2026 AtlantiCare Benefits Booklet

LIFE INSURANCE

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

Evidence of Insurability

Company Provided Basic Life / AD&D Company provided Basic Life coverage is automatic, you do not need to enroll. Coverage is a tax-free benefit up to $50,000. If your coverage exceeds $50,000, the IRS considers this amount taxable as “imputed income”. This does not represent a deduction from you pay but will be reported as taxable income on your annual W-2. Imputed Income will appear on you pay stub under the heading“Group Term Life”. This coverage is age- based. Coverage will reduce at age 70 to 50% on the first day of the month following your 70th birthday. Company Provided Life insurance coverage is automatic —no action is needed. This benefit is tax-free up to $50,000. If your coverage exceeds $50,000, the IRS considers the amount over that limit as taxable imputed income. This isn’t a payroll deduction but will appear as taxable income on your W-2 and show on your pay stub under “Group Term Life.” Coverage is age-based and will reduce to 50% on the first day of the month after your 70th birthday.

*The terms, conditions, limitations, and exclusions of coverage are set forth in the group policy (“Policy”) between the Company and the Insurer. In the event of any conflict between this Handbook (or any Summary Plan Description) and the Policy, the Policy shall govern. As a new hire, you may elect up to 1x your annual salary (maximum $350,000). Higher amounts require a Medical Statement of Health. If already enrolled, you may increase your coverage by one level (up to $350,000). Increases beyond this limit also require a Medical Statement of Health. Note: If you were previously denied coverage, you are not eligible for this offer. Supplemental Life – Teammember 1X – 8X times your basic annual salary up to a maximum of $1,500,000 Supplemental Life – Spouse $10,000 up to up to $100,000 in $10,000 increments Coverage will reduce at age 70 to 50% on the first day of the month following 70th birthday. Supplemental Life – Child(ren) $5,000 or $10,000 You can retrieve the Statement of Health / Evidence of Insurability form through the Forms & Plan Documents tile on myADP.com . You will have 60 days to complete and submit the document. Your additional coverage amount must be approved by the carrier prior to taking effect. You will not see a payroll deduction for the additional amount until coverage is approved. Supplemental Life You can purchase Life and AD&D insurance for yourself, your spouse, and your children.

Basic Life Insurance ~1.5 times base pay Basic AD&D Insurance ~1.5 times base pay

Company provided Basic AD&D coverage is automatic, you do not need to enroll. Coverage is a tax-free benefit up to $50,000. If your coverage exceeds $50,000, the IRS considers this amount taxable as “imputed income”. This does not represent a deduction from you pay but will be reported as taxable income on your annual W-2. Imputed Income will appear on you pay stub under the heading“Group Term Life”. This coverage is age- based. Coverage will reduce at age 70 to 50% on the first day of the month following your 70th birthday.

Don’t Forget to Name a Beneficiary Designate a beneficiary. Your beneficiary is the person(s) who will receive your life insurance benefits payment upon your death. Designate, update or view your beneficiary at myadp.com under Benefits – Manage Information.

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