Employee Benefits Plan: January 1, 2022 Insurance Benefits ...

Employee Benefits Plan: January 1, 2022

Insurance Benefits for Full Time Employees

Dear National Family Member, While we all have spent the last year adapting to our new normal, our continued goal at National Health Care Associates has been to ensure that all of YOU, our Health Care Heroes, have access to a comprehensive, cost-effective benefits program that will provide you and your family with quality healthcare. We are pleased to announce that there will be no increase in plan premiums and we will continue with all of our current plan offerings for the 2022 plan year. We encourage you to carefully review the materials in this enrollment guide along with the resources and more detailed information available at our benefits portal at www.nathealthcarebenefits.com. Please don’t forget to take advantage of the benefit programs that will help you save money and/or plan for out-of-pocket expenses to include: • SaveOnSP for certain Specialty Medications with a ZERO copay (new for 1/1/22). • 90 Day Mail order delivery via Express Scripts for maintenance medications (save one month’s copay). • Rx Manage, an alternative international mail order program with a ZERO copay for many brand-name maintenance medications. • MeMD, our telemedicine provider with a ZERO Copay ($40 for HDHP plans). • Medical & Dependent Care Flexible Spending Accounts to pay for out-of-pocket medical or daycare expenses. For assistance with the enrollment process or for benefits questions, call the NHCA Benefits Helpline at 1-800-201-7898 if you have any questions. Marvin Ostreicher Marvin J. Ostreicher President, National Health Care Associates, Inc.

National Health Care Associates: Benefit Overview

Benefit Overview for January 1, 2022

Table of Contents

Benefit Overview 1

Contact Information 2

Eligibility/ Online Enrollment Instructions 3

Pre-Tax (Section 125) Plan 4

Medical Coverage 5

Preventative Services 6

Health Provider 7

Medical Claims 9

Explanation of Benefits 10

Additional Bills 11

Declining Providers 12

IHP Portal / Mobile App 13

MeMD/Telemedicine 14

Health Plan Comparison 15

Pharmacy Benefit 17

RxManage 21

Health Savings Account 23

Flexible Spending Accounts 25

Dental Plan 27

Vision Plan 28

Life/Disability Benefits 30

Work/Life Assistance Program 31

Voluntary Benefits 32

Liberty Mutual 33

Right to Continue Medical Coverage 34

Notice of Electronic Access 35

Medical Plans No changes. Please review page15 for the health plan overview. MeMD Telemedicine at your fingertips Dental Plans No Changes. Vision Plan No Changes. Pharmacy Plans Express Scripts New SaveOnSP program for certain specialty medications with $0 copay if enrolled on the Premium, Standard or Basic medical plans. Please review the pharmacy chart on page 18 for benefit information. RxManage An optional alternative for Maintenance Medications with a $0.00 Copayment. Group Life/AD&D Insurance No Changes. Group Voluntary Life/AD&D Insurance No Changes. Group Short Term Disability Insurance No Changes. Group Short Term Disability Buy-Up Insurance No Changes. Group Voluntary Long Term Disability Insurance No Changes. Flexible Spending Accounts Health Care FSA Dependent Care FSA Health Savings Account No Changes. Employee Assistance Program A program for employees and their families. Liberty Mutual Discounts on Auto and Home Insurance.

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National Health Care Associates: Contact Info

Benefit Provider Department Phone & Website

Medical Insurance

IHP/ Amwins

Customer Service

1-800-337-4973 https://lin.g-b-s.com/nhcawelcome

Pharmacy Express Scripts

Customer Service

1-877-814-9206 express-scripts.com/NTLPLSNTLPRFF

Health Savings Account Payflex Customer

Service1-888-678-8242 www.payflex.com

Dental Insurance Delta Dental

Customer Service

1-800-452-9310 www.deltadentalnj.com

Vision Insurance AETNA Customer Service

1-800-533-8436 www.aetnavision.com

MeMD/ Telemedicine IHP Customer

Service 1-855-636-3669

Colonial Plans Colonial Customer Service 1-800-325-4368

Short Term Disability

The Hartford

Customer Service 1-888-301-5615

Flexible Spending Account

Optum Customer Service 1-800-243-5543

401(k) Principal Customer Service 1-800-547-7754

24 Hour Access through our Employee Benefits Portal – www.NatHealthCareBenefits.com We have developed a customized benefits portal for National Health Care employees where you will be able to find information on your plan options, contact information, claim forms, enrollment information and many other topics. Just go to www.nathealthcarebenefits.com and navigate to the area of the site that you wish to view. In addition to our employee website, you also have access to our dedicated benefit advocates at our benefit advisory firm, The Hilb Group.

Need help? Call the National Health Care Associates Benefits Help Line at 1-800-201-7898 Simply dial the NHCA Benefits Help Line at 1-800-201-7898 and follow the prompts to get access to an advocate that can answer your questions or guide you through the enrollment process. Benefit Educators from The Hilb Group will be available to discuss your benefits with you and explain the benefit options. Please review the information in this Benefits Guide carefully so you are familiar with your options.

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National Health Care Associates: Eligibility/Online Enrollment Instructions

Eligibility / Online Enrollment Instructions Eligible Employees are defined as follows: Employees who are regularly scheduled to work at least 30 hrs/wk and have satisfied the waiting period are eligible for Medical, Dental, Vision, Life, Voluntary Life, STD, LTD Insurance, the Colonial Group Accident, Cancer, Critical Illness, and Hospital Confinement coverage, Health Savings Account, and Flexible Spending Accounts.

Go to www.nathealthcarebenefits.com. Click on National Health Care logo. On the top menu bar, click on Online Enrollment, this will link you to Benefits Connect, our online enrollment platform. Enter the first 6 characters of your last name, followed by the first letter of your first name, followed by the last 4 digits of your Social Security Number. Password: Enter your full Social Security number without any dashes. Once you log in, you will be prompted to go through the 6 step enrollment process.

Confirm your personal information and make any necessary changes to your profile.

Review your dependents and make any necessary corrections or add a dependent. Select your benefits. Be sure to select any family member to be added to your benefits as well. Continue through until you have selected or waived all benefits. Complete or Update the Beneficiary Information. You may add more than one beneficiary. Indicate percentage amount for each beneficiary. Review Consolidated Enrollment Form and Benefit Selections. Please note: you do not need to sign and return this form; it is for your records.

Should you need assistance with this process, please call the National Health Care Benefits Help Line at 1-800-201-7898.

S T E P 1

S T E P 2

S T E P 3

S T E P 4

S T E P 5

S T E P 6

S T E P 7

National Health Care Associates: Pre-Tax (Section 125) Plan

National Health Care Associates, Inc. has offered and continues to offer a valuable benefit that allows you to take advantage of the tax benefits available under Section 125. This program is designed to allow pre-tax withholdings of your share of the medical, dental, vision, health savings account, flexible spending account deductions; therefore, reducing your income tax liability. Please see the example that illustrates the savings you can achieve.

We have adopted an automatic enrollment feature for this plan. Automatic enrollment means that we will be taking any eligible premiums from your paycheck pre-tax unless you tell us that you don’t want them taken out pre-tax. NHCA has implemented a pre-tax premium payment program under IRC Section 125. Pursuant to the plan document and summary plan description, all eligible employees will be automatically enrolled in the pre-tax premium payment program unless said employee declines enrollment by written notice to their center's human resources manager. Please understand that once you make an election in the pre-tax plan, it is irrevocable and cannot be changed for the balance of the plan year unless you have a qualifying event like a marriage, birth, death or divorce.

Pre-Tax (Section 125) Plan

Income Before Pre-Tax Plan

Income After Pre-Tax Plan

Adjusted Monthly Salary $2,000 $2,000

Before-tax Insurance Premiums - $0 - $400

Taxable Salary $2,000 $1,600

Taxes - Federal & Social Security (25%)

- $500 - $400

After-tax Insurance Premiums - $400 - $0

Net Monthly Salary $1,100 $1,200

MONTHLY SAVINGS $0 $100 Per Month

YEARLY SAVINGS $0 $1,200 Per Year!

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National Health Care Associates: Medical Coverage

Medical Coverage National Health Care Associates will continue to offer five (5) medical plan options through InnovativeHealth Plan II (IHP II) powered by AmWINS and pharmacy through Express Scripts. These plans contain comprehensive health care benefits, including free preventive care services and coverage for prescription drugs. The following benefit summaries highlight the basic provisions of the medical plans provided to you by National Health Care Associates for 2022. To locate participating providers, refer to page 7 of this guide. What is Innovative Health Plan II? IHP II is a unique health insurance program. As a member, you can enjoy an Open Access medical network to maximize a provider of choice when you seek treatment. Our Open Access medical plan separates claims & providers into their own categories:

1. Professional and Ancillary Claims 2. Facility Claims

Professional and Ancillary Claims Through the Multi Plan network, you have access to all Physician, Urgent Care, and Lab providers. These include, but are not limited to, Primary Care Physicians, Specialists and Urgent Care Centers. As a member, you have a choice to use a Multi Plan provider or not. If the doctor is not in the Multi Plan network, you may complete a ClaimDOC Provider Nomination Form and return to ClaimDOC (address, email & fax numbers are on the form) and they will make contact with your doctor to discuss participating in the IHP II Open Access medical plan.

Facility Claims Regarding Hospital, Surgery Centers, and Emergency Rooms, you are not limited to a network. You have the freedom to choose any facility to have your medical procedure performed at the most favorable cost. These claims are processed through the Reference Based Reimbursement (RBR) program. When you visit a provider, always present your IHP II ID card. If the provider has any questions about how your plan works, they can call Customer Service at 800-337-4973. Dedicated customer service representatives are available to answer any questions they may have.

National Health Care Associates: Preventative Care

Preventive care covered with no cost sharing Get checkups, screenings, vaccines, prenatal care, contraceptives and more with no out-of-pocket costs.

This includes routine screenings and checkups. It also includes counseling you get to prevent illness, disease or other health problems. Many of these services are covered as part of physical exams. These include regular checkups, and routine gynecological and well-child exams. You won’t have to pay out of pocket for these preventive visits.

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National Health Care Associates: Health Provider

How To Look Up A Multi Plan Provider Physician, Urgent Care or Lab

To find a Multi Plan Network Professional or Ancillary Provider: Step 1 Go to the IHP II website at www.multiplan.com/mpipracanc. Step 2 Enter the zip code and the doctor’s name you are inquiring about to see if they are in network. You can also look up Urgent Care or Lab Facilities.

Your First Appointment with Your New Medical Plan Let us make the introduction. Your plan is open access, which means you have the freedom to choose any health care provider you wish, without restrictions or limitations from your plan. In some cases, your provider may be unfamiliar with your new Plan. Let us remove the unnecessary stress and make the initial introduction for you! A ClaimDOC Member Advocate will contact your provider and introduce your new plan BEFORE your first appointment, ensuring that your provider has the information they need to treat you and submit your claims. To nominate your provider, simply complete the ClaimDOC Provider Nomination Form located on the next page, and submit it to ClaimDOC (submission options are located on the form). Or, if a phone call is easier for you, you may submit your request by calling 800-337-4973. We are ready to partner with you!

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National Health Care Associates: Health Provider Form

Provider Nomination Form Your Medical Plan is Open-Access; this means that you have the freedom to choose any provider you wish, without restrictions or limitations from your plan. As long as your provider submits your medical claim to Group Benefit Services, your plan administrator, your health care services will be covered at the "in-network" benefit level, regardless of the source of care. As part of ClaimDOC's Pave the Way™ program, a ClaimDOC Member Advocate will contact your healthcare provider BEFORE your first appointment to educate them on your new plan and ensure they have the necessary information to submit your claims. Please submit a completed form for each provider by email, fax, or US mail. You may also submit your request by visiting claim-doc.com/pnf or calling a ClaimDOC Member Advocate at 1 (888) 330-7295.

Additional Information and/or Patient Information:

Fax: (844) 605-7636 Email: [email protected]

To check the status of your provider nomination, please call 1 (888) 330-7295.

Please submit your completed form to: Mail: ClaimDOC, LLC. PO Box 42155 Urbandale, IA 50322

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National Health Care Associates: Medical Claims

Know How Claims Are ProcessedWhen you see a Multi Plan Preferred Practitioner or Ancillary Provider: Claims are submitted for you and you may be asked to pay your patient responsibility (i.e. copay) before you leave. Innovative Health Plan II will process the claim to:

• Make sure it is an eligible expense under your plan. • Make sure the provider charged you the correct patient responsibility amount. • Make sure the service is paid at the Multi Plan discounted rate.

When you visit a Hospital or a non-Multi Plan Practitioner or Ancillary Provider: Our Innovative Health Plan II is an Open Access medical plan that allows you to go to any hospital or visit non-Multi Plan Practitioners or Ancillary Providers, and provides the same benefit amount (i.e. copay or coinsurance). However, these Hospitals or non-Multi Plan Practitioners or Ancillary Providers may not submit the claim for you and may request payment at time of service. If so, please follow the following steps: • Contact ClaimDOC at 1-888-330-7295, our Member Advocate to Pave the Way.

Introducing the Plan to Your Providers If your provider is not in the Multiplan Practitioner & Ancillary Only Network, that's okay! Remember, your plan doesn't impose out-of-network penalties. As part of ClaimDOC's Pave the Way™ program, we will reach out to your healthcare providers to educate them on your new plan and to ensure they have all of the necessary information to accept and submit your claims. Submit your provider nomination request by using any of the following options:

Your Responsibilities • Know and confirm your benefits before receiving treatment. • Show your new ID card before receiving health care services. • Notify your employer of any changes in your address or family status. • Sign in to the IHP II benefits website or call Customer Service at 800-337-4973 before receiving services to verify that your doctor or health care professional participates in the Multi Plan Practitioner and Ancillary Network. • Contact ClaimDOC and submit your claim if you receive a bill after any applicable deductible, co-insurance or copay.

Submit an online form on: claim-doc.com/pnf

Email your form to: [email protected]

Call a ClaimDOC Member Advocate: 1 (888) 330-7295

Download the: ClaimDOC Mobile Application

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National Health Care Associates: Explanation of Benefits

Understanding Your Explanation of Benefits (EOB)Whenever you receive a bill from any medical provider following a visit for medical treatment, always compare the bill to the Explanation of Benefits (EOB) that you received from Amwins Connect Administrators (formerly Group Benefit Services), your Plan Administrator. You are only responsible for paying the amount in the Patient Responsibility section illustrated on the EOB after your claim has been fully processed. Once you pay the Patient Responsibility on the EOB, you are required to pay nothing further for the visit/treatment. What is a Paid Claim? A paid claim is considered fully processed. This means that your provider has submitted your claim, and your health plan has processed and paid it according to your benefits. Your EOB may display a “Payment Amount” (the amount paid by your insurance) and/or “Patient Responsibility” (the amount owed by you). If you have questions about a claim or EOB: Call our Customer Service team at 800-337-4973, Monday through Friday, 8:00 AM - 6:00 PM (EST). This phone number is also shown on the back of your ID card. Sample Explanation of Benefits (EOB) • Charged Amount: The full amount the provider billed for services. • Reduction Amount: The amount that was determined to be in excess of the allowable charges for the services you received. • Reason Code: Information on how your claim was processed. Please refer to the “Reason Code Description” on your explanation of benefits for additional details regarding each code. • Payment Amount: The amount the plan paid. • Patient Responsibility: The amount that you owe after the reduction has been applied and the plan has paid. Your liability includes copays, deductible amounts, and any applicable coinsurance. NEVER pay more than the amount stated here, even if your provider sends you a bill for a higher amount. If a provider bills you for amounts beyond your Patient Responsibility, that is called a balance bill and you are not responsible for that amount.

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National Health Care Associates: Additional Bills

What to do if you receive an additional bill from your provider

The medical provider, and/or facility, may send you a follow-up bill indicating that you owe more than the amount you and your insurance paid; this is known as a “balance bill.” A balance bill occurs when your claim is processed, and the medical provider receives the fair and reasonable payment from you and your insurance but seeks to collect additional money directly from you. The “balance” they are attempting to bill you for will match the “Reduction Amount” determined by your plan, as reflected on the EOB you receive from Amwins Connect Administrators. Your Next Steps • If you have received a new balance bill from a provider, please contact ClaimDOC at

1-888-330-7295 as you are not responsible for paying the invoice. Please also send any subsequent bills you receive from your providers.This is the only way ClaimDOC knows that the provider is continuing to bill you.

• If you receive a notice from a collection agency, please contact ClaimDOC immediately.

Timeliness of response to these notices is imperative. ClaimDOC will work directly with the credit agency to seek resolution of the outstanding bill.

• Again, never pay any amount billed to you that is beyond what is stated on your EOB

as patient responsibility. If you did pay the balance bill, you may contact ClaimDOC. As a courtesy, a ClaimDOC Member Advocate will request a reimbursement from the provider, However keep in mind that the provider has no contractual obligation to return those funds to you, and ClaimDOC has no means to force the provider to issue a refund. This is why it is very important to not pay more than the patient responsibility shown on your EOB.

• Should you notice a credit impairment (any type of activity that leads to the reduction

of your credit rating ) as a result of a balance bill, please contact ClaimDOC immediately. What is an unprocessed claim? You may receive a bill from your provider before your claim is fully processed and funded by your health plan. An unprocessed claim occurs when the provider has submitted the claim, but the health plan has not processed or paid it yet. An EOB will not be available until the claim is fully processed. If you receive a Provider bill that indicates the health plan has not made a payment, please contact:

AMWINS / CONNECT ADMINISTRATORS 800-337-4973

Monday - Friday 8:00 AM - 5:00 PM EST [email protected]

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National Health Care Associates: Declining Providers

Declining Providers

When a Provider is Unwilling to Submit Claims There are times when a healthcare provider is unwilling to submit claims to a new health insurance plan, even after ClaimDOC has diligently worked with their office in hopes of coming to a mutually beneficial agreement. Most of the time, their reasoning lies in the fact they have a select few insur-ances they accept, and they cannot deviate from that list. We understand this outcome may be frustrating, but we are here to help you and let you know that you have options. Alternative Providers A ClaimDOC Member Advocate will help you find a new provider. We likely have a relationship with a provider that meets your needs and already submits claims to your health plan. If not, we will locate one or more alternatives for you to consider. If you have a choice in mind, we will reach out to them. Please contact ClaimDOC for assistance. Self-Pay Option If you would like to continue seeing your provider, even though they are unwilling to submit claims to your plan, you may continue to do so on a self-pay basis. This means that you would pay your provider for the service cost and submit a Medical Claim Form. Please be aware that it's likely that you may not be reimbursed for the total amount you pay, as the plan will reimburse you at the same rate it would have paid your provider. It is a fair payment amount; however, your provider may bill a higher amount, and you will be responsible for the difference. Process

• Request a self-pay discount at the time of service • Ask the provider for a copy of the itemized claim • Complete your health plan's Medical Claim Form • Submit the completed Medical Claim Form and the itemized bill from your provider to your Plan Administrator

After you submit the Medical Claim Form to your Plan Administrator, the claim should be processed within 30-45 days, and you will receive an Explanation of Benefits, along with payment (if applicable). The payment will be based on the allowable amounts for the services you received, less your Patient Responsibility (for example, your co-pay, deductible, or coinsurance amount). If you have questions about your reimbursement, please contact your plan administrator.

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National Health Care Associates: IHP Portal/Mobile App

The IHP II Mobile App is also available to you!

Access, Track, and Manage your benefits by mobile, in three easy steps: Step 1 Download the app at the Apple App Store or Google Play Store by searching for “IHP2” or visit ihp.medxoom.com for online access. Step 2 Register for your benefits by verifying your social security number and date of birth. (Don’t worry: Your information will be kept private and secure.) Step 3 Review your profile information by clicking the icon in the upper right-hand corner. Invite adult dependents to register, too.

Sign Up for the IHP II Web Portal

Access our Custom web portal 24/7 and track your claims online at https://lin.g-b-s.com/nhcawelcome.htm: Follow your claims from start to finish and view your claim Explanation of Benefits (EOBs) for you and your dependents (if applicable). • View your Benefits At A Glance which summarizes

your enrolled medical benefits and your covered dependents (if applicable).

• View your ID Card • Search for Doctors in the Multi Plan Network

To register for the web portal: First time users should enter their Participant # in the Username field and leave the Password field blank. Click on the Login button to verify your Personal Information. You will be asked to verify a few pieces of information including your Participant #, Last Name, Zip Code and Date of Birth. Enter that in the fields then click Next to create a password for your account. If any of the information does not match our system you will be notified and you should contact us for assistance. Once you have verified your information you can create a password and a hint that can be emailed to you if you ever forget your login information. Enter that information into the fields and click Submit to complete the setup. You will now be able to use your Participant ID and password to log on to our system.

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National Health Care Associates: MeMD/Telemedicine

Ready to talk? The doctor is in! Telemedicine at your fingertips. Just register with IHP2 mobile app on iTunes or Google Play Store and enjoy access to healthcare anytime.

Call us now for a consult! 855-636-3669

What can MeMD Telemedicine help you and your family with?

• Cuts & Bruises • Allergies • Stings • Body Aches • Bronchitis • Bruises • Dehydration • Diarrhea • Fever • Insomnia

• Prescriptions • Nausea • Hives • Itchy Eyes • Skin Infections • Sore Throat • Sprains • Back Strains • Headaches • UTI’s

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National Health Care Associates: Health Plan Comparison

Premium Plan Standard Plan

HSA Eligible Plan No No

Deductible (Based on Calendar year) $750 per person $2,000 family maximum $1,250 per person $3,500 family maximum

Co-Insurance after Deductible 0% 10%

Out of Pocket Maximum (includes deductible and all copayments)

$7,900 per person $15,800 family maximum $7,900 per person $15,800 family maximum

Inpatient Services

Hospital Semi-private room and related services $500 copayment after deductible $500 copayment and 10% after deductible

Skilled Nursing Facilities $250 copayment at a NHCA facility $500 for non-NHCA facility 60 day limit per year

$250 copayment at a NHCA facility $500 for non-NHCA facility 60 day limit per year

Outpatient

Outpatient Procedures/Testing $500 copayment after deductible $500 copayment and 10% after deductible

Emergency Room Services $250 copayment $250 copayment

Physician Services

Office Visits to Primary Care Physician $0 for Routine Annual Physical $30 copayment for all other visits

$0 for Routine Annual Physical $30 copayment for all other visits

Office Visits to Specialty Physician $40 copayment $40 copayment

MeMD / Telemedicine Covered in full $0 copayment Covered in full $0 copayment

Chiropractic Care $45 copayment - 20 visits per year $45 copayment - 20 visits per year

Vision Care Routine Eye Exam covered in full every 24 months

Routine Eye Exam covered in full every 24 months

Independent Lab, X-Ray, Clinics & Walk-in Treatment Centers

Lab Services Preventive Lab and X-Ray Covered in full Diagnostic Lab & X-Ray $10 copayment- Free Standing $25 copayment - Hospital

Preventive Lab and X-Ray Covered in full Diagnostic Lab & X-Ray $10 copayment- Free Standing $25 copayment -Hospital

Machine Tests (MRI, CT and PET Scans) $250 copayment-Free Standing $500 - Hospital

$250 copayment-Free Standing $500 - Hospital

Walk-in Treatment & Urgent Care Centers $50 copayment $75 copayment

Mental Health Substance Abuse Services

Inpatient Services $500 copayment after deductible $500 copayment and 10% after deductible

Outpatient Services $40 copayment $40 copayment

Maternity

First initial visit $40 copayment $40 copayment

Hospital Stay $500 copayment after deductible $500 copayment after deductible

Other Services

Physical/Speech/Occupational/Respiratory Therapy

$45 copayment 30 visits per year per therapeutic category


Durable Medical Equipment 30% coinsurance 40% coinsurance

Dependent Coverage Age Age 26 Age 26

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National Health Care Associates: Health Plan Comparison

Basic Plan HSA Plan Bronze HSA Plan*

No Yes Yes

$1,750 per person $5,000 family maximum $2,000 individual / $4,000 family coverage $6,600 individual / $13,200 family coverage

20% 15% 0%

$7,900 per person $15,800 family maximum $6,750 per person $13,500 family maximum $6,600 per person $13,200 family maximum

20% coinsurance after deductible 15% coinsurance after deductible Covered in full after deductible

20% coinsurance after deductible 60 day limit per year

15% coinsurance after deductible 60 day limit per year

Covered in full after deductible 60 day limit per year


$300 copayment 15% coinsurance after deductible Covered in full after deductible

* The Bronze H S A plan does not meet the Minimum Creditable Coverage (MCC) in the State of MA

$0 for Routine Annual Physical $30 copayment for all other visits

$0 for Routine Annual Physical 15% coinsurance after deductible for all other visits

$0 for Routine Annual Physical Covered in full after deductible for all other visits


Covered in full $0 copayment $40 copayment $40 copayment

$50 copayment - 20 visits per year 15% coinsurance after deductible - 20 visits per year

Covered in full after deductible - 20 visits per year




Preventive Lab and X-Ray Covered in full Diagnostic Lab & X-Ray 20% coinsurance after deductible-Free Standing 30% coinsurance after deductible - Hospital

Preventive Lab and X-Ray Covered in full Diagnostic Lab & X-Ray 15% coinsurance after deductible-Free Standing 25% coinsurance after deductible - Hospital

Preventive Lab and X-Ray Covered in full Diagnostic Lab & X-Ray Covered in full after deductible

15% coinsurance after deductible-Free Standing 25% coinsurance after deductible - Hospital

15% coinsurance after deductible - Free Standing 25% coinsurance after deductible - Hospital

Covered in full after deductible







15% coinsurance after deductible 30 visits per year per therapeutic category

Covered in full after deductible; 30 visits per year per therapeutic category


Age 26 Age 26 Age 26

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National Health Care Associates: Express Scripts Pharmacy Benefit

What you need to know Our covered drug list (formulary) with Express Scripts excludes certain drugs that have preferred brand or generic equivalent drugs available. If you choose a non-covered drug, you will be responsible for the entire cost of the drug and it will not count towards your out- of- pocket maximum. To fill prescriptions at a Retail Pharmacy just show your new Express Scripts Rx ID card. For Mail Order Pharmacy refills, your refill can be done at retail pharmacy or through Express Scripts' mail order program, which is available online or by completing the form and returning it to Express Scripts. Diabetes Program: Diabetic medications are covered as indicated on the pharmacy benefit table, except the maximums are capped at $100 for the first two fills at a retail pharmacy and capped at $150 when using the Express Scripts Mail Order Saver Program for a 90 day supply. Note: Maintenance medications at a retail pharmacy for a 30/90 day supply after the 2nd fill will be subject to 50% up to $300/$900 maximum. Additionally, a free glucose meter from One Touch is available to members with diabetes. How to save money Talk to your doctor about the drugs you are taking to see if there is a generic alternative or a less expensive brand option. Since you pay a percentage of the cost of each drug you purchase, it is beneficial for you to comparison shop the pharmacy that you are going to purchase your drugs from. We have identified the following website to do the comparison shopping for you, www.goodrx.com

Pharmacy We have selected Express Scripts as our pharmacy insurance company. IHP will manage our medical benefits. Express Scripts will manage our pharmacy (prescription drug) benefits. You will receive two ID cards this year. Once for medical and a second one for pharmacy. Please refer to the plan specific pharmacy benefit table on page 18. Based on the plan you select for enrollment, the applicable pharmacy benefits will apply. Additionally, there is a per prescription maximum cost of $300 per 30 day supply. This safeguards you in the event that you are taking a very expensive drug, your maximum cost is capped at $300 per refill. Additionally, your costs are also capped by the medical plan out of pocket maximum. See the pharmacy benefit table for more detailed information.

MAINTENANCE MEDICATIONSRetail Pharmacy - 30/90 DAY SUPPLY After 2nd Fill

Plan Generic Brand (Preferred/Non-Preferred)

Premium, Standard or Basic $18/$54 or less 50% up to $300/$900 Max

H.S.A. $18/$54 or less (After Deductible) 50% up to $300/$900 Max (After Deductible)

Bronze H.S.A. Covered in Full (After Deductible) Covered in Full (After Deductible)

SPECIALTY MEDICATIONS

Plan Accredo Specialty Pharmacy 30 DAY SUPPLY (Specialty Medications Must be Ordered through Accredo Scripts)

Premium, Standard or Basic 40% up to $300 Max

H.S.A. 40% up to $300 Max (After Deductible)

Bronze H.S.A. Covered in Full (After Deductible)

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NON-MAINTENANCE MEDICATIONSRetail Pharmacy – 30 DAY SUPPLY


Premium, Standard or Basic $9 or less 30% up to $300 Max

H.S.A. $9 or less (After Deductible) 30% up to $300 Max (After Deductible)


MAINTENANCE MEDICATIONS Express Scripts Mail Order Program - 90 DAY SUPPLY


Premium, Standard or Basic $18 or less 30% x 2 up to $600 Max

H.S.A. $18 or less (After Deductible) 30% x 2 up to $600 Max (After Deductible)


Lowest Cost Option

Pharmacy Benefit Table

SaveOnSP Program

Plan For Select Specialty Medications only

Premium, Standard or Basic $0 if participating in SaveOnSP program; otherwise 30% (no maximum)

H.S.A. N/A

Bronze H.S.A. N/A

NEW

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Express Scripts Express Scripts will be managing your prescription plan. We care about your health and work to make medications safer and more affordable. We encourage you to take advantage of the services and resources available to help you and your dependents manage your pharmacy benefit. We look forward to serving you soon! Home Delivery from Express Scripts Pharmacy One of the best things about home delivery is that we ship up to a 3-month supply of your long-term medications (the kind you take regularly) right to your door from Express Scripts PharmacySM. It’s safe, secure and speedy—and means less time in a pharmacy line! To start ordering a 3-month supply from Express Scripts Pharmacy, register or log in at express-scripts.com. Here’s a quick look at the benefits of home delivery: • Free standard shipping1

• Delivery of up to a 3-month supply of your long-term medications • 24/7 access to a pharmacist from the privacy of your home

28% savings over retail pharmacies on average2 • Ability to order your refills online or on the phone 1 Cost of standard shipping is included as part of your prescription plan. 2 Average percentage savings figure based on analysis of Jan-Dec 2018 claims for clients with an integrated benefit, excluding Medicare clients and clients participating in mandatory mail programs. Patient savings based on patient shifting all long-term medications to mail. Savings may vary based on your plan design. New SaveOnSP Program SaveOnSP is available to all members of the Premium, Standard, and Basic plans. This program allows members to receive certain specialty medications at no cost. Members using medications offered under SaveOnSP will be alerted and then need only call SaveOnSP at 1-800-683-1074 to register. Individuals who are eligible for the program but choose not to participate will be responsible for 30% of the medication’s cost, with no dollar limit applied. Additionally, payments toward these medications would not count toward one’s deductible and out-of-pocket maximums.

Accredo, Your Specialty Pharmacy Accredo is the Express Scripts specialty pharmacy. A specialty pharmacy provides medication and therapy for patients with serious, chronic conditions like cancer and hepatitis C. Accredo offers teams of pharmacists, nurses and clinicians who are specially trained on your condition. This level of individualized, focus care gives you the most comprehensive, compassionate and customized care available. Accredo offers many patient support services, including: • Personal care and health advocacy assistance from patient

care coordinators

• Guidance for patients and caregivers for taking specialty medications most effectively

• All necessary ancillary supplies such as syringes and sharps containers

Specialty medications must be filled through Accredo to receive coverage. To learn more about Accredo, please visit accredo.com. Network Retail Pharmacies Network pharmacies are retail pharmacies that are preferred by your prescription plan. Use them for prescriptions you need on a short-term basis, like an antibiotic to treat an infection. When you go to an in- network pharmacy for up to a 30-day supply of medication, you’ll typically pay less than at a retail pharmacy that’s out of your network. To find an in-network pharmacy near you, go to express-scripts.com/ NTLPLSNTLPRFF and select Locate a Pharmacy. Search results will indicate whether a pharmacy dispenses up to a 3-month supply. You may also log in at express-scripts.com and choose Find a Pharmacy from the menu under Prescriptions or call Express Scripts at 800.496.4182. Be sure to show your new Express Scripts ID card at the pharmacy. You can also access your ID card by downloading the Express Scripts® mobile app. If you don’t show your ID card and instead choose to pay the entire cost of the medication, you must submit a claim form to Express Scripts for reimbursement. You’ll be reimbursed based on the covered medication’s contracted rate minus the appropriate copayment. This amount will be lower than the amount you paid out of pocket at the retail pharmacy.

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If you need to transfer your prescription from an out-of-network pharmacy to an in-network pharmacy, just choose one of the following: • Bring your prescription vial or container to an in-network pharmacy,

and the pharmacist will transfer it.

• Call a pharmacy in your network, and ask the pharmacist to transfer your medication.

• Ask your doctor to call your prescription in to an in-network pharmacy.

Manage Your Prescription One of the great things about being an Express Scripts member is that you can manage your medication easily on your laptop, tablet, desktop or phone. Whether you want to check your order status, look for savings opportunities, look up information about your benefit, get a refill or even find a pharmacy, the Express Scripts website and mobile app can help! Just register at express-scripts.com or on the mobile app. You can download the mobile app to your mobile device for free by searching your app store for Express Scripts. (Availability and features may vary.) Formulary A preferred drug list, also called a formulary, helps keep healthcare costs down for everybody. It's a list of medications that have been reviewed and approved for safety, effectiveness and cost by a panel of doctors and pharmacists. This list is continually reviewed and updated as new medications become available. Note that certain medications are excluded from your formulary, which means they’re not covered. An equally effective and safe alternative may be available. To check pricing and coverage for a medication, visit expressscripts.com for the latest coverage information. Drug classes with excluded medications include Autonomic and Central Nervous System, Cardiovascular and Dermatological.

21

National Health Care Associates: RxManage

National Health Care Associates, Inc. and Affiliates has partnered with RxManage to offer you savings on your prescription medications. You can now order medications from the International Program at zero co-pay on Premium, Standard & Basic plans.

What is the International Program? The Program allows you to order from a formulary of over 200 brand medications from pharmacies in New Zealand, Australia, Canada and England. Will my medication be exactly the same as what I currently take? Yes it will. To be on the formulary a medication must be available from the same manufacturer internationally as the US brand, or from the International license holder. How do I place an order on the Personal Importation Program? Ordering is easy! You can place your first order online at the website address below, or phone at 1-800-883-8841. Upload your prescription to your account or fax to 1-800-883-1814. A prescription is required for each medication. https://my.globalrxmanage.com/customers/national-health-care-associates-inc/sign-up. Once established, your online account is available 24 hours a day, 7 days a week. Log into your account from your computer or mobile device using your Account ID and password at https://my.globalrxmanage.com/customers/login.

How long will it take to receive my medication? 10-15 working days after the order has shipped. Please make sure you have a 30 day supply on hand before placing your first order for each medication. How do I place a refill order? Refill orders are placed automatically. You will receive a refill reminder by phone or email. Any changes are to be notified to Rx Manage within 48 hours. If no changes are notified the order automatically ships, ensuring a smooth continuous supply of medication. What is the amount of medication I can order? Using the Personal Importation Program, you can order a 90 day supply of medication. Where do I go if I have questions about the program? Our call center is open 9am-9pm Monday to Friday (EST) and 9am to 4pm Saturday and Sunday to answer simple questions or take your orders. Call us on 1-800-883-8841. Alternatively you can email us on [email protected]

International Pharmacy Program

Order by phone 1-800-883-8841

Email us at [email protected]

Order online rxmanage.com90 day supply90

$0 CO-PAY*

Available for over 250 Brand Medications

* when ordered with Rx Manage

Scan this QR code for a

NEW ACCOUNT ACTIVATION

RxManage sources medication from dispensing pharmacies in New Zealand, Australia, United Kingdom and Canada. These countries are classed as Tier One countries (designated by the US Congress) for pharmaceutical supply.

22

National Health Care Associates: RxManage

RxManage Frequently Asked Questions

Does the RxManage Personal Importation Program replace our current prescription benefit plan? No, the RxManage Personal Importation Program is a voluntary program for brand name medications listed on the RxManage formulary. Medications not listed on the formulary will need to be obtained using your current prescription benefit plan. Will my medication shipped from a Tier 1 country look the same as my current medication? Sometimes pharmaceutical companies use different names for the same medication internationally so your medication may not be called the same as it is in the USA. Tablet appearance can also differ between countries for the same medication. Rest assured that to meet the requirements of the Program each medication is thoroughly researched by our pharmacist to ensure it is bio-equivalent and dose-equivalent to the US brand. Can I send in a prescription for a newly prescribed medication? RxManage is unable to supply newly prescribed medication. When taking a newly prescribed medication a trial supply needs to be obtained locally. This ensures that you have been

advised how to take the medication and are aware of possible side effects. The medication trial is to make certain that there are no adverse reactions to the medication and that your physician would like you to continue on the medication long term. After your 30 day trial you can then order a 90 day supply using our program. I have ordered a cold chain product. What do I need to do next? Due to export requirements for cold chain orders you will need to send us an image of either:

• your passport; OR • your driver's license, with a signed declaration of U.S. citizenship; OR • your state issued identification card, with a signed declaration of U.S. citizenship.

You can send us your documents via email or fax, or upload your documents. Your order will be delivered by FedEx within 24 to 48 hours, and will require refrigeration upon arrival. If we have your email address on file, FedEx will send you tracking updates.

National Health Care Associates: Health Savings Account

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Using your HSA If you choose one of the two eligible HSA Plans, you should consider opening a Health Savings Account.

2022 HSA Contribution Limits Individual $3,650 Family $7,300 HSA Catch Up Contribution $1,000 Age 55 or Older

How it works Step 1 Visit participating doctors, hospitals and other health care professionals. Step 2 Pay for covered health care services and prescriptions until you meet your yearly deductible. Use your HSA if you’d like. Step 3 Then, pay a copay or coinsurance at each visit. Again, you can use your HSA for these costs. Step 4 Pay until you reach the out-of-pocket maximum. Now your health plan pays for covered services when you visit doctors, hospitals and pharmacies. You pay nothing.

Three easy ways to pay Pay directly with a debit card linked to your HSA. Debit card. Pay directly with a debit card linked to your HSA. Online bill payment. Pay for health care expenses on your computer, directly from your HSA. Online withdrawal. Transfer funds from your HSA to your personal bank account. Check for qualified costs Here are some costs the IRS lets you use your HSA to pay for: • Contact lenses and LASIK surgery • Copays and coinsurance • Deductible payments • Dental care and braces • Hearing aids • Prescription drugs • Wheelchairs Visit Payflex.com for more information. There’s even a tool to help you organize medical expenses and HSA withdrawals online. And visit the IRS website at www.irs.gov for a list of qualified health care costs.

24

National Health Care Associates: Health Savings Account

Online tools, information,tips & programs To get started, go to www.payflex.com and create your profile. Follow the registration process to set up your HSA. Start using the online tools available to help you manage your account. Once you’ve logged, you can: • Check your account balance • Review plan information • Print a summary of doctor visits, medical tests and other activities • Print or order ID cards • Review claims and more Plus, PayFlex lets you: Understand the best contribution amount foryour needs and project how your accountcan grow. See what you’ll pay for certain types ofcare, based on your actual plan. You cancompare estimated costs for up to 10 doctors or health care facilities at a time. Compare in- and out-of-network cost estimates for office visits, surgeries, medicaltests, treatments and more. Look up costs for prescription drugs —even before you fill a prescription. HSA Expense Manager Available through the PayFlex website, theHSA Expense Manager allows you to trackyour out-of-pocket health care expenses bytype, dependent or event. Set up custom ized expense categories to track and man age your out-of-pocket spending accordingto your own personal preference. My HSA Receipts Available through the PayFlex website, theHSA Receipt Manager allows you to attachreceipts and important documents to yourHSA transactions. Use this tool to organize your bills, receipts and paperwork. Find ways to stay healthier with personalized health searches, online wellness programs and other support. Help is a phone call away, too. Call Member Services with questions. The number is: 1-888-678-8242.

Make the most of your HSA It’s smart to research costs and quality, no matter what health plan you have. But it’s even more important with an HSA. After all, it’s your money. Contribute anytime You, your employer, and your spouse and family members can con-tribute anytime, up to a yearly maximum. The more you contribute, the bigger your account can grow. And there are convenient ways to contribute. Write a check. Set up an electronic funds transfer from your bank account. Use a payroll deduction if that’s available. Do what works best for you. Avoid surprises. Know how much you have. You can only use the money that’s in your HSA at the time you want to make a payment. Make sure to keep track of how much is avail-able in your HSA. Log in to www.payflex.com and check your account balances. Know what your health plan covers? For example: • Do you need a primary care physician, also known as a PCP? • How much is your copay or coinsurance? • Do you have in-network and out-of-network costs? • Is a referral needed? • What about approval for some services?

National Health Care Associates: Flexible Spending Accounts

25

A Health Advantage FSA from Optum is the smart way to save and pay for eligible health care and dependent care expenses. It’s smart because you can set aside pre-tax dollars in your FSA. You don’t have to pay Federal, State (except New Jersey) or FICA taxes on the money you put into your account. Whenever you need to pay out-of-pocket for eligible health care costs, just use your Optum™ Payment Card. It’s that easy. Sign up for a Health Advantage FSA during benefits enrollment. After you enroll, watch the mail for your welcome letter and subsequent delivery of your Optum Payment Card. Health Care FSA The money you choose to put into your Health Advantage Health Care Flexible Spending Account (FSA) is available to you on the first day of your plan year. You don’t have to wait until your FSA balance grows to pay for eligible expenses. How it works. You can enroll in a Health Advantage Health Care FSA and use the funds for your and any of your IRS dependents’ health care expenses (typically your spouse and children). Allowable expenses typically include your out-of-pocket health care expenses that are not paid or not fully paid by your insurance plan such as deductibles, copays, pre-scription drugs, vision and dental expenses, etc. (see IRS publication 502 for details as to eligible expenses). With a Health Care FSA, you choose how much to contribute, from a minimum of $520 up to a maximum of $2,750 per year (subject to change based on release of IRS FSA limits for 2022). Your employer deducts this amount from each paycheck, before taxes. Thus, you save money as you lower your income taxes. The Health Care FSA is only available to employees who either waive medical coverage or enroll in the Premium, Standard or Basic medical plans.

Health Advantage Flexible Spending Accounts

Dependent Care FSA With a Health Advantage Dependent Care Flexible Spending Account (FSA)*, you can save for day care, child care, nursery school and preschool tax-free. If you are working, you may also be able to use your account to pay for day camp for your child under 13 or to care for qualifying dependent adults, like elderly parents, who can’t care for themselves. How it works. You can enroll in a Health Advantage Dependent Care FSA as long as you and your spouse are working, looking for work or enrolled as a full-time student. With a Dependent Care FSA, you choose how much to contribute, from a minimum amount of $520 up to a maximum of $5,000 per household, per year. Your employer deducts this amount from each paycheck, before taxes. You don’t have to pay Federal, State (except New Jersey) or payroll taxes on the money credited to your account. You save money as you lower your income taxes.

26

National Health Care Associates: Flexible Spending Accounts

Important to know about your FSA

CALL OPTUM CUSTOMER SERVICE AT 1-800-243-5543

WITH QUESTIONS ONCE YOU ARE ENROLLED

Access your funds immediately. The money in your health FSA is available to you immediately. The money in your dependent care FSA is available based only on the funds you have contributed to date. The “Use it or Lose it” rule. The “use it or lose it” rule means that you will lose any money left in your account at the end of the plan year. So be sure to try to use all of your FSA funds. But even if some funds are left in your account at the end of the plan year, you may still come out ahead because of the tax savings. Save your receipts. Be careful how you use your Health Advantage FSA. You will want to keep receipts from your doctors, dentists, clinic, pharmacy and hospital for all eligible health care expenses. All receipts should include the date and description of service, provider’s name and amount paid. You may need to provide proof that all of your FSA expenses meet IRS requirements for eligibility. Changing your contributions. Generally, you may only elect or change the amount of your FSA contribution annually at open enrollment or upon becoming newly eligible except in special situations. In special situations — such as marriage, divorce, or, if you have a baby — you may be able to adjust the amount you contribute to your Health Advantage FSA. This is called a qualifying change in status. If you have a change in status, your benefits representative can help you adjust your contributions. For specific details, check your employer’s plan document. If you leave the company during the plan year, you may submit FSA claims for expenses incurred while you were still covered under the plan.

27

National Health Care Associates: Dental Plan

Delta Dental has two networks available under this plan. The Delta Dental Premier network is the largest of the Delta Dental networks with over 351,000 participating dentist offices nationally (80%+). Delta Dental PPOSM is a smaller, but more discounted network with over 266,000 participating dentist offices nationwide. Delta Dental’s network discounts average 25% to 35% less. You may use any fully licensed dentist under this plan, but it is to your advantage to use a network dentist, especially PPO, since they accept the Delta Dental allowance as their maximum charge and cannot bill Delta Dental patients for amounts above this level. Delta Dental PPO dentists offer the lowest fees of our networks. Participating dentists will be paid directly by Delta Dental for covered services. Non-participating dentists will bill you directly, and Delta Dental may make claim payment directly to you. You will maximize benefits and reduce paperwork by using a Delta Dental participating dentist. If you do not have a dentist, you may obtain a current listing of participating dentists in any area, by calling 1-800 DELTA OK (1-800-335-8265). Provide your zip code to the representative and a directory for that area will be mailed to your home. If you have Internet access, you may also visit our website at deltadentalct.com to locate participating dentists. At the time of your first appointment, tell the dentist that you are covered under this program and provide your group number and ID number. Your dependents, if covered, should provide the employee’s ID number. Claim questions and other information needs should be directed to Delta Dental’s customer service department at 1-800-452-9310. This overview contains a general description of your dental care program for your use as a convenient reference. Complete details of your program appear in the group contract between your plan sponsor and Delta Dental of New Jersey, Inc. which governs the benefits and operation of your program. In CT, Delta Dental of Connecticut writes dental coverage on an insured basis and Delta Dental of New Jersey administers self-funded dental benefit programs. The group contract would control if there should be any inconsistency or difference between its provisions and the information in this overview.

Delta Dental PPOSM plus Premier Low Plan Medium Plan High Plan

If a Delta Dental, PPOSM, Delta Dental Premier® or Non-Network Dentist is Used

Calendar Year Per Person Deductible $50 $50 $50

Family Aggregate Maximum Deductible $150 $150 $150

Calendar Year Maximum (Per Person) $1,000 $1,200 $1,500

Plan Pays: Plan Pays: Plan Pays:Preventive & Diagnostic (No Deductible)Exams, Cleanings (2 per calendar year) 100% 100% 100%

Bitewing X-Rays, Fluoride Treatment (1 per calendar year) 100% 100% 100%

Full Mouth X-Rays (1 per 5yrs) 100% 100% 100%

Remaining Basic (After Deductible)Sealants (to age 14) 50% 100% 100%

Fillings, Extractions, Root Canals (Endodontics) 50% 80% 80%

Oral Surgery, Space Maintainers, Repair of Dentures 50% 80% 80%

Crowns & Prosthodontics (After Deductible)

Crowns (1 per 5 yrs) & Gold Restorations N/C 50% 50%

Bridgework (1 per 5 yrs), Full & Partial Dentures N/C 50% 50%

Periodontal N/C 50% 50%

Prostesis over Implant N/C 50% 50%

Orthodontia (Dependent Children to age 19)

Coinsurance N/C N/C 50%

Lifetime Maximum N/C N/C $1,500

Dependent children are covered to age 26.

Dental Benefit Comparison

28

National Health Care Associates: Vision Plan

Vision Benefits Eye exams, eyewear and more Aetna VisionSM Preferred Smarter is having a vision plan that saves you money.

Retail price Out-of-pocket cost with Aetna Vision Preferred

Your savings with Aetna Vision Preferred

Exam $114.00 $0 $94.00

Frames $124.41 $0 $124.41

Lenses $83.00 $20.00 $63.00

Total $321.41 $20.00 $281.41

Savings for routine eye exams, contact lenses and eyeglasses, including designer frames:

It’s easy to use After you sign up, you’ll get a welcome packet. It includes: • Your member ID card • Basic plan information • A list of vision offices and retailers near you See your way to better health Your vision insurance plan isn’t just for your eyes. It’s for your overall health, too. That’s because routine eye exams can reveal diseases like glaucoma and other serious health conditions like cardiovascular disease and diabetes. Go practically anywhere for eye care Choose from more than 55,000+ vision offices and retailers including these popular chains: • JCPenney Optical • LensCrafters® • Pearle Vision® • Sears® Optical • Target Optical®

29

National Health Care Associates: Vision Plan

In Network Out of Network*Exam Aetna Vision NetworkUse your Exam coverage once every calendar year.Routine/Comprehensive Eye Exam $0 Copay $45 ReimbursementStandard Contact Lens Fit/Follow up Member pays discounted fee of $40 Not CoveredPremium Contact Lens Fit/FollowUp Member pays 90% of retail Not CoveredEyeglass Lenses /Lens optionsUse your Lens coverage once every calendar year to purchase either 1 pair of eyeglass lenses OR 1 order of contact lenses.Single Vision Lenses $20 Copay $35 ReimbursementBifocal Vision Lenses $20 Copay $55 ReimbursementTrifocal Vision Lenses $20 Copay $65 ReimbursementLenticular Vision Lenses $20 Copay $80 ReimbursementStandard Progessive Vision Lenses $85 Copay $55 ReimbursementPremium Progressive Vision Lenses1 20% Discount off retail minus $120 plan allowance

plus $85. Copay = member out-of-pocket$55 Reimbursement

UV Treatment Member pays discounted fee of $15 Not CoveredTint (Solid and Gradient) $0 Copay $5 ReimbursementStandard Plastic Scratch Coating Member pays discounted fee of $15 Not CoveredStandard Polycarbonate Lenses - Adult Member pays discounted fee of $40 Not CoveredStandard Polycarbonate Lenses - Children to age 19 $0 Copay $5 Reimbursement

Standard Anti-Reflective Coating Member pays discounted fee of $45 Not CoveredContact LensesUse your Contact Lens coverage once every calendar year to purchase either 1 pair of eyeglass lenses OR 1 order of contact lenses.

Conventional Contact Lenses $130 Allowance** additional 15% off balance over the allowance $105 Reimbursement

Disposable Contact Lenses $130 Allowance $105 Reimbursement Medically Necessary Contact Lenses $0 Copay $200 Reimbursement FramesUse your Frame coverage once every 2 calendar years.Any Frame available, including frames for prescription sunglasses

$130 Allowance additional 20% off balance over the allowance. $70 Reimbursement

DiscountsDiscounts cannot be combined with any other discounts or promotional offers and may not be available on all brands.

Additional pairs of eyeglasses or prescription sunglasses. Discount applies to purchases made after the plan allowances** have been exhausted.

Up to a 40% Discount No Discount

Non-covered items such as cleaning cloths and contact lens solution2

20% Discount No Discount

Lasik Laser vision correction or PRK from U.S. Laser Network3 only. Call 1-800-422-6600

15% discount off retail or 5% discount off the promotional No Discount

Retinal Imaging4 Member pays a discounted fee up to $39 No Discount

Replacement Contact Lenses Receive significant savings after your lens benefit has been exhausted on replacement contacts by ordering online. Visit www.aetnavision.com for details

No Discount

Partial list of exclusions and limitations

Vision insurance plans contain exclusions and limitations. Not all vision services are covered. See your plan booklet for details. *You can choose to receive care outside the network. Simply pay for the services up front and then submit a claim form to receive an amount up to the out of network reimbursement amounts listed above. Reimbursement will not exceed the providers actual charge. Claim forms can be found at www.aetnavision.com or by calling customer service Mon-Sun @877-9-SEE-AETNA. Submit completed claim form with receipts to Aetna, PO Box 8504 Mason, OH 45040-7111. **Allowances are one time use benefits. No remaining balances may be used. The plan does not provide a declining balance benefit. 1 Premium progressives and premium anti-reflective Brand designations are subject to annual review and change based on market conditions. Ask your eye care provider for more information. 2 Non covered discounts may not be available in all states. 3 Lasik or PRK from the US Laser Network, owned and operated by LCA Vision. 4 Retinal Imaging available at participating locations. Contact your eyecare provider to verify if available.

30

National Health Care Associates: Life/Disability Benefits

Group Life & Disability Insurance Plans

Group Short Term Disability Company Paid Benefit The short term disability benefit is payable after an eight day waiting period. The benefit amount is up to $200/week with the benefit payable for 26 weeks. Voluntary Buy-Up Benefit You may purchase up to 70% of your salary up to additional $800/week with the benefit payable for 26 weeks. * Employees employed by a New Jersey employer are covered under the New Jersey state temporary disability benefits plan. * Employees working is Rhode Island are covered under the Rhode Island temporary disability benefits plan. Guaranteed issue is available for newly eligible enrollees. All others will need to complete Evidence of Insurability.

Group Long Term Disability Voluntary Buy-Up Benefit You may purchase a benefit amount of 60% of your salary up to $10,000/month maximum. The disability waiting period is 180 days and the benefit is payable through your Social Security Normal Retirement Age. Guaranteed issue is available for newly eligible enrollees. All others will need to complete Evidence of Insurability.

Group Life Insurance Company Paid Benefit Your death benefit is equal to one times your annual salary up to a $50,000 maximum. Voluntary Buy-Up Benefit Employees May purchase between one and five times your annual salary up to a $500,000 maximum ($375,000 Guaranteed Issue). Employees currently enrolled in Voluntary Life can increase 1 times their annual salary without having to complete an Evidence of Insurability (EOI) form. Any amounts over 1 times salary per year or over the $375,000 Guarnteed Issue amount will require EOI. Spouse May purchase up to 50% of Employee's Basic and Voluntary Life Insurance amount combined in $5,000 increments up to $250,000 maximum ($50,000 Guaranteed Issue). Children May purchase a flat $10,000 through age 26 ($1,000 benefit from birth to 14 days). Guaranteed issue is available for newly eligible enrollees. All others will need to complete Evidence of Insurability.

31

National Health Care Associates: Work/Life Assistance Program

The Hartford’s Employee Assistance Program

Life presents complex challenges. If the unexpected happens, you should have simple solutions to help cope with the stress and life changes that may result. That’s why The Hartford’s Ability Assist® Counseling Services, offered by ComPsych®, can play such an important role. Our straightforward approach takes the complexity out of benefits when life throws you a curve. Compassionate Solution for Common Challenges From everyday issues like job pressures, relationships and retirement planning to highly impactful issues like grief, loss, or a disability, Ability Assist is your resource for professional support. You and your family, including spouse and dependents can access Ability Assist at any time. Service Features The service includes up to three face-to-face emotional or work-life counseling sessions per occurrence per year. This means you and your family members won’t have to share visits. You can each get counseling help for your own unique needs. Counseling for your legal, financial, medical and benefit-related concerns is also available by phone. Ability Assist Counseling Services • Emotional or Work-Life Counseling • Financial Information and Resources • Legal Support and Resources • Health and Benefit Services

Extras That Support and Assist For access over the phone, call toll-free 1-800-96-HELPS (1-800-964-3577) Visit www.guidanceresources.com to access hundreds of personal health topics and resources for child and elder care, attorneys or financial planners. If you’re a first-time user, click on the Register tab. 1. In the Organization Web ID field, enter: HLF902 2. In the Company Name field at the bottom of

personalization page enter: ABILI 3. After selecting “Ability Assist program”, create your

confidential username and password.

32

National Health Care Associates: Voluntary Employee Paid Plans

Voluntary Employee Paid Plans Colonial Life Benefits To learn more about these voluntary employee paid plans and their cost, please visit our online enrollment system by following the instructions provided inthis guide. Group Non-Occupational Accident Insurance Colonial Life’s Group Accident Insurance helps you fill some of the gaps caused by increasing deductibles, co-payments and out of pocket expenses related to an accidental injury. Policy benefits include payment for seeking emergency treatment at an ER, Urgent Care or Doctor’s Office, Ambulance, Hospital Admission, Imaging, Physical Therapy, Follow Up Care, Accidental Death and More. Plan pays a $50 annual wellness benefit per covered person. Group Medical BridgeSM – Plan 1 Colonial Life’s Group Hospital Confinement Plan provides you with a lump sum benefit of $1,000 or $1,500 should you or a covered member of your family be hospitalized. There is an additional benefit for ER visit for accident and a $50 annual wellness benefit per covered person. Cancer Insurance Colonial Life’s Cancer Insurance pays a variety of benefits should you or a covered member of your family be diagnosed with cancer. Benefits can include a lump sum upon diagnosis, up to $5,000, daily hospital confinement, radiation, chemotherapy, experimental treatment, surgery and more. Plan pays an annual wellness benefit of $75 or $100 per covered person depending on the level of coverage selected.

Protection M

ade Simple

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help you and your family deal with the

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Visit these

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©2014 The Paul Revere Life Insurance Company, Worcester, MA

Colonial Voluntary Benefits insurance products are underwritten by The Paul Revere Life Insurance Company.

9-14 | NS-14109-NY

OPENEN

ENRENROLLMLMENT

IS HE HERERE!

LEARN M ORE

*Group Critical Illness *Accident

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Control the increasing costs related to health care.

Colonial Customer Service Phone 800-325-4368

Critical Illness - Help Employees with Serious Illness Expenses Colonial Life’s Critical Illness Insurance pays a lump sum in the event that a covered person has a heart attack, stroke, end stage renal failure, major organ failure or coronary artery disease. You select the benefit amount that works for you and your budget. Your spouse’s coverage is 50% and children’s is 25%. Plan pays an annual wellness benefit of $50 per covered person. All of the plans are portable, you can keep the coverage if you change your job or retire.

33

National Health Care Associates: Liberty Mutual

We customize. You could save $947.†

Client # 135773 *Not available in all states. **Based on the average premium for condo policies as of April 2017. †Savings validated by new customers who switched to Liberty Mutual between 1/2020-10/2020 and participated in a countrywide survey. Savings may vary. Comparison does not apply in MA. §Discounts and savings are available where state laws and regulations allow, and may vary by state. Certain discounts apply to specific coverages only. To the extent permitted by law, applicants are individually underwritten; not all applicants may qualify. ||Optional coverage in some states; availability varies by state. Eligibility rules apply. ¶Coverage is provided on the optional Towing & Labor Coverage endorsement. May vary by state. Applies to mechanical breakdowns and disablements only, and may be subject to limits. #Subject to eligibility requirements. Benefits and eligibility requirements may vary by state. [§§Available to 12-month Superior and Ultra auto policies in TN and MN. Terms and conditions apply.] [||||Affinity employer groups of 100+ members only. Discount filed and approved and varies by state.] Coverage provided and underwritten by Liberty Mutual Insurance Company or its subsidiaries or affiliates, 175 Berkeley Street, Boston, MA 02116. In Texas, coverage provided and underwritten by one or more of the following companies: Liberty Insurance Corporation, Liberty Lloyds of Texas Insurance Company, Liberty Mutual Fire Insurance Company, Liberty Mutual Personal Insurance Company, Peerless Indemnity Insurance Company, and Liberty County Mutual Insurance Company. Learn more about our privacy policy at libertymutual.com/privacy. ©2021 Liberty Mutual Insurance 14781145

Switch to customized insurance and only pay for what you need. As an employee of National Health Care Associates & Affiliates, you could save $947 by bundling your auto and home insurance.† More benefits you’ll love: Violation-Free Discount§ Customers can earn a discount for three years of violation-free driving. Get an even larger discount when you reach five years. Better Car Replacement™|| If your car is totaled, we’ll give you the money for a model that’s one year newer. 24-Hour Roadside Assistance¶ If your car breaks down, we won’t leave you stranded. From a jump-start to a tow, our optional 24-Hour Roadside Assistance will get you moving again. Multi-Policy Discount§ When you insure both your car and your home with Liberty Mutual, you qualify for comprehensive protection and additional savings. Loss Forgiveness# Your price won’t increase because of the first qualified loss in your home. Inflation Protection Automatically adjust your coverage limits at your policy’s renewal to keep pace with inflation and you will also receive a discount on your policy premium. Convenient Payment Options§§ We are committed to making billing easy and hassle-free. Have your payments deducted automatically from your checking or savings account.

For a free quote, call 1-844-677-8443 or visit

www.libertymutual.com/nhca

34

National Health Care Associates: Right to Continue Medical Coverage

Introduction You’re getting this notice because you recently gained coverage under a group health plan (the Plan). This notice has important information about your right to COBRA continuation coverage, which is a temporary extension of coverage under the Plan. This notice explains COBRA continuation coverage, when it may become available to you and your family, and what you need to do to protect your right to get it. When you become eligible for COBRA, you may also become eligible for other coverage options that may cost less than COBRA continuation coverage. The right to COBRA continuation coverage was created by a federal law, the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA). COBRA continuation coverage can become available to you and other members of your family when group health coverage would otherwise end. For more information about your rights and obligations under the Plan and under federal law, you should review the Plan’s Summary Plan Description or contact the Plan Administrator. You may have other options available to you when you lose group health coverage. For example, you may be eligible to buy an individual plan through the Health Insurance Marketplace. By enrolling in coverage through the Marketplace, you may qualify for lower costs on your monthly premiums and lower out-of-pocket costs. Additionally, you may qualify for a 30-day special enrollment period for another group health plan for which you are eligible (such as a spouse’s plan), even if that plan generally doesn’t accept late enrollees. What is COBRA continuation coverage? COBRA continuation coverage is a continuation of Plan coverage when it would otherwise end because of a life event. This is also called a “qualify-ing event.” Specific qualifying events are listed later in this notice. After a qualifying event, COBRA continuation coverage must be offered to each person who is a “qualified beneficiary.” You, your spouse, and your dependent children could become qualified beneficiaries if coverage under the Plan is lost because of the qualifying event. Under the Plan, qualified beneficiaries who elect COBRA continuation coverage [choose and enter appropriate information: must pay or aren’t required to pay] for COBRA continuation coverage. If you’re an employee, you’ll become a qualified beneficiary if you lose your coverage under the Plan because of the following qualifying events: • Your hours of employment are reduced, or • Your employment ends for any reason other than your gross misconduct. If you’re the spouse of an employee, you’ll become a qualified beneficiary if you lose your coverage under the Plan because of the following qualifying events: • Your spouse dies; • Your spouse’s hours of employment are reduced; • Your spouse’s employment ends for any reason other than his or her

gross misconduct; • Your spouse becomes entitled to Medicare benefits (under Part A,

Part B, or both); or • You become divorced or legally separated from your spouse. Your dependent children will become qualified beneficiaries if they lose coverage under the Plan because of the following qualifying events: • The parent-employee dies;

• The parent-employee’s hours of employment are reduced; • The parent-employee’s employment ends for any reason other than his

or her gross misconduct; • The parent-employee becomes entitled to Medicare benefits (Part A,

Part B, or both); • The parents become divorced or legally separated; or • The child stops being eligible for coverage under the Plan as a

“dependent child.” [If the Plan provides retiree health coverage, add the following paragraph:] Sometimes, filing a proceeding in bankruptcy under title 11 of the United States Code can be a qualifying event. If a proceeding in bankruptcy is filed with respect to [enter name of employer sponsoring the Plan], and that bankruptcy results in the loss of coverage of any retired employee covered under the Plan, the retired employee will become a qualified beneficiary. The retired employee’s spouse, surviving spouse, and dependent children will also become qualified beneficiaries if bankruptcy results in the loss of their coverage under the Plan. When is COBRA continuation coverage available? The Plan will offer COBRA continuation coverage to qualified beneficiaries only after the Plan Administrator has been notified that a qualifying event has occurred. The employer must notify the Plan Administrator of the following qualifying events: • The end of employment or reduction of hours of employment; • Death of the employee; • [add if Plan provides retiree health coverage: Commencement of a

proceeding in bankruptcy with respect to the employer;]; or • The employee’s becoming entitled to Medicare benefits (under Part A,

Part B, or both). For all other qualifying events (divorce or legal separation of the employee and spouse or a dependent child’s losing eligibility for coverage as a dependent child), you must notify the Plan Administrator within 60 days [or enter longer period permitted under the terms of the Plan] after the qualifying event occurs. You must provide this notice to: [Enter name of appropriate party]. [Add description of any additional Plan procedures for this notice, including a description of any required information or documentation.] How is COBRA continuation coverage provided? Once the Plan Administrator receives notice that a qualifying event has occurred, COBRA continuation coverage will be offered to each of the qualified beneficiaries. Each qualified beneficiary will have an independent right to elect COBRA continuation coverage. Covered employees may elect COBRA continuation coverage on behalf of their spouses, and parents may elect COBRA continuation coverage on behalf of their children. COBRA continuation coverage is a temporary continuation of coverage that generally lasts for 18 months due to employment termination or reduction of hours of work. Certain qualifying events, or a second qualifying event during the initial period of coverage, may permit a beneficiary to receive a maximum of 36 months of coverage. There are also ways in which this 18-month period of COBRA continuation coverage can be extended: Disability extension of 18-month period of COBRA continuation coverage

35

National Health Care Associates: Notice of Electronic Access

If you are enrolled in both COBRA continuation coverage and Medicare, Medicare will generally pay first (primary payer) and COBRA continuation coverage will pay second. Certain plans may pay as if secondary to Medicare, even if you are not enrolled in Medicare. For more information visit https://www.medicare.gov/medicare-and-you. If you have questions Questions concerning your Plan or your COBRA continuation coverage rights should be addressed to the contact or contacts identified below. For more information about your rights under the Employee Retirement Income Security Act (ERISA), including COBRA, the Patient Protection and Affordable Care Act, and other laws affecting group health plans, contact the nearest Regional or District Office of the U.S. Department of Labor’s Employee Benefits Security Administration (EBSA) in your area or visit www.dol.gov/ebsa. (Addresses and phone numbers of Regional and District EBSA Offices are available through EBSA’s website.) For more information about the Marketplace, visit www.HealthCare.gov. Keep your Plan informed of address changes To protect your family’s rights, let the Plan Administrator know about any changes in the addresses of family members. You should also keep a copy, for your records, of any notices you send to the Plan Administrator. Plan contact information National Healthcare Benefits Helpline: 800-201-7898 Hilb Group, 2000 Chapel View Blvd., Suite 240 Cranston RI 02920.

Notice of Electronic Access to Important Health Plan Notices from National Health Care, Inc. & Affiliates VEBA National Health Care, Inc. & Affiliates VEBA has developed a website where we have posted notices that have important information about your health plan coverage, including all notices and disclosures required by the Employee Retirement Income Security Act (ERISA) and the Patient Protection and Affordable Care Act (ACA). Employees of National Health Care can access these notices and disclosures at www.nathealthcarebenefits.com. To access the materials, click on the Notices tab. From there, you may view, download, or print the notices and disclosures. You may request a paper version of any or all of the notices and disclosures, which will be provided free of charge, by calling Human Resources or the Benefits Helpline at 1-800-201-7898.

If you or anyone in your family covered under the Plan is determined by Social Security to be disabled and you notify the Plan Administrator in a timely fashion, you and your entire family may be entitled to get up to an additional 11 months of COBRA continuation coverage, for a maximum of 29 months. The disability would have to have started at some time before the 60th day of COBRA continuation coverage and must last at least until the end of the 18-month period of COBRA continuation coverage. [Add description of any additional Plan procedures for this notice, including a description of any required information or documentation, the name of the appropriate party to whom notice must be sent, and the time period for giving notice.] Second qualifying event extension of 18-month period of continuation coverage If your family experiences another qualifying event during the 18 months of COBRA continuation coverage, the spouse and dependent children in your family can get up to 18 additional months of COBRA continuation coverage, for a maximum of 36 months, if the Plan is properly notified about the second qualifying event. This extension may be available to the spouse and any dependent children getting COBRA continuation coverage if the employee or former employee dies; becomes entitled to Medicare benefits (under Part A, Part B, or both); gets divorced or legally separated; or if the dependent child stops being eligible under the Plan as a dependent child. This extension is only available if the second qualifying event would have caused the spouse or dependent child to lose coverage under the Plan had the first qualifying event not occurred. Are there other coverage options besides COBRA Continuation Coverage? Yes. Instead of enrolling in COBRA continuation coverage, there may be other coverage options for you and your family through the Health Insurance Marketplace, Medicare, Medicaid, Children’s Health Insurance Program (CHIP), or other group health plan coverage options (such as a spouse’s plan) through what is called a “special enrollment period.” Some of these options may cost less than COBRA continuation coverage. You can learn more about many of these options at www.healthcare.gov. Can I enroll in Medicare instead of COBRA continuation coverage after my group health plan coverage ends? In general, if you don’t enroll in Medicare Part A or B when you are first eligible because you are still employed, after the Medicare initial enrollment period, you have an 8-month special enrollment period to sign up for Medicare Part A or B, beginning on the earlier of • The month after your employment ends; or • The month after group health plan coverage based on current

employment ends. If you don’t enroll in Medicare and elect COBRA continuation coverage instead, you may have to pay a Part B late enrollment penalty and you may have a gap in coverage if you decide you want Part B later. If you elect COBRA continuation coverage and later enroll in Medicare Part A or B before the COBRA continuation coverage ends, the Plan may terminate your continuation coverage. However, if Medicare Part A or B is effective on or before the date of the COBRA election, COBRA coverage may not be dis-continued on account of Medicare entitlement, even if you enroll in the other part of Medicare after the date of the election of COBRA coverage.

Benefits Consultant

2000 Chapel View Blvd., Suite 240 Cranston RI 02920

Toll free phone 800.678.1700 Toll free fax 800.457.6742

850 Silas Deane Highway Wethersfield, CT 06109

Employee Benefits Plan: January 1, 2022 Insurance Benefits ...

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