2022 JL Marine Systems Benefits at a Glance

2022 JL Marine Systems Benefits at a Glance

BENEFITS GUIDE 2022

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Contents & Contacts

BROKER Company Name

M.E. Wilson Company / Amanda Sands

Company Phone Number Company Email Address

813-349-2259

[email protected]

HUMAN RESOURCES

___________________________________

Chelsea McGee

813-689-9932 ext. 2109 813-689-9932 ext. 2002

Angela Cross

MEDICAL

page 3

Company Name

Cigna

Company Phone Number Company Web Address

866-494-2111

www.mycigna.com

HEALTH SAVINGS ACCOUNT (HSA) AND FLEXIBLE SPENDING ACCOUNT (FSA)

page 5/6

Company Name

Paylocity

Company Phone Number Company Web Address

888-873-8205

www.paylocity.com

TELEMEDICINE Company Name

page 7

MDLive

Company Phone Number Company Web Address DENTAL AND VISION Company Name Company Phone Number Company Web Address

888-726-3171

MDLiveforCigna.com

page 8/9

Guardian

800-247-4695

www.guardiananytime.com

EMPLOYER PAID AND VOLUNTARY LIFE INSURANCE

page 10

Company Name

Guardian

Company Phone Number Company Web Address

800-247-4695

www.guardiananytime.com

SHORT-TERM AND LONG-TERM DISABILITY

page 10

Company Name

Guardian

Company Phone Number Company Web Address

800-247-4695

www.guardiananytime.com

VOLUNTARY BENEFITS

page 11

Company Name

Guardian

Company Phone Number Company Web Address

800-247-4695

www.guardiananytime.com

EMPLOYEE ASSISTANCE PROGRAM

page 13

Company Name

Guardian

Company Phone Number Company Web Address

1-800-386-7055

www.worklife.uprisehealth.com

HOW TO ENROLL

page 14

DISCLOSURE NOTICES

page 15

Your Benefits

Your Benefits

JL Marine Systems offers a variety of benefits allowing you the opportunity to customize a benefits package that meets your personal needs. In the following pages, you will learn more about the benefits offered. You will 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.

Medical

JL Marine Systems pays the entire cost of the employee & dependents low medical plan.

JL Marine Systems offers you the option to elect this voluntary benefit. You pay the full cost for dental coverage.

Dental

JL Marine Systems offers you the option to elect this voluntary benefit. You pay the full cost for vision coverage.

Vision

JL Marine Systems pays the entire cost for the basic life. You pay the full cost for the voluntary life coverage.

Basic & Voluntary Life

Short-Term and Long Term Disability

JL Marine Systems pays for short and long term disability for eligible employees.

JL Marine Systems offers you the option to elect voluntary Critical Illness, Accident (and Hospital Confinement coverage. You pay the full cost for coverages.

Voluntary Benefits

Pre-tax benefits

?

You must actively choose any benefit that you pay for or share in the cost with through JL Marine Systems.

Why do I pay for benefits pre-tax?

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.

Your part of the cost is automatically deducted from your paycheck. Premiums for medical, dental, and vision are deducted pre-tax. Health Savings Account and Flexible Spending Account contributions are also deducted pre-tax.

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Eligibility

Eligibility

Employees working 30 + hours/week are eligible for benefits the first of the month following 60 days. If you enroll in the benefits, you may also cover your eligible dependents, these include:

Eligible dependents include:  Your Legal spouse

 Your married or unmarried natural children, step- children living with you, legally adopted children and any other children for whom you have legal guardianship, who are: ► 26 years or younger. Coverage ends the month in which dependent turns 26. An employee’s unmarried child age 26 or older who is permanently and totally disabled, whose disability began before age 26, and for whom the employee submits proof of permanent and total disability when requested at reasonable intervals.

When can you enroll?

You can sign up for benefits at any of the following times: • After completing your 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.

Examples of qualified family-status changes are as follows: • Your marriage • Your divorce or legal separation

• 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)

• 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

If you fail to notify Human Resources within 30 days of a family status change, you will be required to wait until the next annual enrollment period to make benefit changes unless you have another family status change.

When does coverage end? • Medical, Dental, Vision – End of the calendar month in which your employment ends • Life and Disability – Date your employment ends

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Medical

JL Marine Systems offers two medical plans through Cigna. The below chart provides an overview and comparison of these plans. To find a participating provider, visit www.mycigna.com.

OAP HSA Sportsman

OAPIN 2000 Blade

IN-NETWORK: Plan Year or Calendar Year Basis

Calendar Year

Calendar Year

Deductible (Individual / Family) Coinsurance (Cigna / Member)

$3,000 / $6,000

$2,000/ $4,000

60% / 40%

80% / 20%

Maximum Out-of-Pocket (Individual/Family)

$6,000 / $12,000

$4,000 / $8,000

Maximum Out-of-Pocket Includes

Deductible, Coinsurance & Copayments Eligible – Health Savings Account page

Deductible, Coinsurance & Copayments

Health Savings Account

Not Eligible

PREVENTIVE CARE:

Wellness Immunizations Mammography/Colonoscopy COPAYMENTS: Virtual Visits (Telemedicine)

Covered 100%

Covered 100%

No Referral Required

No Referral Required

40% Coinsurance, after Deductible

$25 Copay

Office Visits Consultations for Illness/Injury

40% Coinsurance, after Deductible

$25 Copay

Specialist Visits Inpatient Hospital Outpatient Surgery Emergency Room

40% Coinsurance, after Deductible 40% Coinsurance, after Deductible 40% Coinsurance, after Deductible 40% Coinsurance, after Deductible 40% Coinsurance, after Deductible 40% Coinsurance, after Deductible

$45 Copay

20% after deductible 20% after deductible

$500 Copay $50 Copay

Urgent Care

OUTPATIENT DIAGNOSTIC SERVICES:

Independent/Freestanding Lab X-Rays

40% Coinsurance, after Deductible

Covered 100%

Complex Diagnostic (MRI, CT, PET, Etc.) – Freestanding Facility

40% Coinsurance, after Deductible

$500 Copay

PRESCRIPTIONS:

After Deductible

Tier 1: $10 Copay Tier 2: $50 Copay Tier 3: $80 Copay Tier 4: $150 Copay

Tier 1: $10 Copay Tier 2: $50 Copay Tier 3: $80 Copay

Retail (30 day supply)

3 x Copay

Mail Order (90 day supply)

3 x Copay

OUT-OF-NETWORK: Deductible (Individual / Family)

$6,000/$12,000

$4,000 / $8,000

Coinsurance

60% / 40%

50% / 50%

Maximum Out-of-Pocket (Individual/Family)

$12,000 / $24,000

$8,000 / $16,000

The chart below provides a brief overview of the medical 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.

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Mediicall Contriibutiions

OA HSA Sportsman

Bi-Weekly

Weekly

Employee only

$ 0.00 $ 0.00 $ 0.00 $ 0.00

$ 0.00 $ 0.00 $ 0.00 $ 0.00

Employee + Spouse Employee + Child(ren) Employee + Family

OAPIN 2000 Blade

Bi-Weekly

Weekly $11.43 $39.77 $26.28 $62.39

Employee only

$22.85 $79.53 $52.56 $124.78

Employee + Spouse Employee + Child(ren) Employee + Family

Additional 2022 Benefits:

 $100 Gift Card for those employees that complete their annual wellness exam  $100 Gift Card for annual vision exam  $100 Gift Card for one dental exam and cleaning  $50 Gift Card for completing MyCigna health screening online  $15 Gift Card for flu shots

4

Health Savings Account (HSA) Employees enrolling in the OAP HSA (Sportsman) may open and contribute to a Health Savings Account (HSA). With an HSA you can put money aside, through payroll deductions, to help pay for HSA eligible expenses. The contributions you make are taken pre-tax. Our HSA is offered through Paylocity.

2022 IRS Annual Maximum HSA Contribution Limits

Employee Only

$3,650

Employee + Spouse, Child(ren) or both

$7,300 Additional $1,000 annually catch-up amounts for available for employees 55 years or older

JL Marine Contributions

Employee Contributes: Minimum -$100.00

JL Marine Contributes: $250

JL Marine Contributes: Dollar for Dollar up to Max $500

Employee Contributes: $100 - $500

2022 Max Contribution from JL Marine Systems is $750

WHAT ARE THE BENEFITS OF A HEALTH SAVINGS ACCOUNT?

 The money you put aside is PRE-TAX  The HSA is a bank account in your name. If you retire or should you leave JL Marine Systems, you take this account with you.  The account rolls over year to year. You will not have to forfeit any unused funds.  You will receive a debit card upon opening an HSA for quick and easy utilization of the fund.  The list of eligible expenses is vast! These expenses include things covered under the medical, dental, and vision coverage – as well as some items that aren't!

Some examples of HSA eligible expenses are as follows: • Dental expenses • Prescription Drugs and Over the Counter Drugs • Eye surgery (laser eye surgery or radial keratotomy) • Fertility enhancements

• Acupuncture and Chiropractic services • Alcohol and drug dependency treatment • Ambulance • Artificial limbs • Contact lenses and solution • Physical and speech therapies • Smoking-cessation programs and products • Vasectomy

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• Hearing aids and batteries for use • Long-term care and Nursing home

• Maternity Expenses • Organ transplants • Wheelchairs

Paylocity’s Debit Smart Card gives employees access to elected funds on a single card. Paying for qualified medical, dental & vision has never been easier. With the debit card loaded with your account balances, this will require no claim forms and no more paying out-of-pocket. This Paylocity Debit Smart Card is paired with the HSA which will ensure that employees stay in compliance with the IRS Guidelines.

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Flexible Spending Account (FSA)

JL Marine Systems offers a both Health Care and Dependent Care Flexible Spending Account to all active employees working 30 or more hours per week. You may elect to have both types of accounts and contribute separate pretax dollar amounts to each. These accounts are kept completely separate; for instance, you could not be reimbursed for dependent care expenses from the health care account. Our FSA and DCFSA are offered through Paylocity.

HEALTH CARE ACCOUNTS A Healthcare FSA can reimburse you for eligible medical, dental and vision expenses, up to the amount you elect to contribute for the plan year. TYPICAL ELIGIBLE EXPENSES The following is a partial list of typical expanses eligible for health care FSA reimbursement. A complete list can be found at www.irs.gov. ▶ Deductible for group health and/or dental plan ▶ Copayments for group health and/or dental plan ▶ Many charges that are not covered by health/dental plan are also eligible for FSA reimbursement, such as: • Eye exams, eyeglasses, contact lenses; • Hearing exams, hearing aids; • Physical exams and mammograms in excess of one per year; • Medical expenses of a dependent not covered by a health plan • Orthodontia

DEPENDENT CARE ACCOUNTS A Dependent Care FSA is a great way to pay dependent care expenses and lower your taxable income. Dependent Care Spending Accounts are pre-tax, payroll deduction accounts established to reimburse employees for out-of-pocket dependent care expenses. To be considered eligible, dependent care expenses must be incurred by an employee who must arrange for care of an eligible dependent in order to work. For married employees, dependent care must be necessary so that both spouses can work.

QUALIFYING DEPENDENT A qualifying dependent is:

• A tax dependent of yours who is under age 13, or • Any other tax dependent of yours, such as an elderly parent, who is physically or mentally incapable of self-care and has the same principal residence as you • A spouse who is physically or mentally incapable of self-care and has the same principal residence as you YOUR CONTRIBUTION The Internal Revenue service limits the amount you can contribute to a dependent care FSA, up to: • $5,000 per year, if you are married and filing a joint return, or if you are a single parent • $2,500 per year, if married and filing separate federal tax returns Estimate what your daycare expenses will be for the year, and allocate enough from your pay, up to the allowable contribution, to cover those expenses.

• Vision corrective surgery (such as Lasik) • Smoking cessation programs and related prescription drugs

YOUR CONTRIBUTION Beginning in January 2022, the IRS limits the amount you may contribute to $2,850 per year. This amount will increase in future years to reflect cost-of-living increases. JUST REMEMBER THIS: FSA dollars are “use-it-or-lose-it” funds. Account balances cannot be carried over from year to year. If you have unused funds at the end of the plan year, or at the end of any applicable grace period, those funds will be forfeited. That’s an IRS requirement. So estimate the amount you want to contribute to your FSA carefully.

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Know Before You Go

MDLive

Convenience Care Treats minor medical concerns. Staffed by nurse practitioners and physician assistants. Located in retail stores and pharmacies. Often open nights and weekends. › Colds and flu › Rashes or skin conditions › Sore throats, earaches, sinus pain

Doctor’s office

Urgent care

ER

Access telehealth services to treat minor medical conditions. Connect with a board-certified doctor via video or phone when where and how it works best for you.

The best place to go for routine or preventive care, to keep track of medications, or for a referral to see a specialist.

For conditions that aren’t life threatening. Staffed by nurses and doctors and usually have extended hours.

For immediate treatment of critical injuries or illness. Open 24/7. If a situation seems life-threatening, call 911 or go to the nearest emergency room.

› Colds and flu › Rashes › Sore throats › Headaches › Stomachaches › Fever › Allergies › UTIsand more

› General health issues › Preventive care › Routine checkups › Immunizations and screenings

› Minor cuts, sprains, burns, rashes › Chronic lower back pain › Minor respiratory symptoms › Fever

› Sudden numbness, weakness › Bleeding › Chest pain › Head injury/major trauma

› Minor cuts or burns › Pregnancy testing › Vaccines

Telemedicine

Telemedicine allow you to see and talk to a doctor from a mobile device or computer 24/7 without an appointment. A majority of visits take between 10-15 minutes, and telemedicine is a part of your health benefits. As part of a telemedicine visit, doctors can diagnose and treat a vast range of non-emergency medical conditions and provide services such as writing a prescription, if needed. This includes:

Common conditions treated (but not limited to):

• Eye/ear infections • Bronchitis • Sinus infections

• Headaches/migraines • Rash/skin infections • Allergies

• Cold/Flu • Stomachache/diarrhea • Urinary tract infections

MDLIVEforCigna.com

Call 888-726-3171

MD Live is available only to employees who are enrolled in one of the JL Marine Systems medical plans

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Dental

JL Marine Systems offers 2 dental plan options through Guardian. These plans are both PPO plans and allow you to use in-network or out-of-network benefits. If out-of- network dentists are used, you will be responsible for paying the difference between Guardian’s allowed amount and what the dentist may charge, also known as “balance billing”. The chart below provides a brief overview of the plans.

LOW PPO Dental Plan

HIGH PPO Dental Plan

IN-NETWORK CALENDAR YEAR DEDUCTIBLE (applies to basic and major services only) Individual $50

$50

$150

$150

Family

ANNUAL MAXIMUM (maximum Guardian will pay towards claims per year) Per covered person $1,000

$1,500

DIAGNOSTIC & PREVENTIVE Exams, Cleanings (2 in 12 months), X-Rays, Sealants, etc. BASIC SERVICES Amalgam Fillings, Extractions - Single Tooth MAJOR SERVICES Crowns,Bridges & Dentures, General Anesthesia

Covered in full

Covered in full

20% after deductible

20% after deductible

50% after deductible

50% after deductible

ORTHODONTICS Children Only (up to 19 years old) OUT-OF-NETWORK 1 CALENDAR YEAR DEDUCTIBLE

25% Lifetime Maximum: $500

50% Lifetime Maximum: $1,000

$50 / $150

$50 / $150

ANNUAL MAXIMUM

$500

$1,500

SERVICES Diagnostic & Preventive Basic Major Orthodontics (child only)

100% 20% after deductible 50% after deductible 75% after deductible

100% 80% after deductible 50% after deductible 50% after deductible

Cost for coverage

Weekly $5.50 $12.75 $15.76 $23.06

Bi-Weekly

Weekly $5.91 $13.71 $18.51 $26.35

Bi-Weekly

Employee

$11.01 $25.51 $31.52 $46.12

$11.83 $27.41 $37.02 $52.70

Employee + Spouse Employee + Child(ren) Employee +Family

1 Subject to balancebilling. Please refer to your plan document for specific details.

Guardian will roll over a portion of your unused annual maximum into your personal Maximum Rollover Account (MRA). If you reach your Plan Annual Maximum in future years, you can use money from your MRA. To qualify for an MRA, you must have a paid claim (not just a visit) and must not have exceeded the paid claims threshold during the benefit year. Your MRA may not exceed the MRA limit. You can view your annual MRA statement detailing your account and those of your dependents on www.guardiananytime.com.

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Vision

JL Marine Systems offers vision coverage through Guardian. The vision plan allows you the flexibility to see any provider. You may go to any vision provider, however those who belong to the David Vision network will be most cost effective. Your provider may ask you to pay expenses at the time of service and then file a claim for reimbursement.

Vision Davis Vision – Full Feature - Designer

IN-NETWORK EXAMS

Every 12 months $25Copay Every 12 months

LENSES

Single vision Lined bi-focal Lined tri-focal Lenticular

$25 Copay

FRAMES

Every 24 months

$150 allowance

CONTACT LENSES (in lieu of glasses)

Every 12 months

Elective Medically Necessary OUT-OF-NETWORK LENSES

$150 allowance Covered 100%

Reimbursed up to $48-$126 depending on lenses

FRAMES

Reimbursed up to$48

CONTACT LENSES (in lieu of glasses)

Reimbursed up to $105 or $210 (medically necessary) Cost for coverage Weekly Bi-Weekly

Employee

$0.90 $2.16 $2.13 $3.48

$1.80 $4.32 $4.27 $6.96

Employee + Spouse Employee + Child(ren) Employee +Family

The chart below provides a brief overview of the vision plan. 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.

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Life and AD&D

Basic Life & AD&D

$30,000 **The Basic Life & AD&D insurance is paid 100% by JL Marine Systems** After age 65 there is a reduction on the basic life amount. Voluntary Life Insurance

Employee Life

Maximum Employee Life

Increments of $10,000 to a maximum of $300,000

Employee Guarantee Issue $150,000 Spouse Life

Increments of $5,000 up to lesser of 100% of employee's amount or $250,000.

100% of employee’s amount or $25,000, whichever is less (for timely entrants/ newly eligible employees)

SpouseGuarantee Issue

Dependent Life

$10,000

AD&D

Included – Equal to life amount

At age 65: 67% reduction At age 70: 34% reduction

Benefit Reduction Schedule

Disability

Short Term Disability JL Marine Systems offers short-term disability (STD) insurance to all active full-time employees. The benefit begins on the 8 th day of accident or sickness and pays 60% of your weekly earning up to a maximum of $1,500. The benefit will pay up to a maximum of 12 weeks. This coverage is 100% paid by JL Marine Systems.

Long Term Disability JL Marine Systems offers long term disability insurance to all active full-time employees. The benefit starts to pay once the short-term disability benefit is exhausted, or after 90 days from the accident or sickness. The benefit pays 60% of your monthly earnings to a maximum of $9,000. The benefit can continue until you are no longer disabled or SSNA (Social Security Normal Retirement Age). This coverage is 100% paid by JL Marine Systems.

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Voluntary Benefits (Weekly)

Critical Illness

Critical Illness Insurance helps supplement your major medical coverage by providing a lump-sum benefit of $20,000 you can use to pay the direct and indirect cost related to a covered critical illness, which can often be expensive and lengthy.

Non-Tobacco -Weekly

Issue Age

Employee Only

Employee/Spouse

16-29 30-39 40-49 50-59 60-69

$2.12 $3.28 $6.46

$3.18 $4.92 $9.69

$20,000 Benefit *Child coverage included with Employee Premium

$12.00 $18.97 $37.02

$18.00 $28.45 $55.52

70+

Tobacco -Weekly

Issue Age

Employee Only

Employee/Spouse

16-29 30-39 40-49 50-59 60-74

$3.46 $5.68

$5.19 $8.52

$20,000 Benefit *Child coverage included with Employee Premium

$12.69 $26.54 $45.28 $84.28

$19.04 $39.81 $67.92 $126.42

70+

Accident

Accident insurance helps offset unexpected medical expenses, such as emergency room fees, deductibles and copayments that can result from a fracture, dislocation or other covered accidental injury.

Weekly Deductions

Employee only

$2.85 $4.77 $5.02 $6.93

Employee + Spouse Employee + Child(ren) Employee + Family

Hospital Indemnity

Hospital confinement insurance provides a lump-sum benefit for a covered hospital confinement or a covered outpatient surgery to help with copays and deductibles that are not covered by most medical plans. *9-month birth exclusion applies, pre-existing conditions may apply.

Weekly Deduction

Employee

$4.80

Employee + Spouse Employee + Child(ren) Employee + Family

$12.54

$8.97

$16.71

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Voluntary Benefits (Bi-Weekly)

Critical Illness

Critical Illness Insurance helps supplement your major medical coverage by providing a lump-sum benefit of $20,000 you can use to pay the direct and indirect cost related to a covered critical illness, which can often be expensive and lengthy.

Non-Tobacco –Bi-Weekly

Issue Age

Employee Only

Employee/Spouse

16-29 30-39 40-49 50-59 60-69

$4.25 $6.55

$6.37 $9.83

$20,000 Benefit *Child coverage included with Employee Premium

$12.92 $24.00 $37.94 $74.03

$19.38 $36.00 $56.91 $111.05

70+

Tobacco –Bi-Weekly

Issue Age

Employee Only

Employee/Spouse

16-29 30-39 40-49 50-59 60-74

$6.92

$10.38 $17.03 $38.08 $79.62 $135.83 $252.83

$11.35 $25.38 $53.08 $90.55 $168.55

$20,000 Benefit *Child coverage included with Employee Premium

70+

Accident

Accident insurance helps offset unexpected medical expenses, such as emergency room fees, deductibles and copayments that can result from a fracture, dislocation or other covered accidental injury.

Bi-Weekly Deductions

Employee only

$5.71 $9.54

Employee + Spouse Employee + Child(ren) Employee + Family

$10.03 $13.86

Hospital Indemnity

Hospital confinement insurance provides a lump-sum benefit for a covered hospital confinement or a covered outpatient surgery to help with copays and deductibles that are not covered by most medical plans. *9-month birth exclusion applies, pre-existing conditions may apply.

Bi-Weekly Deduction

Employee

$9.61

Employee + Spouse Employee + Child(ren) Employee + Family

$25.07 $17.94 $33.41

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No Cost Programs

Employee Assistance Program

All benefits eligible employees are automatically enrolled in Guardian’s Employee Assistance Program (EAP) WorkLifeMatters The EAP program is a confidential resource available 24/7 to help you and your household family members deal with a variety of life stages and/or concerns. Included in your EAP are 3 face-to-face or video visits (per household).

• Legal resources • Financial resources • Work / Life resources

• Health Risk Assessment • Online Will Preparation

Below are examples of concerns and situations the EAP can assist with:

• Dealing with domestic violence • Substance abuse and recovery • Work-related issues • Grief • Eating disorders

• Depression, stress and anxiety • Relationship difficulties • Financial and legal advice • Family issues and parenting • Child and elder care support

Guardian College Tuition Benefit Visit Worklife.uprisehealth.com or call 1-800-386-7055 for confidential consultation and resource services.

Included with your Guardian dental coverage is a college tuition benefit. As the cost of college continues to rise faster than inflation and medical costs, Guardian is helping families keep up by providing this benefit in arrangement with The College Tuition Benefit and the SAGE Scholars Tuition Rewards® Program. • Members enrolled in a Guardian dental plan earn $2,000 in annual Tuition Rewards. • One Tuition Reward point = $1 in tuition reduction. • Tuition Rewards can be used at over 400 institutions, with 90% ranked among "America's Best" by US News and World Report in 2020. • Members can share the benefit with eligible relatives, including children, nieces, nephews, step-children and grandchildren, subject to certain restrictions. • Participating colleges in Florida include The University of Tampa, Saint Leo University, Palm Beach Atlantic University, Rollins College, and more! A complete list can be found on College Tuition Benefit’s website.

UserID: 00506953 Password: Guardian

You are not automatically enrolled. You must sign up using this link: https://guardian.collegetuitionbenefit.com/

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Online Enrollment

1. Log into Web Pay via https://access.paylocity.com/ 2. Access Web Benefits by clicking “Enterprise Benefits”

3. From the Home Page, click on “Start your Enrollment” 4. The enrollment process consists of the following 4 steps/tabs. You will be taken through each tab to make changes or confirm your information on file and choose your benefits for the new plan year. 1. Employee (Personal Information) 2. Family (Family Information) 3. Enroll 4. Confirm

5. You can view and save your confirmation statement of your elections or print it for your records. Click the printer icon on the right side of the screen to print a copy of the statement.

It is highly recommended that you send yourself an email or print off your confirmation statement of your elections.

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Required Annual Employee Disclosure Notices Required Annual Employee Disclosure Notices

THE NEWBORNS’ AND MOTHERS’ HEALTH PROTECTION ACT OF 1996

WOMEN’S HEALTH AND CANCER RIGHTS ACT OF 1998 The Women’s Health and Cancer Rights Act of 1998 requires JL Marine Systems to notify you, as a participant or beneficiary of the JL Marine Systems 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. 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.

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 then 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. 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.

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Required Annual Employee Disclosure Notices continued Required Annual Employee Disclosure Notices

JL Marine Systems, Inc. Human Resources| 813-689-9932 ext. 2109 9010 Palm River Road Tampa, FL 33619

Your Information. Your Rights. Our Responsibilities. This notice describes how medical information about you may be used and disclosed and how you can get access to this information. Please review it carefully. Your Rights When it comes to your health information, you have certain rights. This section explains your rights and some of our responsibilities to help you. Get a copy of your health and claims records • You can ask to see or get a copy of your health and claims records and other health information we have about you. Ask us how to do this. • We will provide a copy or a summary of your health and claims records, usually within 30 days of your request. We may charge a reasonable, cost-based fee. Ask us to correct health and claims records • You can ask us to correct your health and claims records if you think they are incorrect or incomplete. Ask us how to do this. • We may say “no” to your request, but we’ll tell you why in writing within 60 days. Request confidential communications • You can ask us to contact you in a specific way (for example, home or office phone) or to send mail to a different address. • We will consider all reasonable requests, and must say “yes” if you tell us you would be in danger if we do not. Ask us to limit what we use or share • You can ask us not to use or share certain health information for treatment, payment, or our operations. • We are not required to agree to your request, and we may say “no” if it would affect your care.

• You can ask for a list (accounting) of the times we’ve shared your health information for six years prior to the date you ask, who we shared it with, and why. • We will include all the disclosures except for those about treatment, payment, and health care operations, and certain other disclosures (such as any you asked us to make). We’ll provide one accounting a year for free but will charge a reasonable, cost-based fee if you ask for another one within 12 months. • You can ask for a paper copy of this notice at any time, even if you have agreed to receive the notice electronically. We will provide you with a paper copy promptly • If you have given someone medical power of attorney or if someone is your legal guardian, that person can exercise your rights and make choices about your health information. • We will make sure the person has this authority and can act for you before we take any action. • You can complain if you feel we have violated your rights by contacting us using the information at the top of this page. • You can file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201, calling 1-877-696-6775, or

Get a list of those with whom we’ve shared information

Get a copy of this privacy notice

Choose someone to act for you

File a complaint if you feel your rights are violated

visitingwww.hhs.gov/ocr/privacy/hipaa/complaints/. • We will not retaliate against you for filing a complaint.

Your Choices For certain health information, you can tell us your choices about what we share. If you have a clear preference for how we share your information in the situations described below, talk to us. Tell us what you want us to do, and we will follow your instructions.

• Share information with your family, close friends, or others involved in payment for your care • Share information in a disaster relief situation • Contact you for fundraising efforts

In these cases, you have both the right and choice to tell us to:

If you are not able to tell us your preference, for example if you are unconscious, we may go ahead and share your information if we believe it is in your best interest. We may also share your information when needed to lessen a serious and imminent threat to health or safety.

• Marketing purposes • Sale of your information

In these cases we never share your information unless you give us written permission:

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Required Annual Employee Disclosure Notices continued Required Annual Employee Disclosure Notices

Our Uses and Disclosures How do we typically use or share your health information? We typically use or share your health information in the following ways. Help manage the health care treatment you receive • You can ask to see or get a copy of your health and claims records and other health information we have about you. Ask us how to do this.

Example: A doctor sends us information about your diagnosis and treatment plan so we can arrange additional services.

• We will provide a copy or a summary of your health and claims records, usually within 30 days of your request. We may charge a reasonable, cost-based fee. • We can use and disclose your information to run our organization and contact you when necessary. • We are not allowed to use genetic information to decide whether we will give you coverage and the price of that coverage. This does not apply to long term care plans. • We can use and disclose your health information as we pay for your health services. • We may disclose your health information to your health plan sponsor for plan administration.

Run our organization

Example: We use health information about you to develop better services for you

Pay for your health services

Example: We share information about you with your dental plan to coordinate payment for your dental work Example: Your company contracts with us to provide a health plan, and we provide your company with certain statistics to explain the premiums we charge.

Administer your plan

How else can we use or share your health information? We are allowed or required to share your information in other ways – usually in ways that contribute to the public good, such as public health and research. We have to meet many conditions in the law before we can share your information for these purposes. For more information see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/index.html. Help with public health and safety issues • We can share health information about you for certain situations such as: • Preventing disease • Helping with product recalls • Reporting adverse reactions to medications • Reporting suspected abuse, neglect, or domestic violence • Preventing or reducing a serious threat to anyone’s health or safety Do research • We can use or share your information for health research. Comply with the law • We will share information about you if state or federal laws require it, including with the Department of Health and Human Services if it wants to see that we’re complying with federal privacy law.

• We can share health information about you with organ procurement organizations. • We can share health information with a coroner, medical examiner, or funeral director when an individual dies.

Respond to organ and tissue donation requests and work with a medical examiner or funeral director Address workers’ compensation, law enforcement, and other government requests

• We can use or share health information about you: • For workers’ compensation claims

• For law enforcement purposes or with a law enforcement official • With health oversight agencies for activities authorized by law • For special government functions such as military, national security, and presidential protective services • We can share health information about you in response to a court or administrative order, or in response to a subpoena.

Respond to lawsuits and legal actions

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Required Annual Employee Disclosure Notices continued Required Annual Employee Disclosure Notices

Our Responsibilities • We are required by law to maintain the privacy and security of your protected health information. • We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information. • We must follow the duties and privacy practices described in this notice and give you a copy of it. • We will not use or share your information other than as described here unless you tell us we can in writing. If you tell us we can, you may change your mind at any time. Let us know in writing if you change your mind. For more information see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/noticepp.html. Changes to the Terms of This Notice We can change the terms of this notice, and the changes will apply to all information we have about you. The new notice will be available upon request, on our web site, and we will mail a copy to you. Effective 01/01/2021 This Notice of Privacy Practices applies to the following organizations. JL Marine Systems

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, you 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.

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 Required Annual Employee Disclosure Notices

If you or your children are eligible for Medicaid or C H I P and you’re eligible for health coverage from your employer, your state may have a premium assistance program that can help pay for coverage, using funds from their Medicaid or C H I P programs. If you or your children aren’t eligible for Medicaid or C HIP, you won’t be eligible for these premium assistance programs but you may be able to buy individual insurance coverage through the Health Insurance Marketplace. For more information, visit www.healthcare.gov . If you or your dependents are already enrolled in Medicaid or C H I P and you live in a State listed below, contact your State Medicaid or C H I P office to find out if premium assistance is available. If you or your dependents are N O T currently enrolled in Medicaid or CHIP, and you think you or any of your dependents might be eligible for either of these programs, contact your State Medicaid or C H I P office or dial 1-877- KIDS NOW or www.insurekidsnow.gov to find out how to apply. If you qualify, ask your state if it has a program that might help you pay the premiums for an employer-sponsored plan. If you or your dependents are eligible for premium assistance under Medicaid or CH IP, as well as eligible under your employer plan, your employer must allow you to enroll in your employer plan if you aren’t already enrolled. This is called a “special enrollment” opportunity, and you must request coverage within 60 days of being determined eligible for premium assistance . If you have questions about enrolling in your employer plan, contact the Department of Labor at www.askebsa.dol.gov or call 1-866-444-EBSA (3272) . If you live in one of the following states, you may be eligible for assistance paying your employer health plan premiums. The following list of states is current as of July 31, 2021. Contact your State for more information on eligibility –

CALIFORNIA-Medicaid WHeeablstihteI:nsurance Premium Payment (HIPP) Program Ph tht po :n/ e/ :d 9h 1c s6. c- 4a .4g 5o -v8/3h2i p2p Email: [email protected] COLORADO-Health First Colorado (Colorado’s Medicaid Program) & Child Health Plan Plus (CHP+) H ht e tp a s lt :/ h / F w ir w st w C .h o e l a o l r th a f d ir o st W co e lo b r s a it d e o : .com/ H 80 e 0 a - l 2 th 21 F - i 3 r 9 st 43 C / ol S o ta r t a e d R o e M la e y m 7 b 11 er Contact Center: 1- CHP+: https://www.colorado.gov/pacific/hcpf/child- health-plan-plus CH eHaPl t h+ I nCsuusrtaonmc ee rB Sueyr-vI inc eP: r1o-g8r0a0m- 3(5H9I- 1B9I 9) :1 / S t a t e R e l a y 7 1 1 phtrtopgsr:/a/mwww.colorado.gov/pacific/hcpf/health-insurance- buy- HIBI Customer Service: 1-855-692-6442 FLORIDA-Medicaid W htt e p b s s :/ it / e w : ww.flmedicaidtplrecovery.com/flmedicaidtplrecov eP rhyo. cnoem: 1/ h- 8i p7 p7 /- 3i n5d7e- x3 . 2h 6t m8 l

ALABAMA-Medicaid

PWheobnsei :t e1:- 8h 5t t5p-:6/9/2m- 5y4a4l h7 i p p . c o m /

ALASKA-Medicaid

TWheeb sAi tKe : Hhettapl:t/h/mInysaukrhainpcpe.coPmr e/m i u m P a y m e n t P r o g r a m P E h m o a n il e : :1 C - u 8 s 6 t 6 o - m 25 e 1 r - S 4 e 8 r 6 v 1 [email protected] Medicaid Ehtltipg:i/b/idlihtyss:.alaska.gov/dpa/Pages/medicaid/default.aspx

ARKANSAS-Medicaid WP heobnsei t:e1: h- 8tt5p:5/-/MmyyaArRhiHpIpP.cPom(8/55-692-7447)

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GEORGIA-Medicaid Wpreebmsiiutem: h-pttapysm://emnte-pdricoagidra.gmeo-hrgipiap.gov/health-insurance- Phone: 678-564-1162 ext 2131 INDIANA-Medicaid HWeeabl st hi tye : Ihntdtpi a: /n/awPwl awn.i nf o.gro vl o/wf ss-ai n/ hc oi pm/ e a d u l t s 1 9 - 6 4 AP hl loonteh:e1r -M8 7e7d-i4c 3a i8d-4 4 7 9 WPheobnseite1:-h8t0tp0s-4:/5/7w-4w5w8.4in.gov/medicaid/ IOWA-Medicaid and CHIP (Hawki) Mhttepdsi:c/a/iddhsW.ioewbsai.tgeo:v/ime/members MHaewdikciaWidePbhsoitne:e: 1-800-338-8366 hHtat pw: /k/i dPhhso. i onwe :a1. g-o8v0/0H- 2a w5 7k-i8 5 6 3 HhtItpPsP://Wdhebs.sioitwe:a.gov/ime/members/medicaid-a-to-z/hipp HIPP Phone: 1-888-346-9562 KANSAS-Medicaid WP heobnseit:e1: -h8t0tp0s-:7/9/w2-w48w8.k4ancare.ks.gov/ P K r e o n g t r u a c m ky ( I K n I t - e H gr I a P t P ed ) H W e e a b l s th ite I : nsurance Premium Payment https://chfs.ky.gov/agencies/dms/member/Pages/kihipp.aspx Phone: 1-855-459-6328 Email: [email protected] K C H I P Website: https://kidshealth.ky.gov/Pages/index.aspx Phone: 1-877-524-4718 Kentucky Medicaid Website: https://chfs.ky.gov LOUISIANA-Medicaid WP heobnsei t:e 1: w- 8w8 8w- 3. m4 e2 d- 6i c2a0i 7d . (l aM. geodvi coari dw hwowt l .ilnd eh). l ao. rg o1v- /8 l5a5h-i 6p 1p 8 - 5488 (LaHIPP) MAINE-Medicaid Ehtntpros:l/lm/wewntwW.meabisniete.g:ov/dhhs/ofi/applications-forms TP hToYn:eM: 1a-i8n0e0r-e4l4a2y -761010 3 r g 7 n v 0 c/edhPhrse/mofiiu/mapWpliecbatpioanges-:forms a o 4 TTY: Maine relay 711 KENTUCKY-Medicaid h P P t r h t i p o v s n a : t / e e / : Hw 1- e w 8 a 0 w lt 0 . h m -9 I a 7 n in 7 su e -6 .

MASSACHUSETTS-Medicaid and CHIP pWreebmsiiutem: h-attspssis:/ta/nwcwe-wp.amass.gov/info-details/masshealth- Phone: 1-800-862-4840 MINNESOTA-Medicaid Whttepbss:i/t/em: n.gov/dhs/people-we-serve/children-and- fsaemrviilcieess//hoethaletrh--icnasruer/ahnecael.tjhsp-care-programs/programs-and- Phone: 1-800-657-3739 MISSOURI-Medicaid W ht e tp b : s / it / e w : ww.dss.mo.gov/mhd/participants/pages/hipp. htm Phone:573-751-2005 MONTANA-Medicaid Whttepb:s/i/tde:phhs.mt.gov/MontanaHealthcarePrograms/HIPP Phone: 1-800-694-3084 NEBRASKA-Medicaid WPheobnseit:e1: -h8t5tp5:-/6/3w2-w76w3.A3 CCESSNebraska.ne.gov L O i m nc a o h l a n : : 4 4 0 0 2 2 - - 5 4 9 7 5 3 - - 1 7 1 0 7 0 8 0

NEVADA-Medicaid

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NEW HAMPSHIRE-Medicaid WPheobnseit:e6: h0t3t-p2s7:/1/-5w2w1w8 .dhhs.nh.gov/oii/hipp.htm eTxotl5l 2fr1e8e number for the HIPP program: 1-800-852-3345,

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