AtlantiCare 2022 Benefits Booklet

What’s New for 2022

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........17-22 DENTAL...............24-25 VISION.....................26 LIFECENTER..............27 LIFE INSURANCE. .....28 DISABILITY...............29 VOLUNTARY OFFERINGS. ........30-33 SPENDING ACCOUNTS. ............34 RETIREMENT BENEFITS..................35 WELLNESS. .........36-39 LEGAL NOTICES...40-42 GLOSSARY..........43-44 FAQs...................45-47 CONTACTS.........48-49 FORMS................50-56

• Adjusted Salary Bands and Contributions. Please refer to 2022 Medical Plan Biweekly Contribution Rates on page 10. • Telehealth visit copay reduced from $20 to $5 when using AtlantiCare’s Telehealth program. • Effective January 1, 2022, the medical waiver amount reduces to $12.50 per pay into your FSA/HRA account for waiving the medical benefits. You are still able to earn up to an additional $750 for completed Wellness Activities. New Voluntary Benefits Employee Purchasing Program from Purchasing Power – Get what you need now and pay over time, right from your paycheck. No credit check, down payment or hidden fees. 2022 Wellness Activity Checklist • The Wellness Activities and credit amounts have changed. Please review on page 52.

2022 Benefits Changes • Changes to Tier 2 copays and coinsurance

• Pharmacy – increased copays and coinsurance for prescriptions filled at a non-AtlantiCare pharmacy • Lower telehealth visit copay when using AtlantiCare’s Telehealth program • Changes to Out-of-Pocket Maximums • Employee Contribution Changes • Medical Waiver Changes • New Dental Carrier – Horizon Dental. Look for new ID cards to arrive via mail • Vision – reduced premium contribution rates • New Voluntary Benefit – Purchasing Power • Changes to Wellness Activity Checklist

Medical Plan Changes • Horizon Engaged Plan Tier 2 deductible increase from $2,000/$4,000 to $2,500/$5,000. Wellness Credits can reduce deductible to $500/$1,000. • Horizon Engaged Plan Tier 2 inpatient copay increases from $1,000 to $1,250. • Tier 2 High Tech imaging (ex: PET Scan, MRI, CAT Scan) increases to 30% coinsurance after deductible when services are performed at a freestanding facility or in an office. • Our prescription program will continue to afford you with low cost medications at our employee pharmacies in person or through mail order. Prescriptions filled at a non-AtlantiCare pharmacy will see an increase in copays and coinsurances. Please refer to page 14. • Changes to Out-of-Pocket Maximums – In keeping with ACA IRS limits, medical out-of-pocket maximums adjust to $6,950 for single coverage, $13,900 for family coverage.

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