Benefits GuideApril 1, 2020 - March 31, 2021

Welcome to Your 2020–2021 Benefits

About this guideThis benefits guide provides the information you need for enrollment and is designed to provide an overview of the plans offered by Signature Consultants. Please read this guide carefully, and keep it someplace convenient for future reference.

In case of conflict between the information in this guide and the actual plan documents and insurance contracts, the plan documents and insurance contracts will govern.

What’s Inside

Welcome to Your 2020-2021 Benefits 3

Eligibility Rules 3

Enrolling in Your Benefits 4

Medical & Pharmacy Coverage 5-7

Spending Accounts 8

Health Savings Account 9

Supplemental Health Plans 10

Dental Coverage 1 1

Vision Coverage 12

Life, AD&D and Disability Coverage 13

Legal, EAP and Identity Theft Protection 14

Pet Insurance 15-16

Benefits at No Cost 17

401k Program 18

Contact Information 19

Annual Compliance Notices 20-32

If you (and/or your dependents) have Medicare or will become eligible for Medicare in the next 12 months, a Federal law gives you more choices about your prescription drug coverage. Please see Annual Compliance Notice for more details.

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Signature Consultants’ Eligibility Rules

You will be eligible for benefits the first day of the month following/coinciding with 30 days of employment. New hires can begin the benefit enrollment process during the enrollment period listed in the table below. The new hire date is defined by the first day that you start your position.

Eligibility Calendar for New Hires

Start Date Enrollment Period Benefits Effective Date

First Paycheck for Deductions

November 3 thru December 3, 2019 11/17/2019 – 12/15/2019 1/1/2020 1/10/2020

December 4 thru January 3, 2020 12/18/2019 – 1/15/2020 2/1/2020 2/7/2020

January 4 thru January 31, 2020 1/16/2020 – 2/15/2020 3/1/2020 3/13/2020

February 1 thru March 2, 2020 2/16/2020 – 3/15/2020 4/1/2020 4/9/2020

March 3 thru April 1, 2020 3/17/2020 – 4/15/2020 5/1/2020 5/8/2020

April 2 thru May 2, 2020 4/17/2020 – 5/15/2020 6/1/2020 6/12/2020

May 4 thru June 1, 2020 5/17/2020 – 6/15/2020 7/1/2020 7/10/2020

June 2 thru July 2, 2020 6/17/2020 – 7/15/2020 8/1/2020 8/7/2020

July 4 thru August 2, 2020 7/18/2020 – 8/15/2020 9/1/2020 9/11/2020

August 3 thru September 1, 2020 8/17/2020 – 9/15/2020 10/1/2020 10/9/2020

September 2 thru October 2, 2020 9/17/2020 – 10/15/2020 11/1/2020 11/13/2020

October 3 thru November 1, 2020 10/17/2020 – 11/15/2020 12/1/2020 12/11/2020

November 2 thru December 2, 2020 11/17/2020 – 12/15/2020 1/1/2021 1/8/2021

December 3 thru January 2, 2021 12/18/2020 – 1/15/2021 2/1/2021 2/12/2021

January 2 thru January 30, 2021 1/15/2021 – 2/15/2021 3/1/2021 3/12/2021

February 1* thru March 2, 2021 2/15/2021 – 3/15/2021 4/1/2021 4/9/2021

You can enroll in 401(k) through www.wellsfargo.com or call 800-728-3123 at any time after receipt of first paycheck.

Please note that if your start date is pushed to a future date, this may affect your benefit effective date.

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Enrolling in Your Benefits

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If you need your username and/or password reset for www.paycom.com, email paycom@sigconsult.com.

Enrolling in benefits is simple through the Paycom Employee Self-Service feature.

• Go to www.Paycom.com and select “Employee” from the Login drop-down.

• After logging into Employee Self-Service, you will have an option under the “MyBenefits” section. Click “2020 Benefits Enrollment” to be taken through the enrollmentprocess.

• In order for your benefits to become effective, you must “ENROLL” and click the“FINALIZE” button in www.paycom.com located on the lower right hand side of theenrollment screen.

Benefit elections are for the entire 2020-2021 Plan Year. Participants will not be allowed to change elections until the next Open Enrollment period unless they have a change in life status. If there is a change in life status also referred to as a qualified life event, the Benefits Department must be notified within 30 days of the event. For information on qualifying events please contact the Benefits Hotline at 844-393-1020.

Medical & Pharmacy Coverage

Signature Consultants offers three medical plans: $1,000 Deductible, $2,000 Deductible (HSA Compatible) and $3,000 Deductible (HSA Compatible). All three medical plans are PPO plans using the BlueCard PPO nationwide network.

Medical In-Network $1,000 Deductible $2,000 Deductible $3,000 Deductible

HSA Compatible? No Yes Yes

Plan Year Deductible(Single/Family)

$1,000 / $2,000(no member in a family

pays more than the individual deductible)

$2,000 / $4,000(family deductible must be

satisfied before benefit starts for any member)

$3,000 / $6,000(no member in a family

pays more than the individual deductible)

Plan Year Out-of-Pocket (OOP) Maximum (Single/Family)

$3,500 / $7,000(no member in a family

pays more than the individual OOP)

$4,000 / $7,900(family OOP maximum must

be satisfied before any member is covered at 100%)

$6,000 / $12,000(no member in a family

pays more than the individual OOP)

Coinsurance (You Pay) 20% 25% 30%

Preventive Care No Cost No Cost No Cost

Office Services(PCP/Specialist) $30 / $50 Deductible & Coinsurance Deductible & Coinsurance

HospitalInpatient and Outpatient Deductible & Coinsurance Deductible & Coinsurance Deductible & Coinsurance

Emergency Room$350 (waived if admitted)

Ded & Coinsurance for Emergency Professionals

Deductible & Coinsurance Deductible & Coinsurance

Ambulance Deductible & Coinsurance Deductible & Coinsurance Deductible & Coinsurance

Urgent Care $50 Deductible & Coinsurance Deductible & Coinsurance

Diagnostic Test(X-Ray and Bloodwork) Deductible & Coinsurance Deductible & Coinsurance Deductible & Coinsurance

Diagnostic Complex Imaging (CT/PET Scans/

MRIs/MRA) precertification required

Deductible & Coinsurance Deductible & Coinsurance Deductible & Coinsurance

Retail Rx (30-day supply)Generic/ Brand/

Non-Formulary/Specialty

30% (min $10, max $20) 30% (min $25, max $50) 45% (min $40, max $80)

Deductible & Coinsurance Deductible & Coinsurance

Retail Rx (90-day supply) Generic/Brand/Non Formulary/Specialty

30% (min $30, max $60) 30% (min $75, max $150) 45% (min $120, max $240)

Deductible & Coinsurance Deductible & Coinsurance

Mail-Order Rx (90-day supply) Generic/Brand/Non Formulary/Specialty

30% (min $25, max $50) 30% (min $62.50, max 125) 45% (min $100, max $200)

Deductible & Coinsurance Deductible & Coinsurance

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Getting the most from your medical coverage & pharmacy coverage

Your health, your call. We’ll connect you with the solutions you need.When you are enrolled in the BCBS medical plans, you are automatically connected with Personal Care Connection (PCC). Sorting through health care issues can be complicated—especially when you’re dealing with a difficult illness. You want to feel sure that you’re making the right decisions. And you need to understand your insurance benefits.

We can help! Through our Personal Care Connection program, you can talk with a specially trained nurse or other professional who can help you make full use of your company benefits. It’s free and confidential and you can face your decisions with confidence.

Register for MyHealthToolkitFL

• Go to MyhealthtoolkitFL.com• Click the register now button on the right-hand side of the page

• Enter the Member ID located on your membership card (if you don’t have yourinsurance card, enter the Social Security number for the subscriber of the healthplan and your date of birth)

• Follow instructions to complete profile

Want to contact Personal Care Connection? Just call the dedicated customer service line at 833-466-0184.

One of our Personal Care Connection nurses may also reach out to you by phone.See if we can help!

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My Health Toolkit Mobile Website

The My Health Toolkit mobile website offers on-the-go members a myriad of features designed for smaller smartphone screens. When you want to access the mobile site, simply navigate to MyHealthToolkitFL.com on your smartphone and:

• Find the nearest doctor, urgent-care centeror hospital with a GPS-enabled locator

• Access claims and benefit information

To use the mobile site, you must create a My Health Toolkit profile using your computer. If you already have a profile created, you can begin using the mobile site now by scanning this code with your smartphone to be taken to My Health Toolkit mobile.

• View your financial account information

• View your ID card information

Teladoc

If you are enrolled in the Signature Consultants medical program through BCBS, you have a valuable service at your fingertips! We have partnered with Teladoc connecting with a doctor within minutes. Whenever you don’t feel well, you can receive convenient, quality care from a variety of licensed healthcare professionals.

1. Request. Request a visit with a doctor 24 hours a day, 365 days a year, by web, phone, ormobile app with our nationwide network.

2. Visit. Talk to the doctor. Take as much time as you need…there’s no limit!

3. Resolve. If medically necessary, a prescription will be sent to the pharmacy of your choice.

4. Feel Better. It’s that easy!

• Cold and flu

• Allergies

• Pink eye

• Respiratory infections

• Sore throat

• Sinus problems

• Bronchitis

• Dermatologist

• Therapist

Set Up Your Account Today!

It’s quick and easy to register your Teladoc account. If you have dependents younger than 18, you can register them under your account. Adult dependents ages 18 through 26 are also eligible, but must register their own account.

Need a doctor? Think of Teladoc first!

855-Teladoc or www.Teladoc.com

Seek medical care 24/7 from the comfort of your own home!

See and talk to a doctor from your mobile device or computer.

How much do I pay for my service?

Providers $1,000 Plan

$45

$50

$50

$50

$2,000/$3,000 Plans

PCPDeductible and coinsurance apply with a

$45 maximum per service.

DermatologyDeductible and coinsurance apply with a

$75 maximum per service.

Initial and ongoing PsychiatristDeductible & coinsurance apply with a

$200 maximum per service and ongoing to $95.

Psychologist, LicensedDeductible & coinsurance apply with a

$85 maximum per service.

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Spending Accounts

Your Flexible Spending Account (FSA) and Commuter benefits are administered through Discovery Benefits.

Healthcare FSA

Combination FSA

Dependent Care FSA Parking Transit

Taxation Contribute Funds Tax Free

Maximum Contribution

$2,750 plan year maximum

$2,750 plan year maximum

$5,000 calendar year maximum

$270/month (tax free)$3,240/year

$270/month (tax free)$3,240/year*

Type of expenses you can pay for with account funds

Eligible medical, dental and vision

Eligible dental and vision (medical after you have incurred $1,400 single or$2,800 family in medical expenses)

Dependent care for children up to age 13, a disabled dependent of any age or a disabled spouse (that allows you and your spouse to work)

Parking at or near regular place of employment

Transit passes

Using Your Funds For easy access to your FSA funds, you can swipe your Discovery Benefits debit card and avoid out-of-pocket costs. If you use your card at a provider with an Inventory Information Approval System (IIAS), the expense will automatically be approved at the point of sale. If the card is swiped at a merchant that meets the IRS’ 90% rule, you may need to provide documentation to show the expense is eligible.

• Signature Consultants takes every effort to automate the claim receipt process. However,there may be instances when you are required to substantiate purchases made with theDiscovery Benefits debit card so save your receipts! Active employees have 90 days fromthe end of the plan year to file claims incurred during the plan year. Terminatedemployees have 90 days from termination date to file claims incurred during thecoverage period.

• Remember, you may only use the debit card for expenses incurred in the current PlanYear and not for expenses incurred in the prior Plan Year.

• For a complete list of eligible expenses, visit www.irs.gov and see Publication 502.

Mobile App discoverybenefits.com

• Free and Secure

• Check Balances

• File Claims

• View Transactions

• Image Capture

• Text alerts are also available

* I f you are a Massachusetts resident, the maximum you can contribute for transit is $1,680 annually or $140monthly for state tax purposes. It is your responsibility to ensure contributions do not exceed the monthly/annual maximums.

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Health Savings Account (HSA)

What is a Health Savings Account (HSA)?An HSA is a tax favored account used in conjunction with an HSA-compatible health plan. The funds in the account are used to pay for IRS-qualified medical, dental, and vision expenses.

What are the advantages of an HSA?HSA funds roll over year-to-year, there are tax benefits on contributions, earnings and distributions, and long-term investment opportunities are available. The account is yours to keep, so if you switch jobs, the account goes with you!

Who can get an HSA?Any eligible individual that:

• Is enrolled in the $2,000 or $3,000 deductible plans

• Is not covered by other health insurance (except certain types of limited coverage)

• Is not enrolled in Medicare

• Is not claimed as a dependent on someone else’s tax return

• Children cannot establish an HSA

• Eligible spouses can establish their own HSA

• Please contact your tax advisor if you are unsure of your eligibility for an HSA

2020 maximum contributions:• $3,550 for single

• $7,100 for family

• I f you are age 55 or older, you can make an additional “catch up” contribution of $1,000

Using your HSAYou can use the money in your HSA to pay for any “qualified medical expenses” permitted under federal tax laws for you, your spouse or your dependent children. You can pay for expenses of your spouse and dependent children even if they are not covered by the HSA plan such as: medical, prescription drugs, dental and vision services, costs for COBRA continuation premiums, or Medicare premiums.

Can be paired with a Combination Flexible Spending Account (FSA).Combine the HSA with the Combination FSA account for additional tax savings. Eligible dental and vision expenses can be paid for with Combination FSA funds from the first day of the Plan Year. Once you have incurred $1,400 single or $2,800 family in out-of-pocket medical expenses, you can also use your account to pay for eligible medical expenses for the remainder of the Plan Year. Deductible Verification form must be submitted to Discovery Benefits.

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Supplemental Health Plans

Signature Consultants offers you the ability to purchase accident, hospital indemnity and critical illness plans through Reliance Standard. These plans pay cash benefits directly to you and are entirely separate from your medical benefits.

• Benefits can be used to help pay for out-of-pocket medical expenses, to pay ongoing billsor in anyway you want.

• All plans are guaranteed issue coverage, HSA compatible and portable to age 70.

• Accident and Critical Illness plans also include a $50 wellness health screening benefitpayable to you for going for eligible preventive services.

Accident insuranceprovides cash benefits in cases of accidental injuries both on and off the job.

Benefit Amount

Low High

Emergency Treatment $200 $250

Initial Treatment at Physician Office $75 $100

Hospital Admission (once/covered accident) $1,000 $1,500

Hospital Confinement (per day) $250, 365 days max $350, 365 days max

Surgery (benefit depends on injury) Up to $1,500 Up to $2,000

Fractures (benefit depends on injury) Up to $7,500 Up to $10,000

Dislocations (benefit depends on injury) Up to $4,800 Up to $6,400

Burns – Third degree Up to $12,800 Up to $25,600

Critical IllnessPays for a lump-sum payment for

certain illnesses

Low High

Benefit Amount

$15,000 $30,000

Spouse limited to 50% of employee amount, dependent child limited to 25% of employee amount

Life Threatening Cancer, Heart Attack, Stroke, Kidney (Renal) Failure, Major Organ Transplant

100% 100%

Coronary Artery Bypass or Cancer in Situ

25% 25%

Hospital Indemnityhelps pay the out-of-pocket costs

associated with a hospital stay.

Low High

Hospital Admission $1,000 $2,000

Hospital Confinement $100 per day $200 per day

ICU Confinement $100 per day $200 per day

Refer to the full plan certificates on www.Paycom.com for a full list of benefits.

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Dental Coverage

Accessing Your Coverage Online at www.deltadentalins.com/enrollees

• Register or log in• See benefits, eligibility, deductibles and maximums, check

claims, view or print an ID card• Find a dentist• Dental Plan Support Guide• SmileWay® Wellness site

Go Mobile – Enter www.deltadentalins.com on yoursmartphone’s browser and click the “visit mobile” button

• Find a dentist• View your electronic ID card• Check deductibles and maximums• See your benefits and eligibility• Check claims

Download the mobile app – Search for “Delta Dental” onthe App Store or Google Play and download the free app titled Delta Dental by Delta Dental Plans Association.

• Get a cost estimate• Find a dentist• Check claims• See your benefits, eligibility, deductibles and maximums• Use a musical timer to brush for 2 minutes

In-Network Dental Plans Summary

Enhanced with Orthodontia Standard Basic

Amounts You Pay

Plan Year Deductible (Single/Family) $50 / $150 $50 / $150 $50 / $150

Preventive Services No charge, deductible waived

No charge, deductible waived 10%, deductible waived

Basic Services 20% after deductible 20% after deductible 30% after deductible

Major Services 50% after deductible 50% after deductible Not Covered

Orthodontia Services (children to age 19) 50% after deductible Not Covered Not Covered

Amounts Delta Dental Pays

Plan Year Annual Maximum Benefit (per person) $2,000 $1,500 $750

Orthodontia Lifetime Maximum (per person)

$1,500 Not Covered Not Covered

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Vision Coverage

Signature Consultants’ vision plan provides coverage both in-network (Select Network) and out-of-network. Significant out of pocket savings are available with your plan by utilizing an EyeMed network provider.

Vision Plan Highlights

Benefit Frequency

Examination Once in a 12 month period

Lenses or Contact Lenses Once in a 12 month period

Frames Once in a 12 month period

Benefit Amount You Pay (In-Network)

Amount Eyemed Reimburses You (Out-of-Network)

Comprehensive eye examination $10 copay Up to $21

Single vision lenses $10 copay Up to $18

Bifocal lenses $10 copay Up to $32

Trifocal lenses $10 copay Up to $56

Standard progressive lenses $10 copay Up to $77

Standard contact lens fit and follow-up Up to $40 copay Not covered

Annual Allowances Paid by Eyemed

Amount Eyemed Pays (In-Network)

Amount Eyemed Reimburses You (Out-of-Network)

Frames $175 allowance; You must pay any balance over $175, discounted by 20% Up to $88

Conventional contact lenses (in lieu of lenses)

$175 allowance; You must pay any balance over $175, discounted by 15% Up to $140

Disposable contact lenses (in lieu of lenses)

$175 allowance; You must pay any balance over $175 Up to $140

Medically Necessary Paid in full Up to $210

Download the EyeMed Members App. It’s the easy way to view your ID card, see benefit details, and find a provider near you.

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Life, Accidental Death & Dismemberment Insurance

Basic Life and Accidental Death & Dismemberment

Signature Consultants provides $10,000 of basic life and accidental death and dismemberment (AD&D) insurance, at no cost to you, through Cigna when you are enrolled in a Signature Consultants medical plan. Please make sure you designate a beneficiary for basic life and AD&D to receive benefits in the event of a claim.

Voluntary Life InsuranceYou have the option to purchase voluntary life insurance coverage through Cigna.

The chart below provides an overview of the plans.

Voluntary Employee Life Increments of $10,000 to a maximum of 5x salary up to $500,000 Guaranteed Issue amount (GI): $150,000 (only new hire)*Evidence of Insurability form required.

Voluntary Spouse LifeIncrements of $5,000 up to $250,000, not to exceed 100% of Voluntary Employee Life amount. Guaranteed Issue amount (GI): $40,000 (only new hire)*Evidence of Insurability form required.

Voluntary Child Life Children 6 months to age 19 (26 if full-time student): $10,000 Children less than 6 months: $500

*Evidence of InsurabilityForm (EOI)

*An evidence of insurability (EOI) form may be required.- If you are in your new hire enrollment period and wish to apply over the GI.- If you are not in your new hire period and you wish to apply for any amount.

Voluntary Short-Term Disability (STD)

Guaranteed Issue if you are a new hire.

All others require an Evidence of Insurability Form (EOI)

STD pays you a weekly benefit up to 11-weeks after satisfying a 14-day elimination period if you are unable to work due to illness or injury. The allowed benefit is 60% of weekly earnings, based on the greater of employee’s base salary or prior year total earnings, subject to a maximum weekly benefit amount.

NOTE: The following states have Statutory Disability Insurance: CA, HI, NJ, NY, PR, RI. Therefore, if you elect Signature Consultants’ disability policy, the benefits will be offset by the state plan. Please check your state website for further details on waiting period and coverage.

Voluntary Long-Term Disability (LTD)

You will receive a benefit of 60% of your monthly salary to a maximum of $12,500 per month. You will continue to receive the LTD benefit until the day your disability ceases or to your Social Security Normal Retirement Age. LTD plan picks begins after you have been disabled for a continuous 90-day period.

Life, AD&D and Disability Insurance

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Guaranteed Issue if you are a new hire.

All others require an EOI.

Legal & Identity Theft Protection

Legal Insurance – Have your own attorney on retainer for less than the cost of a cup of coffee a day!

With MetLaw, you, your spouse and dependents can receive fully covered legal services for a wide range of personal legal matters. Because no matter how old you are, you have legal needs, such as: divorce, traffic tickets, buying or selling a home, bankruptcy, wills, probate, DUI, immigration, credit report issues, child support, custody and visitation, garnishments, loan modifications, foreclosures, criminal defense, litigation, small claims court, personal injury, landlord-tenant disputes, domestic violence and more.

Simply give MetLaw a call or log into the member site to view your plan coverage and find attorneys. As long as you use a Network Attorney for a covered matter there are no deductibles, no copayments, no waiting periods, no claim forms and no limits on usage.

• Telephone and office consultations

• Estate planning documents

• Document review

• Family, juvenile and elder law

• Real estate matters

• Document preparation

• Financial matters

• Identity theft matters

• Defense of civil lawsuits

• Immigration assistance

• Consumer protection

• Personal property protection

*Note, once you enroll, you must remain in the Plan for the entire Plan year.

Protect your privacy, identity, and finances with PrivacyArmor® Plus.

• Identity and credit monitoring

• Tri-bureau credit alerts

• Unlimited credit reports from TransUnion

• Dark web monitoring

• Financial transaction monitoring

• Social media reputation monitoring

• Accounts secured with two-factorauthentication

• 24/7 Privacy Advocate remediation

• $1 million identity theft insurance policy

• 401(k) and HSA stolen fundreimbursement

• Tax fraud refund advances

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90% reimbursement

$212reimbursement

You pay: $43Nationwide pays: $381

You pay: $128Nationwide pays: $296

You pay: $212Nationwide pays: $212

70% reimbursement

50% reimbursement

Examples reflect reimbursement after $250 annual deductible has been fulfilled.

$381reimbursement

$296reimbursement

My Pet Protection from Nationwide

Our popular My Pet Protection pet insurance plans now feature morechoices and more flexibility

Problems such as upset stomach are among the most common reasons dogs and cats goto the vet. The average cost for this kind of visit is $424. Here’s how My Pet Protectionwould cover the bill.*

• Get cash backChoose from three levels of reimbursement:90%, 70% or 50%*

• Available exclusively for employeesThese plans aren’t available to the general public

• Same price for pets of all agesYour rate won’t go up because your pet hada birthday

• Use any vet, anywhereNo networks, no pre-approvals

• Optional wellness coverage availableIncludes spay/neuter, dental cleaning,exams, vaccinations and more

Choose the reimbursement level that fits your needs

• Unlimited, 24/7 access toa veterinary professional($150 value). *

Get more—enjoy these extras when you protect your pet with aNationwide pet insurance policy

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• Discounts on hand-pickedpet products and services.

• Fast, convenient electronicclaim payments.

• Mobile claims submissionwith the free VitusVet app.

• Access to our award-winningmagazine, The Companion.

• Multiple-pet discountsavailable.†

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*Some exclusions may apply. Certain coverages may be subject to pre-existing exclusion. See policy documents for a complete list of exclusions. Reimbursement options may not be available in all states. †Pet owners receive a 5% multiple-pet discount by insuring two to three pets or a 10% discount on each policy for four or more pets.

Insurance terms, definitions and explanations are intended for informational purposes only and do not in any way replace or modify the definitions and information contained in individual insurance contracts, policies or declaration pages, which are controlling. Such terms and availability may vary by state and exclusions may apply. Underwritten by Veterinary Pet Insurance Company (CA), Columbus, OH, an AM Best A+ rated company (2018); National Casualty Company (all other states), Columbus, OH, an AM Best A+ rated company (2018). Agency of Record: DVM Insurance Agency. Nationwide, the Nationwide N and Eagle, and Nationwide is on your side are service marks of Nationwide Mutual Insurance Company. ©2019 Nationwide. 19GRP5915

19GRMPP907050

1. Visit any vet, anywhere. 3. Get reimbursed.2. Submit claim.

My Pet Protection from Nationwide

Both plans feature a $250 annual deductible and have a maximum annual benefit of $7,500.

Pre-existing conditions are not covered. Any illness or injury a pet had prior to start of policy will beconsidered pre-existing.*

Choose the level of coverage that fits your needs

How to use your pet insurance plan

Get 90%, 70% or 50% reimbursement on these vet bills and more.*

Accidents, including poisonings and allergic reactions

Injuries, including cuts, sprains and broken bones

Common illnesses, including ear infections, vomitingand diarrhea

Serious/chronic illnesses, including cancer anddiabetes

Hereditary and congenital conditions

Surgeries and hospitalization

X-rays, MRIs and CT scans

Prescription medications and therapeutic diets

Wellness exams

Vaccinations

Spay/neuter

Flea and tick prevention

Heartworm testing and prevention

Routine blood tests

Benefits at No Cost

Employee Assistance Program (EAP) All employees and family members are covered at no cost.Your EAP can help you find solutions for the everyday challenges of work and home, as well as for more serious issues involving emotional and physical well-being. This program can assist with:

• Childcare and/or eldercare referrals

• Personal relationship information and counseling

• Health management support and referrals

• Financial planning assistance

• Stress management

Help is easy to access:

Telephone consultation: Speak confidentially with a master’s level consultant to clarify your need, evaluate options, and create an action plan.

Face-to-face consultations: You and each of your dependents can consult with a local counselor up to five times per issue for short-term problem resolution.

Online resources: Access interactive tools, articles and free materials online.

PerkSpot Online Discount Mall—Free to all Signature employees!

Create your account: Get started by creating your account at: www.sigconsult.perskspot.com

Choose your perks: From travel to electronics, choose from over 25 different categories of perks!

Subscribe to weekly perks: Subscribe to weekly emails to make sure you never miss a deal!

Explore the local map: Find deals in your neighborhood with the local map!

Save on thousands of your favorite brands.

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401(k) Plan Highlights

2020 IRS contribution dollar limits: $19,500 annually, $6,500 additional annual catch up contribution if you are age 50+

Access Signature Consultants’ 401(k) plan through Wells Fargo Institutional Retirement Trust at www.wellsfargo.com.

From the comfort of home or virtually anywhere, day or night, you can access your retirement account online at www.wellsfargo.com or by calling Participant Services at (800) 728-3123. You may also text “Retirement” to 93557 to enroll.

Once you sign up, you can use the website to do everything from calculating how much you may need in retirement to choosing how much you want to save and how to invest it.

Registering on the Wells Fargo site. First time user?

To get started, follow these simple steps:

1. Choose Sign Up at the top of the page.

2. Answer a short series of questions; be sure to check the box indicating you don’t have anaccount number.

3. Click the name of your retirement plan account.

4. Select your ePreferences.

Have other Wells Fargo accounts? Sign on using your existing username and password, then select the name of your retirement plan.

Don’t automatically see your retirement plan account in your account summary? Once you’ve signed on, visit the Account Services tab, then under Account Information, select Add Accounts. Your retirement account should be available to add.

Managing your account online. Once you are enrolled in Signature Consultants’ retirement plan, managing and updating your account online is simple. Some of the things you can do online include:

• Check your balance

• Change your contribution rate

•

Choose investments•

View your account transaction history•

Update your beneficiaries

CALL: 800-SAVE-123 (800-728-3123). The Retirement Service Center offers 24-hour automated account access. Representatives are also available Monday through Friday from 7:00 am to 11:00 pm Eastern Time. You’ll need your Social Security number (SSN) and your personal identification number (PIN), which is initially the last four digits of your SSN.

You’ll be required to change your PIN the first time you call.

Managing your account by phone. Accessing, managing, and updating your account over the phone is simple. Some of the things you can do over the phone include:

• Enroll in your plan

• Get a free retirement consultation

• Increase your contribution rate

• Choose investments18

Insurance Contact Information

Benefit Provider Phone Number Website or Email

Signature Employee Benefits Benefits Hotline 844-393-1020 benefits@sigconsult.com

Medical and Personal Care Connection

Blue Cross Blue Shield 833-466-0184 www.myhealthtoolkitfl.com

Prescription DrugsSpecialty Pharmacy

OptumRx

BriovaRx

855-811-2218

877-259-9428

www.optumrx.com

www.briovarx.com

Teladoc (phone or video physician care)

Teladoc 866-789-8155 www.teladoc.com

Spending and Savings Accounts (FSA/HSA/Parking/Transit)

Discovery Benefits 866-451-3399 www.discoverybenefits.com

Supplemental Health(accident, critical illness, hospital indemnity)

Reliance Standard 800-351-7500 www.reliancestandard.com

Dental Delta Dental 800-521-2651 www.deltadentalins.com

Vision EyeMed 866-723-0513 www.eyemed.com

Life, AD&D and Disability Cigna

Life/Accident Claims: 800-238-2125

Disability:800-362-4462

www.Cigna.com/customer-forms

Legal Hyatt Legal 800-821-6400 www.info.legalplans.com Access code GetLaw

Employee Assistance Program Magellan 800-327-6764 www.magellanhealth.com/member

Identity Theft Protection InfoArmor 800-789-2720 www.myprivacyarmor.com

Pet Insurance Nationwide 877-738-7874 www.petinsurance.com/sigconsult

Online Discount Mall Perkspot www.Sigconsult.perskspot.com

401(k) Wells Fargo 800-728-3123 www.wellsfargo.com

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Annual Compliance Notice

Important Notice to Employees from Signature About Creditable Prescription Drug Coverage and Medicare

The purpose of this notice is to advise you that the prescription drug coverage listed below under the Signature medical plan are expected to pay out, on average, at least as much as the standard Medicare prescription drug coverage will pay in 2020. This is known as “creditable coverage.”

Why this is important. If you or your covered dependent(s) are enrolled in any prescription drug coverage during 2020 listed in this notice and are or become covered by Medicare, you may decide to enroll in a Medicare prescription drug plan later and not be subject to a late enrollment penalty—as long as you had creditable coverage within 63 days of your Medicare prescription drug plan enrollment. You should keep this notice with your important records.

If you or your family members aren’t currently covered by Medicare and won’t become covered by Medicare in the next 12 months, this notice doesn’t apply to you.

Please read the notice below carefully. It has information about prescription drug coverage with Signature and prescription drug coverage available for people with Medicare. It also tells you where to find more information to help you make decisions about your prescription drug coverage.

Notice of Creditable CoverageYou may have heard about Medicare’s prescription drug coverage (called Part D), and wondered how it would affect you. Prescription drug coverage is available to everyone with Medicare through Medicare prescription drug plans. All Medicare prescription drug plans provide at least a standard level of coverage set by Medicare. Some plans also offer more coverage for a higher monthly premium. Individuals can enroll in a Medicare prescription drug plan when they first become eligible, and each year from October 15 through December 7. Individuals leaving employer/union coverage may be eligible for a Medicare Special Enrollment Period.

If you are covered by one of the Signature prescription drug plans listed, you’ll be interested to know that the prescription drug coverage under the plans is, on average, at least as good as standard Medicare prescription drug coverage for 2020. This is called creditable coverage. Coverage under one of these plans will help you avoid a late Part D enrollment penalty if you are or become eligible for Medicare and later decide to enroll in a Medicare prescription drug plan.

$1,000 Deductible $2,000 Deductible $3,000 Deductible

If you decide to enroll in a Medicare prescription drug plan and you are an active employee or family member of an active employee, you may also continue your employer coverage. In this case, the Signature plan will continue to pay primary or secondary as it had before you enrolled in a Medicare prescription drug plan. If you waive or drop Signature coverage, Medicare will be your only payer. You can re-enroll in the employer plan at annual enrollment or if you have a special enrollment event for the Signature plan, assuming you remain eligible.

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Annual Compliance Notice

Important Notice to Employees from Signature About Creditable Prescription Drug Coverage and Medicare

You should know that if you waive or leave coverage with Signature and you go 63 days or longer without creditable prescription drug coverage (once your applicable Medicare enrollment period ends), your monthly Part D premium will go up at least 1% per month for every month that you did not have creditable coverage. For example, if you go 19 months without coverage, your Medicare prescription drug plan premium will always be at least 19% higher than what most other people pay. You’ll have to pay this higher premium as long as you have Medicare prescription drug coverage. In addition, you may have to wait until the following October to enroll in Part D.

You may receive this notice at other times in the future—such as before the next period you can enroll in Medicare prescription drug coverage, if this Signature coverage changes, or upon your request.

For more information about your options under Medicare prescription drug coverageMore detailed information about Medicare plans that offer prescription drug coverage is in the Medicare & You handbook. Medicare participants will get a copy of the handbook in the mail every year from Medicare. You may also be contacted directly by Medicare prescription drug plans. Here’s how to get more information about Medicare prescription drug plans:

• Visit www.medicare.gov for personalized help.

• Call your State Health Insurance Assistance Program(see a copy of the Medicare & You handbook for the telephone number).

• Call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048.

For people with limited income and resources, extra help paying for a Medicare prescription drug plan is available. Information about this extra help is available from the Social Security Administration (SSA). For more information about this extra help, visit SSA online at www.socialsecurity.gov or call 1-800-772-1213 (TTY 1-800-325-0778).

Remember: Keep this notice. If you enroll in a Medicare prescription drug plan after your applicable Medicare enrollment period ends, you may need to provide a copy of this notice when you join a Part D plan to show that you are not required to pay a higher Part D premium amount.

For more information about this notice or your prescription drug coverage, contact your Benefits Department.

21

Annual Compliance Notice

Notice of Special Enrollment Rights for Health Plan Coverage

As you know, if you have declined enrollment in Signature Consultants’ medical plan for you or your dependents (including your spouse) because of other health insurance coverage, you or your dependents may be able to enroll in some coverages under this plan without waiting for the next Open Enrollment period, provided that you request enrollment within 30 days after your other coverage ends. In addition, if you have a new dependent as a result of marriage, birth, adoption or placement for adoption, you may be able to enroll yourself and your eligible dependents, provided that you request enrollment within 30 days after the marriage, birth, adoption or placement for adoption.

Signature Consultants will also allow a special enrollment opportunity if you or your eligible dependents either:

• Lose Medicaid or Children’s Health Insurance Program (CHIP) coveragebecause you are no longer eligible, or

• Become eligible for a state’s premium assistance program under Medicaid or CHIP.

For these enrollment opportunities, you will have 60 days—instead of 30—from the date of the Medicaid/CHIP eligibility change to request enrollment in the Signature group health plan. Note that this new 60-day extension doesn’t apply to enrollment opportunities other than due to the Medicaid/CHIP eligibility change.

Note: If your dependent becomes eligible for a special enrollment right, you may add the dependent to your current coverage or change to another medical plan.

Women’s Health and Cancer Rights Act Notice

If you have had or are going to have a mastectomy, you may be entitled to certain benefits under the Women’s Health and Cancer Rights Act of 1998 (WHCRA). For individuals receiving mastectomy-related benefits, coverage will be provided in a manner determined in consultation with the attending physician and the patient for:

• All stages of reconstruction of the breast on which the mastectomy was performed;

• Surgery and reconstruction of the other breast to produce asymmetrical appearance;

• Prostheses; and

• Treatment of physical complications of the mastectomy, including lymphedema.

These benefits will be provided subject to the same deductibles and coinsurance applicable to other medical and surgical benefits provided under this plan. If you would like more information on WHCRA benefits, call your plan administrator.

22

Annual Compliance Notice

Newborns’ and Mothers’ Health Protection Act Notice

Group health plans and health insurance issuers generally may not, under Federal law, restrict benefits for any hospital length of stay in connection with childbirth for the mother or newborn child to less than 48 hours following a vaginal delivery, or less than 96 hours following a cesarean section. However, Federal law generally does not prohibit the mother’s or newborn’s attending provider, after consulting with the mother, from discharging the mother or her newborn earlier than 48 hours (or 96 hours as applicable). In any case, plans and issuers may not, under Federal law, require that a provider obtain authorization from the plan or the insurance issuer for prescribing a length of stay not in excess of 48 hours(or 96 hours). If you would like more information on maternity benefits, call your plan administrator.

Protections from Disclosure of Medical Information

We are required by law to maintain the privacy and security of your personally identifiable health information. The wellness program will never disclose any of your personal information either publicly or to the employer, except as necessary to respond to a request from you for a reasonable accommodation needed to participate in the wellness program, or as expressly permitted by law. Medical information that personally identifies you that is provided in connection with the wellness program will not be provided to your supervisors or managers and may never be used to make decisions regarding your employment.

Your health information will not be sold, exchanged, transferred, or otherwise disclosed except to the extent permitted by law to carry out specific activities related to the wellness program, and you will not be asked or required to waive the confidentiality of your health information as a condition of participating in the wellness program or receiving an incentive. Anyone who receives your information for purposes of providing you services as part of the wellness program will abide by the same confidentiality requirements

In addition, all medical information obtained through the wellness program will be maintained separate from your personnel records, information stored electronically will be encrypted, and no information you provide as part of the wellness program will be used in making any employment decision. Appropriate precautions will be taken to avoid any data breach, and in the event a data breach occurs involving information you provide in connection with the wellness program, we will notify you immediately.

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 your Benefits Department.

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Annual Compliance Notice

HIPAA Privacy Notice Reminder

The privacy rules under the Health Insurance Portability and Accountability Act (HIPAA) require the Signature Consultants, LLC Health & Welfare Plan (the “Plan”) to periodically send a reminder to participants about the availability of the Plan’s Privacy Notice and how to obtain that notice. The Privacy Notice explains participants’ rights and the Plan’s legal duties with respect to protected health information (PHI) and how the Plan may use and disclose PHI.

To obtain a copy of the Privacy Notice contact your plan administrator at (844) 393-1020.

You may also contact the Plan’s Privacy Official at (844) 393-1020 for more information on the Plan’s privacy policies or your rights under HIPAA.

General Notice of COBRA Continuation Coverage Rights**Continuation Coverage Rights Under COBRA**

Introduction

You’re getting this notice because you recently gained coverage under a group health plan (the Plan). This notice has important information about your right to COBRA continuation coverage, which is a temporary extension of coverage under the Plan. This notice explains COBRA continuation coverage, when it may become available to you and your family, and what you need to do to protect your right to get it. When you become eligible for COBRA, you may also become eligible for other coverage options that may cost less than COBRA continuation coverage.

The right to COBRA continuation coverage was created by a federal law, the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA). COBRA continuation coverage can become available to you and other members of your family when group health coverage would otherwise end. For more information about your rights and obligations under the Plan and under federal law, you should review the Plan’s Summary Plan Description or contact the Plan Administrator.

You may have other options available to you when you lose group health coverage. For example, you may be eligible to buy an individual plan through the Health Insurance Marketplace. By enrolling in coverage through the Marketplace, you may qualify for lower costs on your monthly premiums and lower out-of-pocket costs. Additionally, you may qualify for a 30-day special enrollment period for another group health plan for which you are eligible (such as a spouse’s plan), even if that plan generally doesn’t accept late enrollees.

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Annual Compliance Notice

General Notice of COBRA Continuation Coverage Rights**Continuation Coverage Rights Under COBRA**

What is COBRA continuation coverage?

COBRA continuation coverage is a continuation of Plan coverage when it would otherwise end because of a life event. This is also called a “qualifying event.” Specific qualifying events are listed 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 are required to pay for COBRA continuation coverage.

If you’re an employee, you’ll become a qualified beneficiary if you lose your coverage under the Plan because of the following qualifying events:

• Your hours of employment are reduced, or

• Your employment ends for any reason other than your gross misconduct.

If you’re the spouse of an employee, you’ll become a qualified beneficiary if you lose your coverage under the Plan because of the following qualifying events:

• Your spouse dies;

• Your spouse’s hours of employment are reduced;

• Your spouse’s employment ends for any reason other than his or hergross misconduct;

• Your spouse becomes entitled to Medicare benefits(under Part A, Part B, or both); or

• You become divorced or legally separated from your spouse.

Your dependent children will become qualified beneficiaries if they lose coverage under the Plan because of the following qualifying events:

• The parent-employee dies;

• The parent-employee’s hours of employment are reduced;

• The parent-employee’s employment ends for any reason other thanhis or her gross misconduct;

• The parent-employee becomes entitled to Medicare benefits (Part A, Part B, or both);

• The parents become divorced or legally separated; or

• The child stops being eligible for coverage under the Plan as a “dependent child.”

25

Annual Compliance Notice

General Notice of COBRA Continuation Coverage Rights**Continuation Coverage Rights Under COBRA**

When is COBRA continuation coverage available?

The Plan will offer COBRA continuation coverage to qualified beneficiaries only after the Plan Administrator has been notified that a qualifying event has occurred. The employer must notify the Plan Administrator of the following qualifying events:

• The end of employment or reduction of hours of employment;

• Death of the employee;

• The employee’s becoming entitled to Medicare benefits(under Part A, Part B, or both).

For all other qualifying events (divorce or legal separation of the employee and spouse or a dependent child’s losing eligibility for coverage as a dependent child), you must notify the Plan Administrator within 60 days after the qualifying event occurs. You must provide this notice to: Signature Consultants.

How is COBRA continuation coverage provided?

Once the Plan Administrator receives notice that a qualifying event has occurred, COBRA continuation coverage will be offered to each of the qualified beneficiaries. Each qualified beneficiary will have an independent right to elect COBRA continuation coverage. Covered employees may elect COBRA continuation coverage on behalf of their spouses, and parents may elect COBRA continuation coverage on behalf of their children.

COBRA continuation coverage is a temporary continuation of coverage that generally lasts for 18 months due to employment termination or reduction of hours of work. Certain qualifying events, or a second qualifying event during the initial period of coverage, may permit a beneficiary to receive a maximum of 36 months of coverage.

There are also ways in which this 18-month period of COBRA continuation coverage can be extended:

Disability extension of 18-month period of COBRA continuation coverage

If you or anyone in your family covered under the Plan is determined by Social Security to be disabled and you notify the Plan Administrator in a timely fashion, you and your entire family may be entitled to get up to an additional 11 months of COBRA continuation coverage, for a maximum of 29 months. The disability would have to have started at some time before the 60th day of COBRA continuation coverage and must last at least until the end of the 18-month period of COBRA continuation coverage.

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Second qualifying event extension of 18-month period of continuation coverageIf your family experiences another qualifying event during the 18 months of COBRA continuation coverage, the spouse and dependent children in your family can get up to 18 additional months of COBRA continuation coverage, for a maximum of 36 months, if the Plan is properly notified about the second qualifying event. This extension may be available to the spouse and any dependent children getting COBRA continuation coverage if the employee or former employee dies; becomes entitled to Medicare benefits (under Part A, Part B, or both); gets divorced or legally separated; or if the dependent child stops being eligible under the Plan as a dependent child. This extension is only available if the second qualifying event would have caused the spouse or dependent child to lose coverage under the Plan had the first qualifying event not occurred.

Are there other coverage options besides COBRA Continuation Coverage?Yes. Instead of enrolling in COBRA continuation coverage, there may be other coverage options for you and your family through the Health Insurance Marketplace, Medicaid, or other group health plan coverage options (such as a spouse’s plan) through what is called a “special enrollment period.” Some of these options may cost less than COBRA continuation coverage. You can learn more about many of these options at www.healthcare.gov.

If you have questionsQuestions concerning your Plan or your COBRA continuation coverage rights should be addressed to the contact or contacts identified below. For more information about your rights under the Employee Retirement Income Security Act (ERISA), including COBRA, the Patient Protection and Affordable Care Act, and other laws affecting group health plans, contact the nearest Regional or District Office of the U.S. Department of Labor’s Employee Benefits Security Administration (EBSA) in your area or visit www.dol.gov/ebsa. (Addresses and phone numbers of Regional and District EBSA Offices are available through EBSA’s website.) For more information about the Marketplace, visit www.healthcare.gov.

Keep your Plan informed of address changesTo protect your family’s rights, let the Plan Administrator know about any changes in the addresses of family members. You should also keep a copy, for your records, of any notices you send to the Plan Administrator.

Plan contact informationNancy Tarchis, Director of Benefit Services, 200 West Cypress Creek Rd., Suite 400, Ft. Lauderdale, FL 33309 Telephone: (844) 393-1020, Email: benefits@sigconsult.com

Annual Compliance Notice

General Notice of COBRA Continuation Coverage Rights**Continuation Coverage Rights Under COBRA**

27

PART A: General InformationWhen key parts of the health care law took effect in 2014, there became a new way to buy health insurance: the Health Insurance Marketplace. To assist you as you evaluate options for you and your family, this notice provides some basic information about the new Marketplace and employment based health coverage offered by your employer.

What is the Health Insurance Marketplace?The Marketplace is designed to help you find health insurance that meets your needs and fits your budget. The Marketplace offers “one-stop shopping” to find and compare private health insurance options. You may also be eligible for a new kind of tax credit that lowers your monthly premium right away. Open Enrollment for health insurance coverage through the Marketplace begins in November of every year for coverage starting as early as the following January.

Can I Save Money on my Health Insurance Premiums in the Marketplace?You may qualify to save money and lower your monthly premium, but only if your employer does not offer coverage, or offers coverage that doesn’t meet certain standards. The savings on your premium that you’re eligible for depends on your household income.

Does Employer Health Coverage Affect Eligibility for Premium Savings through the Marketplace?Yes. If you have an offer of health coverage from your employer that meets certain standards, you will not be eligible for a tax credit through the Marketplace and may wish to enroll in your employer’s health plan. However, you may be eligible for a tax credit that lowers your monthly premium or a reduction in certain cost-sharing if your employer does not offer coverage to you at all or does not offer coverage that meets certain standards. If the cost of a plan from your employer that would cover you (and not any other members of your family) is more than 9.78% of your household income for the year, or if the coverage your employer provides does not meet the “minimum value” standard set by the Affordable Care Act, you may be eligible for a tax credit.1

Note: If you purchase a health plan through the Marketplace instead of accepting health coverage offered by your employer, then you may lose the employer contribution (if any) to the employer- offered coverage. Also, this employer contribution—as well as your employee contribution to employer-offered coverage—is often excluded from income for Federal and State income tax purposes. Your payments for coverage through the Marketplace are made on an after-tax basis.

How Can I Get More Information?For more information about your coverage offered by your employer, please check your summary plan description or contact Signature Consultants’ Human Resources at 1-954-717-1014.

The Marketplace can help you evaluate your coverage options, including your eligibility for coverage through the Marketplace and its cost. Please visit www.healthcare.gov for more information, including an online application for health insurance coverage and contact information for a Health Insurance Marketplace in your area.

1An employer-sponsored health plan meets the “minimum value standard” if the plan’s share of the total allowed benefit costs covered by the plan is no less than 60 percent of such costs.

Annual Compliance Notice

New Health Insurance Marketplace Coverage Options and Your Health Coverage

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PART B: Information about health coverage offered by your employeeThis section contains information about any health coverage offered by your employer. If you decide to complete an application for coverage in the Marketplace, you will be asked to provide this information. This information is numbered to correspond to the Marketplace application. Here is some basic information about health coverage offered by this employer:

As your employer, we offer a health plan to:

All employees. Eligible employees are: All W2 employees Some employees. Eligible employees are: With respect to dependents: We do offer coverage. Eligible dependents are:

1. Natural children: Child(ren) up to age 26 regardless of student, marital, disability ordependent status

2. Stepchildren: Child(ren) up to age 26 regardless of student, marital, disability or dependentstatus

3. Legally adopted (or placed for adoption): Child(ren) up to age 26 regardless of student,marital, disability or dependent status

4. Foster children: Child(ren) up to age 26 regardless of student, marital, disability ordependent status

5. Disabled children (need to be disabled prior to the limiting age): Disabled child(ren)of any age (for a disabled child over age 26, he or she must have been disabled on orbefore the day he or she turned age 26)

6. Children for whom the employee is legal guardian: Child(ren) up to age 26 regardless ofstudent, marital, disability or dependent status

7. Spouse as determined under state law (including same sex spouse where permitted)We do not offer coverage. If checked, this coverage meets the minimum value standard, and the cost of this coverageto you is intended to be affordable, based on employee wages.

Even if your employer intends your coverage to be affordable, you may still be eligible for a premium discount through the Marketplace. The Marketplace will use your household income, along with other factors, to determine whether you may be eligible for a premium discount. If, for example, your wages vary from week to week (perhaps you are an hourly employee or you work on a commission basis), if you are newly employed mid-year, or if you have other income losses, you may still qualify for a premium discount.

If you decide to shop for coverage in the Marketplace, www.healthcare.gov will guide you through the process. Here’s the employer information you’ll enter when you visit www.healthcare.gov to find out if you can get a tax credit to lower your monthly premiums.

Annual Compliance Notice

New Health Insurance Marketplace Coverage Optionsand Your Health Coverage

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Annual Compliance Notice

Premium Assistance Under Medicaid and theChildren’s Health Insurance Program (CHIP)

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. For more information, visit www.healthcare.gov.

If you or your dependents are already enrolled in Medicaid or CHIP and you live in a State listed below, contact your State Medicaid or CHIP office to find out if premium assistance is available.

If you or your dependents are NOT currently enrolled in Medicaid or CHIP, and you think you or any of your dependents might be eligible for either of these programs, contact your State Medicaid or CHIP office or dial 1-877-KIDS NOW or www.insurekidsnow.gov to find out how to apply. If you qualify, ask your state if it has a program that might help you pay the premiums for an employer-sponsored plan.

If you or your dependents are eligible for premium assistance under Medicaid or CHIP, as well as eligible under your employer plan, your employer must allow you to enroll in your employer plan if you aren’t already enrolled. This is called a “special enrollment” opportunity, and you must request coverage within 60 days of being determined eligible for premium assistance. If you have questions about enrolling in your employer plan, contact the Department of Labor at www.askebsa.dol.gov or call 1-866-444-EBSA (3272).

If you live in one of the following states, you may be eligible for assistance paying your employer health plan premiums. The following list of states is current as of July 31, 2019. Contact your State for more information on eligibility—

ALABAMA—Medicaid FLORIDA—Medicaid

Website: myalhipp.com Phone: 1-855-692-5447

Website: flmedicaidtplrecovery.com/hipp Phone: 1-877-357-3268

ALASKA—Medicaid GEORGIA—Medicaid

The AK Health Insurance Premium Payment Program Website: myakhipp.com Phone: 1-866-251-4861Email: CustomerService@MyAKHIPP.comMedicaid Eligibility: dhss.alaska.gov

Website: medicaid.georgia.gov Phone: 678-564-1162 ext 2131

ARKANSAS—Medicaid INDIANA—Medicaid

Website: myarhipp.com Phone: 1-855-MyARHIPP (855-692-7447)

Healthy Indiana Plan for low-income adults 19–64 Website: www.in.gov/fssa/hip Phone: 1-877-438-4479All other Medicaid Website: indianamedicaid.comPhone: 1-800-403-0864

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KANSAS – Medicaid NEW HAMPSHIRE – Medicaid

Website: kdheks.gov/hcf/Phone: 1-785-296-3512

Website: dhhs.nh.gov/oii/hipp.htm Phone: 603-271-5218Toll free number for the HIPP program: 1-800-852-3345, ext 5218 (in NH only)

KENTUCKY – Medicaid NEW JERSEY – Medicaid and CHIP

Website: kidshealth.ky.govPhone: 1-800-635-2570 or (877) 524-4718/(877) 807-4719 (TDD/TTY)

Medicaid Website: state.nj.us/humanservices/dmahs/clients/medicaidMedicaid Phone: 609-631-2392CHIP Website: njfamilycare.orgCHIPPhone: 1-800-701-0710

LOUISIANA – Medicaid NEW YORK – Medicaid

Website: dhh.louisiana.gov/index.cfm/subhome/1/n/331Phone: 1-888-695-2447 or 1-877-2LaCHIP (1-877-252-2447)TTY Users call: 1-800-220-5404

Website: health.ny.gov/health_care/medicaidPhone: 1-800-541-2831

MAINE – Medicaid NORTH CAROLINA – Medicaid

Website: www.maine.gov/dhhs/ofi/public-assistancePhone: 1-800-442-6003TTY: Maine relay 711

Website: medicaid.ncdhhs.govPhone: 919-855-4100

MASSACHUSETTS – Medicaid and CHIP NORTH DAKOTA – Medicaid

Website: mass.gov/eohhs/gov/departments/masshealthPhone: 1-800-862-4840

Website: nd.gov/dhs/services/medicalserv/medicaidPhone: 1-844-854-4825

MINNESOTA – Medicaid OKLAHOMA – Medicaid and CHIP

Website: mn.gov/dhs/people-we-serve/seniors/health-care/health-care-programs/programs-and-services/other-insurance.jspPhone: 1-800-657-3739

Website: insureoklahoma.orgPhone: 1-888-365-3742

MISSOURI – Medicaid OREGON – Medicaid

Website: dss.mo.gov/mhd/participants/pages/hipp.htmPhone: 573-751-2005

Website: healthcare.oregon.gov/Pages/index.aspxPhone: 1-800-699-9075

MONTANA – Medicaid PENNSYLVANIA – Medicaid

Website: dphhs.mt.gov/MontanaHealthcarePrograms/HIPPPhone: 1-800-694-3084

Website: http://www.dhs.pa.gov/provider/medicalassistance/healthinsurancepremiumpaymenthippprogram /index.htmPhone: 1-800-692-7462

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NEBRASKA – Medicaid RHODE ISLAND – Medicaid and CHIP

Website: ACCESSNebraska.ne.govPhone: 855-632-7633Lincoln: 402-473-7000Omaha: 402-595-1178

Website: www.eohhs.ri.govPhone: 855-697-4347, or 401-462-0311 (Direct RIte Share Line)

NEVADA – Medicaid SOUTH CAROLINA – Medicaid

Medicaid Website: dhcfp.nv.govMedicaid Phone: 1-800-992-0900

Website: scdhhs.govPhone: 1-888-549-0820

SOUTH DAKOTA - Medicaid WASHINGTON – Medicaid

Website: dss.sd.govPhone: 1-888-828-0059

Website: hca.wa.govPhone: 1-800-562-3022 ext. 15473

TEXAS – Medicaid WEST VIRGINIA – Medicaid

Website: gethipptexas.comPhone: 1-800-440-0493

Website: mywvhipp.comToll-free phone: 1-855-MyWVHIPP (1-855-699-8447)

UTAH – Medicaid and CHIP WISCONSIN – Medicaid and CHIP

Medicaid Website: medicaid.utah.govCHIP Website: health.utah.gov/chipPhone: 1-877-543-7669

Website:dhs.wisconsin.gov/publications/p1/p10095.pdfPhone: 1-800-362-3002

VERMONT– Medicaid WYOMING – Medicaid

Website: greenmountaincare.orgPhone: 1-800-250-8427

Website: wyequalitycare.acs-inc.comPhone: 307-777-7531

VIRGINIA – Medicaid and CHIP

Medicaid Website: coverva.orgMedicaid Phone: 1-800-432-5924 or 1-855-242-8282CHIP Website: coverva.org(select the ‘Programs’ tab and then select‘Premium Assistance’)CHIP Phone: 1-855-242-8282

To see if any other states have added a premium assistance program since July 31, 2019, or for more information on special enrollment rights, contact either:

U.S. Department of Labor Employee Benefits Security Administrationwww.dol.gov/agencies/ebsa1-866-444-EBSA (3272)

U.S. Department of Health and Human Services Centers for Medicare & Medicaid Services www.cms.gov1-877-267-2323, Menu Option 4, Ext. 61565

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