Alice + Olivia 2022 Benefit Guide

Alice + Olivia 2022 Benefit Guide

BENEFITS GUIDE

An overview of the wide array of benefits provided by Alice + Olivia to help you enjoy increased well-being and financial security

PREPARED BY BRIO BENEFITS FOR ALICE AND OLIVIA

Table of Contents

3

INTRODUCTION

4

ALEX- YOUR VIRTUAL BENEFIT COUNSELOR

5

ELIGIBILITY

7

MAKING A CHANGE (after Open Enrollment)

8

BENEFITS AT A GLANCE

9

WHAT YOU PAY

10

WHEN YOU CAN ENROLL

11

MEDICAL PLAN OPTIONS

14

HEALTH REIMBURSEMENT ACCOUNT (HRA)

15

TELEMEDICINE

16

DENTAL PLAN OPTIONS

17

VISION PLAN

18

BASIC LIFE INSURANCE | AD&D

19

SHORT & LONG TERM DISABILITY

20

EMPLOYEE ASSISTANCE PROGRAM (EAP)

21

401K RETIREMENT PLAN

22

FLEXIBLE SPENDING ACCOUNT(S)

23

IMPORTANT EMPLOYEE NOTIFICATIONS

29

BENEFIT PLAN CONTACT INFORMATION

30

GLOSSARY

Welcome to Alice + Olivia Employee Benefits Program!

Alice + Olivia cares about its employees and we’re continually making improvements to make Alice + Olivia a great place to work. We recognize that Alice + Olivia’s most valuable resource is its employees and that the health and wellness of our employees has a direct impact on the continued success of the Company. We are pleased to announce that our program is evolving. Wellness is more than just physical health – wellness encompasses career, financial, social and emotional aspects as well. This benefit guide will provide information around the various plan designs available to you and your family.

Sincerely,

HumanResources

PLEASE NOTE: This overview has been prepared to briefly highlight key features of your plan and is not to replace your insurance contract or booklet. We have compiled information into summary form to answer questions we most commonly receive. Please refer to the insurance carrier’s contracts and booklets for more detailed information and plan limitations. Actual claims paid are subject to the terms and conditions of the individual carrier’s contracts.

Introductio n Meet Alex!

WHO IS ALEX AND HOW CAN IT HELP ME?

We understand that making decisions around benefits is important to all of our employees, but at times can be both difficult and confusing.

To enhance your understanding and to make YOUR benefit experience easier, we are excited to offer ALEX, a virtual benefit counselor. ALEX is an interactive decision making support tool that can help you decide which benefit options are right for YOU! Think of it as your personal guide that helps you make important benefit decisions.

HERE ARE A COUPLE OF IMPORTANT THINGS TO KNOW ABOUT THE ALEX TOOL:

It’s personalized, so you can see which plan makes the most sense for YOU, not your coworkers, or your boss, or even me, your local benefits genius.

It's fun to use. There’s no boring insurance jargon or complicated legal jibber -jabber.

It’s confidential, so you can get the guidance you need without revealing all of your fascinating secrets.

It’s available all year! You can find out information about your benefits at any time and your significant other can use it as well!

*Please be aware that Alex is a support tool and NOT where you make your actual benefit elections

SEE HOW ALEX CAN HELP AT:

www.myalex.com/Alice-Olivia/2021

Introductio n Eligibility

FLEXIBLE SOLUTIONS TO MEET YOUR BENEFIT NEEDS

CONTROLLING COST...WHAT YOU CAN DO

We consider our employee benefits program to be one of our most important investments. Because we recognize the value our employees bring to our company, we are committed to providing you with a complete benefits program as part of your total compensation. This guide has been prepared to assist you in making informed decisions regarding your employee benefits. We urge you to read this guide carefully and keep it as a reference. If you are well-informed, you will be better able to make the benefit choices that best meet your needs. When making your choices, you should consider: • The benefits offered • The cost of coverage • Physicians and facilities available • Any ongoing medical needs for you and your family

In light of increasing health care costs, there are steps you can take to manage your out-of-pocket health care expenses. Use the following tips to save time and money:

• Always confirm that your physician, eye doctor, and dentist are still part of the network by calling the customer service number on your ID card or visiting the carrier’s website. • Check your area for urgent care center locations as an alternative to emergency room services. Only visit the emergency room in the case of a true emergency. You can also use telemedicine to help treat a wide range of non-emergency medical conditions. • Use generic prescriptions, if available. Ask your doctor for a generic drug or request the generic equivalent when having your prescription filled. • Save time and money by taking advantage of the mail order prescription service. This service works best for maintenance drugs that you take throughout the year. Mail order is convenient; prescriptions are delivered right to your door.

Eligibility

WHO IS ELIGIBLE?

DEPENDENT VERIFICATION

If you are enrolling your spouse, domestic partner or child(ren) to your health insurance, you must submit dependent verification within 30 days of the enrollment date to Human Resources. Failure to provide supporting documentation will result in the removal of your dependent(s) from coverage.

All active full-time employees who work at least 30 average hours per week are eligible for benefits. Your benefits are effective on the first of the month following 60 days of your hire date. If you do not enroll during this time period, you will not be eligible for benefits until the next Open Enrollment, unless you have a Qualifying Life Event Change.

TAXATION of DOMESTIC PARTNER BENEFITS

ELIGIBLE DEPENDENTS

It is important to note the taxation differential resulting from spouse vs. domestic partner coverage. Team members with domestic partners (non-spouses) are taxed on the employer portion of the benefits provided to the partner (imputed income) and the team member must contribute on an after tax basis for the portion of the benefits for the domestic partner. Team members are advised to speak with the tax expert regarding treatment for their benefits.

Spouse – An individual to whom you are legally

•

married.

• Domestic partner (same or opposite sex) – An individual with whom you are in a relationship with and share a dwelling. Completion and approval of a Domestic Partner Affidavit is required. An affidavit will be provided by Human Resources. Your or your spouse’s child who is under age 26, including a natural child, stepchild, a legally adopted child, a child placed for adoption or a child for whom you or your spouse are the legal guardian. • • An unmarried child, age 26 or older, who is disabled and dependent upon you. Disabled dependent must be covered prior to age 26 to continue benefit.

3

Making a Change

QUALIFYING LIFE EVENT

If you have a qualifying life event change, you may be able to change your benefits before the next Open Enrollment. You must notify Human Resources within 30 days of the change.

Change in residence if change affects

•

• Marriage, domestic partnership, annulment, legal separation, or divorce

benefit options

Medical Child Support Order

•

Birth or adoption

•

Entitlement to Medicare or Medicaid.

•

• Death of spouse, domestic partner, or child

Reduction in hours

•

Change in dependent’s eligibility

•

status (e.g., turns 26 years old)

Enrollment in Marketplace/Exchange

•

• Change in teammember employment status by you or your spouse/domestic partner

Contact Human Resources for a complete explanation of qualifying life event changes.

You must take action within 30 days after your qualifying event date to add, change, or drop coverage. You must submit supporting documentation within 30 days from the date of the event. If your documentation is not submitted within 30 days from the date of the event and/or does not support the change, your request will be denied. Benefits are effective first of the month following the event date. For a birth or adoption, benefits are effective date of event.

Benefits at a Glance

TYPE OF BENEFIT

BENEFITS CARRIER/COVERAGE OPTION

Meritain – Base HDHP with HRA Meritain – Standard EPO Meritain – Enhanced POS

Medical

Unum

Dental

Vision

Unum through EyeMed

Basic Life and AD&D

Unum

Telemedicine

Teladoc

Health Reimbursement Arrangement (HRA)

American Benefits Group (ABG)

Flexible Spending Account (FSA)

American Benefits Group (ABG)

401K

Cuna Mutual Retirement Solutions

Transit Accounts

American Benefits Group (ABG)

Short-Term Disability

Unum

Long-Term Disability

Unum

Benefits Portal

Benefit Plan Manager

Benefits Provided By Alice + Olivia

Effective January 1, 2022, Alice + Olivia’s benefit plans will run on a calendar year basis. The only exceptions are the Medical and Dependent Care Flexible Spending Accounts, which will run from November 1, 2021-October 31, 2022

What You Pay

Plan Option 1 Base HDHP Plan w/ HRA

Plan Option 2 Standard EPO Plan

Plan Option 3 Enhanced POS Plan

Meritain Medical

Per Biweekly Paycheck

Per Biweekly Paycheck

Per Biweekly Paycheck

Employee

$79.82

$99.44

$145.48

Employee + Spouse

$165.54

$198.89

$290.96

Employee + Child(ren)

$148.99

$179.00

$261.87

Employee + Family

$248.32

$298.33

$436.44

Unum Dental

Per Biweekly Paycheck

Employee

$5.00

Employee + Spouse

$13.36

Employee + Child(ren)

$15.15

Employee + Family

$21.12

Unum Vision through EyeMed

Per Biweekly Paycheck

Employee

$2.47

Employee + Spouse

$4.68

Employee + Child(ren)

$5.49

Employee + Family

$7.72

When You Can Enroll e an Enroll

ON-GOING BENEFIT ELIGIBILITY

NEWHIRES/ NEWLY ELIGIBLE FOR BENEFITS

When you are first hired or become eligible for benefits (your benefits are effective on the 1 st of the month following 60 days after your full time hire date), you have 30 days to enroll for benefits. Your benefits effective date will be communicated to you at that time. If you do not enroll within your enrollment time period, you will not be eligible for benefits until the next Open Enrollment, unless you have a Qualifying Life Event.

To maintain benefit eligibility, you must average thirty (30) or more paid hours per week. Your ongoing measurement period will begin on the first of the month following your benefit effective date. There is a 12 month look back period to review your paid hours: If you fall below thirty paid hours in the 12 month look back period, a letter will be sent to your home address communicating your future loss of benefit eligibility. Your benefits will terminate first of the month following the sixty (60) day administration period. Continuation of coverage through COBRA will be available following the end of your active coverage period. However, you may have other options available to you (i.e. spouse’s plan, the Insurance Marketplace, etc.). If you were ineligible for benefits and have now gained benefit eligibility based on the 12 month look back period, a letter will be sent to your home address communicating your gain of benefit eligibility. Your benefits will be effective 1 st of the month following the sixty (60) day administration period. Please see Human Resources for enrollment material.

OPEN ENROLLMENT

During Open Enrollment, you will have the opportunity to enroll or make changes to your benefit elections. You must enroll by the Open Enrollment deadline for your benefits to be effective January 1 st . Except for a Qualifying Life Event, you will not be able to change your elections until the next year’s Open Enrollment.

Medical Plan Options

All three Meritain medical plan options use the Aetna Choice POS II network . Your provider must send claims to Meritain (not Aetna) at the address on the back of your ID card to avoid delays in processing. Only the Enhanced POS Plan has coverage for Out of Network services. Your out-of-pocket costs will be less for in- network care. If you seek care from an out-of-network doctor, you’ll pay a greater percentage of the cost.

You have three medical plans to choose from. The medical plans provide comprehensive coverage but are different in how they are designed.

You decide which Meritain Medical plan best meets your needs:

Base HDHP Plan w/ HRA

•

Standard EPO Plan

•

Enhanced POS Plan

•

Meritain MEDICAL PLANS

Meritain, a subsidiary of Aetna, is the administrator of your medical plan. Meritain issues ID cards, processes claims, and handles service issues.

Pharmacy Benefits

Pharmacy – Helpful Tips

Capital Rx will administer your prescription drug benefits

• You will receive an ID card with both Meritain and Capital Rx information on the card

• Contact Capital Rx with any questions about your prescription drug coverage

Special note for Mail Order and Specialty drugs:

• If you wish to receive your prescription(s) by mail, you will need to

fill them through Walmart Mail Pharmacy. You can contact Walmart at 1-800-236-7563 to get the process started

• All specialty medications will need to be filled through Walmart Specialty Pharmacy

Meritain Medical

Standard EPO

Base HDHP

Enhanced POS

Preventive

100% Covered

100% Covered

100% Covered

Primary & Specialist Visit

After Deductible: 10%

$25 / $40

$25 / $40

Deductible (Plan Year)

$2,850 / $5,700

$1,000 / $2,000

$1,000 / $2,000

Deductible Assistance (HRA)

$1,500 / $3,000

None

None

Coinsurance

10%

20%

10%

Inpatient & Outpatient Hospital

After Deductible: 10% After Deductible: 20% After Deductible: 10%

Emergency Room

$200 Copay

$200 Copay

$200 Copay

Rx

Ded. then $15 / $35 / $75

$100 then $15 / $35 / $75 $100 then $15 / $35 / $75

Gross Max Out of Pocket

$4,000 / $8,000

$5,000 / $10,000

$3,000 / $6,000

Net Max Out of Pocket

$2,500 /$5,000

$5,000 / $10,000

$3,000 / $6,000

Deductible

$2,000 / $4,000

No out of network coverage

Coinsurance

30%

Max Out of Pocket

$6,000 / $12,000

80 th

Reimbursements*

* Paid according to reasonable percentile. Excess charges are the patient’s responsibility

The best way to verify whether your doctor, lab or hospital participates in the Aetna Choice POS II network is to call the provider and ask. You can also search online at www.aetna.com/docfind/custom/mymeritain/ or call customer service at 1.800.925.2272 .

Health Reimbursement Account (HRA)

We ease the financial exposures for employees enrolled in the HDHP Plan only by funding a portion of the in- network deductible for employees and their dependents through a Health Reimbursement Account (HRA). If you are enrolled in the HDHP Plan, Alice + Olivia covers the first $1,500 of the deductible for employee only coverage, and the first $3,000 of the deductible for employees with dependents. The HRA can only be used for medical deductible-related expenses, and cannot be used for copays or dental or vision expenses.

SUBMITTING A CLAIM

In order to have expenses reimbursed out of your HRA, you must provide American Benefits Group with the necessary information showing that the expense is consistent with your company’s HRA plan design. You should provide an Explanation of Benefits (EOB) from Meritain, as well as a copy of the bill from your provider.

You can submit claims for reimbursement by email to [email protected] or by fax to 877-723-0147.

If you do not have access to email or fax, send your claims to: PO Box 1209, Northampton, MA 01061-1209

ACCESSING FUND ACCOUNT

American Benefits Group administers the HRA. For questions about the HRA, contact American Benefits Group by phone or online:

Phone

800.499.3539

Website

www.amben.com

Telemedicine

VIRTUAL VISITS Access to care online at anytime

Access virtual visits

Employees and covered dependents enrolled in a medical plan through Meritain are eligible to use the program.

When you don’t feel well or your child is sick, the last thing you want to do is leave the comfort of home to sit in a waiting room. Now you don’t have to. A virtual visit lets you see and talk to a doctor from your mobile device or computer without an appointment. Most visits take about 10 – 15 minutes and doctors can write a prescription*, if needed, that you can pick up at your local pharmacy.

Through Meritain, you have access to Teladoc – the largest U.S. provider of telephonic and virtual care doctor visits

Access 24/7 medical advice by phone, website or mobile app

U.S.-based, board-certified and state-licensed doctors that are specially trained in telemedicine

$0 copay on the Base, Standard, and Enhanced Plans!

Conditions commonly treated through a virtual visit

Doctors can diagnose and treat a wide range of non-emergency medical conditions, including:

How do I access telehealth?

• Cold/flu

• Migraine/ headaches

• Rash

• Pink eye

• Sinus problems

• Sore Throat

Use virtual visits when:

• Your doctor is not available

• You become ill while traveling

• You are considering visiting a hospital emergency room for a non-emergency health condition

Not good for:

• Anything requiring an exam or test

• Complex or chronic conditions

• Injuries requiring bandaging or sprains/broken bones

10

Dental Plan Options

Receiving regular dental care can not only catch minor problems before they become major and expensive to treat – it may even help improve your overall health.

Unum Dental

To see if provider participates in the UNUM “ Dentemax Plus/AlwaysCare ” network, visit unumdentalcare.com or download the UNUM “ AlwaysAssist ” app

BENEFITS

In Network

Out Of Network

Exams (every 12 months)

Annual Maximum (Combined In and Out of Network)

$1,500

100%

100%

Preventive Care – Deductible Waived

70%

70%

Basic Care

50%

50%

Major Care

$50 / $150

Deductible

A portion of unused maximum can potentially rollover to the next year

Maximum Rollover

Vision Plan Vision Plan

Vision Care with Unum through Eyemed

To find a provider that participates in the EyeMed Vision Care Insight network through UNUM, visit www.eyemedvisioncare.com/unum. Although this plan is offered through UNUM, UNUM leases EyeMed’s network. You will receive an ID card from EyeMed directly, and will need to log on to EyeMed’s website, EYEMED.COM, to view claims.

BENEFITS

In Network

Out Of Network

Exams (every 12 months)

$10 copay

Plan Pays Up To $40

Vision Exam

Frames (every 24 months)

Plan Pays Up To: $105

Frames

Plan pays up to $150 allowance,

Lenses (every 12 months)

Single Bifocal Trifocal

Plan Pays Up To:

$25 copay

$40 to $150 depending on lens

Contact Lenses – In lieu of glasses (every 12 months)

Plan Pays up To: $150

$150 allowance

Conventional

Basic Life/AD&D Insurance Life and AD&D

This benefit is paid for 100% by Alice + Olivia. There is no cost to you, the employee.

All benefit eligible employees with Alice + Olivia are provided with employer-paid Basic Life and Basic Accidental Death & Dismemberment (AD&D) coverage. All eligible employees are automatically enrolled in Basic Life and Basic AD&D.

Employee Basic Life Insurance • Benefit amount is 1x base salary up to a maximum of $350,000

Basic Accidental Death and Dismemberment (AD&D) • 100% of the Basic Life benefit • Provides specified benefits for a covered accidental bodily injury that directly causes dismemberment • In the event of death that occurs from a covered accident, both Life and AD&D benefit would be payable each in the amount of the basic life insurance Benefits After Age 70 Your life benefits will reduce after age 70, and the reduction schedule is as follows: • Reduce by 50% at age 70 • Benefits will terminate at retirement

Refer to the Unum plan documents for a complete description of this plan.

Disability

This benefit is paid for 100% by Alice + Olivia. There is no cost to you, the employee.

Alice + Olivia provides employees with group short-term and long term disability coverage for those unexpected situations that may keep you from performing the daily responsibilities of your job. Your disability plan is available to help supplement your income when you are not able to continue employment for a certain period of time. Short-term and/or long-term disability benefits may be reduced by benefits received from state disability or temporary worker’s compensation programs. Total benefits received from the policy, state disability, temporary worker’s compensation programs and employers sick pay may not exceed 100% of your income prior to your disability. Short-Term Disability You will need to satisfy a 7-day elimination period. Benefits for short-term disability would begin on the 8 th day. This elimination period can be satisfied with days of partial disability, total disability or a combination of both. If you are totally disabled beyond the elimination period due to a covered injury or sickness, you will be eligible to receive a monthly benefit equal to 60% of your basic monthly income, up to $2,000 per week. This benefit has a duration of 13 weeks (after which Long Term Benefits may begin). Long-Term Disability You will need to satisfy a 90-day elimination period before long-term disability benefits would begin. This elimination period can be satisfied with days of partial disability, total disability or a combination of both. If you are totally disabled beyond the elimination period due to a covered injury or sickness, you will be eligible to receive a monthly benefit equal to 60% of your basic monthly income, up to $10,000 per month.

Refer to the UNUM plan documents for a complete description of this plan.

Employee Assistance Plan

24

7

401(k) Plan Highlights

Getting into the plan • Once you are age 21 and complete three months of service you are eligible to join in the plan • You will be automatically enrolled in the Plan on the first day of the month coinciding with the date on which the eligibility requirements are met. Elective deferrals in the amount of 2% of compensation will automatically be deducted from your compensation, unless you elect not to participate in the Plan or change or stop your contributions • Alice+Olivia will make a matching contribution of 50%on the first 6% of pay you defer • You select the investment(s) that are right for your situation

Receiving benefits from the plan • Vesting refers to your "ownership" of a benefit from the Plan. You are always 100% vested in your Plan contributions and your rollover contributions, plus any earnings they generate. • You will be fully vested in your plan benefits when you have completed four years of service with us (working at least 1,000 hours per year)

• You may take a loan from this plan

• If you have certain financial hardship situations, you may be able to withdraw money from the plan

• Visitwww.BenefitsForYou.com to see your Summary Plan Description for more detailed information about our plan

Flexible Spending Accounts

Flexible spending accounts (FSA) provide you with an important tax advantage that can help you pay health care and dependent care expenses on a pre-tax basis. As an eligible employee, you can set aside a portion of your pre-tax salary in an account, and that money is deducted from your paycheck over the course of the year. The amount you contribute to the FSA is not subject to social security (FICA), federal, state or local income taxes – effectively adjusting your annual taxable salary. HEALTH CARE REIMBURSEMENT FSA The Health Care Reimbursement FSA allows you to pay for certain IRS-approved health care expenses not covered by your insurance or reimbursed by any other benefit plan. Eligible expenses include those incurred by you, as well as your spouse and/or dependents. Typical expenses include co-pays, coinsurance, deductibles, and prescription drug expenses. For more information about eligible expenses, please refer to IRS Publication 502 available atwww.irs.gov/pub/irs-pdf/p502.pdf.

DEPENDENT CARE REIMBURSEMENT FSA The Dependent Care Reimbursement FSA allows you to use pre-tax dollars toward qualified dependent care. Care must be for a tax-dependent child under age 13 who lives with you, or a tax-dependent spouse or child who lives with you and is incapable of caring for themselves. Also, the care must be needed so that you and your spouse (if applicable) can go to work. Care must be given during normal working hours and cannot be provided by another one of your dependents. Typical expenses include baby-sitters, nursery schools, pre- schools, and day care centers.

The 2022 annual maximum contribution to the Dependent Care Reimbursement FSA is $5,000

DEPENDENT CARE FSA - “USE IT OR LOSE IT” RULE

Dependent Care Reimbursement FSA account runs on a plan year basis. The current plan year is from January 1, 2022 through December 31, 2022; claims can only be for services/expenses incurred between January 1, 2022 through December 31, 2022

The 2022 annual maximum contribution to the Health Care Reimbursement FSA is $2,850

NOTE:

Applies to BOTH Healthcare and Dependent Care FSA - regarding Highly Compensated employees, Nondiscrimination testing will be performed every year. Your elected FSA amounts may decrease should the testing results discriminate in favor of highly compensated employees.

Participants MUST re-enroll in the FSA Accounts each year

The FSA and DCFSA plan year will run from January 1, 2022 through December 31, 2022

Important Employee Notifications e Notifications I l

MODEL GENERAL NOTICE OF COBRA CONTINUATION COVERAGE RIGHTS

Introduction

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. ”

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.

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; 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 after the qualifying event occurs. You must provide this notice to your employer. 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

What is COBRA continuation coverage?

COBRA continuation coverage is a continuation of Plan coverage when it would otherwise end because of a life event. This is also called a “qualifying event. ” Specific qualifying events are listed later in this notice. After a qualifying event, COBRA continuation coverage must be offered to each person who is a “qualified beneficiary. ” You, your spouse, and your dependent children could become qualified beneficiaries if coverage under the Plan is lost because of the qualifying event. Under the Plan, qualified beneficiaries who elect COBRA continuation coverage must 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

Important Employee Notifications

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.

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 visitwww.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, visitwww.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.

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

1. Disability extension of 18-month period of COBRA continuation coverage: If you or anyone in your family covered under the Plan is determined by Social Security to be disabled and you notify the Plan Administrator in a timely fashion, you and your entire family may be entitled to get up to an additional 11 months of COBRA continuation coverage, for a maximum of 29 months. The disability would have to have started at some time before the 60th day of COBRA continuation coverage and must last at least until the end of the 18-month period of COBRA continuation coverage. 2. 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.

Women’s Health and Cancer Rights Act Notification

If you have had or are going to have a mastectomy, you may be entitled to certain benefits under the Women’s Health and Cancer Rights Act of 1998. For individuals receiving mastectomy-related benefits, coverage will be provided in a manner determined in consultation with the attending physician and the patient, for: • All stages of reconstruction of the breast on which the mastectomy was performed; • Surgery and reconstruction of the other breast to produce a symmetrical appearance; • Prostheses; and • Treatment of physical complications of the mastectomy, including lymphedemas. These benefits will be provided subject to the same deductibles and coinsurance applicable to other medical and surgical benefits provided under the medical plan.

Newborns’ and Mother’s Health Protection Act of 1996

Group health plans and health insurance issuers generally may not, under Federal law, restrict benefits for any hospital length of stay in connection with childbirth for the mother or newborn child to less than 48 hours following a vaginal delivery, or less than 96 hours following a cesarean section. However, Federal law generally does not prohibit the mother’s or newborn’s attending provider, after consulting with the mother, from discharging the mother or her newborn earlier than 48 hours (or 96 hours as applicable). In any case, plans and issuers may not, under Federal law, require that a provider obtain authorization from the plan or the insurance issuer for prescribing a length of stay not in excess of 48 hours (or 96 hours). 39

Are there other coverage options besides COBRA Continuation Coverage?:

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

Important Employee Notifications

Notice of Special Enrollment Rights

Prescription Drug Coverage and Medicare Part D Please read this notice carefully and keep it where you can find it. This notice has information about your current prescription drug coverage with Alice + Olivia and about your options under Medicare’s prescription drug coverage. This information can help you decide whether or not you want to join a Medicare drug plan. If you are considering joining, you should compare your current coverage, including which drugs are covered at what cost, with the coverage and costs of the plans offering Medicare prescription drug coverage in your area. Information about where you can get help to make decisions about your prescription drug coverage is at the end of this notice. There are two important things you need to know about your current coverage and Medicare’s prescription drug coverage: 1. Medicare prescription drug coverage became available in 2006 to everyone with Medicare. You can get this coverage if you join a Medicare Prescription Drug Plan or join a Medicare Advantage Plan (like an HMO or PPO) that offers prescription drug coverage. All Medicare drug plans provide at least a Alice + Olivia level of coverage set by Medicare. Some plans may also offer more coverage fora higher monthly premium. 2. Alice + Olivia has determined that the prescription drug coverage offered by Capital Rx is, on average for all plan participants, expected to pay out as much as Alice + Olivia Medicare prescription drug coverage pays and is therefore considered Creditable Coverage. Because your existing coverage is Creditable Coverage, you can keep this coverage and not pay a higher premium (a penalty) if you later decide to join a Medicare drug plan.

If you are declining enrollment for yourself or your dependents (including your spouse or domestic partner) because of other health insurance or group health plan coverage, you may be able to enroll yourself and your dependents in this plan if you or your dependents lose eligibility for that other coverage (or if the employer stops contributing toward your or your dependents’ other coverage). However, you must request enrollment within 31 days after you or your dependents’ other coverage ends (or after the employer stops contributing toward the other coverage). In addition, if you have a new dependent as a result of marriage, birth, adoption, or placement for adoption, you may be able to enroll yourself and your dependents. However, you must request enrollment within 31 days after the marriage, birth, adoption, or placement for adoption. To request special enrollment or obtain more information, please contact Human Resources. Medicaid and the Children’s Health Insurance Program (CHIP) If you or your children are eligible for Medicaid or CHIP and you’re eligible for health coverage from your employer, your state may have a premium assistance program that can help pay for coverage, using funds from their Medicaid or CHIP programs. If you or your children aren’t eligible for Medicaid or CHIP, you won’t be eligible for these premium assistance programs but you may be able to buy individual insurance coverage through the Health Insurance Marketplace. For more information, visit www.healthcare.gov. If you or your dependents are already enrolled in Medicaid or CHIP and you live in a State listed on http://www.dol.gov/ebsa/pdf/chipmodelnotice.pdf, contact your State Medicaid or CHIP office to find out if premium assistance is available. If you or your dependents are NOT currently enrolled in Medicaid or CHIP, and you think you or any of your dependents might be eligible for either of these programs, contact your State Medicaid or CHIP office or dial 1-877- KIDS NOW or www.insurekidsnow.gov to find out how to apply. If you qualify, ask your state if it has a program that might help you pay the premiums for an employer- sponsored plan. If you or your dependents are eligible for premium assistance under Medicaid or CHIP, as well as eligible under your employer plan, your employer must allow you to enroll in your employer plan if you aren’t already enrolled. This is called a “special enrollment” opportunity, and you must request coverage within 60 days of being determined eligible for premium assistance. If you have questions about enrolling in your employer plan, contact the Department of Labor at ww.askebsa.dol.gov or call 1-866-444-3272. 8-4-EBSA6464(3272). 40

WHEN CAN YOU JOIN A MEDICARE DRUG PLAN?

You can join a Medicare drug plan when you first become eligible for Medicare and each year from October 15th through December 7th. However, if you lose your current creditable prescription drug coverage, through no fault of your own, you will also be eligible for a two (2) month Special Enrollment Period (SEP) to join a Medicare drug plan. WHAT HAPPENS TO YOUR CURRENT COVERAGE IF YOU DECIDE TO JOIN A MEDICARE DRUG PLAN? If you decide to join a Medicare drug plan, your current Alice + Olivia coverage will not be affected. Your current coverage pays for other health expenses in addition to prescription drugs. If you enroll in a Medicare prescription drug plan, you and your eligible dependents will still be eligible to receive all of your current health and prescription drug benefits. If you decide to join a Medicare drug plan and drop Alice + Olivia coverage, be aware that you and your dependents may not be able to get this coverage back until the next Alice + Olivia open enrollment period.

Important Employee Notifications rt t l tifi ti I

WHEN WILL YOU PAY A HIGHER PREMIUM (PENALTY) TO JOIN A MEDICARE DRUG PLAN? You should also know that if you drop or lose your current coverage with Alice + Olivia and don’t join a Medicare drug plan within 63 continuous days after your current coverage ends, you may pay a higher premium (a penalty) to join a Medicare drug plan later. If you go 63 continuous days or longer without creditable prescription drug coverage, your monthly premium may go up by at least 1% of the Medicare base beneficiary premium per month for every month that you did not have that coverage. For example, if you go nineteen months without creditable coverage, your premium may consistently be at least 19% higher than the Medicare base beneficiary premium. You may have to pay this higher premium (a penalty) as long as you have Medicare prescription drug coverage. In addition, you may have to wait until the following October to join. SUMMARY OF OPTIONS FOR MEDICARE ELIGIBLE TEAM MEMBERS (AND/OR DEPENDENTS) Medical and prescription drug coverage are offered as a package under Alice + Olivia plan (you cannot elect medical coverage without prescription drug coverage). 1. Continue medical and prescription drug coverage under Alice + Olivia plan and do not elect Medicare D coverage. IMPACT – Your claims continue to be paid by Alice + Olivia plan. and prescription drug coverage under Alice + Olivia plan and elect Medicare D coverage. IMPACT – As an active team member (or dependent of an active team member) Alice + Olivia plan continues to pay primary on your claims (before Medicare D). 2. Continue medical 3. Drop Alice + Olivia plan coverage and elect Medicare Part D coverage. IMPACT – Medicare is your primary coverage. You will not be able to rejoin Alice + Olivia plan until the next open enrollment period unless you experience a qualified life event. FOR MORE INFORMATION ABOUT THIS NOTICE OR YOUR CURRENT PRESCRIPTION DRUG COVERAGE Contact the person listed below for further information. NOTE: You’ll get this notice each year. You will also get it before the next period you can join a Medicare drug plan, and if this coverage through Alice + Olivia changes. You also may request a copy of this notice at any time.

FOR MORE INFORMATION ABOUT YOUR OPTIONS UNDER MEDICARE PRESCRIPTION DRUG COVERAGE More detailed information about Medicare plans that offer prescription drug coverage is in the “Medicare & You” handbook. You’ll get a copy of the handbook in the mail every year from Medicare. You my also be contracted directly by Medicare drug plans. For more information about Medicare prescription drug coverage:

Visitwww.medicare.gov

•

• Call your State Health Insurance Assistance Program (see the inside back cover of your copy of the “Medicare & You” handbook for their telephone number) for personalized help

Call 1-800-MEDICARE (1-800-633-4227).

•

TTY users should call 1-877-486-2048

If you have limited income and resources, extra help paying for Medicare prescription drug coverage is available. For information about this extra help, visit Social Security on the web at www.socialsecurity.gov, or call them at 1-800-772-1213 (TTY 1-800-325-0778).

If you have questions, contact Human Resources.

REMEMBER: KEEP THIS CREDITABLE COVERAGE NOTICE. IF YOU DECIDE TO JOIN ONE OF THE MEDICARE DRUG PLANS, YOU MAY BE REQUIRED TO PROVIDE A COPY OF THIS NOTICE WHEN YOU JOIN TO SHOW WHETHER OR NOT YOU HAVE MAINTAINED CREDITABLE COVERAGE AND, THEREFORE, WHETHER OR NOT YOU ARE REQUIRED TO PAY A HIGHER PREMIUM (A PENALTY).

Important Employee Notifications

HIPAA Privacy

Alice + Olivia’s Health and Welfare Plan (Plan) maintains a

HIPAA Privacy Notice that provides information to

individuals whose Protected Health Information (PHI) will

be used or maintained by the Plan. If you would like a

copy of the Plan’s HIPAA Privacy Notice, please contact

Human Resources.

Notes

Benefit Plan Contact Information

Provider

Coverage Type

Phone and Web

Meritain 1 (800) 566-9311 www.Meritain.com

Medical

Unum Dental 800-400-9304 www.unum.com /

Dental

Unum Vision through Eyemed 855-652-8686 www.eyemedvisioncare.com/unum /en

Vision

Unum 1 (866) 679-3054 www.unum.com /

Life & AD&D (Basic & Optional) Long-Term/Short-Term Disability Employee Assistance Plan (EAP)

Capital Rx 1 (800) 424-5940 www.cap-rx.com /

yes

Pharmacy

Health Reimbursement Account Flexible Spending Account • Health Care • Dependent Care

American Benefits Group 800-499-3539. https://www.amben.com/participants.html

yes

yes

Glossary