2026 AtlantiCare Benefits Booklet

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Benefits Book 2026

WELCOME....................................2 WHAT’S NEW..............................3 HOW TO ENROLL......................4 HEALTHCARE TRANSFORMATION CONSORTIUM (HTC)...............6 GETTING TO KNOW YOUR PLAN.................................7 MEDICAL......................................8 PRESCRIPTION DRUG.......... 17 FQHC........................................... 19 ADDITIONAL MEDICAL PLAN RESOURCES................. 20 WELLNESS PROGRAM......... 21 DENTAL...................................... 23 VISION........................................ 25 LIFE INSURANCE.................... 28 DISABILITY............................... 30 VOLUNTARY OFFERINGS... 31 EDUCATIONAL SUPPORT & CAREER DEVELOPMENT...................... 31 FINANCIAL WELL-BEING.... 32 HEALTH &WELLNESS.......... 33 SAVINGS.................................... 34 VOLUNTARY BENEFITS....... 35 SPENDING ACCOUNTS............................... 38 RETIREMENT BENEFITS................................... 39 CONTACTS................................ 41 LEGAL NOTICES....................... 43 WELLNESS CHECKLIST........ 45

DEARTEAM, Every day, you show up with compassion, strength, and dedication—caring for our patients, community, and each other. At AtlantiCare, we are committed to caring for you with that same devotion. That’s why I’m excited to share our 2026 Benefits Guide. This year, while your coverage and costs remain relatively the same, you’ll experience even greater support. Beginning January 1, our health plan will be administered by Aetna, giving you access to their broad provider network and user-friendly digital tools, while AtlantiCare continues to design and protect the benefits you know and trust.

Service Centers andWebsites

AtlantiCare Benefits Service Center 1-800-211-3252

Monday through Friday, 8:00 am to 6:00 pm You can access the AtlantiCare Benefits Service/ Enrollment Site to make your elections via myadp. com. Navigate to the Benefits tab. For more information, see How to Enroll on page 4. Chat and Co-browsing available Monday through Friday 8:00 am to 8:00 pm EST, excluding all major U.S. holidays. Access via myadp.com .

This transition reflects something bigger: our investment in you. By working with other leading health systems through the Healthcare Transformation Consortium, we are building a more sustainable and supportive benefits experience for today and tomorrow. Please take time to review this guide and explore the resources available to you and your family. We want you to feel confident, cared for, and supported at every stage of your journey—because when you thrive, we all thrive.

FSATeamMember Benefits Center

Call Center Hours: Monday through Friday, 8:00 am to 8:00 pm 1-800-307-0230 Email requests can be submitted outside of business hours:

With gratitude,

support@myFlexdollars.com Website: myflexdollars.com

*See Contacts on page 41 for specific benefit policies. For Legal Notices or Frequently Asked Questions about your benefits visit myadp.com. Information is available under the Forms & Documents section on the Benefits Tab, as well as on the Starfish Benefits portal. Legal Notices can also be found on page 43.

Christine Carson Chief Human Resources Officer

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WHAT’SNEWFOR 2026?

• AtlantiCare joined the Healthcare Transformation Consortium (HTC) • AtlantiCare will be moving to Aetna as our Medical Plan Administrator • Employee Medical Plan contribution rates increased slightly. • Enhanced Life Insurance Benefits with increased maximum coverages • New option to enroll in Spousal and/or Child(ren) Supplemental Life coverage

• Increased limits for Health Care FSA and Dependent Care FSA • New Partnership with Jersey Shore Federal Credit Union

Learn More! • Attend an on-site benefits fair or help desk. More info on the Starfish! • Attend an information session to review 2026 changes. More info on the Starfish! • Visit the benefits tab on the HR Portal.

What’s New for 2026 Visit myadp.com to enroll, change and review your elections. Keep up with your wellness at wellness.atlanticare.org. Open Enrollment is voluntary.

All benefits except for Flexible Spending will roll over for 2026. Please review your benefits and make any appropriate changes. NOTE: For the voluntary Flexible Spending Account(s), youmust enroll each year.

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HOWTOENROLL Take 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 workbook. • Review your dependent information. • Consider your 2026 health expenses to determine if participating in a flexible spending account or other voluntary benefits makes sense. • Review the 2026Wellness Program to earn HRA dollars. • Confirm your elections.* *If using MyADP.com click Confirmonce elections are selected.

Who Can Be Covered? Eligible dependents include: • Your spouse or domestic partner*

• 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. *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 the registry of domestic partnership with a local government.

Remember: • The choices you make during Open Enrollment will go into effect on

January 1, and remain until December 31, unless you have a qualifying life event. • Newly eligible teammembers must actively elect to either participate in or waive benefits. Those who do not confirm enrollment within 30 days will be automatically enrolled in the Aetna Select Plan– ‘Employee Only,’ and the Horizon Basic Dental Plan – ‘Employee Only.’ • The choices you make as a new hire are efective from the first day of the month after you are hired, until December 31.

ChangingYour Coverage During the Year / Qualifying Life Events (QLE) If you experience a Qualifying Life Event, you have 30 days to make the necessary changes

Examples of a QLE include: • Adoption • Birth of a child • Marriage • Divorce • Death of a dependent

• Teammember/dependent lose other coverage • Teammember/dependent gain other coverage

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.

• A reduction or increase in the hours of employment resulting in a switch between part-time and full-time status

Please be sure to go back into your enrollment screen to add your dependent onto your coverage after completing the verification process.

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HOWTOENROLL (CONT.)

1 Login to myadp.com

2 Click Benefits on the left side. An Annual Enrollment / NewHire tile will appear, informing you howmany days you have to enroll.

3 Click ENROLL NOW 4 Select your 2026 Elections. 5 Review Benefits Summary. Click Confirm Elections . A confirmationmessage will appear (below).

6 Read the message and click I AGREE. 7 Download to save or print your confirmation statement (above).

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HEALTHCARE TRANSFORMATIONCONSORTIUM (HTC) At AtlantiCare, one of the ways we continue to be a great place to work is by investing in what matters most—you. That includes ensuring your health benefits remain strong, sustainable, and designed with your needs in mind. That’s why we’ve joined the Healthcare Transformation Consortium (HTC) —a strategic collaboration of leading, independent New Jersey health systems committed to enhancing the employee health care experience. We’re proud to stand alongside respected organizations like Atlantic Health System, CentraState Healthcare System, Holy Name Medical Center, Hunterdon

Healthcare, Saint Peters Healthcare System, Valley Health System, and RWJBarnabas Health—together representing coverage for more than 110,000 individuals across the state. Here’s what this collaboration helps support: • Improved Access and Choice: Opportunities to increase provider access and ofer more flexible care options for you and your dependents. • Innovative Programs: Potential for new services that support everything from maternity and preventive care to chronic condition management. • Affordability Over Time: By collaborating with other organizations, we can help reduce administrative costs—helping to control premium increases and protect your benefits long-term. • Simplified, High-Quality Care: Leveraging best practices from across this collaboration, we are committed to making it easier for you to get the right care at the right time.

The consortium’s long-term vision emphasizes continuous improvement, innovation, and sustainable healthcare models that adapt to changing needs. The continued success of the HTC stems fromworking closely with like-minded organizations. Sharing best practices, learning from each other, and leading the transition from fee-for-service to value-based care will continue to grow with the incorporation of new organizations choosing to become part of the consortium. The goal of the HTC is to bring the lessons learned frommanaging the cost and quality of its own employee health plans to local employers in New Jersey.

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GETTINGTOKNOWYOURNEW MEDICAL PLANTHIRDPARTY ADMINISTRATOR

FAQ Q: What does a Third-Party Administrator (TPA) do? A: A TPA processes claims, manages provider networks, issues ID cards, and provides customer service. The health plan itself continues to be AtlantiCare’s. Q: Will my benefits change under Aetna? A: The plan design remains AtlantiCare’s. While the administrator changes, our benefits strategy, oferings, and priorities continue to be guided by AtlantiCare. Through Aetna and the HTC network, you will have more options for care and resources available.

Beginning in January 2026, Aetna will be acting as the Third-Party Administrator (TPA) for the AtlantiCare Health Plan. Aetna is one of the nation’s leading diversified health care benefits companies which includes a provider network spanning hundreds of thousands of doctors and thousands of hospitals. With Aetna, you’ll have access to the following: • Care Management including personalized nurse support through the 24/7 Nurse Help Line. 1-833-590-1141 • Tools, tips and support centers are available through the Aetna/ AtlantiCare member microsite – Locate a provider, review your personal health record, and watch informational health videos. • Access to information—whenever, wherever – Your member website is fully mobile. Remember,

this is your one-stop shop for getting the help you need. And when you download the Aetna Health TM app, you can access it all from the palm of your hand.

Search for Aetna Health SM app in the App Store or Google Play, or scan this QR code to download the app

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MEDICAL

You have two choices in Medical Plan Coverage: • Aetna Select Plan • Aetna Choice Plan

Plans At A Glance – both plans provide: Free Preventive Care – Preventive services are covered at 100%, ensuring you receive important checkups, screenings, and immunizations without any out-of-pocket cost. This helps you stay on top of your health and catch potential issues early. Financial Protection – Annual out-of-pocket maximums provide a safeguard by capping the total amount you may pay each year. Once you reach this limit, the plan pays 100% of covered services for the remainder of the year, giving you peace of mind and financial security.

Network Access –With a wide network of doctors, specialists, and healthcare facilities, you’ll have more options when choosing where and fromwhom to receive care. This not only ofers convenience but can also lead to lower costs when you stay within the network. You do not need a referral to see any network doctor. Health Programs and Resources – A variety of programs and tools are available to support your health and wellness goals. From condition management resources and telehealth services to wellness coaching and digital apps, these oferings are designed to help you make the most of your coverage and stay healthy throughout the year.

Aetna Select Plan The Aetna Select Plan ofers a lower biweekly contribution; and with this Plan, you are also eligible for an AtlantiCare-funded Health Reimbursement Account (HRA) to help you to ofset some of your out-of-pocket costs. Wellness Credits earned in 2025 will be applied to your HRA in 2026. This plan allows for more afordable out-of-pocket costs when you receive care from Inner Circle Tier 1 or HTC Tier 2 providers.

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MEDICAL (CONT.)

Features of the Select Plan: Three-levels of providers and benefits. The Select Plan covers the same services across all three tiers noted above; however, the amount of your cost sharing will vary based on the tier designation of the provider fromwhom you receive care: 1) Inner Circle Tier 1 (AtlantiCare and its affiliates): when you receive care from an Inner Circle provider, you will have the least amount of cost-sharing and you will not be required to meet a deductible. 2) After the Inner Circle, the remaining participating doctors and hospitals are grouped into two tiers – HTC Tier 2 and Aetna Tier 3. Your out-of-pocket costs depend on which tier the doctor or hospital is in. For example: a. HTC Tier 2 : With this tier, there is more member cost- sharing required than the Inner Circle as reimbursement for covered services will be subject to a deductible of $250 for individual coverage and $500 for family coverage. b. Aetna Tier 3 : This tier includes all other Aetna In-Network providers that are neither Inner Circle nor HTC Tier 2 providers. Tier 3 also includes all Aetna providers that participate in the national Aetna network. When you use Tier 3 providers, you will have the highest amount of cost sharing. There is a deductible of $350 for individual coverage and $700 for family coverage; and the copays for covered services are the highest amongst all tiers, reaching up to $1,250 for some services.

If services are not available from Inner Circle providers, your cost sharing responsibility will be at the HTC Tier 2 or Aetna Tier 3 level of coverage. The level of cost sharing will be based on the tier status of the provider fromwhom you receive care. • The deductibles will cross-apply between all applicable tiers, meaning that the deductible amounts incurred under HTC Tier 2 will also be counted towards Aetna Tier 3 deductibles (and vice versa). For family coverage, if an individual within the family unit satisfies the individual deductible amount, the plan will pay benefits for that individual even if the family deductible is not satisfied. • There are no out-of-network benefits under the Select plan (with the exception for emergency situations). • The below chart provides a visual outline of the plan’s tiers and corresponding member cost-share.

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MEDICAL (CONT.)

Aetna Choice Plan (PPO) The Aetna Choice Plan covers the same services as the Select Plan and includes three levels of In-Network benefits as well as reimbursement for non participating (i.e. Out-of-Network) physicians and facilities. This plan is the most expensive when it comes to howmuch you contribute each pay period, but you have greater flexibility in where you can seek medical care. Wellness Credits earned in 2025 will be applied to your AtlantiCare-funded Health Reimbursement Account in 2026.

Features of theAetna Choice Plan: Four levels of providers and benefits: 1) Inner Circle Tier 1 (AtlantiCare and its affiliates) providers: No deductibles, lowest copays and and the least amount out-of-pocket costs 2) In-Network (HTC Tier 2 and Aetna Tier 3 national network): After satisfying a deductible and/or a copay, benefits are covered at 100% 3) Out-of-Network (non-participating):

Most cost sharing – covered services are reimbursed at 50% after the deductible. It is also important to note that an Out-of-Network provider may “balance bill” for any amounts in the event their charges are over what is considered over the reasonable and customary charge. Charges that are balanced billed are not counted towards the Plan’s out-of-pocket maximum limits. If services are not available at AtlantiCare, your responsibility will be at either the In-Network or Out-of-Network level of coverage. For both plans, visit https://aetnaresource.com/n/AtlantiCare-Health to find a participating physician, facility or other service provider.

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MEDICAL (CONT.)

The Plans At-A-Glance

Aetna Select Plan

Aetna Choice Plan

Has AtlantiCare Network (Inner Circle)

Has Out-of-Network Providers Has High CopaysWhen Using Non-AtlantiCare Facilities Lowest Contributions Access to Telehealth Benefit Has AtlantiCare-Funded HRA (based onWellness Activities completed in 2025)

Spouse & Partner Preferred Choice Premium AtlantiCare continuously balances the need to ofer 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 premiumwill 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 premiumwill not be applied if your spouse/partner is not ofered benefits through their employer, is not currently employed or also works at AtlantiCare.

PREMIUM SALARY $50

Less than $110,000 More than $110,000

$100

AtlantiCare will conduct audits throughout the year, during 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.

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MEDICAL (CONT.)

Medical Plan Bi-Weekly Contribution Rates

Full-Time

Part-Time

$50.01k -$110k

$110.01k - $150k

$150.01k - $200k

$200.01k +

$50.01k -$110k

$110.01k - $150k

$150.01k - $200k

$200.01k +

$0 - $50k

Aetna Select Plan Employee

$45.76 $57.20 $85.79 $102.95 $114.39 $91.51 $108.67 $160.15 $200.19 $228.79

Employee + Spouse $82.36 $102.95 $154.43 $185.32 $205.91 $164.73 $195.61 $288.27 $360.34 $411.81 Employee + Child(ren) $64.06 $80.08 $120.11 $144.14 $160.15 $128.12 $152.14 $224.21 $280.26 $320.30 Family $128.12 $160.15 $240.23 $288.27 $320.30 $256.24 $304.29 $448.42 $560.53 $640.60

Aetna Choice Plan Employee

$153.90 $180.09 $212.84 $232.48 $252.13 $203.01 $235.76 $288.15 $340.54 $392.93

Employee + Spouse $277.02 $324.17 $383.11 $418.47 $453.83 $365.43 $424.36 $518.67 $612.97 $707.27 Employee + Child(ren) $215.46 $252.13 $297.97 $325.48 $352.98 $284.22 $330.06 $403.41 $476.76 $550.10 Family $430.91 $504.26 $595.94 $650.95 $705.97 $568.44 $660.12 $806.82 $953.51 $1,100.21

*$25surchargewillbeadded toyourbi-weeklydeductions ifyouutilize tobaccoproducts.ASpouse&PartnerPreferredChoicePremiummayalsoapply.Seepage11 fordetails. **Note,salarychangesmay result inchanges toyourcontribution rate

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MEDICAL (CONT.)

Compare 2026 Medical Plan Choices

AETNA SELECT PLAN HTC (Tier 2) Standard Plus Savings

Inner Circle (Tier 1) Maximum Savings

Aetna (Tier 3) Standard Savings

Medical Services

Deductible (per person/per family)

$0/$0

$250/$500

$350/$700

Out-of-Pocket Maximum (per person/per family) Facility Benefits Room & Board / Ancillary

$3,500 / $7,000

$250 copay per admit

$750 copay per admit

$1,250 copay per admit

Outpatient Facility Benefits Outpatient Surgery (Hospital Based)

$50 copay

$400 copay

$750 copay

Outpatient Surgery (Surgical Center)

$50 copay

$400 copay

$750 copay

Physician Services Surgeon

Covered 100%

Covered 100% after deductible Covered 100% after deductible

Anesthesia

Covered 100%

Covered 100% after deductible Covered 100% after deductible

Inpatient Physician Visit

Covered 100%

Covered 100% after deductible Covered 100% after deductible

Physician Office Visits -Primary Care

$10 copay

$40 copay

$60 copay

Physician Office Visits - Specialist

$15 copay

$55 copay

$75 copay

Physician Office Visits - Routine Well Care

$0 copay

Supplemental Services Telemedicine

$5 copay

$20 copay

Urgent Care

$25 copay

$75 copay

$90 copay

Emergency Services

$200 copay

Diagnostic X-ray and Lab - Cost share for diagnostic X-Ray and Lab when performed as part of a physician office visit Outpatient X-ray and Lab - Performed in an outpatient hospital or independent lab.

Covered 100% no deductible Covered 100% no deductible Covered 100% no deductible

Covered 100% after $10 copay Covered 100% after $40 copay Covered 100% after $60 copay

Diagnostic hi-tech imaging

$10 copay

$125 copay

$150 copay

Covered 100% no deductible, copay waived

Routine Vision Exam annually

Non-Routine Vision Exams

$15 copay

$55 copay

$75 copay

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. * AtlantiCare also covers some services for gender assignment. Check the plan document for more information.

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MEDICAL (CONT.) Compare 2026 Medical Plan Choices

Aetna Choice Plan

Inner Circle (Tier 1) Maximum Savings

HTC (Tier 2) Standard Plus Savings

Aetna (Tier 3) Standard Savings

Medical Services

Out-of-Network

Deductible (per person/per family)

$0/$0

$150/$300

$350/$700

$1,000/$2,000

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

$3,500 / $7,000

$5,000/$10,000

Facility Benefits

$500 copay per admit after deductible

$1,000 copay per admit after deductible

Room & Board / Ancillary

$250 copay per admit

Covered 50% after deductible

Outpatient Facility Benefits

Outpatient Surgery (Hospital Based)

$50 copay

$300 copay

$600 copay

Covered 50% after deductible

Outpatient Surgery (Surgical Center)

$50 copay

$300 copay

$600 copay

Covered 50% after deductible

Physician Services

Surgeon

Covered 100%

Covered 100% after deductible Covered 100% after deductible Covered 50% after deductible

Anesthesia

Covered 100%

Covered 100% after deductible Covered 100% after deductible Covered 50% after deductible

Inpatient Physician Visit

Covered 100%

Covered 100% after deductible Covered 100% after deductible Covered 50% after deductible

Physician Office Visits -Primary Care

$10 copay

$30 copay

$50 copay

Covered 50% after deductible

Physician Office Visits - Specialist

$15 copay

$45 copay

$65 copay

Covered 50% after deductible

Physician Office Visits - Routine Well Care

$0 copay

Covered 50% after deductible

Supplemental Services

Telemedicine

$5 copay

$20 copay after deductible

N/A

Urgent Care

$25 copay

$75 copay

$90 copay

Covered 50% after deductible

Emergency Services

$200 copay

Covered 100% no deductible Covered 100% no deductible Covered 100% no deductible

Covered 50% after deductible

Covered 100% after $10 copay

Covered 100% after $30 copay Covered 100% after $50 copay

Covered 50% after deductible

Diagnostic hi-tech imaging

$10 copay

$100 copay

$150 copy

Covered 50% after deductible

Covered 100% no deductible, copay waived

Covered 100%, no deductible, copay waived

Routine Vision Exam annually

Non-Routine Vision Exams

$15 copay

$45 copay

$65 copay

Covered 50% after deductible

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MEDICAL (CONT.)

Make The Most Of Your Medical Benefits • Consider the Aetna Select Plan – The contributions are low cost, and unless you have many physicians who are out of network, the Aetna Select Plan’s 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 Aetna 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 wellness credits which would be applied to a Health Reimbursement Spending Account.

WAIVING BENEFITS If you waive your medical benefits, $12.50 per pay* will be deposited into a Healthcare Reimbursement Account (HRA). You can use the HRA to be reimbursed for eligible expenses. The HRA is administered by Baker Tilly. For a list of eligible expenses, log in to your account at www.MyFlexDollars.com . More information on Spending Accounts on page 38. In addition, your earned wellness credits from 2025 of up to $250 will also be deposited into this account that will be applied the following year . For more information, refer to theWellness Program portion of this book on page 21. 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.

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MEDICAL (CONT.)

Helpful Tip

What if AtlantiCare does not provide the service I require? AtlantiCare is able to provide you with enhanced benefits when you utilize our services because the dollars spent for these services stay within AtlantiCare. While AtlantiCare ofers most services, not all services are provided at the AtlantiCare Inner Circle level. If you require services outside of AtlantiCare you will still have access to these services. However, depending on the plan you choose, you will be required to pay for them at the HTC (Tier 2) or Aetna (Tier 3) benefit level. If the service can only be provided through an out-of-network provider, please contact Aetna to file an appeal prior to receiving the service. Never assume your provider is referring you to an Inner Circle provider. Please contact Aetna Customer Service Center at 1-833-313-1962 for verification of provider’s tier level or by accessing your account through Aetna’s website or downloading the Aetna Health app.

If you know that you will need services performed at a non-AtlantiCare facility, utilize your Flexible Spending Account (FSA) to help you budget for the expense and reduce your taxable income at the same time. Interested in a FSA? Enroll during your new hire enrollment period or the annual enrollment period.

Aetna connects you to care and support wherever you are!

The Aetna Health app ofers 24/7 connection to all the ins and outs of your plan. We’re always looking for ways to make things more convenient for you.

Search for Aetna Health SM app in the App Store or Google Play, or scan this QR code to download the app.

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PRESCRIPTIONDRUGCOVERAGE

Always consider using the AtlantiCare Pharmacy first, because it typically provides the least out-of-pocket cost. AtlantiCare Pharmacy (Retail and Mail Order) The AtlantiCare Pharmacy ofers 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: Atlantic City

• Regardless of which medical plan option you choose, you automatically receive prescription drug coverage 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. • Should you need a replacement ID card, please call MedImpact Customer Service at 1-833-229-3595 . • Refer to the table below for the copay amounts you will pay under the Prescription Drug plan. • The maximum amount that you will pay for prescriptions per year: Single $1,750/Family $3,500.

AtlantiCare HealthPlex, 1401 Atlantic Ave. Tel: 1-609-441-7088 Fax: 1-609-441-7089 Hours of Operation: Monday through Friday, 8:00 am to 6:00 pm Galloway* 54West Jimmie Leeds Road Tel: 1-609-404-7444 Fax: 1-609-404-7445 Hours of Operation: Monday through Friday, 8:00 am to 6:00 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

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

Copays for 30- day supply

Minimum $15 $50 N/A

15% 30% 100%

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

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

In the case of an emergency, you may use the AtlantiCare Community Pharmacy located inside the ARMC City and Mainland campuses. Hours of operation are Monday through Friday, 8:00 am to 8:00 pm, and Saturday and Sunday, 9:00 am to 6:00 pm. Please note, you may utilize these pharmacies for emergencies only. They do not carry enough supply for employees’ daily usage. *AtlantiCare pharmacy offers mail order service for all active employees and their dependents at no additional cost. Medications are delivered within 2-3 days. Please call the Galloway Pharmacy at 1-609-404-7444 to arrange for your medications to be shipped to your home.

Copays (up to 30-day supply)

Maximum $150 $150 $150

10% 20% 30%

*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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PRESCRIPTIONDRUGCOVERAGE (CONT.)

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. To find a participating pharmacy, or to see if your medication is covered, visit the MedImpact Member portal at https://www.medimpact.com/web/login . 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. • Please call the Galloway Pharmacy at 1-609-404-7444 to arrange for your medications to be shipped to your home. Specialty Medications AtlantiCare Pharmacy is your dedicated pharmacy for all specialty medications. Our AtlantiCare Pharmacy is nationally accredited Specialty Pharmacy to help ensure that we can continue to service our members for all of their specialty medication needs. If you get a prescription for a specialty medication, our dedicated team of pharmacists will: • Reach out to counsel you on proper use and storage of your specialty medication • Review your chart to ensure your medication is safe and appropriate • Communicate with your provider regarding any concerns for drug interactions, adverse events, or insurance coverage • Work closely with you to ensure that you experience optimal therapeutic outcomes If AtlantiCare Pharmacy is unable to fill your medication, they will direct you to MedImpact Customer Service for assistance in obtaining your medication at another pharmacy.

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