SPD Coast Real Estate Benefit Plan · 8/1/2016 · Hoban and Associates, Inc. d/b/a Coast Real...

HOBANANDASSOCIATES,INC.d/b/aCOASTREALESTATESERVICES

BENEFITPLAN

SUMMARYPLANDESCRIPTION

August1,2016

TABLEOFCONTENTS

PLANINFORMATION...................................................................................................................................1

INTRODUCTION...........................................................................................................................................2EstablishmentandPurpose............................................................................................................................................2SpecificPlanInformation................................................................................................................................................2AdditionalHealthPlansProvisions.................................................................................................................................3

PLANADMINISTRATION..............................................................................................................................7InGeneral.......................................................................................................................................................................7AmendmentandTermination.........................................................................................................................................7

PATIENTPROTECTIONANDAFFORDABLECAREACT....................................................................................8ACAReportingObligationsonHealthCareCoverage.....................................................................................................8CoverageforDependentsUptoAge26.........................................................................................................................8EssentialHealthBenefits................................................................................................................................................8LifetimeandAnnualDollarLimitsonEssentialHealthBenefits......................................................................................9PreexistingConditionExclusions(PCEs)..........................................................................................................................9Rescissions......................................................................................................................................................................990-DayWaitingPeriodLimit...........................................................................................................................................9InsuranceIssuerRebates..............................................................................................................................................10PatientProtections.......................................................................................................................................................10PreventiveCare.............................................................................................................................................................10Cost-SharingLimitationsonEssentialHealthBenefits(Out-of-PocketMaximums).....................................................11CoverageforClinicalTrials............................................................................................................................................11ClaimsAppealProcess..................................................................................................................................................11

CLAIMSANDAPPEALPROCEDURES...........................................................................................................13Non-HealthClaims........................................................................................................................................................13HealthClaims................................................................................................................................................................13WhenHealthClaimsMustBeFiled...............................................................................................................................14TimingofClaimDecisions.............................................................................................................................................14ClaimsAppealProcedure..............................................................................................................................................16TimingofanAppeal......................................................................................................................................................16TimingofNotificationofBenefitDeterminationonReview.........................................................................................16InternalReviewandDecision........................................................................................................................................17ExternalReview............................................................................................................................................................17

NOTICEOFCONTINUATIONCOVERAGERIGHTSUNDERCOBRA.................................................................19Introduction..................................................................................................................................................................19WhatisCOBRAContinuationCoverage?......................................................................................................................19WhenisCOBRAContinuationCoverageAvailable?......................................................................................................20YouMustGiveNoticeofSomeQualifyingEvents.........................................................................................................20HowisCOBRAContinuationCoverageProvided?.........................................................................................................20DisabilityExtensionof18-MonthPeriodofCOBRAContinuationcoverage.................................................................20SecondQualifyingEventExtensionof18-MonthPeriodofCOBRAContinuationCoverage.........................................21AreThereOtherCoverageOptionsBesidesCOBRAContinuationCoverage?..............................................................21IfYouHaveQuestions...................................................................................................................................................21KeepYourPlanInformedofAddressChanges..............................................................................................................21PlanContactInformation..............................................................................................................................................21

STATEMENTOFERISARIGHTS...................................................................................................................22ReceiveInformationAboutYourPlanandBenefits......................................................................................................22ContinueGroupHealthPlanCoverage.........................................................................................................................22ReductionorEliminationofExclusionaryPeriods.........................................................................................................22PrudentActionsbyPlanFiduciaries..............................................................................................................................22EnforceYourRights.......................................................................................................................................................23AssistancewithYourQuestions....................................................................................................................................23

OTHERIMPORTANTINFORMATION..........................................................................................................24PrivacyofInformation..................................................................................................................................................24ControllingDocuments.................................................................................................................................................24

APPENDIXA..............................................................................................................................................25InsurancePolicyIssuersandContractAdministrator...................................................................................................25

APPENDIXB..............................................................................................................................................26ComponentHealthPlansClaimsAppealsContactInformation....................................................................................26

APPENDIXC..............................................................................................................................................27EligibilityandParticipationRequirements....................................................................................................................27DependentEligibility.....................................................................................................................................................27EligibilityRulesforVariableHourEmployees...............................................................................................................27BreaksinService...........................................................................................................................................................28

APPENDIXD..............................................................................................................................................29PremiumAssistanceunderMedicaidandCHIP............................................................................................................29

HobanandAssociates,Inc.d/b/aCoastRealEstateServicesBenefitPlanSummaryPlanDescriptionAugust1,2016

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PLANINFORMATION

THIS DOCUMENT, WHEN INCORPORATED INTO THE BENEFIT BOOKLET/EVIDENCE OF COVERAGE, WILLCONSTITUTETHISPLAN'SSUMMARYPLANDESCRIPTIONPURSUANTTOTHEEMPLOYEERETIREMENTINCOMESECURITYACTOF1974

PlanName: HobanandAssociates,Inc.d/b/aCoastRealEstateServicesBenefitPlan

TypeofPlan: WelfareBenefitPlan

PlanYear: January1throughDecember31ofthesamecalendaryear

PlanNumber: 501

EffectiveDateofthisSummaryPlanDescription:

August1,2016

OriginalEffectiveDateofPlan: January1,1998

FundingMethod: Fundedthroughfully-insuredcontractsandself-insuredarrangements

SourceofContributions: FromCoastRealEstateServices’sgeneralassetsandEmployeecontributions,whenrequired

PlanSponsorandPlanAdministrator:

HobanandAssociates,Inc.d/b/aCoastRealEstateServices2829RuckerAvenueEverett,WA98201(425)339-3638

PlanSponsor’sEmployerIdentificationNumber:

91-1476354

AgentforServiceofLegalProcess:

HobanandAssociates,Inc.d/b/aCoastRealEstateServices2829RuckerAvenueEverett,WA98201(425)339-3638


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INTRODUCTION

EstablishmentandPurposeHobanandAssociates,Inc.d/b/aCoastRealEstateServices(CoastRealEstateServices)maintainstheHobanandAssociates, Inc. d/b/a Coast Real Estate Services Benefit Plan (the “Plan”) for the exclusive benefit of, and toprovidewelfarebenefitsto,itseligibleemployees,theirspousesandeligibledependents.

ThesebenefitsareprovidedundervariousinsurancecontractsenteredintobetweenCoastRealEstateServicesand insurance companies or service providers (issuers) as well as through self-insured plans funded by thegeneralassetsofCoastRealEstateServices.

The benefit plans offered under this Plan and their contract issuers or contract administrators are listed inAppendixA.DetailedinformationonthebenefitslistedinAppendixAmaybefoundintheinsurancecontracts,evidenceofcoverage,orofficialplandocumentsforeachbenefit(PlanDocuments).

Thisdocument,togetherwiththePlandocumentsforeachbenefit,constitutestheSummaryPlanDescriptionforthePlan. If the termsof this SummaryPlanDescription conflictwith the termsof the relateddocuments, thetermsoftherelateddocumentswillcontrol,unlesssupersededbyapplicablelaw.

CertainofthebenefitsprovidedbythisPlanarehealthplansandtherebysubjecttotheprovisionsoftheHealthInsurance Portability and Accountability Act of 1996 (HIPAA) including regulations affecting themaintenance,creationoruseofProtectedHealthInformation(PHI)(asthattermisdefinedunderHIPAA).PleaserefertotheNoticeofPrivacyPracticesissuedbythePlanforadescriptionofhowyourmedicalinformationmaybeusedanddisclosedandhowyoucangetaccesstothisinformation.

SpecificPlanInformation§ EligibilityRules.PleaserefertoAppendixCofthisSummaryPlanDescriptiontodetermineyoureligibility

forparticipating ineachparticularbenefitprogram.The specificPlanDocumentswill alsodefineeligibledependents (ifapplicable)andthetermsunderwhichyoumayparticipate (includingthedefinitionofaneligible employee and a description of any waiting period which may precede the date your coveragebegins).

§ Benefits Provided.EachPlanDocumentwill containacompletedescriptionof thebenefitsavailableandanylimitationsorexclusionsapplicabletothosebenefits.

§ Contributions. Coast Real Estate Services, at its discretion, may require employee contributions as aconditionofparticipationinanyparticularbenefitplan.Employeecontributionsmaybemadeonanafter-taxbasisoronapre-taxbasisthroughacafeteriaplancomponentbenefitprogramunderthePlan.

§ Changing Elections. Federal tax law generally requires that an electionmade under the Plan remain ineffectwithoutmodificationfortheentirePlanYearforwhichtheelectionismade.Youmay,however,beable to revoke or change an election on account of, and consistentwith one of the “Change in Status”qualifying events adopted by Coast Real Estate Services, as permitted by federal tax law. Any electionsmadeonanafter-taxbasismaybechangedinaccordancewithCoastRealEstateServices’spolicyandanyspecificplanlimitations.SeebelowforadditionalspecialopenenrollmentsrightsunderHIPAA.

§ Cessationof Participation.Unlessotherwisestated in thePlanDocumentyourcoveragewill ceaseupontheearliestofthefollowing:ú thedateyoureligibleclassiseliminated;

ú thedateyouceasetobeamemberofaneligibleclass;

ú thedateyouceasetopayanyrequiredcontributionstowardthecostofthePlan;or,

ú thedatethePlanisterminated.


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§ Restitution to the Plan. The Plan has the right to recover overpaid benefits and to seek subrogation orreimbursement in certain circumstances and with respect to certain component benefit programs. Theapplicableinsurancecontracts(includingthecertificateofinsurancebooklets),plans,andothergoverningdocuments provide additional information about the Plan’s recovery, subrogation, and reimbursementrights.

AdditionalHealthPlansProvisionsSpecialOpenEnrollmentRights forCertain IndividualsunderHealth InsurancePortabilityandAccountabilityAct of 1996 (HIPAA). If you are declining enrollment for yourself or your dependents (including your spouse)because of other health insurance coverage, you may in the future be able to enroll yourself and yourdependentsinoneofthehealthcareoptionsofferedbythePlanSponsor,providedthatyourequestenrollmentwithin31daysafteryourothercoverageendsoranycompanycontributionsforsuchcoveragehaveterminated.

Inaddition,ifyouhaveanewdependentasaresultofmarriage,birth,adoption,orplacementforadoption,youmaybeabletoenrollyourselfandyourdependents,providedthatyourequestenrollmentwithin31daysafterthemarriage,birth,adoption,orplacementforadoption.Ifyouotherwisedeclinetoenroll,youmayberequiredtowaituntilthegroup’snextopenenrollmenttodoso.Youalsomaybesubjecttoadditionallimitationsonthecoverageavailableat that time.Coveragewillgenerallybeginonthe firstdayof thecalendarmonth followingthe timely enrollment request.However, if the special enrollmentevent is birthor adoptionorplacement foradoption, if timelyenrolled, coverage for suchnewbornoradoptedchildrenwillbeginasof thedateofbirth,adoptionorplacementforadoption.

Anyrequestsforspecialenrollmentortoobtainmoreinformationshouldbedirectedto:

HobanandAssociates,Inc.d/b/aCoastRealEstateServicesAttn:V.P.ofHumanResources2829RuckerAvenueEverett,WA98201(425)551-0818

MedicaidandtheChildren’sHealthInsuranceProgram(CHIP).Ifyouareeligibleforhealthcoveragefromyouremployer,butareunabletoaffordthepremiums,somestateshavepremiumassistanceprogramsthatcanhelppayforcoverage.ThesestatesusefundsfromtheirMedicaidorCHIPprogramstohelppeoplewhoareeligiblefor employer-sponsored health coverage, but need assistance in paying their health premiums. If you or yourdependentsarenoteligibleforMedicaid,CHIP,orastatepremiumassistanceprogramyoumaybeabletobuyindividual insurance coverage through a Health Insurance Marketplace. For more information, visitwww.healthcare.gov.

IfyouoryourdependentsarealreadyenrolledinMedicaidorCHIPandyouliveinastatelistedinAppendixD,youcancontactyourstateMedicaidorCHIPofficetofindoutifpremiumassistanceisavailable.

If you or your dependents areNOT currently enrolled inMedicaid or CHIP, and you think you or any of yourdependentsmightbeeligible foreitherof theseprograms,youcancontactyourstateMedicaidorCHIPofficeusingtheinformationcontainedinAppendixD,orcall1-877-543-7669orgotowww.insurekidsnow.govtofindouthowtoapply.Ifyouqualify,youcanaskthestateifithasaprogramthatmighthelpyoupaythepremiumsforanemployer-sponsoredplan.

OnceitisdeterminedthatyouoryourdependentsareeligibleforpremiumassistanceunderMedicaidorCHIP,youremployer’shealthplanisrequiredtopermityouandyourdependentstoenrollintheplan–aslongasyouand your dependents are eligible, but not already enrolled in the employer’s plan. This is called a “specialenrollment” opportunity, and you must request coverage within 60 days of being determined eligible forpremiumassistance.


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QualifiedMedical Child SupportOrders.ThePlanmayberequiredtocoveryourchild(ren)duetoaQualifiedMedicalChildSupportOrder(QMCSO)evenifyouhavenotenrolledthechild.YoumayobtainacopyofCoastReal Estate Services’s procedures governingQMCSOdeterminations, free of charge, by contacting theHumanResourcesDepartment.

A QMCSO is any judgment, decree or order, including a court approved settlement agreement, issued by adomestic relations court or other court of competent jurisdiction, or through an administrative processestablishedunderstatelawwhichhastheforceandeffectoflawinthatstate,andwhichassignstoachildtheright to receivehealthbenefits forwhichaparticipantorbeneficiary iseligibleunder thePlan,and thatCoastRealEstateServicesdeterminesisqualifiedunderthetermsofERISAandapplicablestatelaw.Childrenwhomaybe covered under a QMCSO include children born out of wedlock, those not claimed as dependents on yourfederalincometaxreturn,andchildrenwhodon’tresidewithyou.

Michelle’sLaw.AllgrouphealthcarecoveragemaintainedunderthisPlanthatrequiresacertificationofstudentstatusforanyperiodofdependentcoverageshallcomplywithMichelle’sLaw.Eligibilityforsuchcoverageforadependentchildwhoisenrolled inan institutionofhighereducationatthebeginningofamedicallynecessaryleaveofabsencewillbeextended if the leavenormallywould cause thedependent child to loseeligibility forcoverageunderthegrouphealthcarecoverageduetolossofstudentstatus.Thiseligibilityextensionshall lastup to one year beginning on the first day of the leave of absence or the date the coveragewould otherwiseterminateduetolossofstudentstatus,whicheverisearlier.

Newborns’ and Mothers’ Health Protection Act of 1996. Under federal law, group health plans and healthinsurance issuersofferinggrouphealth insurancecoveragegenerallymaynot restrictbenefits foranyhospitallengthofstay inconnectionwithchildbirthforthemotherornewbornchildto lessthan48hoursfollowingavaginaldelivery,orlessthan96hoursfollowingadeliverybycesareansection.However,theplan,orissuermaypayforashorterstayiftheattendingprovider(e.g.,yourphysician,nursemidwife,orphysicianassistant),afterconsultationwiththemother,dischargesthemotherornewbornearlier.

Also,under federal law,plansand issuersmaynot set the levelofbenefitsorout-of-pocket costs so that anylaterportionof the48hour (or96hour) stay is treated inamanner less favorable to themotherornewbornthananyearlierportionofthestay.Inaddition,aplanorissuermaynotrequirethataphysicianorotherhealthcareproviderobtainauthorizationforprescribingalengthofstayofupto48hours(or96hours).However,touse certain providers or facilities, or to reduce your out-of-pocket costs, youmay be required to obtain pre-certification.Forinformationonpre-certification,contactyourPlanAdministrator.

Women'sHealthandCancerRightsActof1998.Inthecaseofanemployeeordependentwhoreceivesbenefitsundertheplaninconnectionwithamastectomyandwhoelectsbreastreconstruction(inamannerdeterminedinconsultationwiththeattendingphysicianandthepatient),coveragewillbeprovidedfor:

§ Reconstruction of the breast on which mastectomy has been performed, including nipple and areolareconstructionandre-pigmentationtorestorethephysicalappearanceofthebreast;

§ Surgeryandreconstructionontheotherbreasttoproduceasymmetricalappearance;

§ Prostheses;and

§ Treatmentforphysicalcomplicationsofallstagesofmastectomy,includinglymphedemas.

Coverageforreconstructivebreastsurgerymaynotbedeniedorreducedonthegroundsthat it iscosmetic innature or that it otherwise does not meet the coverage definition of "medically necessary". Benefits will beprovidedonthesamebasisasforanyotherillnessorinjuryunderthePlan.

Mental Health Parity and Addiction Equity. All group health care coverage maintained under this Plan thatprovidesbothmedical and surgicalbenefits, aswell asmentalhealthor substanceusedisorderbenefits, shallprovidesuchbenefitssubjecttothefollowing:


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§ The financial requirements applicable to such mental health or substance use disorder benefits are nomore restrictive than the predominant financial requirements applied to substantially all medical andsurgicalbenefitscoveredbytheplan (orcoverage),andtherearenoseparatecostsharingrequirementsthatareapplicableonlywithrespecttomentalhealthorsubstanceusedisorderbenefits;

§ Thetreatmentlimitationsapplicabletosuchmentalhealthorsubstanceusedisorderbenefitsarenomorerestrictive than the predominant treatment limitations applied to substantially all medical and surgicalbenefits covered by the plan (or coverage) and there are no separate treatment limitations that areapplicableonlywithrespecttomentalhealthorsubstanceusedisorderbenefits;and,

§ Theplanadministratoror insurermustmakeavailable toparticipantsorbeneficiaries,uponrequest, thecriteria formedical necessity determinations formental health and substance use disorder benefits andprovidethereasonforanydenialofreimbursementorpaymentforservices.

UnderACA,grouphealthplansareprohibitedfromimposingannualorlifetimedollarlimitsonEssentialHealthBenefits,includingmentalhealthandsubstanceusedisorderservicesandbehavioralhealthtreatment.

Genetic Information Nondiscrimination Act of 2008. The Genetic Information Nondiscrimination Act of 2008(GINA) prohibits employers and other entities covered by GINA Title II from requesting or requiring geneticinformation of an individual or family member of the individual, except as specifically allowed by GINA. Ingeneral,GINA:

§ Prohibits thisPlan fromadjustingpremiumsor contributionamounts foragroupon thebasisofgeneticinformation;

§ Prohibits this Plan from requesting or mandating that an individual or family member of an individualundergo a genetic test, providing that such prohibition does not limit the authority of a health careprofessional to request an individual to undergo a genetic test, or preclude a group health plan fromobtainingorusingtheresultsofaagenetictestinmakingadeterminationregardingpayment;

§ AllowsthisPlantorequest,butnotmandate, thataparticipantorbeneficiaryundergoagenetic test forresearchpurposes if thePlandoesnotuse the information forunderwritingpurposesandmeetscertaindisclosurerequirements;and,

§ ProhibitsthisPlanfromrequesting,requiring,orpurchasinggeneticinformationforunderwritingpurposes,orwithrespecttoanyindividualinadvanceoforinconnectionwithsuchindividual’senrollment.

To comply with this law, Coast Real Estate Services asks that you not provide genetic information whenresponding to any request for medical information. ‘Genetic information' as defined by GINA includes anindividual'sfamilymedicalhistory,theresultsofanindividual'sorfamilymember'sgenetictests,thefactthatanindividual or an individual's familymember sought or received genetic services, and genetic information of afetus carriedby an individualor an individual's familymemberor anembryo lawfullyheldby an individualorfamilymemberreceivingassistedreproductiveservices.

Wellness Program Alternative Standard and Disclosure Policy. In the event this Plan includes a wellnessprogramthatrequiresindividualstosatisfyastandardrelatedtoahealthfactor,anditisunreasonablydifficultduetoamedicalconditionforyoutoachievethestandardsfortherewardunderthewellnessprogram,orifitismedically inadvisable foryoutoattempttoachievethestandards fortherewardunderthisprogram,thePlanwillworkwithyoutodevelopanotherwaytoqualifyforthereward.Anyrequestsforanalternativestandardortoobtainmoreinformationshouldbedirectedto:



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In addition, anymedical information obtained by awellness programmay only be used for purposes of planoperationsandmayonlybedisclosedtotheplanadministratorinaggregateformthatdoesnotdisclose,andisnotreasonablylikelytodisclosetheidentityofspecificindividuals,exceptasisnecessarytoadministertheplan.Usethecontactinformationabovetorequestadditionalinformationonwhat,ifany,medicalinformationwillbeobtainedandifmedicalinformationisreceived:

§ Whowillreceivethemedicalinformation;

§ Howthemedicalinformationwillbeused;and,

§ Therestrictionsonitsdisclosureandthemethodsemployedtopreventimproperdisclosureofthemedicalinformation(includingwhethertheprogramcomplieswithHIPAAprivacyrequirements).

FMLA: Family and Medical Leave Act of 1993. Notwithstanding the above rule regarding termination ofparticipationoranyotherprovisiontothecontraryinthisPlan,ifyougoonaqualifyingleaveundertheFamilyandMedicalLeaveActof1993(FMLA),thefollowingruleswillapply.

§ OnlytotheextentrequiredbyFMLA(amongotherthings,thismeansonlyforthedurationofaqualifyingleave), Coast Real Estate Serviceswill continue tomaintain your health benefits on the same terms andconditionsasthoughyouwerestillanactiveemployee.

§ Except as otherwise provided by FMLA, your Plan participation will cease when the Plan Administratorlearns that you do not intend to return to work after your leave. If earlier, your Plan participation willimmediatelyceaseuponexpirationofyourFMLAleave,ifyoufailtoreturntoworkatsuchtime.

§ Except as otherwise provided in FMLA, if you fail to return to work after the FMLA leave, you will berequired to reimburseCoastReal Estate Services for the costof the coverageCoastReal Estate ServicesprovidedyouwhileyouwereonFMLAleave(thecostequalstheCOBRApremium,withouta2%add-on).

§ Eligibleemployeesmaytakeupto12weeks’ leaveduringa12-monthperiodforthebirthoradoptionoftheemployee’s child; the serious illnessof theemployee’s spouse, child,orparent; theemployee’sowndisabling serious illness; and the employee’s spouse, son, daughter, or parent is on active duty in themilitaryoriscalledupforactiveduty(qualifyingexigencyleave).

ú Eligibleemployeeswhoarefamilymembersofactivedutymilitarypersonnelinjuredorill inthelineofmilitary duty, and perhapsmedically unfit to perform the duties of themember’s office, grade,rank,orratingmaytakeupto26workweeksofjob-and-benefits-protectedleaveduringa12-monthperiodtocarefortheservicemember.Thesameprovisionsapplytoarelativeofaveteranwhowaspreviously a member of the Armed Forces during the five years preceding the date of treatment,recuperation,ortherapy.

ú Eligibleemployeesmaytakeupto15calendardaysofqualifyingexigencyleavetospendtimewithaservicemember who is on ordered short-term temporary, rest and recuperation leave duringdeployment.

USERRA: Employees onMilitary Leave.Employeesgoing intoor returning frommilitary servicewillhavePlanrightsmandated by theUniformed Services Employment and Reemployment Rights Act of 1994. These rightsincludeupto24monthsofextendedhealthcarecoverageuponpaymentoftheentirecostofcoverageplusareasonableadministrationfeeandimmediatecoveragewithnopreexistingconditionsexclusionsappliedinthePlanuponreturnfromservice(andwill runconcurrentlywithanyCOBRAcontinuationcoverage,totheextentallowed by law). These rights apply only to Employees and their Dependents covered under the Plan beforeleavingformilitaryservice.


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PLANADMINISTRATION

InGeneralCoastReal Estate Services is thePlanAdministratorof thePlanandaNamedFiduciarywithin themeaningofsuchtermsasusedintheEmployeeRetirementIncomeSecurityActof1974,asamended("ERISA").CoastRealEstateServicesisthePlan'sagentforserviceoflegalprocess.

CoastRealEstateServiceshasthedutyandauthoritytointerpretandconstruethePlaninregardtoallquestionsofeligibility,thestatusandrightsofanyPlanparticipantunderthePlan,andthemanner,time,andamountofpayment of anybenefits under the Plan. Each Employee shall, from time to time, upon request of Coast RealEstate Services, furnish to Coast Real Estate Services such data and information as Coast Real Estate ServicesshallrequireintheperformanceofitsdutiesunderthePlan.

CoastRealEstateServicesmaydesignateanyindividual,partnershiporcorporationastheAdministratortocarryout its duties and responsibilitieswith respect to the administration of the Plan. Such designation shall be inwritingandsuchwritingshallbekeptwiththerecordsofthePlan.

CoastRealEstateServicesmayadoptsuchrulesandproceduresasitdeemsdesirablefortheadministrationofthePlan,providedthatanysuchrulesandproceduresshallbeconsistentwithprovisionsofthePlanandERISA.

CoastRealEstateServiceswilldischarge itsdutieswith respect to thePlan (i) solely in the interestofpersonseligibletoreceivebenefitsunderthePlan,(ii)fortheexclusivepurposeofprovidingbenefitstopersonseligibletoreceivebenefitsunderthePlanandofdefrayingreasonableexpensesofadministeringthePlan,and(iii)withthecare,skill,prudenceanddiligenceunderthecircumstancesthenprevailingthataprudentpersonactinginalikecapacityandfamiliarwithsuchmatterswoulduseintheconductofanenterpriseoflikecharacterandwithlikeaims.

AmendmentandTerminationCoastRealEstateServices intends tomaintain thePlan indefinitely,but isundernoobligation tocontinue thePlanandcanamendorterminatethePlanbyprovidingwrittennoticetothePlanparticipants. InamendingorterminatingthePlan,CoastRealEstateServicescannotretroactivelyreducethebenefitstowhichaparticipantisentitledpriortotheterminationoramendment.


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PATIENTPROTECTIONANDAFFORDABLECAREACT

ACAReportingObligationsonHealthCareCoverageUnderthePatientProtectionandAffordableCareAct’s(ACA)IndividualMandate(CodeSection5000A(f)andanyaccompanying regulations or guidance) each individual is required to have basic health insurance coverage(known as minimum essential coverage), qualify for an exemption, or make a shared responsibility paymentwhenfilingtheirfederalincometaxreturn.FailuretoenrollinaplanofferingminimumessentialcoveragemayresultintheIRSapplyingpersonalfinancialpenalties.

InadditiontotheIndividualMandate,certainlargeemployers(includingcertainsmallemployersthatarepartofalargercontrolledgroup)maybesubjecttoapenaltytaxforfailingtoofferminimumessentialcoveragetomostfull-time employees and their dependent children or offering health care coverage that is not “affordable”(exceedsaspecifiedpercentageoftheemployee’shouseholdincome)ordoesnotoffer“minimumvalue”(planpaysatleast60%ofthetotalcostofbenefits).

Effectiveasofthe2015calendaryeartheACArequiresemployers,insurancecarriers,andACAMarketplacestoreporttotheInternalRevenueService(IRS),andseparatelytocoveredindividuals,onthehealthcarecoverageprovided to individuals for purposes of the Individual and Employer Mandates noted above. The type ofreportingform(s)youreceivewilldependonthecoverageyouenrolledinduringthepriorcalendaryear:

§ Form 1095-A, Health Insurance Marketplace Statement. The ACA Marketplace sends this form toindividuals enrolled in coverage in the Marketplace, with information about the coverage, who wascovered,andwhen.

§ Form1095-B,Health Coverage.Health insurance companies and certain small employers that offer self-insuredhealthcoveragesendthisformtoindividualstheycover,withinformationaboutwhowascoveredandwhen.

§ Form1095-C,Employer-ProvidedHealth InsuranceOfferandCoverage.Certain largeemployerssendthisformtofull-timeemployees,withinformationaboutwhatcoveragetheemployeroffered.Largeemployersthatofferself-insuredhealthcoveragewillalsosendthisformtoindividualstheycover,withinformationaboutwhowascoveredandwhen.

IfyouareenrolledinoneoftheComponentHealthPlansunderthisPlan,youmayrefertoyourForm1095ortothatComponentHealthPlan’sSummaryofBenefitsandCoverage(SBC)todetermineifyouarecoveredunderaplanthatprovidesminimumessentialcoverageandisofminimumvalue.

CoverageforDependentsUptoAge26Group health plans must make dependent coverage to adult children available until they turn age 26. Themandate applies to any adult child whether or not he or she is eligible to enroll in some other employer-sponsoredgrouphealthplan.AdultchildrenshallincludethosewhoareachildofthePlanparticipant,whetherornottheyliveathomeoraremarriedornotmarried,adependentontheemployee’staxreturn,orastudent.Adultchildrenunderage26mustbeofferedcoverageeven if theydonot live inaparticularservicearea (butplansarenotrequiredtocoverout-of-networkservicesfortheseadultchildren).

EssentialHealthBenefits ACAgenerallydefinesEssentialHealthBenefitstoincludethefollowingbroadcategoriesofhealthcarebenefits.EssentialHealthBenefitscoveredunderthisPlanaresubjecttocertainadditionalrequirementsunderACA.§ Ambulatorypatientservices(i.e.outpatientcarereceivedwithoutbeingadmittedtothehospital)

§ Emergencyservices

§ Hospitalization


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§ Maternityandnewborncare

§ Mentalhealthandsubstanceusedisorderservices,includingbehavioralhealthtreatment

§ Prescriptiondrugs

§ Rehabilitativeandhabilitativeservicesanddevices

§ Laboratoryservices

§ Preventiveandwellnessservices,includingchronicdiseasemanagement

§ Pediatricservices,includingoralandvisioncare

ACAregulations furtherdefineEssentialHealthBenefitsbasedonstate-specific“benchmark”plans,or forself-insuredplans,ontheFederalEmployeesHealthBenefitProgram.

LifetimeandAnnualDollarLimitsonEssentialHealthBenefitsUnderACA,thisPlanisprohibitedfromimposinglifetimeorannuallimitsonthedollarvalueofEssentialHealthBenefits provided to any individual, regardless of whether the benefits are provided in-network or out-of-network.ThisPlan isnotprohibited,however, fromplacing lifetimeorannualdollar limitsonspecific coveredbenefitsthatarenotEssentialHealthBenefitstotheextentsuchlimitsareotherwisepermittedunderapplicablefederalorstatelaw.

PreexistingConditionExclusions(PCEs)Grouphealthplansareprohibitedfromdenyingcoverageorexcludingspecificbenefitsfromcoverageduetoanindividual’spreexistingcondition,regardlessoftheindividual’sage.APCEincludesanyhealthconditionorillnessthat is present before the coverage effective date, regardless of whether medical advice or treatment wasactuallyreceivedorrecommended.ThisACAprovisioneffectivelyeliminatestheneedtoprovideCertificatesofCreditableCoveragewhencoverageunderthisPlanhasended.

RescissionsTheComponentHealthPlansinthisPlanaregenerallyprohibitedfromrescindingthecoverageofaparticipant.Rescissionmeans a cancellation or discontinuance of coverage that has a retroactive effect. A cancellation ordiscontinuanceisnotaprohibitedrescissionif:

§ It is initiatedbyan individual and theplan, issuer, employeror sponsordoesnot takeanyactions toinfluencetheindividual’sdecisiontoretaliateagainsttheindividual;

§ ItisinitiatedbytheMarketplace;

§ Itonlyhasaprospectiveeffect;or,

§ Itiseffectiveretroactivelyduetoafailuretotimelypayrequiredpremiumsorcontributionstowardthecostofcoverage,includingnonpaymentofCOBRApremiums.

Rescissionsarepermittedforfraudortheintentionalmisrepresentationoffactbytheparticipantasprohibitedby the terms of the plan. The planmust provide at least 30 days’ advance notice to the affected participantbefore coverage may be rescinded, and only as permitted under Section 2702(c) or Section 2742(b) of ACA.Rescissionsaresubjecttointernalclaimsandappealsandexternalreview.

90-DayWaitingPeriodLimitGrouphealthplansmaynotapplyawaitingperiodforcoveragethatexceeds90days.Awaitingperiodisdefinedastheperiodthatmustpassbeforecoverageforaneligibleemployeeorhisorherdependentbecomeseffectiveunder the Plan. ACA regulations permit plans to condition health coverage eligibility on an employee’scompletion of an employment-based orientation period of up to onemonth before application of the 90-daywaitingperiodlimits.Areasonableandbonafideemploymentbasedorientationperiodispermissibleifitisnotdesignedtoavoidcompliancewiththe90-daywaitingperiodlimitation.


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InsuranceIssuerRebatesIntheeventthatCoastRealEstateServicesqualifiesandreceivesareturnofpremium(Rebate)asaresultoftheissuer's failure tomeet theMedical LossRatio (MLR) requirementsunderACA, thePlanSponsor, at itsoptionshalleither:

§ Reimburse Plan participants through a payroll adjustment in the amount determined under the ACAregulations;or,

§ Reduce employee contributions (current or future) by an amount determined under ACA regulations toreflecttheemployee’sshareoftheRebate;or,

§ UsetheRebatetoenhancebenefitsunderthePlanbyanamountdeterminedunderACAregulations.

PatientProtectionsEmergency Services. If anon-grandfatheredComponentHealthPlanprovidesbenefits foremergency services,theComponentHealth Planmaynot require preauthorization andmust provide emergency services coverageregardlessofwhethertheproviderisin-orout-of-network.Theplangenerallycannotimposeanycopaymentorcoinsuranceforout-of-networkemergencyservices that isgreater thanwhatwouldbe imposed if theserviceswereprovidedin-network.ACAregulationssetforthminimumpaymentstandardstoensurethataplandoesnotpayanunreasonably lowamounttoanout-of-networkemergencyserviceproviderwhomay, inturn,“balancebill” thepatient. Emergency care isnot limited to treatmentwithin24hoursof theonsetofanemergency.Aplan or issuer must provide for emergency services, without any time limit within which treatment must besought.

Plansarerequiredtodisclosehowtheyreachedtheout-of-networkpaymentamountwithin30daysofarequestbyaParticipantandaspartofanyclaimsreview.

Primary Care Provider Designation. If this Plan requires or allows participants to designate primary careproviders,orifthePlanautomaticallydesignatesaprimarycareproviderforaparticipant,thentheparticipanthastherighttodesignateanyprimarycareproviderwhoparticipatesinthePlan’snetworkandwhoisavailableto accept the participant or participant’s family members. For children, the participant may designate apediatricianas theprimarycareprovider.Classificationofaprimarycareprovider isdeterminedbasedon theplanorpolicytermsandinaccordancewithapplicablestatelaw.

AccesstoObstetricalorGynecologicalCare.Aparticipant,regardlessofage,shallnotneedpriorauthorizationfrom the Plan or from any other person (including a primary care provider) in order to obtain access toobstetrical or gynecological care from a health care professional in the Plan’s network who specializes inobstetricsorgynecology.

Access to Pediatric Care. If the Plan requires or provides for the designation of a participating primary careprovider for a dependent child, the Plan shall permit such person to designate a physician (allopathic orosteopathic)whospecializesinpediatrics(includingpediatricsubspecialties)asthechild’sprimarycareproviderifsuchproviderparticipatesinthenetworkofthePlanorissuer.

PreventiveCareNon-grandfathered group health plans subject to the preventive services coverage mandate must providecoverage for all of the following preventive services without imposing any co-payments, co-insurance,deductibles, or other cost-sharing requirements. If the attending provider determines that the service ismedicallynecessary,aplanmustprovidecoverageregardlessofsexassignedatbirth,genderidentity,orgenderoftheindividualasrecordedbytheplan:

§ Evidence-based items or services with an A or B rating currently recommended by the United StatesPreventiveServicesTaskForce(USPSTF)withrespecttotheindividualseekingcare;


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§ Immunizationsforroutineuseinchildren,adolescents,oradultscurrentlyrecommendedbytheAdvisoryCommitteeonImmunizationPractices(ACIP)oftheCentersforDiseaseControlandPrevention;

§ Forinfants,childrenandadolescents:Evidence-informedpreventivecareandscreeningssupportedbytheHealth Resources and Services Administration (HRSA), including well-woman preventive services andpreconception/prenatalcarethatareage-anddevelopmentally-appropriate;and,

§ Forwomen: Evidence-informed preventive care and screening provided for in comprehensive guidelinessupportedbyHRSA,totheextentnotincludedincertainrecommendationsoftheUSPSTF.

ú HRSA guideline recommendation includes all FDA-approved contraceptive methods, sterilizationprocedures,andpatienteducationandcounselingforallwomenwithreproductivecapacity.EffectiveforplanyearsbeginningonorafterJuly10,2015,Plansmustcoveratleastoneformofcontraceptionineachofthecurrently18distinctmethodstheFDAhasidentifiedinitsBirthControlGuide.

ú USPSTFrecommendedgeneticcounselingandBRCAtestingtodetermineafamilyhistorypotentiallyassociatedwithanincreasedriskformutationsinbreastcancersusceptibilitygenesmustbeprovidedto women with positive screen results as well as women who previously have had breast cancer,ovariancancerorothernon-BRCA-relatedcancerwhoarecurrentlyasymptomaticandcancer-free.

Cost-SharingLimitationsonEssentialHealthBenefits(Out-of-PocketMaximums)ACArequiresgrouphealthplanstoapplyauniformmaximumlimitforout-of-pocketexpenses(deductibles,co-insurance,co-pays,orsimilarcharges)onallEssentialHealthBenefitsofnogreaterthanthemaximumamountssetannuallyby the InternalRevenueService (IRS) forHSA-eligiblehigh-deductiblehealthplansasadjusted forinflationusingthe“premiumsadjustmentpercentage.”

§ Theoverallcost-sharing limitonlyappliestobenefitsprovided in-network.Aplanmay includeout-of-networkexpensesatitsdiscretion.

§ Out-of-pocket expenditures on all Essential Health Benefits must accrue to one out-of-pocketmaximum,withoutconsiderationforwhetheraplanusesmorethanoneserviceprovidertoadministerbenefits.

§ Plansarenotrequiredtoapplytheannual limitationonout-of-pocketmaximumstobenefitsthatarenotEssentialHealthBenefits.SeeaboveinthisSectionforalistofEssentialHealthBenefits.

§ EmbeddedRule: Forplanyearsbeginning in2016, the self-only cost-sharing limitmustapply toeachcoveredindividual,whethertheindividualhasself-only,family,orothercoverage.

CoverageforClinicalTrialsNon-grandfatheredgrouphealthplansmustprovidebenefitcoverage(includingphysiciancharges, labs,x-rays,professionalfeesandotherroutinemedicalcosts)forcertainroutinepatientcostsforqualifiedindividualswhoparticipateinanapprovedclinicaltrial.Approvedclinicaltrialsmustbecoveredforthetreatmentofcancerandother life-threateningdiseasesorconditions.Thecoveragedoesnotapplyfortheactualdevice,equipment,ordrug that is typically given to participating patients free of charge by the company sponsoring the trial. Inaddition, if a Participant experiences complications as a result of the clinical trial, any treatment of thosecomplicationsmustbecoveredonthesamebasisthatthetreatmentwouldbecoveredforindividualsnotintheclinicaltrial.

ClaimsAppealProcessIn addition to the claimsappealsproceduresdescribed in this Planand the SummaryPlanDescription, anon-grandfathered group health plan shall implement an effective appeals process for appeals of coveragedeterminationsandclaims,underwhichthePlanorissuershall,ataminimum:

§ Haveineffectaninternalclaimsappealprocess;


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§ Providenotice to enrollees, in a culturally and linguistically appropriatemanner, of available internaland external appeals processes, and the availability of any applicable office of health insuranceconsumerassistanceorombudsmantoassistsuchenrolleeswiththeappealsprocesses;and

§ Allowenrolleestoreviewtheirfiles,topresentevidenceandtestimonyaspartoftheappealsprocess,andtoreceivecontinuedcoveragependingtheoutcomeoftheappealsprocess.

§ Agrouphealthplanshallalso:

§ ComplywiththeapplicablestateExternalReviewprocessforsuchplansandissuersthat,ataminimum,includestheconsumerprotectionssetforthintheUniformExternalReviewModelActpromulgatedbytheNationalAssociationofInsuranceCommissionersandisbindingonsuchplans;or,

§ Implement an effective External Review process that meets minimum standards established by theSecretarythroughguidanceandthatissimilartotheprocessapplicabletotheinternalclaimsprocess:

ú iftheapplicablestatehasnotestablishedanExternalReviewprocessthatmeetstherequirementsapplicabletotheinternalclaimsprocess;or

ú iftheplanisaself-insuredplanthatisnotsubjecttostateinsuranceregulation(includingastatelawthatestablishesanExternalReviewprocesswhosetermsaresimilartotheprocessapplicabletotheinternalclaimsprocess.)


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CLAIMSANDAPPEALPROCEDURES

Insofaras theseproceduresareconsistentwiththeprovisionsofACA, theproceduresoutlinedbelowmustbefollowedbyPlanparticipants(“claimants”)toobtainpaymentofbenefitsunderthisPlan.

Non-HealthClaimsForpurposesofallnon-healthinsuredwelfareplancoverage(disability,Life,AD&D,etc.)thecertificatebookletprovidedbytheissuerscontainsadetaileddescriptionoftheissuer’sclaimssubmissionrulesandclaimsappealprocedures.

HealthClaimsForpurposesoftheHealthClaimsandClaimsAppealProcedurecontainedinthisSummaryPlanDescription,theterm“Administrator”willmeaneither the issueror thePlanAdministratordependingupon thepolicyorplanunderwhichtheclaimhasbeenfiled.

YoumustfollowtheproceduresoutlinedbelowtoobtainpaymentofhealthbenefitsunderthisPlan.

YoushoulddirectallclaimsandquestionsregardinghealthclaimstotheAdministrator.TheAdministratorshallhavefinalauthorityforadjudicatingallclaimsandafullreviewofthedecisiononsuchclaimsinaccordancewiththefollowingprovisionsandwithERISA.

As an individual claimingbenefits under thePlan, you shall be responsible for supplying, at such times and insuch manner as the Administrator in its sole discretion may require, written proof that the expenses wereincurredorthatthebenefitiscoveredunderthePlan.IftheAdministratorinitssolediscretionshalldeterminethatyouhavenot incurredacoveredexpenseorthatthebenefit isnotcoveredunderthePlan,or ifyouhavefailedtofurnishsuchproofasisrequested,nobenefitsshallbepayabletoyouunderthePlan.

UnderthePlan,therearefourtypesofclaims:UrgentPre-Service,Non-urgentPre-Service,Concurrent,andPost-Service.

§ Pre-ServiceClaims.A"Pre-ServiceClaim"isaclaimforabenefitunderthePlanwherethePlanconditionsreceiptofthebenefit,inwholeorinpart,onapprovalofthebenefitinadvanceofobtainingmedicalcare.

A "Pre-ServiceUrgent Care Claim" is any claim formedical care or treatmentwith respect towhich theapplicationofthetimeperiodsformakingnon-urgentcaredeterminationscouldseriouslyjeopardizeyourlifeorhealthoryourabilitytoregainmaximumfunction,or,intheopinionofaphysicianwithknowledgeofyourmedicalcondition,wouldsubjectyoutoseverepainthatcannotbeadequatelymanagedwithoutthecareortreatmentthatisthesubjectoftheclaim.

Itisimportanttorememberthat,ifyouneedmedicalcareforaconditionwhichcouldseriouslyjeopardizeyour life, there is no need to contact the Plan for prior approval. You should obtain such care withoutdelay.

Further,ifthePlandoesnotrequireyoutoobtainapprovalofamedicalservicepriortogettingtreatment,then there isno “Pre-ServiceClaim.”You simply follow thePlan'sprocedureswith respect toanynoticewhichmayberequiredafterreceiptoftreatment,andfiletheclaimasaPost-ServiceClaim.

§ Concurrent Claims: A “Concurrent Claim” arises when the Plan has approved an ongoing course oftreatment to be provided over a period of time or number of treatments, and either (a) the Plandeterminesthatthecourseoftreatmentshouldbereducedorterminated,or(b)yourequestanextensionofthecourseoftreatmentbeyondthatwhichthePlanhasapproved.

If thePlandoesnot requireyou toobtainapprovalofamedical serviceprior togetting treatment, thenthereisnoneedtocontacttheAdministratortorequestanextensionofacourseoftreatment.Yousimply


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followthePlan'sprocedureswithrespecttoanynoticewhichmayberequiredafterreceiptoftreatment,andfiletheclaimasaPost-ServiceClaim.

§ Post-ServiceClaims:A“Post-ServiceClaim”isaclaimforabenefitunderthePlanaftertheserviceshavebeenrendered.

WhenHealthClaimsMustBeFiledHealth claimsmust be filedwith theAdministratorwithin one year of the date charges for the serviceswereincurred. Benefits are based upon the Plan's provisions at the time the charges were incurred. Charges areconsidered incurredwhentreatmentorcare isgivenorsuppliesareprovided.Claimsfiled laterthanthatdateshallbedenied,unlessitisshownthatitwasnotreasonablypossibletofilewithinthistimeframe.

ThePlan,uponreceiptofawrittennoticeofaclaim,willfurnishyouaformforfilingproofofloss.Ifsuchformsare not furnished within 15 days after notice is given, you will be considered to have complied with therequirementofthePlanwithrespecttoproofoflossandwrittenproofcoveringtheoccurrence,thecharacter,andtheextentofthelossforwhichtheclaimismade.

APre-ServiceClaim(includingaConcurrentClaimthatalsoisaPre-ServiceClaim)isconsideredtobefiledwhentherequestforapprovaloftreatmentorservicesismadeandreceivedbytheAdministratorinaccordancewiththePlan’sprocedures.However,aPost-ServiceClaimisconsideredtobefiledwhenthefollowinginformationisreceivedbytheAdministrator:

§ Thedateofservice;§ The name, address, telephone number and tax identification number of the provider of the services or

supplies;§ Theplacewheretheserviceswererendered;§ Thediagnosisandprocedurecodes;§ Theamountofcharges;§ ThenameofthePlan;§ Thenameoftheparticipant;and,§ Thenameofthepatient.

Upon receipt of this information, the claim will be deemed to be filed with the Plan. The Administrator willdetermine if enough information has been submitted to adjudicate the claim. If not, the Administrator mayrequestmoreinformation.TheAdministratormustreceivetheadditionalinformationwithin45days(48hoursinthecaseofPre-ServiceUrgentCareClaims)fromyourreceiptoftherequestforadditionalinformation.Failuretodosomayresultinclaimsbeingdeclinedorbenefitsreduced.

TimingofClaimDecisionsTheAdministratorshallnotifyyou,inaccordancewiththeprovisionssetforthbelow,ofadenial(and,inthecaseofPre-ServiceClaimsandConcurrentClaims,ofdecisionsthataclaimispayableinfull)withinthefollowingtimeframes:

§ Pre-ServiceUrgentCareClaims. Ifyouhaveprovidedallof thenecessary information,theAdministratorwillnotifyyouofitsdecisionassoonaspossible,takingintoaccountthemedicalexigencies,butnotlaterthan72hoursafterreceiptoftheclaim.

If youhavenotprovidedallof the informationneeded toprocess the claim, then theAdministratorwillnotifyyouastowhatspecificinformationisneededassoonaspossible,butnotlaterthan24hoursafterreceiptoftheclaim.TheAdministratorwillnotifyyouofitsdeterminationofbenefitsassoonaspossible,butnot later than48hours, taking intoaccount themedicalexigencies, after theearlierof (i) thePlan'sreceiptofthespecifiedinformation,or(ii)theendoftheperiodaffordedyoutoprovidetheinformation.


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§ Pre-Service Non-urgent Care Claims. If you have provided all of the information needed to process theclaim,theAdministratorwillnotifyyouofitsdecisionwithinareasonableperiodoftimeappropriatetothemedical circumstances, but not later than 15 days after receipt of the claim. If an extension has beenrequested,theAdministratorwillnotifyyouofitsdecisionpriortotheendofthe15-dayextensionperiod.

Ifyouhavenotprovidedallofthe informationneededtoprocesstheclaim,theAdministratorwillnotifyyouastowhatspecificinformationisneededassoonaspossible,butnotlaterthan5daysafterreceiptoftheclaim.Youwillbegivenatleast45daysfromreceiptofthenoticewithinwhichtoprovidethespecifiedinformation.

§ ConcurrentClaims:

ú Plan Notice of Reduction or Termination. If the Administrator is notifying you of a reduction ortermination of a course of treatment (other than by Plan amendment or termination), theAdministratorwillnotifyyouofitsdecisionsufficientlyinadvanceofthereductionorterminationtoallow you to appeal and obtain a determination on review of that adverse benefit determinationbeforethebenefitisreducedorterminated.

ú Request by Claimant Involving Urgent Care. If the Administrator receives a request from you toextend the courseof treatmentbeyond theperiodof timeornumberof treatments that is a claiminvolvingUrgentCare,theAdministratorwillnotifyyouofitsdecisionassoonaspossible,takingintoaccountthemedicalexigencies,butnotlaterthan24hoursafterreceiptoftheclaim,aslongasyoumaketherequestatleast24hourspriortotheexpirationoftheprescribedperiodoftimeornumberoftreatments. Ifyousubmittherequest lessthan24hourspriortotheexpirationoftheprescribedperiodoftimeornumberoftreatments,therequestwillbetreatedasaclaiminvolvingUrgentCareanddecidedwithintheUrgentCaretimeframe.

ú RequestbyClaimantInvolvingNon-urgentCare.IftheAdministratorreceivesarequestfromyoutoextend the course of treatment beyond the period of timeor number of treatments and the claimdoesnotinvolveUrgentCare,therequestwillbetreatedasanewbenefitclaimandwillbedecidedwithinthetimeframeappropriatetothetypeofclaim(eitherasaPre-ServiceNon-urgentClaimoraPost-ServiceClaim).

§ Post-Service Claims. If you have provided all of the information needed to process the claim, theAdministratorwillnotifyyouofitsdecisionwithinareasonableperiodoftime,butnotlaterthan30daysafter receipt of the claim, unless an extension has been requested, then prior to the end of the 15-dayextensionperiod.

If theextensiondescribedabove isnecessarybecauseyou failed to submit the informationnecessary todecidetheclaim,thenoticeofextensionmustdescribespecificallytherequiredinformation.Youshallbeaffordedatleast45daysfromthereceiptofsuchnoticewithinwhichtoprovidethespecifiedinformation.

§ Extensions – Pre-ServiceUrgent CareClaims.Noextensionsareavailable inconnectionwithPre-ServiceUrgentCareClaims.

§ Extensions–Pre-ServiceNon-urgentCareClaims.ThisperiodmaybeextendedbythePlanforupto15days,providedthattheAdministratorbothdeterminesthatsuchanextensionisnecessaryduetomattersbeyond the control of the Plan and notifies you, prior to the expiration of the initial 15-day processingperiod, of the circumstances requiring the extension of time and the date bywhich the Plan expects torenderadecision.

§ Extensions–Post-ServiceClaims.ThisperiodmaybeextendedbythePlanforupto15days,providedthattheAdministratorbothdeterminesthatsuchanextensionisnecessaryduetomattersbeyondthecontrolof the Plan and notifies you, prior to the expiration of the initial 30-day processing period, of thecircumstancesrequiringtheextensionoftimeandthedatebywhichthePlanexpectstorenderadecision.

§ CalculatingTimePeriods.TheperiodoftimewithinwhichabenefitdeterminationisrequiredtobemadeshallbeginatthetimeaclaimisdeemedtobefiledinaccordancewiththeproceduresofthePlan.


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ClaimsAppealProcedureNature of Denial. The notice of a denial of a claim shall bewritten or in electronic form (in compliancewithERISAregulations),ororalinthecaseofaPre-ServiceUrgentCareclaim,aslongasawrittenorelectronicnoticeisfurnishedtoyouwithin3daysoftheoralnotice,andshallsetforth:

§ Thespecificreasonforthedenial;

§ Specific references to thepertinentPlanprovisionsonwhich thedenial isbased includinga copyofanyinternalguidelineusedinthebenefitdeterminationornoticeofwhereandhowyoucanobtainacopyfreeofcharge;

§ A description of any additional material or information necessary for you to perfect the claim and anexplanationastowhysuchinformationisnecessary;

§ AnexplanationofthePlan’sclaimsappealsprocedures;

§ YourrighttobringacivilactionunderERISASection502(a);

§ If your claim is denied based on medical necessity, experimental treatment, or similar exclusion orlimitation, an explanation of the scientific or clinical judgment applied in the benefit determination, ornoticeofwhereandhowyoucanobtainacopyfreeofcharge;and,

§ ForpurposesofPre-ServiceUrgentCareClaims,adescriptionoftheexpeditedreviewprocess.

TimingofanAppeal§ Pre-ServiceClaims.ForPre-ServiceUrgentCareClaims,ifyouchoosetoappeal,pleaserefertoAppendixB

foralistingofnames,addressesandphonenumbersforeachissuer.

§ All Other Claims.Within 180 days after the receipt of the abovematerial, you shall have a reasonableopportunity to appeal the claim denial to the Administrator for a full and fair review. You or your dulyauthorizedrepresentativemay:

ú RequestareviewbyprovidingwrittennoticetotheAdministrator;

ú Submitwrittencomments,documents,recordsandotherinformationrelatingtotheclaim;and,

ú Uponrequest,havereasonableaccesstoandcopiesofalldocuments,records,andotherinformationrelevanttotheclaim.

TimingofNotificationofBenefitDeterminationonReviewThe Administrator shall notify you of the Plan’s benefit determination on review within the following timeframes:

§ Pre-ServiceUrgentCareClaims.Assoonaspossible, taking intoaccount themedicalexigencies,butnotlaterthan72hoursafterreceiptoftheappeal.

§ Pre-Service Non-urgent Care Claims. Within a reasonable period of time appropriate to the medicalcircumstances,butnotlaterthan30daysafterreceiptoftheappeal.

§ Concurrent Claims. The response will bemade in the appropriate time period based upon the type ofclaim:Pre-ServiceUrgent,Pre-ServiceNon-urgentorPost-Service.

§ Post-Service Claims.Within a reasonable periodof time, but not later than 60 days after receipt of theappeal.

§ CalculatingTimePeriods.TheperiodoftimewithinwhichthePlan'sdeterminationisrequiredtobemadeshallbeginatthetimeanappealisfiledinaccordancewiththeproceduresofthisPlan,withoutregardtowhetherallinformationnecessarytomakethedeterminationaccompaniesthefiling.


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InternalReviewandDecision§ Full and Fair Review. The Plan Administrator, as Plan Fiduciary, shall take into account all comments,

documents, and other information submitted by you without regard to whether the information wassubmittedwiththeoriginalclaimandwithoutdeferencetotheoriginaldetermination.Thedecisionshallbebasedinwholeor inpartonamedical judgment,withconsultationwiththeappropriate independenthealth care professionals, if the claim involves investigational or experimental treatment, or issues ofmedicalnecessity,andshallidentifysuchprofessionals.

§ Decision.ThedecisionofthePlanAdministratorshallbewrittenandshallincludespecificreasonsforthedecision,withspecificreferencesandcopiesofthepertinentPlanprovisionsorinternalguidelineonwhichthedecisionisbased.YoualsohavearighttobringacivilactionunderERISASection502(a)followingthedenial of your appeal. If your appeal is denied based onmedical necessity, experimental treatment, orsimilarexclusionorlimitation,youwillreceiveanexplanationofthescientificorclinicaljudgmentappliedonthebenefitdetermination,ornoticeofwhereandhowyoucanobtainacopy.

§ SecondAppeal. Should you receiveanadversedeterminationof theappeal, youhave the right to file asecond appeal. The second appeal must be filed no later than 30 days from the date indicated on theresponse letter to the first appeal. The timing of response to the second appeal shall be made inaccordancewiththesameguidelinesasthoseoutlinedforthefirstappeal.

ExternalReviewNon-grandfathered group health plans subject to ACA, must also offer claimants the opportunity to pursueExternalReviewfollowingexhaustionoftheInternalAppealsproceduressetforthinthissection.

§ RequestinganExternalReview.IntheeventthatanInternalAppealresultsinadenialbaseduponmedicaljudgment or a rescission (in whole or in part), the claimant may request an External Review by givingwritten notice of the appeal to the Plan Administrator within 120 days after the claimant receives thenoticeofdecisionontheInternalAppeal.

§ EligibilityforExternalReview.Within5businessdaysfollowingthedateofreceiptoftheExternalReviewrequest, thePlanAdministratorwill completeapreliminary reviewof the request todeterminewhetherthematteriseligibleforExternalReview.AmatteriseligibleforExternalReviewonlyifitmeetsallofthefollowingrequirements:

ú The claimant is or was covered under the Plan at the time the health care item or service wasrequested;

ú The denial does not relate to the claimant’s failure tomeet the eligibility requirements under theterms of the Plan (in other words, the External Review process does not apply to eligibilitydeterminations);

ú TheclaimanthasexhaustedthePlan’sInternalAppealprocess;and

ú TheclaimanthasprovidedalltheinformationrequiredtoprocessanExternalReview.

§ Notice of External Review Eligibility. Within one (1) business day after completion of the preliminaryreview, the Planwill issue a notification inwriting to the claimant. The notificationwill advise claimantthat:

ú TheclaimisnoteligibleforExternalReview;

ú TheclaimiseligibleandreadyforExternalReview;or

ú ItisunclearwhethertheclaimiseligibleforExternalReviewbecauseclaimanthasnotprovidedalltheinformationrequired.

§ ExternalReviewProcess.IftheclaimiseligibleandreadyforExternalReview,thePlanAdministratorwillassign an Independent Review Organization (IRO) that is accredited by URAC (a nonprofit organization


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promotinghealthcarequalitybyaccreditinghealthcareorganizations)orbyasimilarnationallyrecognizedaccreditingorganizationtoconducttheExternalReview.

ú TheIROwilltimelynotifytheclaimantinwritingoftherequest’seligibilityandacceptanceforExternalReview, including a statement that the claimant may submit in writing, within 10 business days,additionalinformationwhichtheIROmustthenconsiderwhenconductingtheExternalReview;and

ú Within5businessdaysafterthedateofassignmenttotheIRO,thePlanAdministratorwillprovidetheIRO the documents and any information considered in deciding the Initial Claim and the InternalAppeal.

ú Within 45 days after it receives the request for External Review, the IRO will deliver a notice ofdecisiontoclaimant.

ú TheIRO’sdecisionshallbebindingonallpartiesunlessanduntilthereisajudicialdecisionotherwise.

§ Eligibility for Expedited External Review. Claimantmay request an “expedited” External Review in thefollowingcircumstances:

ú Claimant(a)hasreceivedadecisiononaninitialclaiminvolvingeitherurgentcareorconcurrentcare,(b) has filed a request for an appeal, and (c) has amedical condition for which the timeframe forcompletion of an appeal would seriously jeopardize claimant’s life or health or would jeopardizeclaimant’sabilitytoregainmaximumfunction.

ú Claimant (a) has completed an Internal Appeal, and (b) has a medical condition for which thetimeframe a standard External Review would seriously jeopardize claimant’s life or health, wouldjeopardizeclaimant’sabilitytoregainmaximumfunction.

ú Claimant (a)hascompletedan InternalAppeal, (b) theAppealconcernsanadmission,availabilityofcare,continuedstay,orhealthcare itemorserviceforwhichclaimantreceivedemergencyservices,and(c)Claimanthasnotbeendischargedfromthefacility.

§ ExpeditedExternalReviewProcess:

ú A request for an expedited External Review must be accompanied by a written statement fromclaimant’sphysicianthatclaimant’smedicalconditionmeetsthecriteriaabove.

ú The IRO will provide notice of its decision on an expedited External Review as expeditiously asclaimant’smedicalconditionorcircumstancesrequire,butinnoeventmorethan72hoursaftertheIRO’sreceiptofclaimant’srequest.Ifthenoticeisnotinwriting,theIROwillprovidewrittennoticetoclaimantwithin48hoursafteritsdecision.


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NOTICEOFCONTINUATIONCOVERAGERIGHTSUNDERCOBRA

IntroductionYouarereceivingthisnoticebecauseyouhaverecentlybecomecoveredunderagrouphealthplan(thePlan).This notice contains important information about your right to COBRA continuation coverage, which is atemporaryextensionof coverageunder thePlan. ThisnoticegenerallyexplainsCOBRAcontinuation coverage,whenitmaybecomeavailabletoyouandyourfamily,andwhatyouneedtodotoprotecttherighttoreceiveit.Whenyoubecomeeligible forCOBRA,youmayalsobecomeeligible forothercoverageoptions thatmaycostlessthanCOBRAcontinuationcoverage.

The right to COBRA continuation coverage was created by a federal law, the Consolidated Omnibus BudgetReconciliation Act of 1985 (COBRA). COBRA continuation coverage can become available to you and to othermembers of your family who are covered under the Plan when youwould otherwise lose your group healthcoverage.ItcanalsobecomeavailabletoothermembersofyourfamilywhoarecoveredunderthePlanwhenthey would otherwise lose their group health coverage. For additional information about your rights andobligations under the Plan and under federal law, you should review the Plan’s Summary Plan Description orcontactthePlanAdministrator.

Youmayhaveotheroptionsavailabletoyouwhenyoulosegrouphealthcoverage.Forexample,youmaybeeligibletobuyanindividualplanthroughtheHealthInsuranceMarketplace.ByenrollingincoveragethroughtheMarketplace, you may qualify for lower costs on your monthly premiums and lower out-of-pocket costs.Additionally,youmayqualifyfora30-dayspecialenrollmentperiodforanothergrouphealthplanforwhichyouareeligible(suchasaspouse’splan),evenifthatplangenerallydoesn’tacceptlateenrollees.

WhatisCOBRAContinuationCoverage?COBRA continuation coverage is a continuation of health Plan coveragewhen coveragewould otherwise endbecauseof a life event knownas 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 “qualifiedbeneficiary.” You, your spouse and your dependent children could become qualified beneficiaries if coverageunderthePlan is lostbecauseofthequalifyingevent.UnderthePlan,qualifiedbeneficiarieswhoelectCOBRAcontinuationcoveragemustpayforCOBRAcontinuationcoverage.

Ifyouareanemployee,youwillbecomeaqualifiedbeneficiaryifyouloseyourcoverageunderthePlanbecauseeitheroneofthefollowingqualifyingeventshappens:

§ Yourhoursofemploymentarereduced,or

§ Youremploymentendsforanyreasonotherthanyourgrossmisconduct.

Ifyouarethespouseofanemployee,youwillbecomeaqualifiedbeneficiaryifyouloseyourcoverageunderthePlanbecauseanyofthefollowingqualifyingeventshappens:

§ Yourspousedies;

§ Yourspouse’shoursofemploymentarereduced;

§ Yourspouse’semploymentendsforanyreasonotherthanhisorhergrossmisconduct;

§ YourspousebecomesentitledtoMedicarebenefits(underPartA,PartB,orboth);or

§ Youbecomedivorcedorlegallyseparatedfromyourspouse.

YourdependentchildrenwillbecomequalifiedbeneficiariesiftheylosecoverageunderthePlanbecauseanyofthefollowingqualifyingeventshappens:

§ Theparent-employeedies;


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§ Theparent-employee’shoursofemploymentarereduced;

§ Theparent-employee’semploymentendsforanyreasonotherthanhisorhergrossmisconduct;

§ Theparent-employeebecomesentitledtoMedicarebenefits(underPartA,PartB,orboth);

§ Theparentsbecomedivorcedorlegallyseparated;or

§ ThechildstopsbeingeligibleforcoverageunderthePlanasa“dependentchild.”

WhenisCOBRAContinuationCoverageAvailable?ThePlanwillofferCOBRAcontinuationcoveragetoqualifiedbeneficiariesonlyafterthePlanAdministratorhasbeen notified that a qualifying event has occurred. When the qualifying event is the end of employment orreductionof hours of employment, deathof the employee, or the employee’s becoming entitled toMedicarebenefits (under Part A or Part B, or both), the employermust notify the Plan Administrator of the qualifyingevent.

YouMustGiveNoticeofSomeQualifyingEventsFortheotherqualifyingevents(divorceor legalseparationoftheemployeeandspouseoradependentchild’slosingeligibilityforcoverageasadependentchild),youmustnotifythePlanAdministratorwithin60daysafterthe qualifying event occurs. Your noticemust provide the type of qualifying event, the date of the qualifyingevent,andthenameandaddressoftheemployee,spouseordependentwhounderwentthequalifyingevent.

Youmustprovidethisnoticeto:


HowisCOBRAContinuationCoverageProvided?OncethePlanAdministratorreceivesnoticethataqualifyingeventhasoccurred,COBRAcontinuationcoveragewillbeofferedtoeachofthequalifiedbeneficiaries.Eachqualifiedbeneficiarywillhaveanindependentrighttoelect COBRA continuation coverage. Coveredemployeesmayelect COBRA continuation coverageonbehalf oftheirspouses,andparentsmayelectCOBRAcontinuationcoverageonbehalfoftheirchildren.

COBRAcontinuationcoverageisatemporarycontinuationofcoverage.Whenthequalifyingeventisthedeathofthe employee, the employee’s becoming entitled to Medicare benefits (under Part A, Part B, or both), yourdivorce or legal separation, or a dependent child losing eligibility as a dependent child, COBRA continuationcoverage lasts for up to 36months.When thequalifying event is the endof employmentor reductionof theemployee’shoursofemployment,andtheemployeebecameentitledtoMedicarebenefitslessthan18monthsbeforethequalifyingevent,COBRAcontinuationcoverageforqualifiedbeneficiariesotherthantheemployeeslasts until 36 months after the date of Medicare entitlement. For example, if a covered employee becomesentitled to Medicare 8 months before the date on which his employment terminates, COBRA continuationcoverageforhisspouseandchildrencanlastupto36monthsafterthedateofMedicareentitlement,whichisequal to 28months after thedateof thequalifying event (36monthsminus8months).Otherwise,when thequalifying event is the end of employment or reduction of the employee’s hours of employment, COBRAcontinuationcoveragegenerally lastsforonlyuptoatotalof18months.Therearetwowaysinwhichthis18-monthperiodofCOBRAcontinuationcoveragecanbeextended.

DisabilityExtensionof18-MonthPeriodofCOBRAContinuationcoverageIfyouoranyoneinyourfamilycoveredunderthePlanisdeterminedbytheSocialSecurityAdministrationtobedisabledandyounotifythePlanAdministratorinatimelyfashion,youandyourentirefamilymaybeentitledto


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receiveuptoanadditional11monthsofCOBRAcontinuationcoverage,foratotalmaximumof29months.Thedisabilitywould have to have started at some timebefore the 60th day of COBRA continuation coverage andmust last at least until the end of the 18-month period for COBRA continuation coverage. Youmust providenoticetousofreceiptofadeterminationbytheSocialSecurityAdministrationoftotaldisabilitywithin60daysof the date of the notice, the name of the qualified beneficiary who has become disabled, a copy of thedeterminationletter,andtheoriginaldateofdisability.

Youmustprovidethisnoticeto:


SecondQualifyingEventExtensionof18-MonthPeriodofCOBRAContinuationCoverageIfyourfamilyexperiencesanotherqualifyingeventwhilereceiving18monthsofCOBRAcontinuationcoverage,the spouse anddependent children in your family can get up to 18 additionalmonthsof COBRA continuationcoverage,foramaximumof36months,ifnoticeofthesecondqualifyingeventisproperlygiventothePlan.Thisextension may be available to the spouse and dependent children receiving continuation coverage if theemployee or former employee dies, becomes entitled to Medicare (under Part A, Part B, or both), or getsdivorcedorlegallyseparated,orifthedependentchildstopsbeingeligibleunderthePlanasadependentchildbutonlyiftheeventwouldhavecausedthespouseordependentchildtolosecoverageunderthePlanhadthefirstqualifyingeventnotoccurred.

AreThereOtherCoverageOptionsBesidesCOBRAContinuationCoverage?Yes.InsteadofenrollinginCOBRAcontinuationcoverage,theremaybeothercoverageoptionsforyouandyourfamilythroughtheHealthInsuranceMarketplace,Medicaid,orothergrouphealthplancoverageoptions(suchas a spouse’splan) throughwhat is calleda “special enrollmentperiod.” Someof theseoptionsmay cost lessthanCOBRAcontinuationcoverage.Youcanlearnmoreaboutmanyoftheseoptionsatwww.healthcare.gov.

IfYouHaveQuestionsQuestionsconcerningyourPlanoryourCOBRAcontinuationcoveragerightsshouldbeaddressedtothecontactorcontactsidentifiedbelow.FormoreinformationaboutyourrightsunderERISA,includingCOBRA,ACA,HIPAA,and other laws affecting group health plans, contact the nearest Regional or District Office of the U.S.DepartmentofLabor’sEmployeeBenefitsSecurityAdministration(EBSA)inyourareaorvisittheEBSAwebsiteatwww.dol.gov/ebsa. (AddressesandphonenumbersofRegionalandDistrictEBSAOfficesareavailable throughEBSA’swebsite).FormoreinformationabouttheMarketplace,visitwww.healthcare.gov.

KeepYourPlanInformedofAddressChangesInordertoprotectyourfamily’srights,youshouldkeepthePlanAdministratorinformedofanychangesintheaddressesoffamilymembers.Youshouldalsokeepacopy,foryourrecords,ofanynoticesyousendtothePlanAdministrator.

PlanContactInformation HobanandAssociates,Inc.d/b/aCoastRealEstateServicesBenefitPlan HobanandAssociates,Inc.d/b/aCoastRealEstateServices 2829RuckerAvenue Everett,WA98201 (425)339-3638


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STATEMENTOFERISARIGHTS

AsaparticipantintheHobanandAssociates,Inc.d/b/aCoastRealEstateServicesBenefitPlan,youareentitledto certain rights and protections under the Employee Retirement Income Security Act of 1974 (ERISA). ERISAprovidesthatallPlanparticipantsshallbeentitledtothefollowing.

ReceiveInformationAboutYourPlanandBenefitsExamine,without charge,at thePlanAdministrator’sofficeandatother specified locations, suchasworksitesand union halls, all documents governing the Plan, including insurance contracts and collective bargainingagreements,andacopyofthelatestannualreport(Form5500Series)filedbythePlanwiththeUS.DepartmentofLaborandavailableatthePublicDisclosureRoomoftheEmployeeBenefitSecurityAdministration.

Obtain, uponwritten request to the Plan Administrator, copies of documents governing the operation of thePlan,includinginsurancecontractsandcollectivebargainingagreements,andcopiesofthelatestannualreport(Form5500Series)andupdatedSummaryPlanDescription.Theadministratormaymakeareasonablechargeforthecopies.

ReceiveasummaryofthePlan’sannualForm5500(SummaryofAnnualReport),ifanyisrequiredbyERISAtobeprepared. The Plan Administrator is required by law to furnish each participantwith a copy of this SummaryAnnualReport.

ContinueGroupHealthPlanCoverageContinuehealthcarecoverageforyourself,spouseordependentsifthereisalossofcoverageunderthePlanasaresultofaqualifyingevent.Youoryourdependentsmayhavetopayforsuchcoverage.ReviewthisSummaryPlanDescriptionandthedocumentsgoverningyourCOBRAcontinuationcoveragerights.

ReductionorEliminationofExclusionaryPeriodsReceive a reduction or elimination of exclusionary periods of coverage for preexisting conditions under yourhealthplanifyouhavecreditablecoveragefromanotherplan.However,effectiveforplanyearsbeginningonorafter January 1, 2014, the ACA prohibits preexisting condition exclusions in their entirety. Accordingly, untilDecember31,2014,youshouldbeprovidedacertificateofcreditablecoverage,freeofcharge,fromyourgrouphealthplanorhealthinsuranceissuerwhen:

§ Youlosecoverageundertheplan;

§ YoubecomeentitledtoelectCOBRAcontinuationcoverage;or

§ YourCOBRAcontinuationcoverageceases.

Youmustrequestthecertificateofcreditablecoveragebeforelosingcoverageorwithin24monthsafterlosingcoverage.Withoutevidenceofcreditablecoverage,youmaybesubjecttopreexistingconditionexclusionfor12months(18monthsforlateenrollees)afteryourenrollmentdateinsuchcoverage.

PrudentActionsbyPlanFiduciariesInadditiontocreatingrightsforPlanparticipants,ERISAimposesdutiesuponthepeoplewhoareresponsiblefortheoperationoftheemployeebenefitplan.ThepeoplewhooperateyourPlan,called“fiduciaries”ofthePlan,haveadutytodosoprudentlyandintheinterestofyouandotherPlanparticipantsandbeneficiaries.Noone,includingyouremployer,yourunion,oranyotherperson,mayfireyouorotherwisediscriminateagainstyouinanywaytopreventyoufromobtainingawelfarebenefitorexercisingyourrightsunderERISA.


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EnforceYourRightsIfyourclaimforawelfarebenefitisdeniedorignored,inwholeorinpart,youhavearighttoknowwhythiswasdone,toobtaincopiesofdocumentsrelatingtothedecisionwithoutcharge,andtoappealanydenial,allwithincertaintimeschedules.

UnderERISA,therearestepsyoucantaketoenforcetheaboverights.Forinstance,ifyourequestacopyofPlandocumentsorthelatestannualreportfromthePlananddonotreceivethemwithin30days,youmayfilesuitinafederalcourt.Insuchacase,thecourtmayrequirethePlanAdministratortoprovidethematerialsandpayyouupto$110adayuntilyoureceivethematerials,unlessthematerialswerenotsentbecauseofreasonsbeyondthecontroloftheadministrator.Ifyouhaveaclaimforbenefitswhichisdeniedorignored,inwholeorinpart,youmayfilesuit inastateorfederalcourt. Inaddition, ifyoudisagreewiththePlan’sdecisionor lackthereofconcerningthequalifiedstatusofadomesticrelationsorderoramedicalchildsupportorder,youmayfilesuitinfederalcourt.

IfitshouldhappenthatPlanfiduciariesmisusethePlan’smoney,orifyouarediscriminatedagainstforassertingyourrights,youmayseekassistancefromtheU.S.DepartmentofLabor,oryoumayfilesuitinafederalcourt.Thecourtwilldecidewhoshouldpaycourtcostsand legal fees. If youaresuccessful thecourtmayorder thepersonyouhavesuedtopaythesecostsandfees. Ifyoulose,thecourtmayorderyoutopaythesecostsandfees,forexample,ifitfindsyourclaimisfrivolous.

AssistancewithYourQuestionsIfyouhaveanyquestionsaboutyourPlan,youshouldcontactthePlanAdministrator.Ifyouhaveanyquestionsabout thisstatementoraboutyour rightsunderERISA,or ifyouneedassistance inobtainingdocuments fromthePlanAdministrator,youshouldcontactthenearestofficeoftheEmployeeBenefitsSecurityAdministration,U.S.DepartmentofLabor,listedinyourtelephonedirectoryortheDivisionofTechnicalAssistanceandInquiries,Employee Benefits Security Administration, U.S. Department of Labor, 200 Constitution Avenue N.W.,Washington,D.C.20210.Youmayalsoobtain certainpublicationsaboutyour rightsand responsibilitiesunderERISAbycallingthepublicationshotlineoftheEmployeeBenefitsSecurityAdministration.


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OTHERIMPORTANTINFORMATION

PrivacyofInformationIntheadministrationofthisPlan,CoastRealEstateServicesoroneofitsBusinessAssociatesmayberequiredtouseordiscloseprotectedinformationforpurposesofpayingorcausingtobepaidbenefitsunderthisPlan.CoastReal Estate Services has established the following policy regarding the use and disclosure of protected healthinformation(PHI).CoastRealEstateServicesherebyagreesto:

§ NotuseordisclosePHIotherthanaspermittedorrequiredbythePlandocumentorbylaw;

§ EnsurethatanyagentstowhomitprovidesPHIagrees inwritingtothesamerestrictionsandconditionsthatapplytothePlanSponsor;

§ Not use or disclose PHI for employment-related actions and decisions or in connection with any otherbenefitoremployeebenefitPlanofthePlanSponsor;

§ NotuseordisclosePHIthatisgeneticinformationforunderwritingpurposes;

§ ReporttothePlananyuseordisclosureofPHIinconsistentwithPlanprovisions;

§ MakePHIavailableforpurposesofaccess,amendmentandaccountingasrequiredunderHIPAA;

§ MakeinternalpracticesandrecordsregardingPHIavailabletotheHHSSecretary;

§ ReportbreachesofunsecuredPHItoaffectedindividuals,theHHSSecretary,and/orthemediaasrequiredbyHIPAA;and

§ Where feasible, return or destroy all protected health information received from the group health planwhennolongerneededforthepurposeforwhichdisclosurewasmade.

PleaserefertothePlan’sNoticeofPrivacyPracticesforadditionaldetails.

ControllingDocumentsThe information contained in this Summary Plan Description is only a general discussion of the relevantprovisions of the Plan found in the official Plan Document. In all events, the provisions of the official PlanDocumentshallcontrolwithregardtoallmattersconcerningtheadministrationandoperationofthePlan.TheofficialPlanDocumentisavailableforyourreviewattheofficesofHobanandAssociates,Inc.d/b/aCoastRealEstateServices.


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APPENDIXAHOBANANDASSOCIATES,INC.d/b/aCOASTREALESTATESERVICES

BENEFITPLANSUMMARYPLANDESCRIPTION

InsurancePolicyIssuersandContractAdministrator

IssuerNameandAddress PolicyNo. TypeofBenefit

DeltaDentalofWashington97064thAveNESeattle,WA98115

03816 Dental–PPO

LincolnFinancialGroup150NorthRadnor-ChesterRoadRadnor,PA19087

COASTREAL Life

EmployeeAssistanceProgram

VisionServicePlan(VSP)3333QualityDriveRanchoCordova,CA95670

300298050001 Vision–PPO

ContractAdministrator ContractNo. TypeofBenefit

Integraflex2402W.JeffersonStreetBoise,ID83702

— Section105Plan(HRA)

PHCS/MultiPlan,Inc.115FifthAvenueNewYork,NY10003

WCST Medical–PPO


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APPENDIXBHOBANANDASSOCIATES,INC.d/b/aCOASTREALESTATESERVICES


ComponentHealthPlansClaimsAppealsContactInformation

Name Phone/FAX/Address(UseAddressandPhoneNumberonIDCardifdifferent)

DeltaDentalofWashington Attn:ClaimsDepartmentDeltaDentalofWashingtonP.O.Box75983Seattle,WA98175Phone:(800)554-1907

LincolnFinancialGroup Attn:MemberServicesComPsych455N.CityfrontPlazaDriveNBCTower,13thFloorChicago,IL60611-5322Phone:(888)628-4824

VisionServicePlan(VSP) Attn:ClaimsDepartmentVSPP.O.Box385018Birmingham,AL35238-5018Phone:(800)877-7195

ClaimsAppeals:Attn:ClaimsUnitVSP3333QualityDriveRanchoCordova,CA95670Phone:(800)877-7195

ContractAdministrator Phone/FAX/Address

Integraflex Attn:HRAClaimsIntegraflex2402W.JeffersonStreetBoise,ID83702Phone;(208)287-0310Fax:(208)287-0311

PHCS/MultiPlan,Inc. Attn:ClaimsAdministrationTheLoomisCompanyP.O.Box7011Wyomissing,PA19640-6011Phone:(800)367-3721Fax:(610)374-6986


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APPENDIXCHOBANANDASSOCIATES,INC.d/b/aCOASTREALESTATESERVICES


EligibilityandParticipationRequirements

EmployeeClass Line(s)ofCoverage EffectiveDateofEligibility DefinitionofFull-time

RegularFull-TimeEmployees

All Firstdayofthemonthfollowing60daysofemployment

30hoursperweek

VariableHourEmployees

All Firstdayofthemonthcoincidingwithorfollowing13monthsofemployment

Averaging130hourspercalendarmonthduringtheLook-BackMeasurementPeriod

DependentEligibility§ Coverage for dependents, if elected, begins on the date employee coverage begins, unless specified

otherwiseundertheapplicableComponentPlandocument.

§ CoveragealsomaybeavailabletoeligibledomesticpartnersandtheireligibledependentsasdeterminedbytheapplicableComponentPlan.

§ Theterms,“spouse”and“dependent”shallhavethesamemeaningasusedbytheapplicableComponentPlandocument.

EligibilityRulesforVariableHourEmployeesAnemployeewhoisreasonablyexpectedtobeafull-timeemployeeasofhisorherstartdateshallbeofferedcoverageasoftheEffectiveDateofEligibilityspecifiedabove.Anemployeewhoisnotreasonablyexpectedtobeafull-timeemployeeasofhisorherstartdate(VariableHourEmployee),oranemployeewhoisseasonal(inapositionforwhichthecustomaryannualdurationofemploymentissixmonthsorless),willbedeterminedtobe or not to be a full-time employee eligible for benefits under this Plan based on the following rules incompliancewith ACA. To be considered eligible as a full-time employee under ACA rules, the employeemustworkanaverageof30hoursormoreperweekor130hourspercalendarmonth.

DeterminationofFull-TimeStatus.Inordertodeterminethefull-timestatusofanewVariableHourEmployee,CoastRealEstateServiceswillusealook-backmethodtocalculateanemployee’shoursworkedforaperiodoftimespanningaspecifiednumberofmonths(referredtoasthe“InitialMeasurementPeriod”).UponcompletionofaMeasurementPeriod,anemployeewillbeeligibleorineligibleforcoverageforapre-establishedperiodoftimeimmediatelyfollowingtheAdministrativePeriodineffectatthattime(referredtoasthe“StabilityPeriod”).

Look Back Periods Adopted by Coast Real Estate Services. For purposes of the look backmethod, Coast RealEstateServiceshasadoptedthefollowingtimeperiodsforcalculatingfull-timestatus:

§ Initial Measurement and Stability Periods: For newly hired variable hour employees, the MeasurementPeriodwill lasttwelve(12)consecutivemonthsbeginningonthefirstdayofthemonthfollowingdateofhire.Eachemployee’seligibilityforbenefitswillbeassessedduringaone(1)monthAdministrativePeriodimmediately following the Initial Measurement Period. A newly hired variable hour employee who hascompleted his or her Initial Measurement Period will be eligible or ineligible for coverage for a pre-


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established period of time lasting twelve (12) consecutive months immediately following theAdministrativePeriod.

§ OngoingMeasurementPeriod:Foremployeeswhohavecompletedtheir InitialMeasurementPeriod,theOngoingMeasurementPeriodwilllasttwelve(12)consecutivemonthsbeginningonNovember1eachyearandendingonOctober31ofthefollowingcalendaryear.Eachemployee’seligibilityforbenefitswillbere-assessedduringatwo(2)monthAdministrativePeriod immediately followingtheOngoingMeasurementPeriod.

§ Ongoing Stability Period: An employee’s eligibility for benefits after a Stability Period ends will be re-determined using theOngoingMeasurement Period in effect at that time. TheOngoing Stability PeriodbeginsonJanuary1eachyearandendsonDecember31ofthesamecalendaryear.

Hours of Service Used to Calculate Full-Time Status. An “hour of service” refers to each hour for which anemployeeispaid,orentitledtopayment,fortheperformanceofdutiesforCoastRealEstateServiceswithintheUnitedStates, includingtimeduringwhichnodutiesareperformedduetovacation,holiday, illness, incapacity(includingdisability),layoff,juryduty,militaryduty,orleaveofabsence.

§ In the case of hourly employees, Coast Real Estate Services will calculate actual hours of service fromrecordsofhoursworkedandnon-workedhoursforwhichpaymentismadeordue(e.g.,vacation,holiday,illness,incapacity,etc.).

§ Forsalariedemployees,CoastRealEstateServiceswillcalculatehoursofserviceusingoneofthefollowingthreemethods:(i)actualcountingofhoursofservice;(ii)usingadays-workedequivalency(i.e.,eighthoursofserviceforeachdayforwhichtheemployeeisentitledtopayforworkedornon-workedtime);or(iii)using a weeks-worked equivalency (i.e., 40 hours of service per week for each week for which theemployeeisentitledtopayforworkedornon-workedtime).

ACArequiresemployerstouseaspecialhours-of-serviceaveragingmethodfortimeawayduetounpaid leaveunderFMLA,USERRA,orjuryduty.

BreaksinServiceAnemployeeparticipatinginthePlanwhoterminatesemploymentmaybereinstatedwithoutundergoinganewwaitingperiodforeligibility if theemployee is rehiredwithin6months fromdateof termination. IfCoastRealEstateServicesdeterminesthataVariableHourEmployeehasbeencontinuouslyemployedafterthebreak,themeasurementandstabilityperiodsthatwouldhaveappliedtotheemployeehadheorshenotexperiencedthebreakinservicewillcontinueuponrehire.


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APPENDIXDHOBANANDASSOCIATES,INC.d/b/aCOASTREALESTATESERVICES


PremiumAssistanceunderMedicaidandCHIPFreeorLow-CostHealthCoverageforChildrenandFamilies.Ifyouliveinoneofthefollowingstates,youmaybeeligibleforassistancepayingyouremployerhealthplanpremiums.ThefollowinglistofstatesiscurrentasofJuly31,2016.YoushouldcontactyourstateMedicaidand/orCHIPofficeforfurtherinformationoneligibility.

ALABAMA–Medicaidhttp://www.myalhipp.comPhone:1-855-692-5447

ALASKA–MedicaidTheAKHealthInsurancePremiumPaymentProgram:http://myakhipp.com/Phone:1-866-251-4861Email:[email protected]:http://dhss.alaska.gov/dpa/Pages/medicaid/default.aspx

ARKANSAS–Medicaidhttp://myarhipp.com/Phone:1-855-MyARHIPP(855-692-7447)

COLORADO–MedicaidMedicaid:http://www.colorado.gov/hcpfMedicaidCustomerContactCenter:1-800-221-3943

FLORIDA–Medicaidhttp://www.flmedicaidtplrecovery.com/hipp/Phone:1-877-357-3268

GEORGIA–Medicaidhttp://dch.georgia.gov/medicaidClickonHealthInsurancePremiumPayment(HIPP)Phone:404-656-4507

INDIANA–MedicaidHealthyIndianaPlanforlow-incomeadults19-64:http://www.hip.in.govPhone:1-877-438-4479AllotherMedicaid:http://www.indianamedicaid.comPhone:1-800-403-0864

IOWA–Medicaidwww.dhs.state.ia.us/hipp/Phone:1-888-346-9562

KANSAS–Medicaidhttp://www.kdheks.gov/hcf/Phone:1-785-296-3512

KENTUCKY–Medicaidhttp://chfs.ky.gov/dms/default.htmPhone:1-800-635-2570

LOUISIANA–Medicaidhttp://dhh.louisiana.gov/index.cfm/subhome/1/n/331Phone:1-888-695-2447

MAINE–Medicaidhttp://www.maine.gov/dhhs/ofi/public-assistance/index.htmlPhone:1-800-442-6003TTY:Mainerelay711

MASSACHUSETTS–MedicaidandCHIPhttp://www.mass.gov/MassHealthPhone:1-800-462-1120

MINNESOTA–Medicaidhttp://mn.gov/dhs/ma/Phone:1-800-657-3739

MISSOURI–Medicaidhttp://www.dss.mo.gov/mhd/participants/pages/hipp.htmPhone:573-751-2005

MONTANA–Medicaidhttp://dphhs.mt.gov/MontanaHealthcarePrograms/HIPPPhone:1-800-694-3084

NEBRASKA–Medicaidhttp://dhhs.ne.gov/Children_Family_Services/AccessNebraska/Pages/accessnebraska_index.aspxPhone:1-855-632-7633

NEVADA–Medicaidhttp://dwss.nv.gov/Phone:1-800-992-0900

NEWHAMPSHIRE–Medicaidhttp://www.dhhs.nh.gov/oii/documents/hippapp.pdfPhone:603-271-5218

NEWJERSEY–MedicaidandCHIPMedicaidWebsite:http://www.state.nj.us/humanservices/dmahs/clients/medicaid/MedicaidPhone:609-631-2392CHIPWebsite:http://www.njfamilycare.org/index.htmlCHIPPhone:1-800-701-0710


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NEWYORK–Medicaidhttp://www.nyhealth.gov/health_care/medicaid/Phone:1-800-541-2831

NORTHCAROLINA–Medicaidhttp://www.ncdhhs.gov/dmaPhone:919-855-4100

NORTHDAKOTA–Medicaidhttp://www.nd.gov/dhs/services/medicalserv/medicaid/Phone:1-844-854-4825

OKLAHOMA–MedicaidandCHIPhttp://www.insureoklahoma.orgPhone:1-888-365-3742

OREGON–Medicaidhttp://www.oregonhealthykids.govhttp://www.hijossaludablesoregon.govPhone:1-800-699-9075

PENNSYLVANIA–Medicaidhttp://www.dhs.state.pa.us/hippPhone:1-800-692-7462

RHODEISLAND–Medicaidwww.eohhs.ri.govPhone:401-462-5300

SOUTHCAROLINA–Medicaidhttp://www.scdhhs.govPhone:1-888-549-0820

SOUTHDAKOTA–Medicaidhttp://dss.sd.govPhone:1-888-828-0059

TEXAS–Medicaidhttps://www.gethipptexas.com/Phone:1-800-440-0493

UTAH–MedicaidandCHIPMedicaid:http://health.utah.gov/medicaidCHIP:http://health.utah.gov/chipPhone:1-877-543-7669

VERMONT–Medicaidhttp://www.greenmountaincare.org/Phone:1-800-250-8427

VIRGINIA–MedicaidandCHIPMedicaid&CHIP:http://www.coverva.org/programs_premium_assistance.cfmMedicaidPhone:1-800-432-5924CHIPPhone:1-855-242-8282

WASHINGTON–Medicaidhttp://www.hca.wa.gov/medicaid/premiumpymt/pages/index.aspxPhone:1-800-562-3022ext.15473

WESTVIRGINIA–Medicaidwww.dhhr.wv.gov/bms/Medicaid%20Expansion/Pages/default.aspxPhone:1-877-598-5820,HMSThirdPartyLiability

WISCONSIN–MedicaidandCHIPhttps://www.dhs.wisconsin.gov/publications/p1/p10095.pdfPhone:1-800-362-3002

WYOMING–Medicaidhttps://wyequalitycare.acs-inc.com/Phone:307-777-7531

ToseeifanymorestateshaveaddedapremiumassistanceprogramsinceJuly31,2016,orformoreinformationonspecialenrollmentrights,youcancontacteither:

U.S.DepartmentofLabor U.S.DepartmentofHealthandHumanServicesEmployeeBenefitsSecurityAdministration CentersforMedicare&MedicaidServiceswww.dol.gyov/ebsa www.cms.hhs.gov1-866-444-EBSA(3272) 1-877-267-2323,MenuOption4,Ext.61565

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