2021 Benefits Book

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EMPLOYEES

LIFECENTER

INSURANCE

FLEXIBLE SPENDING

MEDICAL

Atlanti Care DENTAL

FAMILY

FUTURE

FITNESS WORK BENEFITS PRESCRIPTION

RETIREMENT SAVINGS LIFE INSURANCE

HEALTHCARE

VOLUNTARY BENEFITS

VISION

CHOICE

WORKFORCE

WELLNESS

INVEST

2021 BENEFITSWORKBOOK

Important decisions deserve a little homework. When you enroll, make a commitment to take the time to understand all of your options and decide what’s best for you, your family and your health. The purpose of this Benefits Workbook is to provide you with important information to help you make the right choices that fit the needs of you and your family. AtlantiCare provides employees with a comprehensive and competitive benefits package to provide coverage to you and your family. It is important for you to make informed decisions and adopt healthy habits. This workbook highlights the 2021 benefits offered to you and your family. Please review all plans offered to recognize the difference in options available so you can decide which is best for your needs. Before choosing a plan, please check with your providers to verify their participation in the plan you are considering. Many of the providers being utilized by AtlantiCare employees and their dependents participate in all plans. Our own AtlantiCare providers and affiliates continue to be the cheapest option. Please visit the Human Resources portal on The Starfish for participating physicians, facilities and other services for all plans.

Dear AtlantiCare Family,

Thank you for your continued commitment to personal health and wellness, at a time when it is more important than ever. Events of the past year have reinforced the value of practicing self-care by being proactive about our health. I am proud of AtlantiCare’s efforts to research and design comprehensive, affordable and meaningful wellness programs and benefits options for you and your loved ones. We recognize that healthcare needs range from acute to preventive, and our goal is to assist you in planning for unforeseen emergencies while providing the tools you can use to build lifelong healthy habits. This year, due to the evolution in our relationship with Geisinger, we will offer two plan options: Horizon Engaged Plan and Horizon PPO . Details about each plan are outlined in the pages that follow. Please review each option and select the 2021 benefits package that works best for you. We also provide a variety of voluntary benefits and wellness programs, each designed to support you and your loved ones on your health and wellness journey. Thank you for engaging in your own health and that of your families. By modeling healthy behaviors, you help us achieve our vision of building healthy communities together.

Keep making a difference,

Lori Herndon President and CEO AtlantiCare

What’s New for 2021

HOME TABL OF CONTENTS WELCOME.................2 WHAT’S NEW. ...........3 SERVICE CENTERS AND WEBSITES..........4 HOW TO ENROLL....5-6 MEDICAL..............7-13 PRESCRIPTION DRUG. ................14-16 ADDITIONAL MEDICAL PLAN RESOURCES........17-19 DENTAL...............20-22 VISION.....................23 LIFECENTER..............24 LIFE INSURANCE. .....25 DISABILITY...............26 VOLUNTARY OFFERINGS. ........27-30 SPENDING ACCOUNTS. ............31 RETIREMENT BENEFITS..................32 WELLNESS. .........33-36 LEGAL NOTICES..37-39 GLOSSARY..........40-41 FAQs...................42-44 CONTACTS.........45-46 FORMS................47-53 WHAT’S NEW SERVICE CENTERS AND WEBSITES HOW TO ENROLL MEDICAL PRESCRIPTION DRUG ADDITIONAL MEDICAL PLAN RESOURCES DENTAL VISION LIFE INSURANCE DISABILITY VOLUNTARY OFFERINGS SPENDING ACCOUNTS RETIREMENT BENEFITS WELLNESS LEGAL NOTICES CONTACTS GLOSSARY

and benchmarking with other organizations where the trend is moving away from cash provisions. The amount will now be $25 per pay into your FSA account for waiving the medical benefits. You are still able to earn up to an additional $750 for completed Wellness Activities. Benefits Service Center Chat and Co-browsing Benefits Service Center Chat and Co-browsing Chat and Co-browsing available Monday through Friday 8:00 am to 8:00 pm EST, excluding all major US holidays. Access via MyOwnRecords (www.portal.adp.com). 2021 Wellness Activity Checklist • The Wellness Activities and credit amounts have changed. Please review on page 49.

2021 Benefits Changes • No longer offering Geisinger Engaged Plan. Offering two plans: Horizon Engaged Plan and Horizon PPO Plan • Changes to Out-of-Pocket Maximums • Employee Contribution Changes • Medical Waiver Changes • New AtlantiCare Benefits Service Center Chat feature • Wellness Activity Changes • New Pharmacy Vendor – MedImpact Medical Plan Changes • As part of the process of ending our partnership with Geisinger we will no longer offer the Geisinger Engaged Plan for 2021. There will be two Plan options: Horizon Engaged Plan and Horizon PPO Plan. Your enrollment in the Geisinger Plan will automatically default to the Horizon Engaged Plan. Should you choose not to participate in the Horizon Engaged Plan, you will need to take action to enroll in the Horizon PPO Plan or waive enrollment. • Prescription coverage is included as part of the Medical plan enrollment. Effective January 1, 2021, new pharmacy vendor MedImpact will replace Geisinger Pharmacy. Employees are encouraged to utilize the AtlantiCare Pharmacy which offers the best savings. All enrollments will receive new ID cards from MedImpact. Cards will be mailed to homes in December. • Changes to Out-of-Pocket Maximums – In keeping with ACA IRS limits, medical out-of-pocket maximums adjust to $6,800 for single coverage, $13,600 for family coverage. Prescription out-of- pocket maximums adjust to $1,750 for single coverage, $3,500 for family coverage. • Employee Contribution Changes – please refer to 2021 Medical Plan Biweekly Contribution Rates on page 9. • Effective January 1, 2021, we are reducing the medical waiver amount that goes into an FSA account for those who waive our benefits. This is in response to our analysis of market trends

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Service Centers and Websites

TABLE OF CONTENTS WELCOME.................2 WHAT’S NEW. ...........3 SERVICE CENTERS AND WEBSITES..........4 HOW TO ENROLL....5-6 MEDICAL..............7-13 PRESCRIPTION DRUG. ................14-16 ADDITIONAL MEDICAL PLAN RESOURCES........17-19 DENTAL...............20-22 VISION.....................23 LIFECENTER..............24 LIFE INSURANCE. .....25 DISABILITY...............26 VOLUNTARY OFFERINGS. ........27-30 SPENDING ACCOUNTS. ............31 RETIREMENT BENEFITS..................32 WELLNESS. .........33-36 LEGAL NOTICES..37-39 GLOSSARY..........40-41 FAQs...................42-44 CONTACTS.........45-46 FORMS................47-53

AtlantiCare Benefits Service Center 1-800-211-3252 Monday through Friday, 8:00 am – 6:00 pm Saturday, 8:00 am – 5:00 pm You can access the AtlantiCare Benefits Service/Enrollment Site to make your elections via MyOwnRecords ( www.portal.adp.com ). Navigate to the Benefits tab and click Health and Welfare. For more information, see How to Enroll on page 5. Chat and Co-browsing available Monday through Friday 8:00 AM to 8:00 PM EST, excluding all major US holidays. Access via MyOwnRecords ( www.portal.adp.com ). FSA Employee Benefits Center 1-800-307-0230 Monday through Friday, 8:30 am – 5:30 pm myflexdollars.com See Contacts on page 40 for specific benefit policies. Wellness Customer Service Team 609-677-7507 Monday through Friday, 7:30 am – 4:00 pm wellness@atlanticare.org Call the Wellness Customer Service Team for inquiries related to Wellness Credits, Wellness Activities and Wellness Program details.

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ow To Enroll

HOME TABL OF CONTENTS WELCOME.................2 WHAT’S NEW. ...........3 I E TERS AND WEBSITES..........4 HOW TO ENROLL....5-6 MEDICAL..............7-13 PRESCRIPTION DRUG. ................14-16 ADDITIONAL MEDICAL PLAN RESOURCES........17-19 DENTAL...............20-22 VISION.....................23 LIFECENTER..............24 LIFE INSURANCE. .....25 DISABILITY...............26 V LUN A Y OFFERINGS. ........27-30 SPENDING ACCOUNTS. ............31 RETIREMENT BENEFITS..................32 WELLNESS. .........33-36 LEGAL NOTICES..37-39 GLOSSARY..........40-41 FAQs...................42-44 CONTACTS.........45-46 FORMS................47-53 WHAT’S NEW SERVICE CENTERS AND WEBSITES HOW TO ENROLL MEDICAL PRESCRIPTION DRUG ADDITIONAL MEDICAL PLAN RESOURCES DENTAL VISION LIFE INSURANCE LONG TERM DISABILITY VOLUNTARY OFFERINGS SPENDING ACCOUNTS RETIREMENT BENEFITS WELLNESS LEGAL NOTICES CONTACTS GLOSSARY

? WHO CAN BE COVERED UNDER YOUR COVERAGE Eligible dependents include: • Your spouse or domestic partner *If you would like to add a domestic partner as a dependent, you will need to complete the online portal process, including dependent verification, to get your domestic partner verified and added. You will be required to provide documentation confirming registry of domestic partnership with a local government. Note that domestic partners are eligible for only medical, prescription drug, dental and vision insurance. • Dependent children, including adopted children, foster children in your care and stepchildren. Children are eligible until the end of the year of their 26th birthday. • Other minor children if you are a legal guardian • Children over age 26 with mental or physical impairments may be eligible – physician certifications must be provided ! QUALIFYING LIFE EVENTS (QLE) If you experience a Qualifying Life Event, you have 30 days to make the necessary changes to your benefits. You can make changes through MyOwnRecords ( www.portal.adp.com ) or call the AtlantiCare Benefits Service Center (1-800-211-3252). Documentation must be submitted to confirm the event, or your old elections will be activated. Examples of a QLE include: • Adoption • Birth of a child • Marriage • Divorce • Death of a dependent

Spend time to learn about your benefit options so you can make the best decisions for you and your family based on your needs. Make Sure You… • Read this Benefits Workbook • Review your dependent information • Use the decision tool found on the enrollment website to help you

decide which plans are best for you and your family • Consider participating in flexible spending accounts and other voluntary offerings • Review the 2021 Wellness Activity Checklist

• Confirm your elections!!! Your elections will be enforced for the full plan year unless you experience a Qualifying Life Event. The choices you make during Open Enrollment will go into effect on January 1, and remain until December 31, unless you have a qualified life event. Newly eligible employees must actively elect to either participate in or waive benefits. Those who fail to confirm enrollment within 30 days will be automatically enrolled in the Horizon Engaged Plan – ‘Employee Only,’ Tobacco surcharge and the Basic Dental Plan - ‘Employee Only.’ The choices you make as a new hire are effective the first of the month after you are hired, until December 31.

• Employee/dependent lose other coverage • Employee/dependent gain other coverage

FORMS

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ow To Enroll

HOME TABL OF CONTENTS WELCOME.................2 WHAT’S NEW. ...........3 I E TERS AND WEBSITES..........4 HO TO ENROLL....5-6 MEDICAL..............7-13 PRESCRIPTION DRUG. ................14-16 ADDITIONAL MEDICAL PLAN RESOURCES........17-19 DENTAL...............20-22 VISION.....................23 LIFECENTER..............24 LIFE INSURANCE. .....25 DISABILITY...............26 V LUN A Y OFFERINGS. ........27-30 SPENDING ACCOUNTS. ............31 RETIREMENT BENEFITS..................32 WELLNESS. .........33-36 LEGAL NOTICES..37-39 GLOSSARY..........40-41 FAQs...................42-44 CONTACTS.........45-46 FORMS................47-53 WHAT’S NEW SERVICE CENTERS AND WEBSITES HOW TO ENROLL MEDICAL PRESCRIPTION DRUG ADDITIONAL MEDICAL PLAN RESOURCES DENTAL VISION LIFE INSURANCE LONG TERM DISABILITY VOLUNTARY OFFERINGS SPENDING ACCOUNTS RETIREMENT BENEFITS WELLNESS LEGAL NOTICES CONTACTS GLOSSARY

u Login to MyOwnRecords ( www.portal.adp.com )

u Click Benefits on the left side. An Annual Enrollment / New Hire tile will appear informing you how many days you have to enroll.

u Hover over Benefits tab, then click Health & Welfare .

u Click ENROLL NOW to make 2021 elections. u Confirm Your Elections. u Click Complete Enrollment . u Review Benefits Summary. Click Confirm Enrollment . A confirmation message will appear.

u Read the message and click I AGREE . u Download to save or print confirmation statement.

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You have two choices in Medical Plan coverage: • Horizon Engaged Plan • Horizon Preferred Provider (PPO) Plan

You have two choices in medical plan options administered by Horizon Blue Cross/Blue Shield: Horizon Engaged Plan and Horizon Preferred Provider (PPO). Horizon Blue Cross Blue Shield Blue Card provides access to one of the broadest networks in the country. Both options include access to AtlantiCare Inner Circle (Tier 1) physicians and you pay less when you are able to use these providers. Horizon Engaged Plan The Horizon Engaged Plan offers a lower biweekly contribution in return for your commitment to engage in your health. You will have the opportunity to complete wellness activities to earn wellness credits that will reduce the wellness deductible up to $2,000 for single coverage and up to $4,000 for spouse or family coverage (wellness credits do not apply to children) that will be applied the following year . For a complete description of activities, please refer to the “Wellness” section in this booklet. You will need to complete these activities by their specific due date to earn the associated wellness credits. • Wellness credits earned reduce the wellness deductible. • Two-tiered network of providers – AtlantiCare Tier (Inner Circle/ Tier1) and the Blue Cross/Blue Shield (Tier 2) • Providers in both tiers are considered in-network providers but pay differently. This means that the same services are covered in both tiers, but when you utilize AtlantiCare and its affiliates, you pay less out-of-pocket. • When you use the Blue Cross/Blue Shield Tier you have additional costs. In some cases, the additional costs could be up to a $1,000 copay and then 30% of the cost of services. • This plan does not cover physicians and facilities who do not participate in the national Blue Cross/Blue Shield network. • If services are not available at AtlantiCare, your responsibility will be at the Tier 2 level of coverage.

Horizon Preferred Provide Plan (PPO) The Horizon Preferred Provider Plan includes the same benefits and provider network as the Horizon Engaged Plan but also offers coverage for physicians and facilities outside of the national Blue Cross/Blue Shield network. This plan is the most expensive when it comes to how much you contribute each pay period, however, your pay cost can be reduced if you complete wellness activities. By completing wellness activities, you can earn up to $750 for single coverage and up to $1,500 for spouse or family coverage (wellness credits do not apply to children). Earned wellness credits are applied to the total cost of your medical contribution and divided over 26 pay periods for the following year. For a complete description of activities, please refer to the “Wellness” section in this booklet. You will need to complete these activities by their specific due date to earn the associated wellness credits. • Wellness credits earned reduce your contributions. • Includes the same benefits and provider networks as the Horizon Engaged Plan, but also offers coverage for physicians and facilities outside of the national Blue Cross/Blue Shield network.

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Medical

! EXTRA FACTS ABOUT YOUR HORIZON PLANS • Your medical plan offers coverage for eye exams and vision hardware • Horizon’s Blue365 discount plan offers nationwide discounts on health and wellness products and services • You can connect with Horizon’s online services to access explanation of benefits (EOBs), claim forms, health news updates and Chat services

Horizon Preferred Provide Plan (PPO) continued • Utilizing AtlantiCare and its affiliates for service will result in the lowest out-of-pocket cost. • Some services performed through a Blue Cross/Blue Shield network provider will be covered at 70% after the deductible is met. • When you use the Blue Cross/Blue Shield network services will usually be paid at 50% after the deductible is met. • If services are not available at AtlantiCare, your responsibility will be at the Tier 2 or Out-of-Network level of coverage. For both plans visit http://atlanticare.horizonblue.com to find a participating physician, facility or other service provider.

The Plans At A Glance

HORIZON ENGAGED HORIZON PPO

Has AtlantiCare Network

Has “Out-of-Network” Providers

Has $1,000 Deductible When Using Non-AtlantiCare Facilities

Lowest Contributions

Wellness Credits Reduce Deductible

Wellness Credits Reduce Contributions

Access to Telehealth Benefit

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? SPOUSE & PARTNER PREFERRED CHOICE PREMIUM AtlantiCare continuously balances the need to offer meaningful and comprehensive employee benefits with the need to remain financially sound in the current healthcare environment. To achieve this balance, we require a Spouse and Partner Preferred Choice Premium. This premium will be applied to your bi-weekly contribution if your spouse/partner chooses to obtain medical coverage through AtlantiCare when they have the option of obtaining benefits through their own employer. This premium will not be applied if your spouse/partner is not offered benefits through their employer, is not currently employed or also works at AtlantiCare. The premium is $75 per paycheck if your base salary is less than $100,000, and $125 per paycheck if your base salary is $100,000 or more. AtlantiCare will conduct audits throughout the year in which you will be asked to supply documentation (i.e., a letter from employer or tax return showing no income) if you have indicated that your spouse/partner is not eligible for medical coverage by their own employer. This acknowledgment is considered a legal process and should be treated as such. If your spouse is self-employed and not obtaining benefits through their business, they will need to supply proof of self-employment. ! TELEHEALTH BENEFIT You can use Horizon CareOnline

to talk to licensed, U.S. board-certified doctors via video, chat or phone 24 hours a day, seven days a week – no appointment is needed. With Horizon CareOnline, you can be treated for symptoms and conditions such as colds, flu, fever, rash, abdominal pain, sinusitis, ear infections and behavioral health. Call 1-877-716-5657 , sign into member online services at Horizonblue.com/atlanticare or visit atlanticare.horizoncareonline.com .

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2021 Medical Plan Bi-Weekly Contribution Rates

Full-Time

Part-Time

$0-49,999k $50-99,999k $100k-149,999k

$150k+

$0-49,999k $50-99,999k $100k-149,999k $150k+

Horizon Engaged Plan

Employee

$35.61 $43.09

$77.26

$83.94 $71.10 $81.95 $154.52 $167.86

Employee + Spouse

$60.98 $73.79 $132.31

$143.74 $121.76 $140.34 $264.61 $287.45

Employee + Child(ren)

$49.15 $59.48 $106.64

$115.86 $98.14 $113.12 $213.28 $231.70

Family

$97.38 $117.83 $211.27

$229.54 $194.42 $224.09 $422.54 $459.02

Horizon PPO

Employee

$141.83 $156.37 $189.58

$193.99 $167.95 $185.17 $294.90 $301.76

Employee + Spouse

$242.89 $267.79 $324.65

$332.20 $287.63 $317.10 $505.04 $516.78

Employee + Child(ren)

$195.77 $215.85 $261.69

$267.79 $231.84 $255.60 $407.06 $416.52

Family

$387.85 $427.60 $518.43

$530.48 $459.29 $506.36 $806.45 $825.21

*$25 surcharge will be added to your bi-weekly contribution if you utilize tobacco products. A Spouse & Partner Preferred Choice Premium may also apply. See page 9 for details.

FORMS

Medical

Make The Most Of Your Medical Benefits • Consider the “Engaged Plan.” The contributions are low cost, and unless you have many physicians who are out of network, the Horizon Engaged Plan’s Blue Card network should meet your needs. • Preventive Care at No Cost – Preventive care is comprised of a variety of clinical services and programs including annual doctor’s checkups, annual immunizations and screenings. Make sure your provider codes all eligible claims as preventive care in order to be eligible for 100% coverage. • Out-of-Pocket Maximums – You are protected from catastrophic medical expenses by the annual out-of-pocket maximum. When your out-of-pocket expenses (deductibles, copays and coinsurances) reach the out-of-pocket maximum, the plan pays the full cost for any covered care you receive for the rest of the year. • Contact Horizon before a procedure to determine what you can expect to pay and to ensure any pre-authorizations have been completed. • Consider participating in Flexible Spending Accounts to supplement your out-of-pocket expenses. • Complete wellness activities to earn credits to reduce your wellness deductible, buy down your bi-weekly contributions or apply to your FSA card. • Utilize an AtlantiCare Primary Care Plus provider. In both medical plans, these providers are only a $10 copay for office visits, compared to a $50 copay for primary care providers that are not AtlantiCare Primary Care Plus designated. To earn this designation, our providers have taken meaningful steps toward the patient-centered medical home model, which means offering same- or next-day urgent appointments, implementing a common electronic medical record, collaborating with AtlantiCare Care Managers for complex patients, and allowing hospitalists to care for patients admitted to ARMC. To find an AtlantiCare Primary Care Plus provider, call the AtlantiCare Access Center at 1-888-569-1000 .

Waiving Benefits If you waive your medical benefits, $25 per pay* will be deposited into a Healthcare Reimbursement Account (HRA). See Spending Accounts on page 30 for more information. In addition, your earned wellness credits from 2020 of up to $750 will also be deposited into this account. See Wellness starting on page 32 for a list of wellness activities and their values. Please visit https://myatlanticare.org to view your online wellness activity checklist or call Health Engagement at 1-609-677-7507 if you have questions about your wellness activities.

*If you are covered by another AtlantiCare employee and you waive medical coverage, you will not be eligible for the waiver benefit.

? KNOW BEFORE YOU GO

Always check to see if AtlantiCare can perform the service before scheduling somewhere else. If it is a routine procedure, the AtlantiCare Access Center should be able to refer you appropriately. Never assume your physician is referring you to a Inner Circle/Tier 1 provider.

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Medical

Compare 2021 Plan Choices

Horizon Engaged Plan

PPO Plan

Medical Services

Inner Circle/Tier 1

Tier 2

Inner Circle/Tier 1

Tier 2

Out-of-Network

Wellness Deductible (per person/per family)

$2,000/$4,000*

N/A

$1,000/$2,000

$2,000/$4,000

Out-of-Pocket Maximum after Deductible (per person/per family)

$6,800/$13,600

$8,800/$17,600

Facility Benefits

Covered 100% after wellness deductible

Covered 100% after $1,000 copay/visit and wellness deductible

Covered 100% after deductible

Covered 100% after $750 copay/visit

$2,000 copay/visit then covered 50%; no deductible

Room & Board / Ancillary

Outpatient Facility Benefits

Covered 100% after $25 copay and wellness deductible Covered 100% after $25 copay and wellness deductible Covered 100% after wellness deductible Covered 100% after wellness deductible Covered 100% after wellness deductible

Outpatient Surgery (Hospital Based)

Covered 70% after $1,000 copay/visit and wellness deductible

Covered 100% after $25 copay

Covered 100% after $750 copay/visit

$2,000 copay/visit then covered 50%; no deductible

Outpatient Surgery (Surgical Center)

Covered 70% after $750 copay/visit and wellness deductible

Covered 100% after $25 copay

Covered 100% after $500 copay/visit

Covered 50% after deductible

Physician Services

Covered 70% after deductible Covered 70% after deductible Covered 70% after deductible Covered 100% after $50 copay/visit; all other services rendered in the office covered 70% after deductible Covered 100% after $65 copay/visit; all other services rendered in the office covered 70% after deductible

Covered 50% after deductible Covered 50% after deductible Covered 50% after deductible

Surgeon

Covered 70% after wellness deductible

Covered 100%

Anesthesia

Covered 70% after wellness deductible

Covered 100%

Inpatient Physician Visit

Covered 70% after wellness deductible

Covered 100%

Covered 100% after $50 copay/visit and wellness deductible; all other services rendered in the office covered 70% after wellness deductible

Covered 100% after $10 copay and wellness deductible

Physician Office Visits - Primary Care

Covered 100% after $10 copay/visit

Covered 50% after deductible

Covered 100% after $65 copay/visit and wellness deductible; all other services rendered in the office covered 70% after wellness deductible

Covered 100% after $10 copay and wellness deductible

Physician Office Visits - Specialist

Covered 100% after $10 copay/visit

Covered 50% after deductible

Physician Office Visits - Routine Well Care

Covered 100%

Covered 100% Covered 100%

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This chart is meant as an overview only. For detailed information, please refer to the Summary Plan Description posted under “Benefit Information” on the HR Portal: Benefits Tab. * For Engaged Plan only, the wellness deductible can be reduced through wellness credits ** AtlantiCare also covers some services for gender assignment. Check the plan document for more information.

Medical

Compare 2021 Plan Choices

Horizon Engaged Plan

PPO Plan

Medical Services

Inner Circle/Tier 1

Tier 2

Inner Circle/Tier 1

Tier 2

Out-of-Network

Supplemental Services

Covered 100% after $20 copay/visit

Covered 100% after $20 copay/visit Covered 100% after $50 copay/visit and deductible; all other services rendered in the office covered 70% after deductible Office and freestanding clinic: Covered 100% after $50 copay/visit and deductible Facility: Covered 70% after deductible Office and freestanding clinic: Covered 100% after $50 copay/visit and deductible Covered 100% after $150 copay

Covered 100% after $20 copay/visit

Telemedicine

Covered 100% after $50 copay/visit and wellness deductible; all other services rendered in the office covered 70% after wellness deductible

Covered 100% after $20 copay and wellness deductible

Covered 100% after $20 copay and deductible

Urgent Care

Covered 100% after $60 copay

Covered 100% after $150 copay and wellness deductible

Covered 100% after $150 copay

Emergency Services

Covered 100% after $150 copay

Office and freestanding clinic: Covered 100% after $50 copay/visit and wellness deductible

Covered 100% after $10 copay and wellness deductible

Covered 100% after $10 copay/visit

Covered 50% after deductible

Diagnostic X-ray

Facility: Covered 70% after wellness deductible

Office and freestanding clinic: Covered 100% after $50 copay/visit and wellness deductible

Covered 100% after $10 copay and wellness deductible

Covered 100% after $10 copay/visit

Covered 50% after deductible

Diagnostic hi-tech imaging

Facility: Covered 70% after wellness deductible

Facility: Covered 70% after deductible

Covered 100% after $10 copay/visit and wellness deductible

Covered 100% after $50 copay/visit and wellness deductible

Covered 100% after $10 copay/visit

Covered 70% after deductible

Covered 50% after deductible

Diagnostic Tests

This chart is meant as an overview only. For detailed information, please refer to the Summary Plan Description posted under “Benefit Information” on the HR Portal: Benefits tab.

Vision care expense benefit for all plans (no network limitations) Routine Vision Exam annually $70 Eyeglasses and/or Contact Lenses every two years $60 Must submit a claim form for reimbursement.

*For Engaged Plan only, the wellness deductible can be reduced through wellness credits **AtlantiCare also covers some services for gender assignment. Check the plan document for more information.

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Prescription Drug

HOME TABL OF CONTENTS WELCOME.................2 WHAT’S NEW. ...........3 I E CENTERS AND WEBSITES..........4 HO TO ENROLL....5-6 MEDICAL..............7-13 PRESCRIPTION DRUG. ................14-16 ADDITIONAL MEDICAL PLAN RESOURCES.........17-19 DENTAL...............20-22 VISION.....................23 LIFECENTER..............24 LIFE INSURANCE. .....25 DISABILITY...............26 VOLUNTARY OFFERINGS. ........27-30 SPENDING ACCOUNTS. ............31 RETIREMENT BENEFITS..................32 WELLNESS. .........33-36 LEGAL NOTICES..37-39 GLOSSARY..........40-41 FAQs...................42-44 CONTACTS.........45-46 FORMS................47-53 WHAT’S NEW SERVICE CENTERS AND WEBSITES HOW TO ENROLL MEDICAL PRESCRIPTION DRUG ADDITIONAL MEDICAL PLAN RESOURCES DENTAL VISION LIFE INSURANCE DISABILITY VOLUNTARY OFFERINGS SPENDING ACCOUNTS RETIREMENT BENEFITS WELLNESS LEGAL NOTICES CONTACTS GLOSSARY

Regardless of which medical plan option you choose, you are eligible for prescription drug benefits through MedImpact. You do not need to enroll separately in the prescription plan. Prescription coverage is included as part of the Medical plan enrollment. Your prescription plan information can be found on your prescription ID card. Refer to the table below for the copay amounts you will pay under the Prescription Drug plan. For more information about prescription benefits, see Prescription Plan FAQs on page 44.

Non-Specialty Medications

AtlantiCare Pharmacy (Retail & Mail Order) Generic Brand Preferred Brand Non-Preferred

Copays for 30/90-day supply $10/$20 $20/$40 $50/$100

Non-AtlantiCare Retail Pharmacy Generic Brand Preferred Brand Non-Preferred Specialty Medications AtlantiCare Retail Pharmacy Generic Brand Preferred Brand Non-Preferred

Copays for 30-day supply 10% 20% 100%

Minimum $10 $25 N/A

Copays (up to 30-day supply) $10 $20 $50

*Other Specialty Pharmacy Generic Brand Preferred Brand Non-Preferred Maximum $150 $150 $150 *If the AtlantiCare Pharmacy is unable to fill your request, they will direct you to contact MedImpact Customer Service for assistance in obtaining your medication. Copays (up to 30-day supply) 10% 20% 30%

FORMS

Prescription Drug

HOME TABL OF CONTENTS WELCOME.................2 WHAT’S NEW. ...........3 I E CENTERS AND WEBSITES..........4 HOW TO ENROLL....5-6 MEDICAL..............7-13 PRESCRIPTION DRUG. ................14-16 ADDITIONAL MEDICAL PLAN RESOURCES........17-19 DENTAL...............20-22 VISION.....................23 LIFECENTER..............24 LIFE INSURANCE. .....25 DISABILITY...............26 VOLUNTARY OFFERINGS. ........27-30 SPENDING ACCOUNTS. ............31 RETIREMENT BENEFITS..................32 WELLNESS. .........33-36 LEGAL NOTICES..37-39 GLOSSARY..........40-41 FAQs...................42-44 CONTACTS.........45-46 FORMS................47-53 WHAT’S NEW SERVICE CENTERS AND WEBSITES HOW TO ENROLL MEDICAL PRESCRIPTION DRUG ADDITIONAL MEDICAL PLAN RESOURCES DENTAL VISION LIFE INSURANCE DISABILITY VOLUNTARY OFFERINGS SPENDING ACCOUNTS RETIREMENT BENEFITS WELLNESS LEGAL NOTICES CONTACTS GLOSSARY

Always consider using the AtlantiCare Pharmacy first, because it typically provides the least out-of-pocket cost.

? DID YOU KNOW?

AtlantiCare Pharmacy (Retail and Mail Order) The AtlantiCare Pharmacy offers AtlantiCare employees and their covered dependents the opportunity to fill prescriptions at a reduced cost. Medications can be filled for as little as $10 (generic) or $20 (brand name preferred) for a 30-day supply. Medication copay costs will double for a 90-day supply. There are three AtlantiCare Pharmacy locations:

AtlantiCare Pharmacy provides an online site to manage your prescription needs, order refills, transfer prescriptions from other pharmacies and much more. Visit https://atlanticare.refillmyrx.com to register and start managing your prescriptions today.

Atlantic City AtlantiCare HealthPlex, 1401 Atlantic Avenue Tel: 1-609-441-7088 Fax: 1-609-441-7089 Hours of Operation: Monday through Friday, 8:00 am to 6:00 pm

Galloway 54 West Jimmie Leeds Road

Tel: 1-609-404-7444 Fax: 1-609-404-7445 Hours of Operation: Monday through Friday, 9:00 am to 5:00 pm Saturday, 9:00 am to 4:00 pm

Manahawkin 517 Route 72W

Tel: 1-609-704-6800 Fax: 1-609-704-6801 Hours of Operation: Monday through Friday, 9:00 am to 5:00 pm

In the case of an emergency, you may use the AtlantiCare Community Pharmacy located inside ARMC City and Mainland Campuses. Hours of operation are 10:00 am to 10:00 pm daily. Please note, you may utilize these pharmacies for emergencies only. They do not carry enough supply for employees’ daily usage.

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Prescription Drug

HOME TABL OF CONTENTS WELCOME.................2 WHAT’S NEW. ...........3 I E CENTERS AND WEBSITES..........4 HOW TO ENROLL....5-6 MEDICAL..............7-13 PRESCRIPTION DRUG. ................14-16 ADDITIONAL MEDICAL PLAN RESOURCES.........17-19 DENTAL...............20-22 VISION.....................23 LIFECENTER..............24 LIFE INSURANCE. .....25 DISABILITY...............26 VOLUNTARY OFFERINGS. ........27-30 SPENDING ACCOUNTS. ............31 RETIREMENT BENEFITS..................32 WELLNESS. .........33-36 LEGAL NOTICES..37-39 GLOSSARY..........40-41 FAQs...................42-44 CONTACTS.........45-46 FORMS................47-53 WHAT’S NEW SERVICE CENTERS AND WEBSITES HOW TO ENROLL MEDICAL PRESCRIPTION DRUG ADDITIONAL MEDICAL PLAN RESOURCES DENTAL VISION LIFE INSURANCE DISABILITY VOLUNTARY OFFERINGS SPENDING ACCOUNTS RETIREMENT BENEFITS WELLNESS LEGAL NOTICES CONTACTS GLOSSARY

Retail Pharmacies (non-AtlantiCare) You can utilize your MedImpact prescription card to access retail pharmacies nationwide. While most large chains participate in the network, we do have some exclusions, such as Walgreens and Rite Aid. When you utilize these pharmacies, please consider the following: • Your copay may be higher than what you would pay at your AtlantiCare pharmacy. • If your medications are not categorized as generic or preferred brand, you may be responsible for the full cost of the prescription. • Any medication obtained from a non-AtlantiCare Pharmacy will only be filled for up to a 30-day supply (90-day supply not available). • Maintenance medications can only be refilled one time at a non-AtlantiCare pharmacy. • AtlantiCare pharmacy offers mail order service for all active employees and their dependents at no additional cost. Medications are delivered within 2-3 days. Mail order forms can be found on the HR Portal: Benefits tab on the Starfish or by calling the Galloway pharmacy at 609-404-7444 . To find a participating pharmacy or to see if your medication is

Rheumatology Program The prescription co-pay for all formulations of Enbrel © , Humira © and Orencia © (other drugs may be included) have increased to $150. Please read below for more information regarding this important update: Is there a way I can avoid the copay increase? Yes. You can avoid the copay increase by scheduling your rheumatology appointments with AtlantiCare Health Services Rheumatology, located at 54 W. Jimmie Leeds Road, Galloway, and 1401 Atlantic Ave., Atlantic City. You will have a $0 copay for your rheumatology prescription as well as your visit at these locations ONLY. What Rheumatologists are available at these locations? Dr. Anan Haija, M.D., is the available provider. Dr. Haija joined AtlantiCare Physician Group in 2012. He is board certified by the American Board of Internal Medicine in internal medicine and the subspecialty of rheumatology. Pharmacy Copays The maximum amount that you will pay for prescriptions per year: Single $1,750/Family $3,500. $ TIPS TO HELP CONTROL YOUR PHARMACY COSTS • Discuss options with your provider • Take advantage of savings by using AtlantiCare Pharmacy for all prescriptions • Check the prescription drug list to compare coverage for generic or brand name medication • Don’t skip taking medication

covered, visit the MedImpact Member portal at https://www.medimpact.com/web/login

Specialty Medications AtlantiCare Pharmacy will process your specialty medications. Please note, specialty medications may require prior authorization, so please plan accordingly. If the AtlantiCare Pharmacy is unable to fill your request, they will direct you to contact MedImpact Customer Service for assistance in obtaining your medication.

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Additional Medical Plan Resources

HOME TABL OF CONTENTS WELCOME.................2 WHAT’S NEW. ...........3 I E CENTERS AND WEBSITES..........4 HO TO ENROLL....5-6 MEDICAL..............7-13 PRESCRIPTION DRUG. ................14-16 ADDITIONAL MEDICAL PLAN RESOURCES........17-19 DENTAL...............20-22 VISION.....................23 LIFECENTER..............24 LIFE INSURANCE. .....25 DISABILITY...............26 VOLUNTARY OFFERINGS. ........27-30 SPENDING ACCOUNTS. ............31 RETIREMENT BENEFITS..................32 WELLNESS. .........33-36 LEGAL NOTICES..37-39 GLOSSARY..........40-41 FAQs...................42-44 CONTACTS.........45-46 FORMS................47-53 WHAT’S NEW SERVICE CENTERS AND WEBSITES HOW TO ENROLL MEDICAL PRESCRIPTION DRUG ADDITIONAL MEDICAL PLAN RESOURCES DENTAL VISION LIFE INSURANCE DISABILITY VOLUNTARY OFFERINGS SPENDING ACCOUNTS RETIREMENT BENEFITS WELLNESS LEGAL NOTICES CONTACTS GLOSSARY

AtlantiCare Health Services - FQHC*

If you have a medical condition such as diabetes, rheumatoid arthritis, congestive heart failure, cardiovascular disease or chronic obstructive pulmonary disease (COPD), you know how difficult it is to manage and coordinate all of the providers and finances involved in your care. Our staff is ready to help improve your health, simplify your life and reduce your out-of-pocket medical expenses.

The resources described here are available to you and your family regardless of which medical plan you elect. • Your physician copays will be waived and most of your medications will be completely free. Medications include Levemir, Humira, Lantus, Novolog, Januvia, Enbrel and others. What’s different about receiving care at these locations? • You will be at the center of a team working together to coordinate and manage your care. • Your personal health coach will be by your side every step of the way, and will also keep the care team informed of your care plan and progress. • The sites listed feature a convenient, on-site pharmacy where you can fill your prescriptions right after your appointment.

There are two convenient locations to provide and coordinate care for you:

Health Services

1401 Atlantic Avenue Suite 2500 and Suite 2600 Atlantic City, NJ 08401 Hours: Monday through Friday: 8:30 am to 6:30 pm 1-609-572-8800

54 Jimmie Leeds Road Suite 8 Galloway, NJ 08205 Hours: Monday through Thursday: 8:00 am to 6:00 pm 1-609-404-7300

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*(Federally Qualified Health Center)

Additional Medical Plan Resources

AtlantiCare Access Center Nurse Triage AtlantiCare offers telephonic nurse triage when your AtlantiCare Physician Group (APG) primary care provider practice is not available. After hours, a nurse is available to answer any questions related to medical care. The hours vary by practice. However, they are typically available from 4:00 pm – 8:30 pm daily, including holidays and weekends. When you call you will speak with a registered nurse (with an average of 30 years experience) who will assess and evaluate your symptoms or injury over the phone, provide physician-approved medical information so you can make an informed decision about where and when to seek treatment, recommend next steps and, if necessary, refer you to the appropriate care and resources.

Care Management As part of your benefits, our Nurse Care Managers are available to help you understand your healthcare options by: • Coordinating your healthcare services • Helping you understand and use your benefits in the most efficient way • Directing you to community resources, support groups, and health and wellness programs when appropriate • Navigating the healthcare system when dealing with a complex medical illness Both Nurse Triage and Care Management are offered as free benefits . All medical and personal information is confidential and may only be shared with those involved in your care. Employee Assistance Program There are times when personal problems affect our ability to function productively, both on the job and at home. The Employee Assistance Program (EAP) is a confidential program designed to help employees and their immediate family members 18 and older, prevent, identify and resolve problems before they affect job performance. EAP offers confidential, brief intervention services both over the phone and in person, seminars, conflict resolution, employee wellness trainings, coaching and support around treatment needs as well as referrals to treatment as necessary. Call 1-800-260-0808 for EAP assistance. You may speak to a Care Manager by calling 1-609-272-6297 .

This is a free benefit as part of your affiliation with our APG primary care practices.

? DID YOU KNOW?

Medical Nutrition Therapy/Counseling with a registered dietitian is a covered benefit, offering six visits per calendar year. Nutritional Counseling is an important part of prevention and treatment of many diseases and conditions. Confirm network providers with your plan prior to scheduling an appointment. Call the AtlantiCare Access Center 1-888-569-1000 to schedule your appointment with an AtlantiCare Registered Dietitian.

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