2023 AtlantiCare Benefits Booklet

How To Enroll

TABLE OF CONTENTS WELCOME.................2 WHAT’S NEW. ...........3 SERVICE CENTERS AND WEBSITES..........4 HOW TO ENROLL....5-6 MEDICAL..............7-14 PRESCRIPTION DRUG. ................15-17 ADDITIONAL MEDICAL PLAN RESOURCES........18-22 DENTAL...............23-24 VISION.....................25 LIFECENTER..............26 LIFE INSURANCE. .....27 DISABILITY...............28 VOLUNTARY OFFERINGS. ........29-32 SPENDING ACCOUNTS. ............33 RETIREMENT BENEFITS..................34 WELLNESS. .........35-38 LEGAL NOTICES...39-41 GLOSSARY..........42-43 FAQs...................44-46 CONTACTS.........47-48 FORMS................49-58

? WHO CAN BE COVERED Eligible dependents include:

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

• 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 • Children over age 26 with mental or physical impairments may be eligible – physician certifications must be provided. ! CHANGING YOUR COVERAGE DURING THE YEAR 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 myadp.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 until the end of the year of their 26th birthday. • Other minor children if you are a legal guardian

• 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 2023 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

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