PLAN YEAR: 1/1/16 – 12/31/16

Benefits at A Glance

Contents & Contact Information

Refer to this list when you need to contact one of your benefit vendors. For general information contact Human Resources.

NEW HIRE ENROLLMENT INFORMATION: Page 6

Provider Phone Number 321-296-8060

Provider Web Address www.explainmybenefits.biz/baers

MEDICAL: Page 7

Provider Name Aetna

Provider Phone Number 800-445-5299

Provider Web Address www.Aetna.com

HEALTH SAVINGS ACCOUNT (HSA): page 8-11

BENEFIT RESOURCE CENTER (BRC): page 12

Provider Name Benefit Resource Center

Provider Phone Number 855-USI-6699

Provider e-mail Address BRCEast@usi.biz

DENTAL: page 13

Provider Name Guardian

Provider Phone Number 888-600-1600

Provider Web Address www.guardiananytime.com

VISION: page 14

Provider Name Guardian

Provider Phone Number 888-600-1600

Provider Web Address www.guardiananytime.com

VOLUNTARY LIFE: page 15

Provider Name Lincoln Financial Group

Provider Phone Number 1-800-423-2765

Provider Web Address www.lfg.com

VOLUNTARY SHORT TERM AND LONG TERM DISABILITY: page 16

Provider Name Lincoln Financial Group

Provider Phone Number 1-800-423-2765

Provider Web Address www.lfg.com

Wellness Program____________________________________________________________________________ page 17

PAYROLL DEDUCTIONS: page 18*Please note that rates for voluntary life, voluntary STD, voluntary LTD, critical care, accident, & group universal life

will be available on the EMB enrollment site.

SUPPLEMENTAL BENEFITS page 19-31

Provider Name Trustmark

Provider Phone Number 1-800-918-8877

Provider Web Address www.trustmark.com

DISCLOSURE NOTICES page 32-37

Your Benefits Plan

Baer's Furniture offers a variety of benefits allowing you the

opportunity to customize a benefits package that meets your personal

needs.

In the following pages, you’ll learn more about the benefits offered.

You’ll also see how choosing the right combination of benefits can

help protect you and your family’s health and finances – and your

family’s future.

Eligible dependents include:

> Your spouse, unless you are legally separated or divorced;

> Your married or unmarried natural children, step-children living

with you, legally adopted children and any other children for

whom you have legal guardianship,

> Newborn to age 30.

► A dependent who is older than 26 years of age, but less than

30 years of age may be eligible for medical benefits through

the end of the calendar year with no qualifications or coverage

restrictions..

When Can You Enroll?

You can sign up for Benefits at any of the following times:

After completing initial eligibility period;

During the annual open enrollment period;

Within 30 days of a qualified family-status change.

If you do not enroll at one of the above times, you must wait for the

next annual open enrollment period.

Eligibility

All Regular full-time employees are eligible to join the. Benefits Plan

on the 1st of the month following 60 days. “Regular Full-Time

Employees” must be regularly scheduled and working at least 30

hours per week.

You may also enroll your dependents in the Benefits Plan when you

enroll.

Benefit Information

3

Benefit Who pays the cost?

Medical Insurance Employer & Employee

Dental Insurance Employee

Voluntary Vision Employee

Voluntary Life Employee

Short Term Disability Employee

Long Term Disability Employee

Accident Employee

Critical Illness Employee

Universal Life Events Employee

Choosing Your Benefits

You must actively choose any benefit that you pay for, or share in the

cost with Baer's Furniture.

Your part of the cost is automatically taken out of your paycheck.

> Before your taxes are calculated – medical, dental, and vision

Making Changes

Generally, you can only change your benefit choices during the

annual benefits enrollment period. However, you may be able to

change your benefit choices at anytime if you have a change in status

including:

> Your marriage

> Your divorce or legal separation

> Birth or adoption of an eligible child

> Death of your spouse or covered child

> Change in your spouse’s work status that affects his or her

benefits

> Change in your work status that affects your benefits

> Change in residence or work site that affects your eligibility for

coverage

> Change in your child’s eligibility for benefits

> Receiving Qualified Medical Child Support Order (QMCSO)

If you do not notify Human Resources within 30 days of a

family status change, you will have to wait until the next

annual enrollment period to make benefit changes unless you

have another family status change.

When Coverage Ends

Coverage will stop on the last day of the month in which

employment with the company ends.

Why do I pay for benefits with

before-tax money?

There is a definite advantage to paying for some benefits

with before-tax money:

Taking the money out before your taxes are calculated

lowers the amount of your pay that is taxable. Therefore,

you pay less in taxes.

Key Benefit Terms

COBRA – A Federal law that allows workers and dependents who

lose their medical, dental, or vision coverage to continue any of these

coverages for a specified length of time by electing and paying for

continuation benefits.

Coinsurance – The percentage of the medical or dental charge that

you pay after the deductible has been met.

Copayment – A flat fee that you pay for medical services, regardless

of the actual amount charged by your doctor or another provider.

This generally applies to physicians’ office visits and prescription

drugs.

Deductible – The amount you pay toward medical and dental

expenses each calendar year before the plan begins paying benefits.

Out of Pocket Maximum – The maximum amount you will pay in

coinsurance during the calendar year

Benefit Information

4

Pre-Existing Conditions Limitations

Notice

Effective 1/1/2014, in accordance with The Patient

Protection and Affordable Care Act, there is no longer any

pre-existing conditions limitations for newly covered

employees or dependents or current employees or

dependents covered by the medical plans.

Frequently Asked Questions About Your Medical Plan

Q. What should I do if I have a problem getting a claim paid?

A. Start by contacting the carrier’s member services number to determine the

nature of the problem. If the issue is the way the doctor or other service provider has

billed the claim, then contact your doctor or Claims Advocate at USI. If the insurance

company has an eligibility issue, contact Human Resources for assistance.

Q. What is the difference between brand formulary, brand non-formulary, and

generic drugs?

A. Brand formulary is a prescription drug that is listed on the formulary (i.e., a list of

prescription drugs covered by the plan). These drugs are protected by a patent issued

to the original innovator or marketer. Brand non-formulary drugs are patent protected

but are not listed. A generic equivalent drug can become available when the patent

protection runs out, and is deemed equal in therapeutic power to the brand name

originals.

Q. When should I go the Urgent Care vs. Emergency Room?

A. For non-life threatening injury/illness after normal doctor’s office hours.

Prescription Drug Benefits at a Reduced Cost – Did you know

you can obtain prescription drugs at local retailers at a reduced cost

and sometimes even free? Publix offers a variety of generic Oral

Antibiotic medications to you absolutely free. Bring in your

prescription for an approved medication and receive it FREE, up to a

14-day supply. Publix recently approved a medication for diabetes.

CVS, Target, Walgreens & WalMart also offer over 400 generic

prescriptions for $4 and a 90 day supply for approx. $10 . Remember

DO NOT show your Aetna ID card to receive these benefits, or you

will be charged your Aetna drug rate.

Member Resources

Aetna Navigator ® Secure Member Website – Aetna Navigator is

your secure member website. It’s where you go to:

Find doctors, dentists, pharmacies & hospitals

Get an ID card

Look up a claim

You’re mobile. So are we.

Check your coverage

Keep track of health care costs

It’s personalized for you and your family

It’s easy to get started – www.aetna.com

You can also get a summary of your doctor visits, medical tests,

prescriptions and other health activities. Look up health topics.

Complete a Health Assessment

Beginning Right® Maternity Program

Helping you and your baby grow healthy – together

You get the Beginning Right Maternity management program with

your Aetna plan.

Information for a healthier pregnancy – You will get materials on –

Prenatal care – Preterm labor symptoms – What to expect

before/after delivery – Newborn care and more

Special attention for Pregnancy risks

Solid support to quit smoking

Aetna Discount Programs

Gym Memberships

Eyeglasses and contacts

Weight-loss programs ( Jenny Craig® - Nutrisystem® - eDiets® )

Chiropractic visits

Massage therapy

Acupuncture

Hearing aids and more

Personal Health Record

Access family history details

Review your office visits, prescriptions, conditions & treatments

Get a health summary

Download & share your information easily with health care providers

Receive important medical alerts

http://healthyis.aetna.com/personalhealth

24-hour Nurse Line for Health Questions

1. Call a registered nurse toll-free

2. Visit member site www.aetna.com

3. Listen to Audio Health Library

In addition to the network of physicians, hospitals, emergency

rooms, and urgent care clinics, you also have the option of going

to the convenient care clinics located within some grocery and

drug stores, for minor illness such as ear aches, colds, flu and so

on. By selecting one of these providers, you pay only the regular

office visit copay; a significant savings over the emergency room

and urgent care copayments.

Please visit the various websites for locations, hours of

operations and scope of services.

CVS Minute Clinic: www.cvs.com

Walgreen’s Take Care Clinic: www.walgreens.com

Getting more from your

Health Care Dollars

6

WHEN IS OPEN ENROLLMENT?

Online Benefit Enrollment system open: December 7th – 20th

All Enrollments must be completed using EMB ENROLL.

HOW TO ENROLL IN YOUR BENEFITS 1. Access the On-Line Enrollment at: www.explainmybenefits.biz/baers

2. Review your Benefit Guide along with the brochures and videos on the page.

3. Click the BLUE Enroll Button at the Right of the Page (2016 Open Enrollment)

4. Please follow the instructions on the page and proceed to your enrollment

5. Complete your enrollment

6. IMPORTANT: RECORD YOUR CONFIRMATION NUMBER _________________________

IMPORTANT THIS YEAR: All benefit eligible employees must confirm a benefit enrollment using EMB ENROLL whether you are electing benefits, keeping benefits the same, making changes, or waiving all benefits. This is a requirement this year.

HOW YOU CAN BE PREPARED?

1. Please have the dates of birth and social security numbers of dependents when you enroll.

2. Look for emails, brochures and other information to be distributed prior to your Open Enrollment!!!

3. View Benefit Resource Portal for more information about the Open Enrollment Process, review your benefit guide and learn about the voluntary benefits offered.

www.explainmybenefits.biz/baers

Medical Insurance

Baer's Furniture offers 2 medical plans from Aetna. To find participating providers go to www.Aetna.com.

The chart below provides a brief comparison of the plans. This chart is intended only to highlight the benefits

available and should not be relied upon to fully determine your coverage. If the below illustration of benefits

conflicts in any way with the Summary Plan Description (SPD), the SPD shall prevail. It is recommended that you

review your exact description of services and supplies that are covered, those which are excluded or limited, and

other terms and conditions of coverage.

7

HNOption H.S.A. (Buy-up) HNOnly (Core Plan)

In-Network non-embedded

Plan Year / Contract Year Basis Calendar Year Calendar Year

Deductible (Individual / Family) $2,500 / $5,000 $5,500 / $11,000

Maximum Out-of-Pocket (Individual / Family) $4, 500 / $ 6,750 $6,350 / $12,700

Out-of Pocket Max Includes Ded, coinsurance, copays & Rx Ded, coinsurance, copays & Rx

Lifetime Major Medical Maximum Unlimited Unlimited

Coinsurance 80% 50%

Preventive

Wellness 100% 100%

Co-pays

Open Access Yes Yes

Office Visits/Consultations for Illness/Injury 20% after CYD $35 copay

Specialist Visits 20% after CYD $75 copay

Inpatient Hospital 20% after CYD 50% after CYD

Outpatient Surgery 20% after CYD 50% after CYD

Emergency Room 20% after CYD $300 copay

Urgent Care 20% after CYD $50 copay

OP Major Diagnostics

Complex Diagnostic 20% after CYD $300 copay

Prescriptions CYD then $200

Retail (30 day supply) 30% /30% /50% $15/$20/50%

Mail Order (90 day supply) 30% /30% /50% $30/$40/50%

Out-of-Network

Deductible (Individual / Family) $5,000 / $10,000

Maximum Out-of-Pocket (Individual / Family) $10,000 / $20,000

Lifetime Major Medical Maximum Unlimited

Coinsurance 60%

MEDICAL PLAN DESIGN & FINANCIAL COMPARISONS

This illustration is intended to give a brief overview of benefits o ffered. Refer to the contract/proposal/plan document for a detailed,

accurate description of benefits. This is an illustration based on estimated enro llment numbers. Final rates will be based on actual

enro llment, plan design chosen and plan effective date. Every attempt has been made to accurately reflect the details o f the plan, should

there be any errors, the terms and conditions of the summary plan description/contract prevail.

Aetna

Dual Option

N/C

Health Savings Accounts

(HSA)

Health Savings Accounts

A health savings account (HSA) is an account funded to help you save for future medical expenses not covered by your

insurance plan, including the deductible, coinsurance and even vision and dental expenses. You must be enrolled in a

HSA compatible health plan to be eligible, there are certain advantages to putting money into these accounts, including

favorable tax treatment and the ability to roll unused funds over from year to year.

Who Can Have an HSA?

Any adult can contribute to an HSA if you:

· Have coverage under an HSA-qualified, high-deductible health plan (HDHP)

· Have no other first-dollar medical coverage (other types of insurance, including specific injury or accident,

disability, dental care, vision care, or long-term care insurance are permitted)

· Are not enrolled in Medicare or Tricare

· Cannot be claimed as a dependent on someone else’s tax return

Contributions to your HSA would be made by you. The total contributions are limited annually. If you make a

contribution, you can deduct the contributions (even if you do not itemize deductions) when completing your federal

income tax return.

Contributions to the account must stop once you are enrolled in Medicare. However, you can keep the money in your

account and use it to pay for medical expenses tax-free.

HDHPs

You must have coverage under the Baer's Furniture HDHP to open and contribute to an HSA.

HSA Contributions

You can make a contribution to your HSA each year that you are eligible. Contributions from all sources can be no

more than:

· Self-only coverage: $3,350 in 2016

· Family coverage: $6,750 in 2016

Individuals ages 55 and older can also make additional “catch-up” contributions. The maximum annual catch-up

contribution is $1,000.

8

Frequently Asked Questions

About HSA Plan Usage

How do I manage my HSA?

Your Health Savings Account (HSA) is your account; the HSA dollars are your dollars. Since you are the account

holder or HSA beneficiary, you manage your HSA account. You may choose when to use your HSA dollars or when

not to use your HSA dollars. HSA dollars pay for any eligible expense. Most commonly, the HSA account holder will

use HSA dollars to pay the out-of-pocket expenses (i.e., deductible and coinsurance) associated with their high

deductible plan.

What expenses are eligible for reimbursement from my HSA?

HSA dollars may be used for qualified medical expenses incurred by the account holder and his or her spouse and

dependents. Qualified medical expenses are outlined within IRS Section 213(d). In summary the IRS Section 213(d)

states that “the expense has to be primarily for the prevention or alleviation of a physical or mental defect or illness”.

In addition to qualified medical expenses, the following insurance premiums may be reimbursed from an HSA:

· COBRA premiums

· Health insurance premiums while receiving unemployment Benefits

· Any health insurance premiums paid, other than for a Medicare supplemental policy, by individuals ages 65

and over

Are dental and vision care qualified medical expenses under an HSA?

Yes, as long as these are deductible under the current rules. For example, cosmetic procedures, like cosmetic

dentistry, would not be considered qualified medical expenses.

What expenses are NOT eligible for reimbursement from my HSA?

The following expenses may not be reimbursed from an HSA:

· Premiums for Medicare supplemental policies

· Expenses covered by another insurance plan

· Expenses incurred prior to the date the HSA was established

· Over-the-counter drugs purchased without a prescription (except insulin)

What is a coverage gap?

This is the gap between total out-of-pocket expenses associated with your high-deductible health plan and your HSA

dollars. For example, assume that you have a $2,000 deductible, a $4,000 maximum out-of-pocket, and either you or

your employer has contributed $2,000 to your HSA account. If your medical costs incurred exceed $4,000 for the

year, then you are financially obligated to pay the difference between your total maximum out-of-pocket ($4,000) and

your HSA balance ($2,000) - ($4,000 - $2,000 = $2,000)

What happens when my HSA funds run out?

You may be financially responsible for any eligible medical expenses that fall within the coverage gap.

Can I use my HSA dollars for non-eligible expenses?

Money withdrawn from an HSA account to reimburse non-eligible medical expenses is taxable income to the account

holder and subject to a 20 percent tax penalty - unless over age 65, disabled or upon death of the account holder.

When can I start using my HSA dollars?

You can use your HSA dollars immediately following your HSA account activation and once contributions have been

made.

9

How do I pay my physician or network facility at time of service with my HSA dollars?

You may request that the network provider submit your claim to your health plan. You should make sure that your

provider has your most up-to-date insurance information. Once the medical claim has been processed, if applicable,

out-of-pocket expenses will be billed. At this time you may choose to use your HSA Debit card to pay for any out-of-

pocket expenses, or you may choose to pay with your own money and receive reimbursement at a later date. You

should always ask that your medical claim be submitted to the health plan before you seek reimbursement from your

HSA. This procedure will ensure that provider discounts are applied. Also, remember to keep all medical receipts and

Explanation of Benefits (EOBs) for tax purposes.

What if I have HSA dollars left in my account at year-end?

The money is yours to keep. It will continue to be available for you and your health care costs next year.

What happens to my HSA dollars if I leave Baer's Furniture?

The funds are yours to keep. You may elect one of the following options:

· Leave your funds in your current HSA account

· Transfer your funds to an HSA with your new employer

· Transfer your funds to another qualifying account within 60 days

Can I use the money in my account to pay for my dependents’ medical expenses?

You can use the money in your account to pay for medical expenses for yourself, your spouse or your dependent

children. You can pay for the unreimbursed expenses of your spouse and dependent children even if they are not

covered by your HDHP.

Can couples establish a “joint” account and both make contributions to the account, including “catch-up”

contributions?

“Joint” HSA accounts are not permitted. Each spouse should consider establishing an account in their own name. This

allows you both to make catch-up contributions when each spouse is 55 or older.

My employer offers an FSA – can I have both an FSA and an HSA?

You can have both types of accounts, but only under certain circumstances. General Flexible Spending Accounts

(FSAs) will probably make you ineligible for an HSA. If your employer offers a “limited purpose” (limited to dental, vision

or preventive care) or “post-deductible” (pay for medical expenses after the plan deductible is met) FSA, then you can

still be eligible for an HSA.

Can I shift my IRA funds to my HSA?

Owners of individual retirement accounts that are enrolled in a high-deductible health plan can shift IRA funds to an

HSA without facing a tax penalty. The IRS allows a one-time transfer that does not exceed your maximum HSA

contribution limit.

Can I borrow against the money in my HSA?

No. You may not borrow against it or pledge the funds in it. For more information on prohibited activities see Section

4975 of the Internal Revenue Code.

10

Frequently Asked Questions

About HSA Plan Usage - continued

HSA Banking Information

11

Opening your Health Savings Account

Follow the steps below to open your Health Savings Account (HSA).

Step 1: Medical Plan Enrollment

Enroll in the Baer’s HSA compatible HDHP Plan.

Step 2: Contribution

Determine how much you plan to contribute to your HSA account before taxes.

Step 3: HSA Establishment

Varies by bank, use their instructions. Chose a bank of your choice, open and deposit money into your HSA right

away so you are prepared if you have a health event. You or anyone else can deposit money into the HSA at

anytime.

Toll-free benefit call center available to:

• Answer questions regarding your health and other benefit plans

• Network: Is my doctor on the plan?

• Plan Coverage: Does my plan cover this?

• Billing: I received a bill from my provider, do I need to pay?

• Once you’ve tried, but need help understanding how a carrier paid your claim

• Specialist support to help you with complex claims issues

• Medical appeals information and support

• Life event (family status) rules – what changes can I make?

• Life Insurance Beneficiary form requirements

• How do I complete an Evidence of Insurability form and where do I send it?

• What happens if I have coverage under two different medical plans?

Benefit Resource Center

Services

12

Dental Insurance

Baer's Furniture offers two dental plans through Guardian.

Guardian’s DMO is an in-network only dental plan. There are no benefits for out-of-network

dentists. There are no plan maximums or deductibles.

The DPPO Plan allows you to use in-network or out-of-network benefits. If out-of-network

dentists are used, you will be responsible to pay the difference between Guardian’s allowed

amount and what the dentist may charge.

Guardian Guardian

DHMO U30

Low Plan

DPPO K7

Buy Up Plan

In-Network In-NetworkOut-of

Network

Deductible

Individual N/A $50 $100

Family N/A $150 $300

Annual Maximum

Individual None $1,000

Diagnostic & PreventativeDeductible

Waived

Deductible

Applies

Exams D0120 No Charge

100% 80%

Cleanings D1110 No Charge

Fluoride D1203 No Charge

X-Rays D0272 No Charge

Sealants D1351 No Charge

Regular Restorative Services Deductible Applies

Amalgam Fillings D2150 No Charge

80% 70%Extractions - Single Tooth D7140 No Charge

Endodontics (Root Canal) D3320 $120 - $170

Periodontics ( Gum Disease) D4211 No Charge

Major Services Deductible Applies

Crowns D2791 $395.00

50% 40%Bridges D6211 $381 - $575

Dentures D5110 $381 - $575

Orthodontics

Lifetime Maximum $2,500Not Covered

Age Limitation Child to age 19

13

Vision Insurance

Baer's Furniture offers a vision plan through Guardian. This vision plan provides coverage both in

and out of network. The chart below provides a brief overview of the plan.

Guardian

Vision

In-Network Out-of-Network

Lenses

Single $25 copay $48 allowance

Bifocal $25 copay $67 allowance

Trifocal $25 copay $86 allowance

Contact Lenses 85% of amount over $120 $105 allowance

Frames 80% of amount over $120 $48 allowance

Exams $15 copay $50 allowance

Frequency

Exam Once every 12 months

Lenses or contact lenses Once every 12 months

Frame Once every 24 months

Lens Options

(Tints, coating, UV, anti-reflective

lenses, polycarbonate & progressive

lenses)

Members receive additional fixed copayments on lens options including

anti-reflective and Scratch-resistant coatings. After copay, standard

polycarbonate available at no charge for dependents less than 19 years

old.

Additional Pairs

Courtesy discount on a second pair of eyeglasses. This discount is

available for 12 months after the covered eye exam and available through

the Davis Vision Network provider who sold the initial pair of eyeglasses.

Laser Vision Correction Up to 25% off the usual charge or 5%. No discounts off promotional price.

14

Voluntary Life Insurance

Baer’s Furniture provides all active employees working 25 or more hours per week

the option to purchase life insurance coverage through a group plan. The chart

below provides an overview of the plan.

15

Note: Please see your Benefits Representative for a Beneficiary Designation Form.

The only time you can enroll in guaranteed issue voluntary life insurance, is at the date you first

become eligible to enroll. If you do not enroll then and later decide that you would like to enroll, you

will be required to complete a medical questionnaire and go through medical underwriting. The

insurance carrier reserves the right to decline coverage based on medical information obtained on the

medical questionnaire.

Voluntary Term Life

Eligible Employee Benefit All F/T, 30 hrs or more

Employee $10,000 to $300,000

Spouse 50% EE amt to $150,000

Dependent Life $10,000

Employee Guarantee Issue $200,000

Spouse Guarantee Issue $30,000

Accelerated Death Benefit50% death benefit, $250,000

max

Waiver of Premium Benefit Yes

Portable/Convertible Yes w/o E of I

Benefit Reduction 35% age 70, add'l 35% age 75

Disability Insurance

Voluntary Disability Income Benefits

Baer’s Furniture provides all active employees working 25 or more hours per week the option to purchase Short

Term and Long Term Disability coverage through a group plan. When you enroll in short term or long term

disability you pay the full cost through payroll deductions.

In the event you become disabled from a non work-related injury or sickness, disability benefits are provided as a

source of income. You are not eligible to receive short-term disability benefits if you are receiving workers’

compensation benefits.

The only time you can enroll in guaranteed issue Short Term or Long Term Disability is at the date you

first become eligible to enroll. If you do not enroll then and later decide that you would like to enroll, you

will be required to a complete a medical questionnaire and go through medical underwriting. The

insurance carrier reserves the right to decline coverage based on medical information obtained on the

medical questionnaire.

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Long Term Disability

Employee Definition All F/T, 30 hrs or more

Monthly Benefit 60% to $5,000

Elimination Period 90 days

Duration of Benefits Later of 65 or SSNRA

Own Occupation 24 months

Pre-Existing

Conditions3/12

Contribution Type Voluntary

Short Term Disability

Employee Definition All F/T, 30 hrs or more

Monthly Benefit 60% to $1,000

Elimination Period 15 days

Pre-Existing Limitation 3/12

Duration of Benefits 11 weeks

Contribution Type Voluntary

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JOIN BAER’S FURNITURE IN MAKING WELLNESS YOUR HEALTHY & MOST ECONOMICAL LIFESTYLE CHOICE!

Dear Baer’s Furniture Team Members, We are thrilled to announce year 2 of the company-wide wellness campaign.

For starters, all employees are invited to take the below simple step to earn a discount of their medical premium.

1) Visit your primary care physician for an annual preventive visit. This One, Annual Preventive Health Visit is a Free Benefit in Your Company Health Plan. More details coming soon! Baer’s Furniture, by law, will not receive your personal, private health information as a result of participating.

Your individual health matters. Each year, unhealthy behaviors impact all of us as this leads to

increased medical claims, lost work days, and decreased quality of life. Adopting company initiatives that

support healthy behaviors is our commitment to supporting you as we work together to cultivate a most

successful and satisfying work environment.

According to best practice studies of companies offering employee wellness programs, it has been found that approximately 50% of employees have not had a primary care preventive physician visit during the past 3-5 years while annual physicals are something that should be practiced annually. Studies indicate that up to 70% of healthcare costs are preventable. Therefore, healthcare professionals view regular health screenings as critical for any chance of early detection and prevention of catastrophic illness. We hope that all employees will take advantage of participating in these most important wellness initiatives so that Baer’s Furniture Co Inc can continue to offer the richest and most affordable health care plans to our valued team member well into the future. Let’s work together to make 2016 one of Baer’s Furniture healthiest and most successful years ever! To Your Health, Ira Baer CFO Your health plan is committed to helping you achieve your best health. Rewards for participating in a wellness program are available to all employees. If you think you might be unable to meet a standard for a reward under this wellness program, you might qualify for an opportunity to earn the same reward by different means. Contact us (Insert HR number) and we will work with you (and, if you wish, with your doctor) to find a wellness program with the same reward that is right for you in light of your health status.

Payroll Deductions

The Charts below show the bi-weekly payroll deduction amounts for each of the benefits offered.

Medical

Aetna

HSA HN

Option

w/o wellness

HSA HN

Option w/

wellness

HN Only

w/o wellness

HN Only

w/ wellness

Employee Only $70.00 $55.00 $45.00 $35.00

Employee + Spouse $310.00 $295.00 $276.00 $266.00

Employee + Child(ren) $260.00 $244.00 $227.00 $217.00

Family $502.00 $487.00 $461.00 $450.00

Dental

Guardian DHMO U30 DPPO K7

Employee Only $5.40 $15.96

Employee + Spouse $10.81 $33.40

Employee + Child(ren) $12.03 $40.02

Family $17.44 $53.44

Vision

Guardian Vision

Employee Only $2.75

Employee + Spouse $4.63

Employee + Child(ren) $4.72

Family $7.47

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*Please note that rates for voluntary life, voluntary STD, voluntary LTD, critical care,

accident, and group universal life will be available on the EMB enrollment site.

Supplemental Benefits

19

Note: Please see your Benefits Representative for a Beneficiary Designation Form.

The only time you can enroll in guaranteed issue voluntary life insurance, is at the date you first become eligible to enroll. If

you do not enroll then and later decide that you would like to enroll, you will be required to complete a medical questionnaire

and go through medical underwriting. The insurance carrier reserves the right to decline coverage based on medical

information obtained on the medical questionnaire.

•Accident

•Universal Life

Costumer Service: 800-918-8877

Claims: 877-201-9373

•Critical Illness

Costumer Service: 877-815-9256

*For questions on claims or benefits contact applicable

carrier above for the supplemental benefits.

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The Patient Protection and Affordable Care Act & The Health Care and Education Affordability Reconciliation Act of 2010, together, create

the most comprehensive health insurance reform ever under taken in recent history by our Country.

Many of the new law’s required changes have already been incorporated into company health plans across the country since the effective

date in September of 2010. However, there will be many more changes taking place in the months to come, as more guidance is issued by

the government to employers, insurance carriers and individuals.

One of the key requirements of the new law beginning in 2014, is the mandate that all U.S. citizens & legal residents either carry health

insurance or pay an income tax penalty. While the tax penalty is not too severe in the first year, it becomes progressively more costly each

year thereafter.

Penalties for failing to buy coverage

Tax penalties for failing to buy coverage are phased in according to the following schedule:

In 2014, the greater of $95 or 1% of taxable income;

In 2015, the greater of $325 or 2% of taxable income;

In 2016, the greater of $695 or 2.5% of taxable income; and

After 2016, the penalty is indexed for inflation.

However, there are two ways to avoid the tax penalty:

You can buy coverage for you and your family through your place of employment, if your employer offers such coverage. That coverage

must meet certain standards set by the law in order for you and the employer to escape respective tax penalties. The coverage must meet

certain minimum coverage standards (Generally pays at least 60% of your covered medical expenses) and must be considered

“affordable” (Employer cannot charge you a premium for single or employee only coverage greater than 9.5% of

your W-2 earnings for the year). The 9.5% would apply to annual salaries of up to about $45,000.

Or, you can provide coverage for you and your family through a Federally run Insurance Exchange that is supposed to be up and running

by 1/1/2014. Essentially, an Exchange is an interactive site where an individual can go to research, evaluate and buy health plans. The

State of Florida chose not to set up a state run exchange, so the Federal government will take over that responsibility.

If you obtain coverage through an Exchange:

The Exchange will sell insurance policies at certain levels of coverage:

– Bronze level – a medical plan designed to pay 60% of covered medical benefits;

– Silver level – a medical plan designed to pay 70% of covered medical benefits;

– Gold level – a medical plan designed to pay 80% of covered medical benefits;

– Platinum level – a medical plan designed to pay 90% of covered medical benefits;

– Catastrophic – available to young adults up to age 30 or those exempt from the individual mandate (additional requirements may apply)

You may only obtain coverage through an Exchange if you are not participating in your employer’s plan.

If you satisfy certain low income thresholds and do not have medical coverage through an employer, or have employer-provided coverage

that is considered “unaffordable” or pays benefits that are below the “Bronze” plan discussed above, there are tax credits available to help

you pay the premiums for coverage purchased through the Exchange. The credits also help pay for expenses like deductibles and co

pays. More information on these credits will be provided to you later.

If you and your family are below 133% of the Federal Poverty Level in 2014, you may qualify for Medicaid.

HealthCare Reform and You

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Required Annual Employee Disclosure Notices

The Newborns’ and Mothers’ Health

Protection Act of 1996

The Newborns’ and Mothers’ Health Protection Act of 1996 prohibits group and

individual health insurance policies from restricting benefits for any hospital length of

stay for the mother or newborn child in connection with childbirth; (1) following a

normal vaginal delivery, to less than 48 hours, and (2) following a cesarean section, to

less than 96 hours. Health insurance policies may not require that a provider obtain

authorization from the health insurance plan or the issuer for prescribing any such

length of stay. Regardless of these standards an attending health care provider may,

in consultation with the mother, discharge the mother or newborn child prior to the

expiration of such minimum length of stay.

Further, a health insurer or health maintenance organization may not:

1. Deny to the mother or newborn child eligibility, or continued eligibility, to enroll

or to renew coverage under the terms of the plan, solely to avoid providing

such length of stay coverage;

2. Provide monetary payments or rebates to mothers to encourage such mothers

to accept less than the minimum coverage;

3. Provide monetary incentives to an attending medical provider to induce such

provider to provide care inconsistent with such length of stay coverage;

4. Require a mother to give birth in a hospital; or

5. Restrict benefits for any portion of a period within a hospital length of stay

described in this notice.

These benefits are subject to the plan’s regular deductible and co-pay. For further

details, refer to your Summary Plan Description. Keep this notice for your records and

call Human Resources for more information.

Women’s Health and Cancer Rights

Act of 1998

The Women’s Health and Cancer Rights Act of 1998 requires Baer’s Furniture to notify

you, as a participant or beneficiary of the Baer’s Furniture Health and Welfare Plan, of

your rights related to benefits provided through the plan in connection with a

mastectomy. You, as a participant or beneficiary, have rights to coverage to be

provided in a manner determined in consultation with your attending physician for:

1. All stages of reconstruction of the breast on which the mastectomy was

performed;

2. Surgery and reconstruction of the other breast to produce a symmetrical

appearance; and

3. Prostheses and treatment of physical compilations of the mastectomy,

including lymphedema.

These benefits are subject to the plan’s regular deductible and co-pay. For further

details, refer to your Summary Plan Description. Keep this notice for your records and

call Human Resources for more information.

Section 111

Effective January 1, 2009 group health plans are required by Federal government to

comply with Section 111 of the Medicare, Medicaid, and SCHIP Extensions of 2007’s

new Medicare Secondary Payer regulations. The mandate is designed to assist in

establishing financial liability of claims assignments. In other words, it will help

establish who pays first. The mandate requires group health plans to collect additional

information, more specifically Social Security numbers for all enrollees, including

dependents 6 months of age or older. Please be prepared to provide this information

on your benefits enrollment form when enrolling into benefits.

Michelle’s Law

The law allows for continued coverage for dependent children who are covered under

your group health plan as a student if they lose their student status because of a

medically necessary leave of absence from school. This law applies to medically

necessary leaves of absence that begin on or after January 1, 2010

If your child is no longer a student, as defined in your Certificate of Coverage, because

he or she is on a medically necessary leave of absence, your child may continue to be

covered under the plan for up to one year from the beginning of the leave of absence.

This continued coverage applies if your child was (1) covered under the plan and (2)

enrolled as at student at a post-secondary educational institution (includes colleges,

universities, some trade schools and certain other post-secondary institutions).

Your employer will require a written certification from the child’s physician that states

that the child is suffering from a serious illness or injury and that the leave of absence

is medically necessary.

Required Annual Employee Disclosure Notices

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Required Annual Employee Disclosure Notices continued

I. No access to protected health information (PHI) except for

summary health information for limited purpose and enrollment /

dis-enrollment information.

Neither the group health plan nor the plan sponsor (or any member of

the plan sponsor’s workforce) shall create or receive protected health

information (PHI) as defined in 45 C.F.R. §160.103 except for (1)

summary health information for purpose of (a) obtaining premium bids

or (b) modifying, amending, or terminating the group health plan, and

(2) enrollment and dis-enrollment information.

II. Insurer for group health plan will provide privacy notice

The insurer for the group health plan will provide the group health

plan’s notice of privacy practices and will satisfy the other requirements

under HIPAA related to the group health plan’s PHI. The notice of

privacy practices will notify participants of the potential disclosure of

summary health information and enrollment / dis-enrollment

information to the group health plan and the plan sponsor.

III. No intimidating or retaliatory acts

The group health plan shall not intimidate, threaten, coerce,

discriminate against, or take other retaliatory action against individuals

for exercising their rights , filing a complaint, participating in an

investigation, or opposing any improper practice under HIPAAA.

IV. No Waiver

The group health plan shall not require an individual to waive his or her

privacy rights under HIPAA as a condition of treatment, payment,

enrollment or eligibility. If such an action should occur by one of the

plan sponsor’s employees, the action shall not be attributed to the

group health plan.

HIPAA Privacy Policy for Fully-Insured

Plans with no Access to PHI

The group health plan is a fully-insured group health plan sponsored

by the “Plan Sponsor”. The group health plan and the plan sponsor

intend to comply with the requirements of 45 C.F.R. §164.530 (k) so

that the group health plan is not subject to most of HIPAA’s privacy

requirements.

Patient Protection:

If the Group Health Plan generally requires the designation of a primary care provider

who participates in the network and who is available to accept you or your family

members. For children, your may designate a pediatrician as the primary care

provider.

You do not need prior authorization from the carrier or from any other person

(including a primary care provider) in order to obtain access to obstetrical or

gynecological care from a health care professional in the network who specializes in

obstetrics or gynecology. The health care professionals, however, may be required to

comply with certain procedures, including obtaining prior authorization for certain

services, following a pre-approved treatment plan or procedures for making referrals.

For a list of participating health care professionals who specialize in obstetrics or

gynecology, or for information on how to select a primary care provider, and for a list of

the participating primary care providers, contact the Plan Administrator or refer to the

carrier website.

It is your responsibility to ensure that the information provided on your application is

accurate and complete. Any omissions or incorrect statements made by you on your

application may invalidate your coverage. The carrier has the right to rescind coverage

on the basis of fraud or misrepresentation.

Required Annual Employee Disclosure Notices

- Continued

Children’s Health Insurance Program

Reauthorization Act (CHIPRA) of 2009

Effective April 1, 2009, a special enrollment period provision is added to comply with

the requirements of the Children’s Health Insurance Program Reauthorization Act

(CHIPRA) of 2009. If you or a dependent is covered under a Medicaid or CHIP plan

and coverage is terminated as a result of the loss of eligibility for Medicaid or CHIP

coverage, you may be able to enroll yourself and/or your dependent(s). However, you

must enroll within 60 days after the date eligibility is lost. If you or a dependent

becomes eligible for premium assistance under an applicable State Medicaid or CHIP

plan to purchase coverage under the group health plan, you may be able to enroll

yourself and/or your dependent(s). However, you must enroll within 60 days after you

or your dependent is determined to be eligible for State premium assistance. Please

note that premium assistance is not available in all states.

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Required Annual Employee Disclosure Notices - Continued

Medicare Part D

This notice applies to employees and covered dependents who are eligible for

Medicare Part D.

Please read this notice carefully and keep it where you can find it. This notice has

information about your current prescription drug coverage with Aetna and about your

options under Medicare’s prescription drug Plan. If you are considering joining, you

should compare your current coverage including which drugs are covered at what cost,

with the coverage and costs of the plans offering Medicare prescription drug coverage

in your area. Information about where you can get help to make decisions about your

prescription drug coverage is at the end of this notice.

1. Medicare prescription drug coverage became available in 2006 to everyone

with Medicare through Medicare prescription drug plans and Medicare

Advantage Plan (like an HMO or PPO) that offer prescription drug coverage.

All Medicare prescription drug plans provide at least a standard level of

coverage set by Medicare. Some plans may also offer more coverage for a

higher monthly premium.

2. Aetna has determined that the prescription drug overage offered by the

Welfare Plan for Employees of Baer’s Furniture under the Aetna option are,

on average for all plan participants, expected to pay out as much as the

standard Medicare prescription drug coverage pays and is therefore

considered Creditable Coverage. Because your existing coverage is

Creditable Coverage, you can keep this coverage and not pay a higher

premium (a penalty) if you later decide to join a Medicare drug plan.

You should also know that if you drop or lose your coverage with Aetna and don’t

enroll in Medicare prescription drug coverage after your current coverage ends, you

may pay more (a penalty) to enroll in Medicare prescription drug coverage later.

___________________________________________________________

When can you join a Medicare Drug Plan?

You can join a Medicare drug plan when you first become eligible for Medicare and

each year from October 15th to December 7th.

However, if you lose your current creditable prescription drug coverage, through no

fault of your own, you will also be eligible for a two (2) month Special Enrollment

Period (SEP) to join a Medicare drug plan.

What happens to your current coverage if you decide to join a Medicare Drug

Plan?

If you decide to join a Medicare drug plan, your current Aetna coverage will not be

affected. You can keep this coverage if you elect part D and this plan will coordinate

with Part D coverage.

If you decide to join a Medicare drug plan and drop your current Aetna coverage, be

aware that you and your dependents will be able to get this coverage back.

When will you pay a higher premium (penalty) to join a Medicare drug Plan?

You should also know that if you drop or lose your current coverage with Aetna and

don’t join a Medicare drug plan within 63 continuous days after your current coverage

ends, you may pay a higher premium (a penalty) to join a Medicare drug plan later.

If you go 63 continuous days or longer without creditable prescription drug coverage,

your monthly premium may go up at least 1% of the Medicare base beneficiary

premium per month for every month that you did not have that coverage. For example,

if you go nineteen months without creditable coverage, your premium may consistently

be at least 19% higher than the Medicare base beneficiary premium. You may have to

pay this higher premium (a penalty) as long as you have Medicare prescription drug

coverage. In addition, you may have to wait until the following October to join.

For more information about this notice or your current prescription drug

coverage…

Contact our office for further information (see contact information below). NOTE:

You’ll get this notice each year. You will also get it before the next period you can join

a Medicare drug plan, and if this coverage through Aetna changes. You also may

request a copy of this notice at any time.

For more information about your options under Medicare prescription drug

coverage…

More detailed information about Medicare plans that offer prescription drug coverage

is in the “Medicare & You” handbook. You’ll get a copy of the handbook in the mail

every year from Medicare. You may also be contacted directly by Medicare drug

plans. For more information about Medicare prescription drug coverage:

> Visit www.medicare.gov

> Call your State Health Insurance Assistance Program (see your copy of the

Medicare & You handbook for their telephone number) for personalized help,

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

2048.

If you have limited income and resources, extra help paying for Medicare prescription

drug coverage is available. For information about this extra help, visit Social Security

on the web at www.socialsecurity.gov, or call them at 1-800-772-1213 (TTY 1-800-

325-0778).

Remember: Keep this notice. If you enroll in one of the new plans approved by

Medicare which offer prescription drug coverage, you may be required to

provide a copy of this notice when you join to show that you are not required to

pay a higher premium amount.

Name of Entity/Sender: Baer's Furniture

Contact--Position/Office: Susan Scovin

Address: 1589 NW 12th Ave.

Pompano Beach, FL 33069

Phone Number: 954-946-8007 ext. 215

Required Annual Employee Disclosure Notices

- Continued

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Notes

______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

The information in this Benefits Summary is presented for illustrative purposes and is based on information

provided by the employer. The text contained in this Summary was taken from various summary plan

descriptions and benefit information. While every effort was taken to accurately report your benefits,

discrepancies or errors are always possible. In case of discrepancy between the Benefits Summary and the

actual plan documents, the actual plan documents will prevail. All information is confidential, pursuant to

the Health Insurance Portability and Accountability Act of 1996. If you have any questions about this

summary, contact Human Resources.

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