Country's Barbecue - Benefit Guide

Country's Barbecue - Benefit Guide

OPEN ENROLLMENT

benefits guide

2022 PLAN YEAR

Introduction

Hello everyone! Open enrollment is here! Country’s Barbecue is proud to offer a comprehensive benefits package which serves the many needs of employees again this year. Please review these materials thoroughly in order to make the best decision for you and your family. Below are answers to some common questions: What’s changing? Monthly premiums have increased. Aging populations, lifestyle changes, and medical utilization are just some of the factors that contribute to increased costs. Our benefits package is reviewed in depth to ensure we continue to offer the best elections available. What if I want the same elections? You don’t need to do anything! You’ll remain on the same plan and benefits you currently have will remain in effect. What if I want to change my elections? Now’s the time! Use Employee Navigator to adjust your elections and notify HR so payroll deductions can be updated. What’s the deadline to make changes? May 30th by midnight!

And now for the fun stuff!

Is there anything Country’s Barbecue 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 August 1st! 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.

Anyone who chooses not to complete one will lose $25 of the company contribution effective June 1.

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! KELLEY AMON 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 a Country’s Barbecue 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 [country’s] • 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

Country’s Barbecue offers the following plans through Humana. Please reference the Summary Plan Description for more details.

Insurance Carrier:

Humana Medical Insurance

Medical Plan:

$5,000 / 100% Copay

$6,350 / 100% HDHP $7,900 / 100% On Hand

In-Network: Office Visit Copay - Primary Care

$35

Deductible; then 100% Coinsurance

Virtual Only - $0

Office Visit Copay - Specialist Care

$50

Deductible; then 100% Coinsurance

Deductible; then 100% Coinsurance

Urgent Care Copay

$100

Deductible; then 100% Coinsurance

Deductible; then 100% Coinsurance

Emergency Room Care

$350 Copay (waived if admitted)

Deductible; then 100% Coinsurance

Deductible; then 100% Coinsurance

Preventative Visit Copay

$0

$0

$0

Diagnostic Testing & Blood Work

$0

Deductible; then 100% Coinsurance

$5

Imaging

Deductible; then 100% Coinsurance

Deductible; then 100% Coinsurance

Deductible; then 100% Coinsurance

Coinsurance

100%

100%

100%

Employee Deductible

$5,000

$6,350

$7,900

Family Deductible

$10,000

$12,700

$15,800

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

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

$10 / $40

Deductible; then 100% Coinsurance

$5

Tier 2 - Preferred

$70

Deductible; then 100% Coinsurance

Deductible; then 100% Coinsurance

Tier 3 - Non-Preferred

25%

Deductible; then 100% Coinsurance

Deductible; then 100% Coinsurance

Tier 4 - Specialty

25% / 35%

Deductible; then 100% Coinsurance

Deductible; then 100% Coinsurance

Employee Weekly Deduction Employee Only

$48.73 $145.91 $131.33 $228.51

$23.80 $96.04 $85.21 $157.45

$23.80 $87.73 $78.14 $142.07

Employee + Spouse

Employee + Child(ren)

Family

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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 Country’s Barbecue 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

Country’s Barbecue 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 Country’s Barbecue, you may no longer contribute to your HSA through Country’s Barbecue 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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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. 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 FDA-approved smoking cessation medications for members 18 years and older

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

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Immunizations (vaccines for adults—doses, recommended ages and recommended populations vary) 2

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

9 Country’s Barbecue 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.

10 Country’s Barbecue 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

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 Unum and offers “in and out-of-network” benefits.

Insurance Carrier:

Unum Dental Insurance

Plan Type:

Basic

Calendar Year Deductible Calendar Year Maximum

$50 Individual / $150 Family

$1,500

Preventive Services

100%

Basic Services Major Services

80% 50%

Orthodontia (dependent children only)

N / A

Out-of-Network Reimbursement

90th UCR

Employee Weekly Deduction Employee Only

$5.74

Employee + Spouse Employee + Child(ren)

$11.49 $14.64 $20.39

Family

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

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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 Unum and offers “in and out-of-network” benefits.

To find an in-network provider, visit www.unum.com/findfieldoffice

Insurance Carrier:

Unum Vision Insurance

Plan Type:

EyeMed

In-Network

Out-of-Network

Exam Services

$10

up to $40 up to $30 up to $50 up to $70 up to $70

Lenses - Single lined Lenses - Bifocal lined Lenses - Trifocal lined Lenses - Lenticular lined

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

$130 Allowance; then 20% off remaining balance

Frames

up to $91

Elective Contact Lenses (in place of lenses & frames)

up to $130; Medically necessary up to $210

$130 Allowance

Frequency: Exam / Lenses / Frames

once every: 12 months / 12 months / 12 months

Employee Weekly Deduction Employee Only

$1.58 $3.15 $3.59 $5.59

Employee + Spouse Employee + Child(ren)

Family

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

Country’s Barbecue 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

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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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14 Country’s Barbecue 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

15 Country’s Barbecue 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

16 Country’s Barbecue 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

17 Country’s Barbecue 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

18 Country’s Barbecue 2022 Enrollment Guide

Legal Notices

MISSOURI - Medicaid Website: http://www.dss.mo.gov/mhd/participants/pages/hipp.htm

RHODE ISLAND - Medicaid Website: http://www.eohhs.ri.gov/ Phone: 401-462-5300 SOUTH CAROLINA - Medicaid Website: http://www.scdhhs.gov Phone: 1-888-549-0820 SOUTH DAKOTA - Medicaid

Phone: 573-751-2005 MONTANA - Medicaid Website: http://dphhs.mt.gov/ MontanaHealthcarePrograms/HIPP

Phone: 1-800-694-3084 NEBRASKA - Medicaid

Website: http://www.dhhs.ne.gov/Children_Family_ Services/AccessNebraska/Pages/accessnebraska_ index.aspx Phone: 1-855-632-7633 NEVADA - Medicaid Website: http://dwss.nv.gov/ Phone: 1-800-992-0900 NEW HAMPSHIRE - Medicaid Website: http://www.dhhs.nh.gov/oii/documents/hippapp.pdf Phone: 603-271-5218 NEW JERSEY - Medicaid and CHIP Medicaid Website: http://www.state.nj.us/humanservices/dmahs/clients/ medicaid/ Medicaid Phone: 609-631-2392 CHIP Website: http://www.njfamilycare.org/index.html CHIP Phone: 1-800-701-0710 NEW YORK - Medicaid Website: http://www.nyhealth.gov/health_care/medicaid/ Phone: 1-800-541-2831 NORTH CAROLINA - Medicaid Website: http://www.ncdhhs.gov/dma Phone: 919-855-4100 NORTH DAKOTA - Medicaid Website: http://www.nd.gov/dhs/services/medicalserv/medicaid/ Phone: 1-844-854-4825 OKLAHOMA - Medicaid and CHIP Website: http://www.insureoklahoma.org Phone: 1-888-365-3742 OREGON - Medicaid Website: http://healthcare.oregon.gov/Pages/index.aspx http://oregonhealthcare.gov/index-es.html Phone: 1-800-699-9075 PENNSYLVANIA - Medicaid Website: http://www.dhs.pa.gov/hipp Phone: 1-800-692-7462

Website: http://dss.sd.gov Phone: 1-888-828-0059 TEXAS - Medicaid Website: http://www.dhs.state.ia.us/hipp/ Phone: 1-888-346-9562 UTAH - Medicaid and CHIP Medicaid Website: http://health.utah.gov/medicaid CHIP Website: http://health.utah.gov/chip

Phone: 1-877-543-7669 VERMONT - Medicaid Website: http://www.greenmountaincare.org Phone: 1-800-250-8427 VIRGINIA - Medicaid and CHIP Medicaid & CHIP Website: http://www.coverva.org/programs_premi- um_assistance.cfm Medicaid Phone: 1-800-432-5924 CHIP Phone: 1-855-242-8282 WASHINGTON - Medicaid Website: http://www.hca.wa.gov/free-or-low-costhealth-care/pro- gram-administration/premiumpayment- program Phone: 1-800-562-3022 ext. 15473 WEST VIRGINIA - Medicaid Website: http://www.dhhr.wv.gov/bms/Medicaid%20Expansion/Pages/ default.aspx Phone: 1-877-598-5820, HMS Third Party Liability WISCONSIN - Medicaid and CHIP Website: http://www.dhs.wisconsin.gov/publications/p1/p10095.pdf

Phone: 1-800-362-3002 WYOMING - Medicaid Website: http://wyequalitycare.acs-inc.com/ Phone: 307-777-7531

To see if any more States have added a premium assistance program since January 31, 2021, or for more information on special enrollment rights, you can contact either:

U.S. Department of Labor Employee Benefits Security Administration www.dol.gov/ebsa 1-866-444-EBSA (3272)

U.S. Department of Health and Human Services Centers for Medicare & Medicaid Services www.cms.hhs.gov 1-877-267-2323, Menu Option 4, Ext. 61565

19 Country’s Barbecue 2022 Enrollment Guide

Legal Notices

Important Notices about Medical Coverage

HIPPA Special Enrollment Rights

These benefits will be provided subject to the same deductibles and co-insurance applicable to other medical and surgical benefits provided under this plan. Our plan complies with these requirements. Benefits for these items generally are compatible to those provided under our plan for similar types of medical services and supplies. Of course, the extent to which any of these items is appropriate following mastectomy is a matter to be determined by consultation between the attending physician and the patient. Our plan neither imposes penalties (for example, reducing or limiting reimbursements) nor provides incentives to induce attending providers to provide care inconsistent with these requirements. If you would like more information on WHCRA benefits, call Yates LLC at (706)323-1600.

If you are declining enrollment for yourself or your dependents (including your spouse) because of other health insurance or group health plan coverage, you may be able to enroll yourself or your dependents in this plan if you or your dependents lose eligibility for that other coverage (or if the employer stops contributing towards your or your dependents’ other coverage). However, you must request enrollment within 30 days after your 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 result of marriage, birth, adoption, or placement for adoption, you may be able to enroll yourself and your dependents. However, you must enroll within 30 days after the marriage, birth, adoption, or placement for adoption. Effective April 1, 2009 special enrollment rights also exist in the following circumstances: • If you or your dependents experience a loss of eligibility for Medicaid or your State Children’s Health Insurance Program (SCHIP) coverage; or • If you or your dependents become eligible for premium assistance under an optional state of Medicaid or SCHIP program that would pay the employee’s portion of the health insurance premium. NOTE: In the two above listed circumstances only, you or your dependents will have sixty (60) days to request special enrollment in the group health plan coverage. An individual must request this special enrollment within sixty (60) days of the loss of coverage described at bullet one, and within sixty (60) days of when eligibility is determined as described in bullet two. Women’s Health and Cancer Rights Act of 1998 Annual Notice 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 (WHCRA). 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 lymphedema.

Paperwork Reduction Act Statement

According to the Paperwork Reduction Act of 1995 (Pub. L. 104-13) (PRA), no persons are required to respond to a collection of information unless such collection displays a valid Office of Management and budget (OMB) control number. The Department notes that a Federal agency cannot conduct or sponsor a collection of information unless it is approved by OMB under the PRA, and displays a currently valid OMB control number, and the public is not required to respond to a collection of information unless it displays a currently valid OMB control number. See 44 U.S.C. 3507. Also, not withstanding any other provisions of law, no person shall be subject to penalty for failing to comply with a collection of information if the collection of information does not display a currently valid OMB control number. See 44 U.S.C. 3512. The public reporting burden for this collection of information is estimated to average approximately seven minutes per respondent. Interested parties are encouraged to send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the U.S. Department of Labor, Employee Benefits Security Administration, Office of Policy and Research, Attention: PRA Clearance Officer, 200 Constitution Avenue, N.W., Room N-5718, Washington, DC 20210 or email ebsa. [email protected] and reference the OMB Control Number 1210- 0137.

20 Country’s Barbecue 2022 Enrollment Guide