillips & Jordan employees a guarantee issue amount of $20,000 for employee and $10,000 for spouses. • Surgical Benefit up to: $2,000 • Anesthesia Benefit up to: $500. Aflac Critical Illness with Cancer

Accident Weekly Premiums Employee Only $4.05 EMP + Spouse $5.79 EMP + Child(ren) $7.72 EMP + Family $9.47

Hospital Indemnity Weekly Premiums

Employee Only EMP + Spouse EMP + Child(ren)

$10.47 $20.81 $15.89 $26.23

EMP + Family

Critical Illness with Cancer Weekly Premiums Employee Only Contact Kelly Wentz with Aflac for your personalized rate. EMP + Spouse EMP + Child(ren) EMP + Family

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Employee Assistance Program Gua rd i an - Wor kL i f eMa t t e r s 1-800-386-7055 www. i bhwork l i fe. com Username: Mat ters | Password: wlm70101

WorkLifeMatters can offer support with: Education • Admissions testing and procedures • Adult re-entry programs • College planning

Phillips & Jordan partners with Guardian and Integrated Behavioral Health (IBH) to offer you and your family a free, confidential, short- term counseling and referral program called WorkLifeMatters providing you with confidential employee assistance. Balancing your work and home is not always easy. With WorkLifeMatters, you don’t have to face life’s challenges alone. WorkLifeMatters provides support and guidance for matters that range from personal issues you might be facing, to providing information on everyday topics that affect your life. You have unlimited access to consult with a professional counselor via telephone. Face-to-face counseling sessions are available, if needed, with an IBH network provider —and up to three sessions are free of charge as part of WorkLifeMatters. For legal and financial topics, you are eligible to receive a free initial 30 minute office or telephone consultation with an attorney or seasoned financial professional and certified public accountant (CPA). Local referrals are available for more complex legal or financial issues for a fee. A variety of training resources — webinars, video and PowerPoint presentations—are also available to help youmanage your quality of life. Connect to a counselor for free support services 24 hours a day, 7 days a week.

• Financial aid resources Legal & Financial Matters • Basic tax planning

• Credit & debt • Immigration • Personal legal and will making • Retirement planning Lifestyle & Fitness Management

• Anxiety and depression • Divorce and separation

• Relationship issues • Drugs and alcohol • Health and well-being • Grief & loss • Pet care Dependent Care & Care Giving • Adoption assistance • Before / after school programs • Day care, elder care, and in-home services • Parenting support • Senior housing options • Special needs care Working Smarter • Balancing work and home life • Career and training development • Effective managing • Relocation • Workspace diversity

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401(k) Ret i rement Plan F i de l i t y I nves tmen t s 1-800-294-4015 www.netbenef i t s . com The Phillips & Jordan 401(k) Retirement Plan is administered by Fidelity Investments and enables you to save money for retirement to cover living expenses such as mortgage, utilities, auto, etc. Automatic Enrollment All eligible newhires are automatically enrolled in the 401(k) Plan at 6%of your annual base salary on the first of the month following 60 days of employment. If you do not select an investment mix of your own, Phillips & Jordan has directed Fidelity to place your contributions into a(n) Fidelity Investments target date fund that most closely aligns with your projected retirement date based upon your birth year. The 2020 maximum annual combined contribution for the Traditional and Roth 401(k) plans is $19,500. Participants age 50 and older may contribute an additional “catch-up” contribution of $6,500 per year. Phillips & Jordan established an Annual Increase Program (AIP) that auto increases your contribution by 1% annually until you reach the AIP cap of 10% or plan limit.

Phillips & Jordan's Contribution Phillips & Jordan matches $0.50 of every dollar you contribute up to 6%. You will get a full 3% match by contributing 6%. You are always 100% vested in your own contributions. The company’s contribution is on a 5 year vesting schedule.

Being vested means that you have the right to receive the money in your account when you retire or leave the company.

Years of Service for Vesting Percentage Less than 1 0 1 20 2 40 3 60 4 80 5 100

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IMPORTANT NOTICES FROM OUR COMPANY REGARDING THE PLAN The following notices provide important information about the group health plan provided by your employer. Please read the attached notices carefully and keep a copy for your records. If you have any questions regarding any of these notices, please contact: Phillips & Jordan Human Resources 10201 Parkside Drive, Suite 300, Knoxville, TN 37922 November 2019 UNIFORMED SERVICES EMPLOYMENT AND REEMPLOYMENT RIGHTS ACT OF 1994 A Subscriber may continue his or her coverage and coverage for his or her Dependents during military leave of absence in accordance with the Uniformed Services Employment and Reemployment Rights Act of 1994. When the Subscriber returns to work from a military leave of absence, the Subscriber will be given credit for the time the Subscriber was covered under the Plan prior to the leave. WOMEN’S HEALTH AND CANCER RIGHTS ACT NOTICE If you have had or are going to have a mastectomy, you may be entitled to certain benefits under the Women’s Health and Cancer Rights Act of 1998 (WHCRA). If you have had or are going to have a mastectomy, you may be entitled to certain benefits. For individuals receiving mastectomy- related benefits, coverage will be provided in a manner determined in consultation with the attending physician and the patient, for: • All stages of reconstruction of the breast on which the mastectomy was performed; • Surgery and reconstruction of the other breast to produce a symmetrical appearance; • Prostheses; and • Treatment of physical complications of the mastectomy, including lymphedema. These benefits will be provided Annual Not ices

subject to the same deductibles and coinsurance applicable to other medical and surgical benefits provided under this plan. If you would like more information on WHCRA benefits, contact your Health Insurance issuer. MASTECTOMY NOTICE Patients who undergo a mastectomy and who elect breast reconstruction in connection with the mastectomy are entitled to coverage for: • Reconstructionof thebreast onwhich the mastectomy was performed; • Surgery and reconstruction of the other breast to produce a symmetrical appearance; and • Prostheses and treatment of physical complications at all stages of the mastectomy, including lymphedemas Inamannerdeterminedinconsultation with the attending physician and the patient. The coverage may be subject to coinsurance and deductibles consistent with those established for other benefits. Please contact Human Resources for more information. Newborns’ and Mothers’ Health Protection Act requires that group health plans and health insurance issuers who offer childbirth coverage generally may not, under federal law, restrict benefits for any hospital length of stay in connection with childbirth for the mother or newborn child to less than 48 hours following a vaginal delivery, or less than 96 hours following a cesarean section. However, federal law generally does not prohibit themother’s or newborn’s attending provider, after consulting with the mother, from discharging the mother or her newborn earlier than 48 hours (or 96 hours as applicable). In any case, plans and issuers may not, under federal law, require that a provider obtain authorization from the plan or the issuer for prescribing a length of stay not in excess of 48 hours (or 96 hours). Refer to your plan document for specific information about childbirth coverage or contact your plan administrator. NEWBORNS’ AND MOTHERS’ HEALTH PROTECTION ACT

For additional information about NMHPA provisions and how Self- funded non Federal governmental plans may opt-out of the NMHPA requirements, visit http://www.cms. gov/CCIIO/Programs-and-Initiatives/ Other-Insurance-Protections/nmhpa_ factsheet.html. HIPAA NOTICE OF PRIVACY PRACTICES The Health Insurance Portability and Accountability Act of 1996 (“HIPAA”) requires that we maintain the privacy of protected health information, give notice of our legal duties and privacy practices regardinghealth information about you and follow the terms of our notice currently in effect. If not attached to this document, you may request a copy of the current Privacy Practices, explaining how medical information about you may be used and disclosed and how you can get access to this information. As Required by Law. We will disclose Health Information when required to do so by international, federal, state or local law. You have the right to inspect and copy, right to an electronic copy of electronic medical records, right to get notice of a breach, right to amend, right to an accounting of disclosures, right to request restrictions, right to request confidential communications, right to a paper copy of this notice and the right to file a complaint if you believe your privacy rights have been violated. NOTICE OF SPECIAL ENROLLMENT RIGHTS TO NEW ENROLLEES If you are declining enrollment for yourself or your dependents (including your spouse) because of other health insurance or group health plan coverage, you may be able to enroll yourself and your dependents in this plan if you or your dependents lose eligibility for that other coverage (or if the employer stops contributing toward your or your dependents’ other coverage). However, you must request enrollment within 30 days after your or your dependents’ other coverage ends (or after the employer stops contributing toward the other coverage). In addition,

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if you have a new dependent as a result of marriage, birth, adoption, or placement for adoption, you may be able to enroll yourself and your dependents. However, you must request enrollment within 30 days after the marriage, birth, adoption, or placement for adoption. If you are decline enrollment for yourself or your dependents (including your spouse) while coverage under Medicaid or a state Children’s Health Insurance Program (CHIP) is in effect, you may be able to enroll yourself and your dependents in this plan if you or your dependents lose eligibility for that other coverage. However, you must request enrollment within 60 days after your or your dependents’ Medicaid or CHIP coverage ends. If you or your dependents (including your spouse) become eligible for a state premium assistance subsidy fromMedicaid or a CHIP programwith respect to coverage under this plan, you may be able to enroll yourself and your dependents (including your spouse) in this plan. However, you must request enrollment within 60 days after you or your dependents become eligible for the premium assistance. To request special enrollment or obtain more information, contact the plan’s General Contact. PLEASE REVIEW IT CAREFULLY. Our Company’s Pledge to You This notice is intended to inform you of the privacy practices followed by the Our Company Health and Welfare Plan (the Plan) and the Plan’s legal obligations regarding your protected health information under the Health Insurance Portability and Accountability Act of 1996 (HIPAA). The notice also explains the privacy rights you and your family members have as participants of the Plan. It is effective in April. [Note: the effective date may not be earlier than the date on which the privacy notice is printed or otherwise published]. The Plan often needs access to your protected health information in order to provide payment for health services and perform plan administrative functions. We want to assure the plan participants covered under the Plan that we comply with federal privacy laws and respect your right to privacy. Our Company requires all members of our workforce and third parties that are provided access to protected

health information to comply with the privacy practices outlined below. Protected Health Information Your protected health information is protected by the HIPAA Privacy Rule. Generally, protected health information is information that identifies an individual created or received by a health care provider, health plan or an employer on behalf of a group health plan that relates to physical or mental health conditions, provision of health care, or payment for health care, whether past, present or future. How We May Use Your Protected Health Information Under the HIPAA Privacy Rule, we may use or disclose your protected health information for certain purposes without your permission. This section describes the ways we can use and disclose your protected health information. Payment. We use or disclose your protected health information without your written authorization in order to determine eligibility for benefits, seek reimbursement from a third party, or coordinate benefits with another health plan under which you are covered. For example, a health care provider that provided treatment to you will provide us with your health information. We use that information in order to determine whether those services are eligible for payment under our group health plan. Health Care Operations. We use and disclose your protected health information in order to perform plan administration functions such as quality assurance activities, resolution of internal grievances, and evaluating plan performance. For example, we review claims experience in order to understand participant utilization and to make plan design changes that are intended to control health care costs. Treatment. Although the law allows use and disclosure of your protected health information for purposes of treatment, as a health plan we generally do not need to disclose your information for treatment purposes. Your physician or health care provider is required to provide you with an explanation of how they use and share your health information for purposes of treatment, payment, and health care operations. As permitted or required by law.

We may also use or disclose your protected health information without your written authorization for other reasons as permitted by law. We are permitted by law to share information, subject to certain requirements, in order to communicate information on health-related benefits or services that may be of interest to you, respond to a court order, or provide information to further public health activities (e.g., preventing the spread of disease) without your written authorization.We are also permitted to share protected health information during a corporate restructuring such as a merger, sale, or acquisition. We will also disclose health information about you when required by law, for example, in order to prevent serious harm to you or others. Pursuant to your Authorization. When required by law, we will ask for your written authorization before using or disclosing your protected health information. If you choose to sign an authorization to disclose information, you can later revoke that authorization to prevent any future uses or disclosures. To Business Associates. We may enter into contracts with entities known as Business Associates that provide services to or perform functions on behalf of the Plan. We may disclose protected health information to Business Associates once they have agreed in writing to safeguard the protected health information. For example, we may disclose your protected health information to a Business Associate to administer claims. Business Associates are also required by law to protect protected health information. To the Plan Sponsor. We may disclose protected health information to certain employees of Our Company for the purpose of administering the Plan. These employees will use or disclose the protected health information only as necessary to perform plan administration functions or as otherwise required by HIPAA, unless you have authorized additional disclosures. Your protected health information cannot be used for employment purposes without your specific authorization. Your Rights Right to Inspect and Copy. In most cases, you have the right to inspect and copy the protected health information we maintain about you. If

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you request copies, we will charge you a reasonable fee to cover the costs of copying, mailing, or other expenses associated with your request. Your request to inspect or review your health information must be submitted in writing to the person listed below. In some circumstances, we may deny your request to inspect and copy your health information. To the extent your information is held in an electronic health record, you may be able to receive the information in an electronic format. Right to Amend. If you believe that information within your records is incorrect or if important information is missing, you have the right to request that we correct the existing information or add the missing information. Your request to amend your health information must be submitted in writing to the person listed below. In some circumstances, we may deny your request to amend your health information. If we deny your request, you may file a statement of disagreement with us for inclusion in any future disclosures of the disputed information. Right to an Accounting of Disclosures. You have the right to receive an accounting of certain disclosures of your protected health information. The accounting will not include disclosures that were made (1) for purposes of treatment, payment or health care operations; (2) to you; (3) pursuant to your authorization; (4) to your friends or family in your presence or because of an emergency; (5) for national security purposes; or (6) incidental to otherwise permissible disclosures. Your request to for an accounting must be submitted in writing to the person listed below. You may request an accounting of disclosures made within the last six years. You may request one accounting free of charge within a 12-month period. Right to Request Restrictions. You have the right to request that we not use or disclose information for treatment, payment, or other administrative purposes except when specifically authorized by you, when required by law, or in emergency circumstances. You also have the right to request that we limit the protected health information that we disclose to

someone involved in your care or the payment for your care, such as a family member or friend. Your request for restrictions must be submitted in writing to the person listed below. We will consider your request, but in most cases are not legally obligated to agree to those restrictions. However, we will comply with any restriction request if the disclosure is to a health plan for purposes of payment or health care operations (not for treatment) and the protected health information pertains solely to a health care item or service that has been paid for out-of-pocket and in full. Right to Request Confidential Communications. You have the right to receive confidential communications containing your health information. Your request for restrictions must be submitted in writing to the person listed below. We are required to accommodate reasonable requests. For example, you may ask that we contact you at your place of employment or send communications regarding treatment to an alternate address. Right to be Notified of a Breach. You have the right to be notified in the event that we (or one of our Business Associates) discover a breach of your unsecured protected health information. Notice of any such breach will be made in accordance with federal requirements. Right to Receive a Paper Copy of this Notice. If you have agreed to accept this notice electronically, you also have a right to obtain a paper copy of this notice from us upon request. To obtain a paper copy of this notice, please contact the person listedbelow. Our Legal Responsibilities We are required by law to protect the privacy of your protected health information, provide you with certain rights with respect to your protected health information, provide you with this notice about our privacy practices, and follow the information practices that are described in this notice. We may change our policies at any time. In the event that we make a significant change in our policies, we will provide you with a revised copy of this notice. You can also request a copy of our notice at any time. For

more information about our privacy practices, contact the person listed below. If you have any questions or complaints, please contact: Human Resources. WELLNESS PROGRAM – NOTICE OF REASONABLE ALTERNATIVES Your health plan is committed to helping you achieve your best health. Rewards for participating in a wellness programare available toall employees. If you think you might be unable to meet a standard for a reward under this wellness program, you might qualify for an opportunity to earn the same reward by different means. Contact us at the above mentioned contact information and we will work with you (and, if you wish, with your doctor) to find a wellness program with the same reward that is right for you in light of your health status.’’ NOTICE REGARDING WELLNESS PROGRAM Our wellness program is a voluntary wellness program available to all employees. The program is administered according to federal rules permitting employer-sponsored wellness programs that seek to improve employee health or prevent disease, including the Americans with Disabilities Act of 1990, the Genetic Information Nondiscrimination Act of 2008, and the Health Insurance Portability and Accountability Act, as applicable, among others. If you choose to participate in the wellness programyouwill be asked to complete a voluntary health risk assessment or “MHA” that asks a series of questions about your health-related activities and behaviors and whether you have or had certainmedical conditions (e.g., cancer, diabetes, or heart disease). You will also be asked to complete a biometric screening, which will include a blood test for [cholesterol and blood sugar.] You are not required to complete the MHA or to participate in the blood test or other medical examinations. However, employees who choose to participate in the wellness program will receive an incentive of discounted medical rates for meeting the requirements. Although you are not required to complete the MHA or participate in the biometric screening, only employees who do so will receive

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the incentive. Additional incentives of up to may be available for employees who participate in certain health-related activities such as health coaching, online courses, preventive screenings and more or achieve certain health outcomes. If you are unable to participate in any of the health- related activities or achieve any of the health outcomes required to earn an incentive, you may be entitled to a reasonable accommodation or an alternative standard. You may request a reasonable accommodation or an alternative standard by contacting our company at the above listed contact information. The information from your MHA and the results from your biometric screening will be used to provide you with information to help you understand your current health and potential risks, and may also be used to offer you services through the wellness program, such as health awareness programs. You also are encouraged to share your results or concerns with your own doctor. Protections from Disclosure of Medical Information We are required by law to maintain the privacy and security of your personally identifiable health information. Although the wellness program and our company may use aggregate information it collects to design a program based on identified health risks in the workplace, our wellness program will never disclose any of your personal information either publicly or to the employer, except as necessary to respond to a request from you for a reasonable accommodation needed to participate in the wellness program, or as expressly permitted by law. Medical information that personally identifies you that is

provided in connection with the wellness programwill not be provided to your supervisors or managers and may never be used to make decisions regarding your employment. Your health information will not be sold, exchanged, transferred, or otherwise disclosed except to the extent permitted by law to carry out specific activities related to the wellness program, and you will not be asked or required to waive the confidentiality of your health information as a condition of participating in the wellness program or receiving an incentive. Anyone who receives your information for purposes of providing you services as part of the wellness program will abide by the same confidentiality requirements. The only individual(s) who will receive your personally identifiable health information is (are) Viverae’s health coach in order to provide you with services under the wellness program. In addition, all medical information obtained through the wellness program will be maintained separate from your personnel records, information stored electronically will be encrypted, and no information you provide as part of the wellness program will be used in making any employment decision. Appropriate precautions will be taken to avoid any data breach, and in the event a data breach occurs involving information you provide in connection with the wellness program, we will notify you immediately. You may not be discriminated against in employment because of the medical information you provide as part of participating in the wellness program, nor may you be subjected to retaliation if you choose not to participate. If you have questions or concerns

regarding this notice, or about protections against discrimination and retaliation, please contact our company at the above listed contact information. PATIENT PROTECTION DISCLOSURE Our Company generally allows the designation of a primary care provider. You have the right to designate any primary care provider who participates in our network and who is available to accept you or your family members. For information on how to select a primary care provider, and for a list of the participating primary care providers, contact our medical provider, listed on themedical benefits page herein. For children, you may designate a pediatrician as the primary care provider. You do not need prior authorization from Our Company 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 our network who specializes in obstetrics or gynecology. The health care professional, 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, contact our medical provider, listed on the medical benefits page herein.

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