Acom Benefit Guide - Class 3 - Eligible Employees: Weekly

Acom Benefit Guide - Class 3 - Eligible Employees: Weekly

CLASS 3 - ALL ELIGIBLE EMPLOYEES: WEEKLY

benefits guide

2022 PLAN YEAR

Introduction

Welcome! Congratulations on your new position with Acom! You can now begin the new hire enrollment process by accessing an online benefit administration system, Employee Navigator. You are required to complete the enrollment process even if you are declining benefits. This will be your only opportunity to enroll until the next Open Enrollment, which is May 1st each year.

You will have 24/7 access from a computer, phone, tablet, etc., as long as you have internet service.

What’s the deadline to make changes? You have 3 months to make changes.

Additional Information

Is there anything Acom can do to help with rising premiums? Yes, but we need your help. The company will contribute $50 towards the cost of the increased premium for the 2022-2023 plan for everyone who reaches Silver Status in Go365 before the end of your first 3 months. How can I reach Silver Status? Reach 5,000 points for Employee Only plans and 8,000 points for all others. See pages 14 - 16 for a sample list and the attached flyers for a comprehensive list of ways to earn points. The most important thing you can do is participate in a biometric screening! • The Biometric screening w/ Nicotine Test = 2,400 points (and you can earn double the points if you are within the target range for things like blood pressure and BMI!) • Complete all three Go365 Health Assessments online = up to 1,250 points • Annual Health screening (physical, mammogram, etc) = 400 points (plus 4 hours of PTO!)

What if I don’t want to/can’t attend the company-held Biometric Screening? You can complete one through your doctor in the month of May and submit through Go365.

During the Enrollment period, you have the opportunity to elect, change, or waive benefits offered for the upcoming plan year. Please remember that changes to your benefits will only be accepted during the Open Enrollment period unless you experience a “Qualifying Event” as defined by the Internal Revenue Service.

Please reach out if you have any questions or concerns! MUNDI HORN HUMAN RESOURCES MANAGER

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About Deductions

Premiums for medical, dental, vision and HSA Contribution plans are all deducted on a pre-tax basis because they are covered under Section 125 of the Internal Revenue Code. Once you elect benefits you will not be approved to make changes to your election or drop coverage until the next Open Enrollment period, unless you have a qualifying event. Voluntary life and short-term disability insurance premiums are deducted on a post-tax basis and may be changed outside of the Open Enrollment period.

Information Needed for Enrollment

In preparation of your enrollment, please have the following information readily available for you and your dependent(s): • Date(s) of birth • Social Security Number(s): Mandatory • Full name, relationship, and Social Security Number(s) for Life Beneficiary(ies). (Beneficiaries must be at least 18 years old or you will be required to name a guardian for him/her.)

All Eligibility

Qualifying Life Events

As an Acom employee, you may be eligible for enrollment in a variety of insurance products. Full-time employees may participate in the benefits package on the 1st of the month following 60 days of employment. You may enroll your eligible dependents for coverage once you are eligible. Your eligible dependents include:

Qualifying events are events that cause an individual to lose his or her group health coverage. The type of qualifying event determines who the qualified beneficiaries are for that event and the period of time that a plan must offer continuation of coverage.

Qualifying events include:

• Marriage • Divorce or legal separation • Birth or adoption of a child • Death of spouse or dependent child • Change in employment status • Loss of other coverage • Entitlement to Medicare or Medicaid • Child turning 26 years old

• Your legal spouse • Your children up to age 26 (as identified in the plan document)

*Once your elections are effective, they will remain in effect through the plan year.

You must notify Human Resources within 30 days of the qualifying life event. Depending on the type of event, you may be asked to provide proof of the event. If you do not contact Human Resources within 30 days of the qualifying event, you will have to wait until the next annual enrollment period to make changes.

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How to Enroll

Step 1: Creating your Employee Navigator Account

Welcome Email:

• You will receive a Welcome email from Employee Navigator • Click on the “Registration Link” in the email • Create an account with username and password of your choice

• Go to https://www.employeenavigator.com/benefits/Account/Register • Enter [First Name], then [Last Name] • Enter your Company Identifier [ACOM] • PIN: Last four of your SSN • Enter your birthdate: MM/DD/YYY • Click “Next” to continue • When prompted, your username will be as follows: [First Name].[Last Name] Option 2:

Step 2: Complete HR Tasks

• Once your account is set up, you will be taken to your employee homepage.

• On the homepage, click the “Complete HR Tasks” to begin your new hire tasks first.

• The first few tasks require you to put in demographic information and e-sign for online acknowledgement.

T I P If you hit “Dismiss, complete later” you’ll be taken to your Home Page. You’ll still be able to start enrollments again by clicking “Start Enrollments”

Step 3: Benefit Elections

• To enroll dependents in a benefit, click the checkbox next to the dependent’s name under “Who am I enrolling?” If you do not click on their name(s), they will not get the insurance. • Below your dependents you can view your available plans and the cost per pay period. To elect a benefit, click Select Plan underneath the plan cost.

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Step 4: Forms

• If you have elected benefits that require a beneficiary designation, Primary Care Physician or completion of an Evidence of Insurability form, you will be prompted or required to complete.

Step 5: Review & Confirm Elections

• Review the benefits you selected on the enrollment summary page to make sure they are correct then click “Sign & Agree” to complete your enrollment. Print a summary of your elections for your records.

T I P If you miss a step you’ll see Enrollment Not Complete in the progress bar with the incomplete steps highlighted. Click on any incomplete steps in the drop down bar to complete them. ALL STEPS MUST BE COMPLETED!

Step 6: HR Tasks (if applicable)

• To complete any required HR tasks, click “Start Tasks”. If your HR department has not assigned any tasks, you’re finished!

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Medical and Pharmacy Coverage

Acom offers the following plans through Humana. Please reference the Summary Plan Description for more details.

Insurance Carrier:

Humana Medical Insurance

Medical Plan:

$6,500 / 100% On Hand

$6,350 / 100% HSA $6,000 / 100% Copay

In-Network: Office Visit Copay - Primary Care

Virtual Only - $0

Deductible; then 100% Coinsurance

$25

Office Visit Copay - Specialist Care

Deductible; then 100% Coinsurance

Deductible; then 100% Coinsurance

$50

Urgent Care Copay

Deductible; then 100% Coinsurance

Deductible; then 100% Coinsurance

$75

Emergency Room Care

Deductible; then 100% Coinsurance

Deductible; then 100% Coinsurance

Deductible; then 100% Coinsurance

Preventative Visit Copay

$0

$0

$0

Diagnostic Testing & Blood Work

Deductible; then 100% Coinsurance

Deductible; then 100% Coinsurance

$0

Imaging

Deductible; then 100% Coinsurance

Deductible; then 100% Coinsurance

Deductible; then 100% Coinsurance

Coinsurance

100%

100%

100%

Employee Deductible

$6,500

$6,350

$6,000

Family Deductible

$13,000

$12,700

$12,000

Employee Out-of-Pocket Max

$6,500 (includes deductible)

$6,350 (includes deductible)

$7,900 (includes deductible)

Family Out-of-Pocket Max

$13,000 (includes deductible)

$12,700 (includes deductible)

$15,800 (includes deductible)

Inpatient Hospital

Deductible; then 100% Coinsurance

Deductible; then 100% Coinsurance

Deductible; then 100% Coinsurance

Outpatient Hospital or Facility

Deductible; then 100% Coinsurance

Deductible; then 100% Coinsurance

Deductible; then 100% Coinsurance

Out-of-Network: Coinsurance

70%

70%

70%

Employee Deductible

$19,050

$19,050

$18,000

Family Deductible

$38,100

$38,100

$36,000

Employee Out-of-Pocket Max

$21,550

$21,550

$23,700

Family Out-of-Pocket Max

$43,100

$43,100

$47,400

Prescription Drugs: ( 30 Day Supply) Tier 1 - Generic

$5

Deductible; then 100% Coinsurance

$15

Tier 2 - Preferred

$5

Deductible; then 100% Coinsurance

$30

Tier 3 - Non-Preferred

Deductible; then 100% Coinsurance

Deductible; then 100% Coinsurance

$50

Tier 4 - Specialty

Deductible; then 100% Coinsurance

Deductible; then 100% Coinsurance

25%

Wellness

Base

Wellness

Base

Wellness

Base

Employee Weekly Deduction

Employee Only

$27.93 $107.77

$39.46 $119.31

$31.05 $114.73

$42.59 $126.27

$54.08 $166.04 $133.54 $230.73

$65.62 $177.58 $145.08 $242.27

Employee + Spouse Employee + Child(ren)

$79.38

$90.91

$85.84

$97.38

Family

$148.51

$160.05

$158.33

$169.87

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HSA Coverage

Your eligibilty

In order to open and fund an HSA, you must meet the

following requirements: • You are enrolled in Acoms High Deductible Plan (HDHP) • Are not covered under another medical plan such as Medicare, Tricare or a spouse’s medical plan (not an HDHP) which provides similar coverage; and • Cannot be claimed as a dependent on another person’s insurance policy or tax return.

Qualified Health Care Expenses

Each time you have a medical, dental or vision expense you decide if you want to pay with money from your HSA. “Qualified Medical Expenses” are determined by the US Treasury, 213(d) expenses, and detailed in IRS Publication 502. Some examples include but are not limited to:

•

Expenses that apply toward your deductible

2022 IRS Calendar Year Contribution Limit

• • • • • •

Prescription expenses Contact lens fitting

Acom is contributing $1,200 annually directly into your HSA

Orthodontia Acupuncture Artificial teeth Eye glasses

The amount you may contribute to your HSA is based on your HDHP medical plan’s tier. 2022 If you cover just yourself on the plan: $3,650 If you cover yourself and a spouse or dependents: $7,300 Age 55+ Catch-Up: $1,000

Whose Medical Expenses Can You Use Your HSA Funds on?

When You Can Begin Contributing

Generally your:

You may begin funding your HSA when your medical HDHP

•

Legally married spouse. Domestic partners are not covered under the tax code. Permanently and totally disabled dependent of any age. Dependent under the age of 19 at the end of calendar year or a full-time student under the age of 24 at the end of the calendar year who also: Lived with you more than 1/2 the calendar year, and Didn’t provide over 1/2 his/her own support in the calendar year, and Didn’t file a joint tax return, other than to claim a refund

benefits begin.

You are able to contribute as little or as much (up to the IRS limit) as you wish out of each paycheck and this election may be changed at any time throughout the year.

•

•

When You Cannot Contribute

If you terminate HDHP medical plan coverage (or employment) with Acom, you may no longer contribute to your HSA through Acom payroll deduction. You own the HSA so your balance can be carried over year after year and the funds you contributed always belong to you.

•

•

Benefits of an HSA

Tax Savings! An HSA provides triple tax savings: (1) tax deductions when you contribute to your account (2) tax-free investment earnings (3) tax-free withdrawals for qualified medical expenses

•

•

Qualifying relative. See IRS Publication 502 for more information.

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Health Reimbursement Arrangement

Acom offers a Health Reimbursement Arrangement (HRA) that funds a portion of the calendar year deductible for you and your covered family members if you elected the Humana Copay Plan. The actual deductible on this plan is $6,000 for an individual and $12,000 for family coverage. Under this HRA, the employee responsibility is the first $2,500 and the company will then reimburse up to $3,500 of the remaining calendar year deductible for an individual. Where there are two or more eligible dependents, the HRA will reimburse the second calendar year deductible for the same amount as the first should your dependent(s) meet the second calendar year deductible.

Health Reimbursement Arrangement (HRA) Illustration Employee Only Illustration

Plan Arrangement

Funding $2,500

Employee pays first $2,500

HRA pays next $3,500 to equal $6,000 plan deductible

$3,500

Coinsurance now pays at 100% (except for copays of any type) Employee is liable for $1,900 in copays to equal out-of-pocket max

$6,000 $7,900 $4,400

Employee out-of-pocket maximum equals $4,400

Employee + Dependent(s) Illustration

Plan Arrangement

Funding $5,000 $7,000 $12,000 $15,800 $8,800

Employee pays first $5,000

HRA pays next $7,000 to equal $12,000 plan deductible Coinsurance now pays at 100% (except for copays of any type) Employee is liable for $3,800 in copays to equal out-of-pocket max

Employee out-of-pocket maximum equals $8,800

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Dental Coverage

Regular dental exams can help you and your dentist detect problems in the early stages when treatment is simpler and costs are lower.

Keeping your teeth and gums clean and healthy will prevent most tooth decay and periodontal disease, and is an important part of maintaining your medical health.

Your PPO dental plan is through Sun Life and offers “in and out-of-network” benefits.

Insurance Carrier:

Sun Life Dental Insurance

Plan Type:

Basic

Enhanced

Calendar Year Deductible Calendar Year Maximum

$50 Individual / $150 Family $50 Individual / $150 Family

$1,000

$2,000

Preventive Services

100%

100%

Basic Services Major Services

80% 50%

90% 60%

Orthodontia (dependent children only) Out-of-Network Reimbursement

N / A

$1,000

90th UCR

90th UCR

Employee Weekly Deduction Employee Only

$3.38 $7.90 $7.77

$6.90

Employee + Spouse Employee + Child(ren)

$13.28 $18.59

Family $23.51 time insured continuously under a dental plan benefits provided for only these services Less than 6 months Preventive Services At least 6 months but less than 12 months Preventive Services and fillings under Basic Services At least 12 months Preventive, Basic, Major and Ortho Services $11.14

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Vision Coverage

The vision plan covers routine eye exams and also pays for all or a portion of the cost of glasses or contact lenses if you need them.

Your PPO vision plan is through Sun Life and offers “in and out-of-network” benefits.

To find an in-network provider, visit www.vsp.com/eye-doctor

Insurance Carrier:

Sun Life Vision Insurance

Plan Type:

In-Network

Out-of-Network

Exam Services

$10 $60

up to $30 up to $31 up to $25 up to $50 up to $60 up to $100

Contact Lens Exam Copay Lenses - Single lined Lenses - Bifocal lined Lenses - Trifocal lined Lenses - Lenticular lined

$10 Copay $10 Copay $10 Copay $10 Copay

$150 Retail Allowance; then 20% off remaining balance

Frames

up to $80

Elective Contact Lenses (in place of lenses & frames)

$150 Retail Allowance

up to $128

Medically Necessary Contacts

$10 Copay

up to $210

Frequency: Exam / Lenses / Frames

once every: 12 months / 12 months / 12 months

Employee Weekly Deduction Employee Only

$2.08 $4.04 $3.75 $5.71

Employee + Spouse Employee + Child(ren)

Family

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Basic Life and AD&D Coverage

Acom provides all Full Time employees with Basic Life and Accidental Death & Dismemberment coverage.

Insurance Carrier:

Sun Life Basic Life Insurance

Basic Life w/ AD&D Eligibility Requirement Life Insurance Benefit

All Full Time Employees

$20,000

Guarantee Issue

Yes

Accidental Death & Dismemberment Benefit (AD&D)

Same as Basic Life Amount

Dependent Life

$10,000

Voluntary Term Life Insurance Coverage

As a supplemental benefit, Acom allows eligible employees to purchase additional life insurance coverage for yourself and your dependents. This coverage is paid for by you and is offered through Sun Life. Rates for the voluntary term life insurance are based on age, and volume, and benefits are subject to applicable age reductions.

Insurance Carrier:

Sun Life Voluntary Life Insurance

Voluntary Life w/ AD&D Eligibility Requirement Employee Benefit Amounts Employee

All Full Time Employees

5x Annual Earnings to $500k in increments of $10k 100% of Employee to $150k in increments of $5k

Spouse

Child(ren)

100% of Employee to $10k

Guarantee Issue Employee

$100k

Spouse Children

$25k $10k

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Disability Coverage

The goal of Acom’s Disability Insurance Plan is to provide you with income replacement should you be unable to work due to a non- work-related illness or injury. The company provides employees with the option to purchase voluntary “Short and Long Term Disability” income benefits. Both the short term and long term disability coverages are offered through Sun Life. Rates will be automatically calculated and shown in Employee Navigator during enrollment process.

Insurance Carrier:

Sun Life Short-Term Disability

Plan Type:

Voluntary

Plan Options

Basic

Enhanced

Benefit Percentage

60% of Weekly Earnings

60% of Weekly Earnings

Maximum Weekly Benefit

$1,500

$1,500

Guaranteed Issue Amount

$1,500

$1,500

Injury Elimination Period Sickness Elimination Period

14 days 14 days

0 days 7 days

Benefit Duration

11 weeks

13 weeks

3 month pre-existing / 12 month waiting period

3 month pre-existing / 12 month waiting period

Pre-existing Condition Limitation

Insurance Carrier:

Sun Life Long-Term Disability

Plan Type:

Employer Paid

Employee Classification

Class 3 - All Eligible Employees

Benefit Percentage

60%

Maximum Monthly Benefit

$10,000

Guaranteed Issue Amount

$10,000

Elimination Period

90 days 2 Years SSNRA Included

Own Occupation Coverage

Benefit Duration

Partial Disability Benefit

Mental & Nervous Limitation Drug & Alcohol Limitation Pre-Existing Condition Limitation

24 Months per Lifetime 24 Months per Lifetime

3 month pre-existing / 12 month waiting period

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PREVENTIVE SERVICE GUIDE Take advantage of all that’s available for your health

PREVENTIVE SERVICE GUIDE Take advantage of all that’s available for your health

Humana wants to make sure your care grows with you as you change, and that you get access to all you need. Did you know that many services, medicines, and screenings are available to you, and at no extra cost out of your pocket, when they are treated as preventive? See throughout for all that’s available to you. Adult preventive services Preventive office visits are covered, as well as the screenings, immunizations and counseling listed below. Screenings Abdominal aortic aneurysm One-time screening for men of specified ages who have ever smoked 1 Alcohol use Screening for all adults Blood pressure Screening for high blood pressure for all adults Cholesterol Screening for adults certain ages or at higher risk 1 Colorectal cancer Screening for adults aged 50–75 Depression Screening for all adults Diabetes Screening for adults aged 35–70 at higher risk 1 Drug use Screening questions for all adults Hepatitis B Screening for adults at higher risk 1 Hepatitis C Screening for adults aged 18-79 HIV Screening for adults at higher risk 1 Lung cancer Annual screening for adults aged 50–80 who smoke or have quit within the past 15 years 1 Obesity Screening for all adults Syphilis Screening for adults at higher risk 1 Tobacco use Screening for all adults Tuberculosis Screening for latent infection for adults at higher risk 1 Humana wants to make sure your care grows with you as you change, and that you get access to all you need. Did you know that many services, medicines, and screenings are available to you, and at no extra cost out of your pocket, when they are treated as preventive? See throughout for all that’s available to you. Adult preventive services Preventive office visits are covered, as well as the screenings, immunizations and counseling listed below. Screenings Abdominal aortic aneurysm One-time screening for men of specified ages who have ever smoked 1 Alcohol use Screening for all adults Blood pressure Screening for high blood pressure for all adults Cholesterol Screening for adults certain ages or at higher risk 1 Colorectal cancer Screening for adults aged 50–75 Depression Screening for all adults Diabetes Screening for adults aged 35–70 at higher risk 1 Drug use Screening questions for all adults Hepatitis B Screening for adults at higher risk 1 Hepatitis C Screening for adults aged 18-79 HIV Screening for adults at higher risk 1 Lung cancer Annual screening for adults aged 50–80 who smoke or have quit within the past 15 years 1 Obesity Screening for all adults Syphilis Screening for adults at higher risk 1 Tobacco use Screening for all adults Tuberculosis Screening for latent infection for adults at higher risk 1 Adult preventive services continued Preventive office visits are covered, as well as the screenings, immunizations and counseling listed below.

Medications and supplements (covered with a doctor’s prescription) Aspirin

Note: You may need to pay all or part of the costs when services are completed to diagnose, monitor or treat an illness, pregnancy or injury, rather than prevent an illness, pregnancy or injury. 1 For more information on the definition of higher or increased risk and age recommendations, please see the US Preventive Guidelines at www.uspreventiveservicestaskforce.org/uspstf/recommendation-topics/uspstf-and-b-recommendations. FDA-approved smoking cessation medications for members 18 years and older GNA0CUOHH 0921 Low- to moderate-dose statin use for adults aged 40–75 at higher risk 1 PrEP pre-exposure prophylaxis with effective antiretroviral therapy to persons at high risk of HIV acquisition 1 Aspirin use to prevent cardiovascular disease and colorectal cancer in adults aged 50-59 Bowel preparation medications for adults aged 50–75

Colonoscopy preparation Tobacco smoking cessation

Statin

HIV prevention

Note: You may need to pay all or part of the costs when services are completed to diagnose, monitor or treat an illness, pregnancy or injury, rather than prevent an illness, pregnancy or injury. 1 For more information on the definition of higher or increased risk and age recommendations, please see the US Preventive Guidelines at www.uspreventiveservicestaskforce.org/uspstf/recommendation-topics/uspstf-and-b-recommendations. Counseling Alcohol use reduction Behavioral counseling interventions to reduce unhealthy alcohol use

GNA0CUOHH 0921 Healthy diet and physical activity Obesity

Counseling to prevent cardiovascular disease for adults who have cardiovascular risk factors or higher risk for chronic disease 1 Referral to intensive, multicomponent behavioral interventions for patients with a body mass index (BMI) of 30 kg/m or higher

Sexually transmitted infections (STI)

Prevention counseling for adults at higher risk 1

Tobacco smoking cessation

Cessation interventions for tobacco users

Other Falls prevention

Exercise interventions for adults aged 65 or older at increased risk for falls Counseling for adults through age 24 to minimize their exposure to ultraviolet radiation

Skin cancer prevention

13 Acom Integrated Solutions 2022 Enrollment Guide Immunizations (vaccines for adults—doses, recommended ages and recommended populations vary) 2

DID YOU KNOW?

Chickenpox/varicella

Preventative Health Care

Women preventive services (includes pregnant women) Preventive office visits are covered, as well as the screenings and counseling listed below. Screenings Anemia

Counseling Genetic counseling for women who have tested positive for BRCA Breast cancer chemoprevention Counseling for women at increased risk for breast cancer 1 Domestic and interpersonal violence Screening and referral for intervention services Healthy weight and weight gain Behavioral counseling interventions to promote healthy weight in pregnancy Tobacco smoking cessation Behavioral interventions and expanded counseling for pregnant tobacco users Perinatal depression Counseling interventions for pregnant and postpartum women at increased risk 1

Screening on a routine basis for pregnant women Urinary tract or other infection screening for pregnant women

Bacteriuria

BRCA

Screening for women at higher risk 1

Breast cancer mammography Cervical cancer

Screening every 1–2 years for women aged 40 or over

Screening for women with a cervix, regardless of sexual history, at specified ages and intervals 4 Screening for younger women and other women at higher risk 1 Screening for pregnant and postpartum women Screening for women after 24 weeks of gestation

Chlamydia infection

Depression

Gestational diabetes

Gonorrhea Hepatitis B

Screening for all women at higher risk 1 Screening for all pregnant women Screening for all pregnant women

HIV

HPV-DNA test

High risk testing every 3 years for women with normal cytology results who are aged 30 or older 1 Screening for women aged 65 and over and women at higher risk 1

Osteoporosis (bone density) Preeclampsia

Screening for all pregnant women

Rh(D) incompatibility

Blood typing/antibody testing for all pregnant women at the first prenatal visit and at 24–28 weeks’ gestation

Other services Breastfeeding 3

Syphilis

Screening for all pregnant women

Equipment and counseling to promote breastfeeding during pregnancy and in the postpartum period Contraceptive methods and counseling 3

Medications and supplements (covered with a doctor’s prescription) Aspirin to prevent preeclampsia Low-dose aspirin after 12 weeks of gestation in women at high risk 1 Breast cancer preventive medications For women at increased risk for breast cancer 1 Contraception FDA-approved contraceptives for women with reproductive capacity to prevent pregnancy

Prenatal vitamins/ folic acid

For women who are pregnant, may become pregnant or are capable of pregnancy

14 Acom Integrated Solutions 2022 Enrollment Guide 4 Women 21–65: with cytology (Pap test) every three years; women 30–65: wanting to lengthen the screening interval. We encourage you to seek any professional advice, including legal counsel, regarding how the new requirements will affect your specific plan. For complete details, refer to your plan’s Certificate of Coverage. 1 For more information on the definition of higher or increased risk and age recommendations, please see the US Preventive Guidelines at www.uspreventiveservicestaskforce.org/uspstf/recommendation-topics/uspstf-and-b-recommendations. 3 On Aug. 1, 2011, the U.S. Department of Health and Human Services released new guidelines regarding coverage of preventive health services for women. The new guidelines state that non-grandfathered insurance plans with plan years beginning on or after Aug. 1, 2012, must include these services without cost sharing.

Preventative Health Care

Child preventive services Preventive office visits are covered, as well as the screenings, immunizations, counseling and supplements listed below.

Immunizations (vaccines for children from birth to age 18—doses, ages and populations vary) 2 Chickenpox/varicella Covid-19 ages 12 and up (within scope of Emergency Use Authorization) Haemophilus influenzae type B Hepatitis A Hepatitis B Human papillomavirus (HPV) Inactivated poliovirus Influenza Measles, mumps, rubella (MMR) Meningococcal Pneumococcal Rotavirus Tetanus, pertussis, diphtheria (Tdap) Counseling Obesity Comprehensive, intensive behavioral interventions to promote improvements in weight status Sexually transmitted infections (STI) Prevention counseling for adolescents at higher risk 1 Skin cancer Brief counseling for children and adolescents to minimize their exposure to ultraviolet radiation Tobacco smoking cessation Education or brief counseling to prevent initiation of tobacco use in school-aged children and adolescents

Screenings Alcohol and drug use

Assessments for adolescents

Autism

Screening for children at 18–24 months Assessments for children of all ages Screening for adolescents aged 12–18 Screening for children under age 3, and surveillance throughout childhood

Behavioral Depression

Developmental

Dyslipidemia

Screening for children at higher risk of lipid disorders 1

Height, weight and body mass index Hemoglobinopathies

Measurements for children of all ages

Screening for sickle cell disease in newborns Screening for adolescents at higher risk 1

Hepatitis B

Hypothyroidism

Screening for newborns

HIV

Screening for adolescents at higher risk 1 Screening for children at risk of exposure For all children throughout development Screening for children aged 6 or older Risk assessment for young children

Lead

Medical history

Obesity

Oral health

Phenylketonuria (PKU) Screening for newborns Sexually transmitted infection

Screening for adolescents at higher risk 1

Tuberculin

Testing for children at higher risk of tuberculosis 1

Vision Screening for all children between the ages 3–5 years old Medications and supplements (covered with a doctor’s prescription) Fluoride supplement Oral supplements starting at age 6 months for children without fluoride in their water sources

Fluoride varnish

Application by a primary care clinician to primary teeth starting at tooth eruption through age 5 Preventive medicine for the eyes of all newborns PrEP pre-exposure phophylaxis with effective antiretroviral therapy to persons at high risk of HIV acquisition 1 Supplements for children ages 6–12 months at risk for anemia

Gonorrhea

HIV pre-exposure prophylaxis

Iron

Refer to your Certificate of Coverage for details about all the covered services and benefit levels.

15 Acom Integrated Solutions 2022 Enrollment Guide 1 For more information on the definition of higher or increased risk and age recommendations, please see the US Preventive Guidelines at http://www.uspreventiveservicestaskforce.org/uspstf/recommendation-topics/uspstf-and-b-recommendations. 2 For more information on immunization recommendations, resources and schedules, please refer to the Centers for Disease Control and Prevention at www.cdc.gov/vaccines/schedules/index.html. This communication provides a general description of certain identified insurance or non-insurance benefits provided under one or more of our health benefit plans. Our health benefit plans have exclusions and limitations and terms under which the coverage may be continued in force or discontinued. For costs and complete details of the coverage, refer to the plan document or call or write Humana, or your Humana insurance agent or broker. In the event of any disagreement between this communication and the plan document, the plan document will control.

Employee Benefit Assistants You Can Count on M ember C laims A dvocate

Acom provides you and your family members a complimentary member claims service to help with claims, billing, missing ID cards and more. give member claims advocate a call if : • You received a provider bill or EOB and feel the claim was processed incorrectly • You are at the doctor or pharmacy and having trouble with your coverage • You need to confirm if a provider is In-Network • You are missing your ID card Y ou can reach the M ember C laims A dvocate team by phone or email

Monday through Friday, 8:30 AM EST - 5:00 PM EST

Cosby Cartledge - [email protected] Resa Carter - [email protected] Anna Meadows - [email protected] (706) 323-1600

16 Acom Integrated Solutions 2022 Enrollment Guide

401k Retirement Plan

Acom offers a retirement plan hosted by Voya to eligible employees. You are eligible for this benefit on the first of the month following 60 days of employment. Employees who are eligible to enroll will do so electronically through the Voya website with the information provided below: Initial Enrollment • VoyaRetirementPlans.com/EnrollmentCenter • Plan Number: 817598 • Verification Number: 81759899 Employer Contributions Acom matches 50% of the employee’s contribution up to 6% for a maximum match of 3% of compensation. The employer contribution is discretionary and can be changed at any time. Employees Currently Contributing to the 401k If you are currently contributing to your 401k and would like to make changes to your personal information, beneficiaries, or elections, please contact the Human Resources Department for instructions. If you would like to review your contributions or account information, please visit the website at www.voya.com. You will then use your username and password to access your account. Vesting See Summary Plan Description (SPD)

Additional Questions? Call the Plan Administrator Angela Demas at 703-750-6750 ext.102

17 Acom Integrated Solutions 2022 Enrollment Guide

Go365

EARNING POINTS in Go365

Challenges Here’s your chance to boost your health even more when you compete against friends and co-workers. Challenge them for most steps taken or pounds lost, or create your own Challenge! Earn more when you do more! The more Go365 activities you complete, the more Points you earn—and the higher your Status.

Take the stairs. Keep your blood pressure in check. Eat more salads. There are lots of things you can do to get healthier. With Go365®, you can earn Points for doing them. Activities These are things you do every day—like taking a walk or getting your flu shot—to be your healthiest. Recommended activities These personalized activities are created just for you, based on what you told us about your health in your Health Assessment. Recommended activities are things like losing weight or exercising more that are designed to jump-start your health, and they’re worth more Points!

5,000 PTS Unlock activities to earn more Points and move up to a higher Status Three ways to get to Bronze 1. Complete at least one Health Assessment section online or on the Go365 App 2. Get a biometric screening 3. Log a verified workout Start here and move up 8,000 PTS

10,000 PTS

Platinum

Gold

Silver

Bronze

Blue

500 Bonus Bucks 1,000 Bonus Bucks

1,500 Bonus Bucks 3,000 Bonus Bucks

5,000 Bonus Bucks 10,000 Bonus Bucks

Earn Bonus Bucks when you reach Silver Status or higher Earn Double Bonus Bucks when you achieve your prior year highest Status

Bonus Bucks are not tied to Points and increase a Go365 member’s buying power in the Go365 Mall. Bonus Bucks are awarded when a Go365 member reaches Silver, Gold and Platinum Status, and are doubled when the prior year highest Status is achieved. For example, a year one Go365 member reaches Gold Status at the end of their program year. The Go365 member will earn 1,000 Bonus Bucks for reaching Silver Status (1,000 Bonus Bucks are awarded the first time a member reaches Silver Status) and 1,500 Bonus Bucks for reaching Gold Status. In the Go365 member’s next program year, the highest Status reached is Gold Status. In this example, 500 Bonus Bucks are awarded at Silver Status and 3,000 Bonus Bucks are awarded when the member reaches Gold Status again. Bonus Bucks apply to the 30,000 Bucks maximum each adult member can earn in a program year. Learn more at Go365.com Go365 is not an insurance product. Not available with all Humana health plans. This document is intended to provide a high-level overview of the primary Go365 account holder’s Points earning potential. All other member types should reference their Go365 account for eligible activities and Points. Recommended activities are not medical advice. Consult your physician. We are committed to helping you achieve your best health. Rewards for participating in Go365 are available to all members. If you think you might be unable to meet a standard for a Go365 reward, you might qualify for an opportunity to earn the same reward by different means. Contact Go365’s Customer Care team by signing in to Go365.com and using the secure live chat feature on the bottom right of the screen or by calling the number on the back of your member ID card, and we will work with you (and, if you wish, with your healthcare practitioner) to develop another way to qualify for the reward.

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18 Acom Integrated Solutions 2022 Enrollment Guide

Go365

Activities and Points Points listed are per program year unless stated otherwise. Education Activity

Points

500

 Health Assessment Take your full Go365 Health Assessment online or on the App and earn Points for completing it for the first time each program year.

50

Health Assessment sections >> Get Active >> Eat Better >> Reduce Stress >> Live Well >> Know Your Health >> Introduce Yourself 200 bonus Points when you complete all six sections



OR

Bonus Points  First Step Health Assessment bonus  Fast Start Health Assessment bonus

500 once/lifetime

250

75 each (up to 300/program year)

 Calculators

 CPR certification

125 125

 First-aid certification

 Update/confirm contact Information

50

 Monthly Go365.com, Humana.com or Go365 App sign-in

10 (up to 120/program year)

 First time Go365 App sign-in  Accept online statements

50 once/lifetime 50 once/lifetime

Available for Go365 members with Humana medical coverage only.

Prevention Activity

Points

 Health screening *

400 per eligible screening

 Dental exam  Vision exam

200 per exam (up to 400/program year)

200 200 400 800 400 400 400

 Flu shot

 Nicotine test **

Biometric screening completion

Body mass index (BMI)



Blood pressure Blood glucose Total cholesterol







Maximum Points for Health Assessment completion per program year is 500. Fast Start bonus awarded for full Health Assessment completion within the first 90 days of your program year. *Subject to certain requirements and will appear as a recommended activity if they are applicable to you. **Cost associated with nicotine tests are the responsibility of the Go365 member. Nicotine tests are not associated with biometric screenings.

WEB AND APP |

APP ONLY |

WEB ONLY

19 Acom Integrated Solutions 2022 Enrollment Guide

Go365

Activities and Points Points listed are per program year unless stated otherwise.

Healthy living Activity  Blood donation

Points

50 each (up to 300/ program year)

 Nicotine test (in-range results)

400

 Virtual well-being coaching ongoing interactions

10 weekly (up to 520/program year)

 Weekly log  Sleep diary

10 weekly

25 weekly (up to 150/ program year)

 Daily health quiz

2 daily

 Fitness habit

up to 25 per month

Biometric screening (in-range results)  Body mass index < 40” f or males and < 35” f or females

≥ 18.5 and < 25, or BMI ≥ 25 and < 30, with a w aist ci r cumfe r ence

800 400 400

Blood p r essu r e(systolic and diastolic)

< 130/85 mm Hg



Blood glucose Total choleste r ol

< 100 m g /dL or A1c < 6.5%



< 200 m g /dL or an HDL ≥ 40 m g / dL f or males and ≥ 50/m g / dL



f or females

400

Fitness Activity

Points

Daily verified workout types

up to 50/day

Steps*

1 Point per 1,000 steps



He art Rate (HR)*

5 Points for every 15 minutes above 60% of maximum HR 5 Points per 100 calories if burn rate exceeds 200 calories/hour



Calorie s*



P artici pating fitness facility*

10 per daily visit



Bonus Points  Exceeded 50 weekly workout Points  Exceeded 100 weekly workout Points

50

only one bonus awarded per week

100

 First lifetime verified workout

500

 Sports leagues

350 Points per league team (up to 1,400/program year)

Challenges Sponsored Challenges are set up by employers or Go365. Member-created Challenges are set up by members.

up to 100/month total for all Challenge-related activities

P artici pat e in a Member -c r eated Challenge P artici pate in a Sponso r ed Challenge

50 50





up to 3,000/program year

Athletic events (running, walking, cross-country skiing, cycling, triathlon)

Lev el 1 (example: 5K) Lev el 2 (example: 10K)

250 350 500





Lev el 3 (example: half-marathon)



*Calculating daily workout Points: Each day, Go365 will look at Points earned across all workout types and award the category with the highest value for that day. Points are awarded for one workout type per day. Week is defined as Sunday–Saturday. Maximum of 50 daily workout Points can be awarded.

WEB AND APP |

APP ONLY |

WEB ONLY

20 Acom Integrated Solutions 2022 Enrollment Guide

Employee Assistance Program

The Employee Assistance Program (EAP) is a benefit program in which we provide employees and their family members up to six free counseling sessions. This information is kept completely confidential. This program is intended to help employees deal with person problems that may adversely impact their work performance, health, and well-being. Through the EAP, individual, family, and group counseling is available to employees and dependents. Regardless of your location, our EAP will find a counselor for you from an extensive network of providers.

Some reasons employees seek counseling: • Depression • Anxiety • Stress • Grief & Loss • Trauma

To schedule an appointment, call an intake professional at (706) 649-6500. You will have to provide the name of your employer and let them know you are utilizing your EAP benefit.

21 Acom Integrated Solutions 2022 Enrollment Guide

FAQ

Frequently Asked Questions What is included in the Medical Out-of-Pocket maximum? What is included in the Pharmacy Out- of-Pocket maximum? The Medical Out-of-Pocket maximum is the maximum amount a member must pay during the policy year for covered essential health benefits. The OOP includes a member’s deductible and any coinsurance member responsibility. The Pharmacy OOP includes only pharmacy co-pays. The Medical OOP does NOT include monthly premiums, or billing from out-of-network providers. What is an in-network vs out-of-network provider? Humana contracts with a wide range of doctors, as well as specialists, hospitals, labs, radiology facilities and pharmacies. These are the providers that are considered “in your network”. Specifically, each of these providers has agreed to accept Humana’s contracted rate for your medical care and services rendered. The contracted rate includes both Humana’s share of the cost, and the member’s. Your share may be in the form of a co-payment, deductible, or co-insurance. For example, Humana’s contracted rate for a primary care visit might be $125. The Plan has a $25 co-payment for the visit; the member will pay $25 of the cost and your insurance plan will pay the remaining $100. An “out-of-network” provider is a medical doctor or facility that is not in contract with Humana. This means that the provider may charge members higher rates for medical services and care, outside of the standard “in-network” rates. For example, a out-of- network provider may charge $200 for a primary care visit. Humana may pay an adjustment of an out-of-network benefit of $80 dollars to the provider, so the member may be balance-billed for the remaining $120 cost of the visit. When can I change my beneficiary information for my Basic Life Insurance? Any time! It is important that all beneficiary information be kept up-to-date. You may need to change it after a marriage, divorce, or birth of a child. You can go into Employee Navigator anytime to update your beneficiary.

Term

Definition

Network Office Visit (PCP)

The “per visit” co-pay cost for a primary care or standard network doctor.

The “per visit” co-pay cost for a specialized doctor (cardiologist, OB/GYN,

Specialist Office Visit

orthopedic, gastrointestinal, etc.)

The amount of money a member owes for any In-network health care services before co-insurance coverage begins. These are generally services that are NOT covered under a standard co-pay (inpatient surgery, outpatient surgery, MRI, etc.) Deductibles run on a calendar year basis. After any applicable deductible is met, the remaining cost of any in-network health care service is divided between the insurance carrier and the member. A 70% / 30% network co-insurance would divide the cost of a service with 70% paid by the insurance carrier and 30% paid by the member. These are generally services that are NOT covered under a standard co-pay (inpatient surgery, outpatient surgery, MRI, etc.) The maximum amount a member must pay during the policy year for covered essential health benefits. The OOP includes a member’s deductible, any co-insurance member responsibility, primary care and specialist office visit co-pays, ER or Urgent Care co- pays, and prescription co-pays / costs. The OOP does NOT include monthly premiums, billing from out-of-network providers, or spending for non-essential health benefits. The cost of a one month supply of a prescription drug. All covered drugs are designated into tiered levels based on drug usage, cost, and clinical effectiveness. Tier 1 usually includes generics, while Tier 2 generally includes preferred brand name medications. Tier 3 typically includes non-preferred brand name medications, Tier 4 usually includes higher cost drugs and Specialty Drugs are covered under a separate tier.

Network Deductible

Co-Insurance

Network Out-of-Pocket Maximum (OOP)

Prescription Drug Tiers and Monthly Co-Pays

22 Acom Integrated Solutions 2022 Enrollment Guide

Legal Notices

Medicaid and the Children’s Health Insurance Program (CHIP) Offer Free or Low-Cost Health Coverage to Children and Families 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 below, 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 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 January 31, 2021. Contact your State for more information on eligibility –

ALABAMA - Medicaid Website: http://myalhipp.com/ Phone: 1-855-692-5447 ALASKA - Medicaid The AK Health Insurance Premium Payment Program Website: http://myakhipp.com/ Phone: 1-866-251-4861 Email: Customer [email protected] Medicaid Eligibility: http://dhss.alaska.gov/dpa/Pages/medicaid/default. aspx ARKANSAS - Medicaid Website: http://myarhipp.com/ Phone: 1-855-MyARHIPP (855-692-7447) COLORADO - Medicaid Website: http://www.colorado.gov/hcpf Customer Contact Center: 1-800-221-3943 KANSAS - Medicaid Website: http://www.kdheks.gov/hcf/ Phone: 1-785-296-3512 KENTUCKY - Medicaid Website: http://chfs.ky.gov/dms/default.htm Phone: 1-800-635-2570 LOUSIANA - Medicaid Website: http://dhh.louisiana.gov/index.cfm/ subhome/l/n/331 Phone: 1-888-695-2447

FLORIDA - Medicaid Website: http://flmedicaidtplrecovery.com/hipp/ Phone: 1-877-357-3268 GEORGIA - Medicaid Website: http://dch.georgia.gov/medicaid - click on Health Insurance Premium Payment (HIPP) Phone: 404-656-4507 INDIANA - Medicaid Healthy Indiana Plan for Low-Income Adults 19-64 Website: http://www.hip.in.gov Phone: 1-877-438-4479 All other Medicaid Website: http://www.indianamedicaid.com Phone: 1-800-403-0864 IOWA - Medicaid Website: http://www.dhs.state.ia.us/hipp/ Phone: 1-888-346-9562 MAINE - Medicaid Website: http://maine.gov/dhhs/ofi/public-assistance/ index.html Phone: 1-800-442-6003 TTY: Maine relay 711

MASSACHUSETTS - Medicaid and CHIP Website: http://www.mass.gov/MassHealth

Phone: 1-800-462-1120 MINNESOTA - Medicaid Website: http://mn.gov/dhs/ma/ Phone: 1-800-657-3739

23 Acom Integrated Solutions 2022 Enrollment Guide