AtlantiCare 2025 Benefits Booklet

LEGAL NOTICES (CONT.)

Welcome.................................... 2 What’s New?............................. 3 How to Enroll........................... 4 Medical....................................... 6 Prescription Drug.................14 FQHC.........................................16 Additional Medical Plan Resources................................17 AtlantiCare Longevity Lifestyle Program................18 Dental.......................................20 Vision.........................................22 Life Insurance........................25 Disability..................................26 Voluntary Offerings.............27 Educational Support & Career Development..........27 Financial Well-being...........28 Health &Wellness................29 Savings.....................................31 Voluntary Benefits...............32 Spending Accounts.............35 Retirement Benefits............36 Contacts...................................38 Legal Notices.........................40 Wellness Checklist...............42

Medicare Part D – Notice of Credible Coverage The Medicare Modernization Act (MMA) requires entities (whose policies include prescription drug coverage) to notify Medicare eligible policyholders whether their prescription drug coverage is creditable coverage, which means that the coverage is expected to pay on average as much as the standard Medicare prescription drug coverage. Children’s Health Insurance Program Reauthorization Act (CHIPRA) If you or your children are eligible for Medicaid or CHIP and you’re eligible for health coverage from your employer, your state may have a premium assistance program that can help pay for coverage, using funds from their Medicaid or CHIP programs. If you or your children aren’t eligible for Medicaid or CHIP, you won’t be eligible for these premium assistance programs but you may be able to buy individual insurance coverage through the Health Insurance Marketplace. Michelle’s Law Notice Michelle’s Law is a federal law that requires certain group health plans to continue eligibility for adult dependent children who are students attending a post-secondary school, where the children would otherwise cease to be considered eligible students due to a medically necessary leave of absence from school. Women’s Health and Cancer Rights Act of 1998 Under federal legislation, annual notification of this benefit is required to all members. In 1998, the federal government enacted a law that mandates certain health coverage for breast reconstructive surgery in any health program that provides medical and surgical benefits for mastectomies. This law is known as the Women’s Health and Cancer Rights Act.

You may not be discriminated against in employment because of the medical information you provide as part of participating in the wellness program, nor may you be subjected to retaliation if you choose not to participate. If you have questions or concerns regarding this notice, or about protections against discrimination and retaliation, please contact AtlantiCare Health Engagement at 1-609-677-7507 or wellness@atlanticare.org . COBRA COBRA continuation coverage is a continuation of Plan coverage when it would otherwise end because of a life event, known as a “qualifying event”later in this notice. After a qualifying event, COBRA continuation coverage must be offered to each person who is a “qualified beneficiary.”You, your spouse and your dependent children could become qualified beneficiaries if coverage under the Plan is lost because of the qualifying event. Under the Plan, qualified beneficiaries who elect COBRA continuation coverage must pay for COBRA continuation coverage. Visit mybenefitdollars.com or contact our COBRA administrator, Baker Tilly, at 1-800-307-0230 for more information. Note: When you leave the Company and are enrolled under COBRA, prescriptions can no longer be filled at an AtlantiCare Pharmacy. A Retail Pharmacy must be used. Medical Plan Required Notices

Full details of the Notices below can be found on The Starfish Human Resources – Benefits Portal or at www.dol.gov .

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