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Published by , 2017-09-20 11:11:07

OE Summary Ben School PY 2017 Print

OE Summary Ben School PY 2017 Print

Benefits

EMPLOYEE ENROLLMENT GUIDE

NOVEMBER 1, 2017 - OCTOBER 31, 2018

Benefits Eligibility & Medical Coverage

ELIGIBILITY PRESCRIPTION COVERAGE
Under the HMO HRA plan, medications may be purchased
Employees working a minimum of 30 hours per week are for a copay, without the need to meet the deductible.
eligible to participate in the Benefits Program on the first Under the HMO Bronze plan, members pay a discounted
of the month following 30 days of employment. Children cost until meeting the plan deductible, then prescriptions
are eligible for medical, dental and vision coverage until the are covered at 70%.
end of the month in which the child reaches age 26. Step Therapy is a component of the prescription drug
program to help employees save on prescription drug
PLAN YEAR HIGHLIGHTS & CHANGES costs. It requires that a generic medication is prescribed
to treat common medical conditions such as asthma,
Medical Plan Design Improvements WNHEAWT’?S high cholesterol and other ongoing conditions before a
• Decreased plan costs! more expensive medication is approved. If a different
medication is necessary, your doctor can contact Cigna for
• Increased health reimbursement funding provided by authorization. Medications in the Step Therapy program
the Benedictine School. are noted with an “ST” in the Prescription Drug list.

Life and Disability Insurance carrier will change to Lincoln LOCATING NETWORK PROVIDERS
Financial Group Participating providers may be located online by visiting
www.cigna.com and selecting the “Find a Doctor” link on
• Benefits under each plan will remain the same and the right side of the page. Members may also register for a
current coverage will transition at the same levels. myCigna.com account from the Cigna homepage to access
to a variety of resources including:
• Employees will have the opportunity to enroll in
voluntary life and disability without requiring proof of • Physician and facility locations and information
good health (subject to guarantee issue limits). • Claims and deductible status or additional ID cards
• Medical services or prescription drug costs and lower
• Lincoln Financial Group’s EmployeeConnectSM will
provide a similar benefits through an updated Employee cost options
Assistance Program. • Discounts on health and wellness services

MEDICAL COVERAGE CIGNA HEALTH IMPROVEMENT
Benedictine School offers medical coverage through Cigna, Cigna offers many wellness opportunities to help you get
a national healthcare company. Cigna provides members healthy and stay healthy. A few of the free tools and services
with access to a nationwide network of providers in available to help you achieve your health and fitness goals
addition to discounts on health and wellness services. include Biometric Screenings, Health Assessments and
Employees have the choice of selecting between two medical Seminars. Log into mycigna.com for additional information.
plans. Both plans cover services through network providers
after meeting the deductible. Referrals to Specialists are HEALTH ADVOCACY SERVICES
not required and preventive care is not subject to the Health Advocacy services are offered to all eligible
deductible. employees. Personal Health Coaches will assist members
in coordinating their medical care and treatment, locating
• Option I: HMO HRA $1500 Plan through the Health providers, explaining benefits and resolving claim issues.
Reimbursement Arrangement (HRA). This is a great plan They also can help members identify wellness services and
to choose for employees with frequent medical visits. alternative medicine as well as locate appropriate senior
care or special needs services.
• Option II: HMO HRA $4000 is higher deductible plan Members have access to these free, confidential services by
with significantly lower premiums and increased funding calling toll-free: (866) 799-2725.
provided by the Benedictine School. This plan is an
excellent choice for employees who use medical services
on limited basis.

2

Medical Plan Comparison

Cigna Open Access Medical Plans HMO HRA Open Access Plan HMO Bronze Open Access Plan
Services Per Benefit Period Network Only - No Referrals Network Only - No Referrals
Health Reimbursement Arrangement Eligible NO
Lifetime Maximum Benefit YES Unlimited
Plan Year Deductible: Individual, Family Unlimited $4,000 / $10,000
Plan Year Out-of-Pocket Limit: Individual, Family $750 / $1,500 $6,350 / $12,700
Preventive Services $6,600 / $13,200 Not Subject to Deductible
Routine Preventive Care - All Ages Not Subject to Deductible 100%
Mammogram, PAP, PSA Tests 100%
Immunizations - All Ages 100% 100%
Hospitalization 100% Deductible Applies
Room & Board - Semi Private 100% 70%
Ancillaries & Surgery Deductible Applies 70%
Physicians Visits 80% 70%
Skilled Nursing Facility - 60 Days 80% 70%
Outpatient Services 80% Deductible Applies
Physicians Visits - PCP/Specialist 80% 70%
Diagnostic/Xray/Lab Deductible Applies 70%
Outpatient Surgery 80% 70%
Emergency Room 80% 70%
Mental Health/Substance Abuse Visits 80% 70%
Prescription Drug Copays 80% Deductible Applies
Tier 1 / Tier 2 / Tier 3: 30-Day Supply 80% 70%
Tier 1 / Tier 2 / Tier 3: 90-Day Supply Not Subject to Deductible 70%
$10 / $50 / $75
$30 / $150 / $225

Please Note: If a medical diagnosis is indicated during a Preventive Care visit, the deductible may apply.

Medical Plan Per Pay Costs $113.47 $48.84
Individual $217.15 $92.79
Individual/Child(ren) $240.18 $102.56
Individual/Spouse $343.79 $146.51
Family

MOBILE ACCESS TO YOUR MEDICAL PLAN
The MyCigna Mobile App gives you an easy way to access your health information.
Anytime. Anywhere. Download it today from the App StoreSM or Google PlayTM .

• Find a doctor or health care facility
• View ID cards for the entire family
• Review deductibles, account balances and claims

3

Health Reimbursement Arrangement

EMPLOYER DEDUCTIBLE CONTRIBUTION

Benedictine School provides a Health Reimbursement Arrangement (HRA) to employees enrolling in both Cigna HMO HRA
medical plans. The HRA is set up through Cigna and will pay for qualified deductible expenses under the medical plan.

How the HRA works: HRA TIPS & TOOLS

• At the start of the plan year, employees enrolled in individual coverage will
have access to HRA funding in the amount of $750. Employees enrolled in • Stay on top of your HRA
family coverage or any other coverage levels will have access $1,500. balance
--Visit: www.mycigna.com
• After an employee has exhausted the HRA funds provided by the Benedictine
School, the remaining deductible expenses are the employee’s responsibility. • Be sure to use your HRA only
for expenses that apply to the
• HRA funds will pay eligible medical plan expenses and the amount will be medical plan deductible
applied to your deductible (the amount you pay out-of-pocket before your -- Expenses that do not apply
plan starts to pay). will not be covered

• Providers will be directly reimbursed through Cigna, without the need to pay • If you anticipate that you will
up-front and submit claim forms. incur expenses during the plan
year which are not covered
• Employees should review their benefit statements or visit mycigna.com to under the medical plan or
track their deductible, HRA balance and claims status. reimbursed through the HRA...

-- Open an FSA and use pre-
tax money to pay for these
expenses.

Benedictine School EBC Employee Benefit Center (EBC)

Website: http://benedictine.ubaebc.com Employees are encouraged to log into the Benedictine School
Username: Benedictine Employee Benefit Center (EBC) to access plan benefits, forms
Password: benefits and other benefit resources. The EBC offers:

• Benefits information 24-hours a day, 7 days a week

• Quick access to plans, provider directories, SPDs,
forms, and other content

• Online Health and Wellness Resources that provides
information to help you and your family manage
lifestyle issues

• Financial Planning Calculators to assist you with
managing your finances

4

Flexible Spending Accounts

The Flexible Spending Account Program (FSA) is administered through CareFlex. FSAs allow you to reduce your taxable
income by setting aside pre-tax dollars to pay for qualified medical and dependent care expenses. You may use the CareFlex
Benefits Card to pay for eligible expenses. Be sure to keep your itemized receipts and statements as documentation. You do
not need to enroll in the medical plan to participate in a FSA.

HEALTH AND DEPENDENT CARE FSA CLAIMS AND REIMBURSEMENT
FSAs allow you to save money on health care and dependent
care expenses by using pre-tax dollars to pay for the following Employees have online access to account information
types of expenses: through the CareFlex Participant Portal. To register for an
account, visit www.mywealthcareonline.com/careflex/ and
• Health Care: Out-of-pocket health care expenses for select “Register for an Account”. If the Benefits Card is not
medical, dental and vision care (such as deductible and used, there are two reimbursement options:
copayments, glasses, orthodontia or prescription drugs).
• Enter claims online through the Participant Portal; or,
• Dependent Care: Child care for children under the age of
13 (such as day care centers, or in-home day care for an • Fax, email or mail a reimbursement request with
incapacitated spouse or elderly parent). School tuition supporting documentation
(kindergarten and higher) and overnight camps are not
eligible expenses. Email: [email protected]

FSA CONTRIBUTIONS Mail: 205 W. Dares Beach Road
Contributions are pre-tax through payroll deductions. The Prince Frederick, MD 20678
maximum you may contribute for the plan year is:
• Health Care FSA: $2,600 Fax: (410) 414-8432

• Dependent Care FSA: $5,000 ($2,500 if you are married For questions, CareFlex can be reached toll-free by calling
and file a separate tax return) (888) 577-2762.

BENEFITS CARD CAREFLEX MOBILE APP
Employees will receive the CareFlex Benefits Card that The Mobile App is a convenient way for you to view your
provides convenient access to FSA funds. It is important account balance and details. In addition, you can also:
to save all your receipts in the event you are required to • File claims and take a picture of a receipt
document the eligibility of an expense. • Upload receipts and other documentation
• Receive notifications
The app may be downloaded by visiting www.careflex.com.
To access your account via your mobile device, enter your
CareFlex Portal account username and password.

CareFlex Benefits Card FSA PLAN YEAR

USING YOUR FSA Expenses must be incurred during the November 1, 2017 -
You can use your funds for yourself as well as any of your October 31, 2018 Plan Year. Contributions cannot be carried
dependents, regardless of whether they are covered by over; remaining funds will be forfeited. Changes to your
your medical, dental or vision plan. For a listing of eligible contribution elections are not permitted unless you have a
expenses, please review the FSA Eligible Expense Guide qualified life status change. Be sure to carefully review your
available online at www.careflex.com. annual Health Care and Dependent Care expenses prior to
making your contribution elections.

Re-Enroll Reminder A new election is required each Plan Year to participate in an FSA, even if you are

keeping the same election. You are not required to be enrolled in a medical plan to enroll in an FSA.

5

Employee Assistance Program

RESOURCES YOU NEED TO MEET LIFE’S CHALLENGES

An Employee Assistance Program (EAP) is available at no cost to all employees. EmployeeConnectSM services are included with
your long-term disability insurance through Lincoln Financial Group. The EAP provides counseling and assistance for a wide
array of personal challenges, family difficulties, stress and other life issues.

Unlimited 24/7 Assistance EmployeeConnectSM counselors are experienced and
You can access the following services anytime, online or credentialed
with a toll-free call: When you call our toll-free line, you’ll talk to an
• Information, resources, and referrals on family matters, experienced professional who will provide counseling,
worklife advice, and referrals. All counselors hold master’s
such as child and elder care; kennels and pet care; event degrees, with broad-based clinical skills and at least three
and vacation planning; moving and relocation; years of experience in counseling on a variety of issues.
car buying; college planning; and more For face-to-face meetings, you will be referred to a fully
• Legal information and referrals for situations requiring credentialed, state-licensed clinician.
expertise in family law, estate planning, landlord/tenant
relations, consumer and civil law, and more You’ll receive a customized information packet for
• Guidance with financial matters, including household each of the work-life services you use.
budgeting, and short- and long-term planning To take advantage of the EmployeeConnectSM program,
or for more information:
In-person Guidance
Some matters are best resolved by meeting with a Visit www.GuidanceResources.com
professional in person. With EmployeeConnectSM, you’ll get: or call 888-628-4824.
• In-person help for short-term issues (up to four* sessions

with a counselor per person, per issue, per year)
• In-person consultations with network lawyers, including

one free 30-minute in-person consultation per legal
issue, and subsequent meetings at a reduced fee

Online resources
EmployeeConnectSM offers a wide range of information and
resources that you can research and access on your own
just by visiting GuidanceResources.com. You’ll find:
• Articles and tutorials
• Streaming videos
• Interactive tools — including financial calculators,

budgeting spreadsheets, and a language translator

6

Dental Coverage

DENTAL PLAN The plan includes the Dental Wellness Plus feature that
offers members the opportunity to increase their benefit
The Cigna PPO Dental plan covers services in or out-of- the following year. Members must receive an exam and
network. The plan year maximum benefit and deductible cleaning during the year to be eligible. Please refer to
is based on a calendar year. your plan materials for additional information on this
feature.
Cigna PPO dental providers have agreed to accept the
contracted fee as payment in full for covered services. Cigna PPO network providers and further plan information
Services received through non-network providers are can be can be accessed online by visiting www.cigna.com.
reimbursed based on Usual, Customary and Reasonable
(UCR) charges at the 80th percentile. Members are
responsible for costs that exceed these charges.

Cigna Dental PPO In Network Out-of-Network

Calendar Year Benefit Per Person * Year 1: $1,000, Year 2: $1,100
Year 3: $1,200, Year 4: $1,300
Calendar Year Individual Deductible
Calendar Year Family Deductible $25 $25
Class I Expenses - Preventive Care (Deductible Waived)
$75 $75
Oral Exams, Cleanings, X-rays, Fluoride Application, Sealants, Space
Maintainers 100% 100% of UCR **

Class II Expenses - Basic Restorative Care 80% 80% of UCR **

Fillings, Emergency Care, Root Canal Therapy/Endodontics, Osseous Surgery,
Periodontal Scaling and Root Planing, Oral Surgery, Extractions of Impacted
Teeth, Repairs to Bridges, Crowns, Inlays

Class III Expenses - Major Restorative 80% 80% of UCR **

Crowns, Dentures, Bridges, Inlays/Onlays, Prosthesis Over Implant,
Stainless Steel/Resin Crowns

Class IV Expenses - Child Orthodontia, Deductible Waived 50% - $1,500 Lifetime Maximum

Dependent children to age 19

* Your yearly benefit increases to the next level if Class 1 services are utilized in the prior year

** Services received out-of-network are reimbursed based on Usual, Customary and Reasonable charges (UCR) at the 80th percentile.

Dental Plan Per Pay Costs $5.90
Individual $12.18
Individual/Child(ren) $9.81
Individual/Spouse $16.78
Family

7

Vision Coverage

VISION PLAN Services received out-of-network are reimbursed
based on a schedule as outlined below. Members
The Cigna PPO Vision plan covers services in and out- will need to pay for services at the time of the visit
of-network. The Cigna network includes independent and submit a claim form to Cigna for reimbursement.
optometrists and ophthalmologists as well as retail Members may visit www.cigna.com for provider
providers such as Pearle Vision, Sears Optical and JCPenney information and further details.
Optical. Savings are maximized when receiving care from
participating providers.

Cigna Vision PPO In Network Out-of-Network L•o cating Network Providers
Reimbursement
Service Frequency • Log in to myCigna.com and
Once per Plan Year click on the “Cigna Vision
Eye Exams coverage” page
Lenses 100% Up to $45
• Select “View Details”, then
Single Vision 100% Up to $32 “Find a Cigna Vision Network
Bifocal 100% Up to $55 Eye Care Professional” to
Trifocal 100% Up to $65 search the Cigna Vision
Lenticular 100% Up to $80 Directory.

Frames Benefit up to $130 Up to $71 • If you don’t have access to
myCigna.com, visit www.
Contact Lenses (in lieu of eyeglasses) Benefit up to $130 Up to $105 cigna.com and click on the
Elective 100% Up to $210 orange “Find a Doctor” tab
Therapeutic at the top. Select the “Cigna
Vision Directory” and enter
Vision Plan Per Pay Costs your city, state and zip code.

Individual $2.27 • Questions? Call the toll-free
Individual/Child(ren) $3.36 number found on your Cigna
Individual/Spouse $4.48 ID Card to speak with a Cigna
Family $5.81 Vision customer service
representative.

8

Life & Voluntary Supplemental Life

GROUP LIFE AND SUPPLEMENTAL/DEPENDENT LIFE

Benedictine School provides Basic Life and Accidental Death and Dismemberment Insurance (AD&D) at no cost to eligible
employees. Employees may purchase Voluntary Life and Disability Insurance through Lincoln Financial Group. Voluntary Life
benefits may be purchased for a spouse and/or child(ren) provided the employee purchases coverage.

BASIC LIFE AND AD&D VOLUNTARY LIFE RATES
• Life Insurance Benefit of $15,000
• AD&D Benefit of $15,000 Voluntary Life Monthly Rates Per $1,000
• Benefits are issued without evidence of good
health Age Employee Spouse

<24 $0.05 $0.05

25-29 $0.06 $0.06

30-34 $0.08 $0.08

VOLUNTARY LIFE BENEFIT OPTIONS 35-39 $0.09 $0.09

• Employee: Increments of $10,000 up to a 40-44 $0.13 $0.13
maximum of $150,000, not to
exceed five times annual salary 45-49 $0.20 $0.20

Guarantee Issue: $150,000 50-54 $0.30 $0.30

55-59 $0.46 $0.46

• Spouse: Increments of $5,000 up to 60-64 $0.66 $0.66
$50,000, not to exceed 2 1/2 times
the employee’s salary 65-69 $1.27 $1.27
Guarantee Issue: $30,000
70-74 $2.06 N/A

75+ $4.21 N/A

All Children $0.112/$1,000

• Children: To age 19 (or to age 26 Note: Spouse coverage ends at age 70
if a full-time student):
Increments of $2,000 up to $10,000 EVIDENCE OF INSURABILITY
14 days to 6 months: $250. 6 month
to age 19 (26 if a full-time student): Employees applying for this coverage 31 days after
option of $2,500, $5,000, or $10,000 becoming eligible will need to complete a form attesting
Guarantee Issue: $10,000 to good health and may be subject to a health exam.


OPEN ENROLLMENT for Voluntary Life

Lincoln Financial Group is offering employees the opportunity to elect benefits on a guaranteed acceptance basis
without requiring proof of good health (subject to guarantee issue limits). Employees applying for coverage at a later
date will be subject to medical evidence of insurability. We encourage you to take advantage of this limited time offer.

9

Voluntary Disability

VOLUNTARY DISABILITY

Disability Insurance helps to supplement an employee’s income in the event of a non-work related accident or illness. These
plans are available to employees through Lincoln Financial Group (LFG) at discounted group rates. Employees who apply for
this coverage after their initial eligibility period will be subject to medical evidence of insurability.

VOLUNTARY SHORT TERM DISABILITY VOLUNTARY LONG TERM DISABILITY
Employees may purchase Voluntary Short Term Disability
coverage which pays benefits for up to 11 weeks. Employees may purchase Voluntary Long Term Disability
coverage which pays benefits for an extensive disability.
• The policy pays 60% of your weekly salary, to a
maximum of $1,000 per week. • The policy pays 60% of your monthly salary, to a
maximum of $5,000 per month.
• Benefits begin on the 15th day of a disability due to
an accident or an illness. • Benefits begin after 90 days of a disability and are
payable for 2 years if you are disabled from your
• Employees receiving care, treatment or medication own occupation, then to Social Security Normal
for a condition during the 3 months prior to the Retirement Age (SSNRA) if you are disabled from
coverage date must remain treatment free for any occupation.
6 months to be covered for that condition. Any
condition that occurs within 12 month after the • Employees receiving care, treatment or medication
effective date is subject to pre-existing condition for a condition during the 3 months prior to the
limitions. coverage date must remain treatment free for
6 months to be covered for that condition. Any
The employees coverage will transition and credit condition that occurs within 12 month after the
apply toward the pre-existing condition time period. effective date is subject to pre-existing condition
limitions.• The cost of this plan is $0.48 per $100
• The cost of this plan is $0.39 per $10 of benefit.

Sample Cost Calculation - Salary of $30,000 Sample Cost Calculation - Salary of $30,000
$30k divided by 52 weeks = $577 x 60% (.6) = $346 $30k divided by 12 months = $2,500 x .48 = $1,200
$346 x 0.39 = $134.94 divided by $10 = $13.49 $1,200 divided by $100 = $12.00
$13.49 per month x 12 divided by 26 pays = $6.23 per pay $12.00 per month x 12 divided by 26 pays = $5.54 per pay

OPEN ENROLLMENT for Voluntary Disability

Lincoln Financial Group is offering employees the opportunity to elect benefits on a guaranteed acceptance basis
without requiring proof of good health (subject to guarantee issue limits). Employees applying for coverage at a later
date will be subject to medical evidence of insurability. We encourage you to take advantage of this limited time offer.

10

Additional Voluntary Plans

VOLUNTARY ACCIDENT AND CRITICAL ILLNESS

Employees have the opportunity to purchase voluntary accident and critical illness coverage through Cigna. Each plan pays
benefits directly to the employee, and coverage may also be purchased for a spouse and eligible dependents. Both plans are
portable and may be continued in the event of an employee’s termination of employment.

Employees may elect one or both plans: Critical Illness Insurance: Supplements health coverage for
expenses associated with a critical illness. The plan pays
Accident Insurance: Helps to offset the cost of deductible a cash benefit when diagnosed with a covered condition.
expenses, copays or fees incurred from accidental Employees may purchase a benefit amount of $5,000,
injuries. The plan pays a lump sum cash benefit for a $10,000 or $20,000. Spousal benefits are available for up
broad range of accident treatments and conditions. to 50% of the employee amount and 25% of the employee
Examples of covered injuries include burns, dislocations, amount may be purchased for child(ren). Examples of
fractures, lacerations. Services covered under this plan covered conditions include:
include: • Cancer
• Heart Attack or Stroke
• Emergency Care Treatment • Renal (Kidney) Failure
• Major Organ Transplant
• Intensive Care Stay or Hospital Admission • Paralysis
• Amyotrophic Lateral Sclerosis (Lou Gehrig’s disease)
• Ambulance Services • Blindness
• Coronary Artery Disease (surgery)
• Office visits,
Covered members are also provided with a $50 benefit
• Diagnostics amount for annual Health Screening Tests.

• Follow-up Care

This plan also includes a yearly benefit of $50 per
person for Wellness Visits, Health Screening Tests and
Preventive Care services for each covered member.

Accident Plan - Per Pay Costs Non-Smoker Per Pay Cost - Benefit Amount of $10,000 *
Individual Age
Individual/Child(ren) Employee Employee + Spouse Family
Individual/Spouse <25
Family $4.18 25-29 $1.78 $3.15 $3.30
$7.73 30-34
$7.37 35-39 $2.05 $3.50 $3.66
$10.61 40-44
45-49 $2.68 $4.34 $4.49
50-54
55-59 $3.58 $5.71 $5.86
60-64
65-69 $4.67 $7.20 $7.36
70-74 $6.56 $10.07 $10.22
75 - 79
$8.62 $13.88 $14.03

$11.49 $18.84 $19.00

$14.66 $24.47 $24.62

$18.43 $30.09 $30.24

$25.22 $41.61 $41.76

$33.27 $54.83 $54.99

* Rates illustrated reflect an employee benefit amount of $10,000, a
benefit amount of 50% of the employee amount for a spouse and 25% of
the employee amount for child(ren). Please refer to the plan document
for complete cost details.

Please refer to the Cigna plan documents for additional information.
11

retirement plan & benefit changes

403(b) RETIREMENT PLAN CHANGING Your Benefits

Benedictine School offers employees the opportunity to Employee medical, dental, vision and FSA contributions
participate in a comprehensive retirement plan through are payroll deducted on a pre-tax basis before State,
Principal Financial Group. The tax deferred income plan Federal and Social Security taxes are withheld.
allows employees to save money on a pre-tax basis.
Employees may invest up to a maximum set by law of • Benefits you elect are in effect through the
$18,000 in calendar year 2017 and 2018. Employees age entire Plan Year and cannot be changed unless
50 or older may defer an additional $6,000 as a catch-up you have a qualified life status change.
contribution. For plan eligibility and details, please contact
the Human Resources Department. • If you have a qualified benefits change and wish
to change your benefits accordingly, you must
contact the Human Resources Department and
complete the necessary paperwork within 30
days of the qualified change.

Benefit Contacts Directory

Medical, Dental, Vision Plan and Cigna (800) 244-6224 www.mycigna.com
Health Reimbursement Arrangment www. careflex.com
www.lifeworkstrategies.com
Flexible Spending Accounts CareFlex (888) 577-2762 www.mycigna.com
www.principal.com
Employee Assistance Program LifeWork Strategies (877) 252-8550
(800) 754-3207
Basic Life, Voluntary Life, Cigna (800) 547-7754
Voluntary Disability, Critical IIlness and
Accident Plans

Retirement Plan Principal Financial Group

Insurance Broker Jennifer Shipp, Vice President (443) 837-0662 [email protected]
Insurance Solutions [email protected]
Megan Ross, Account Coordinator (443) 837-0667

This summary provides an overview of your health and welfare benefits. It does not include all of the terms, coverages, exclusions,
limitations and conditions of the actual contract language. The descriptions within this summary do not guarantee coverage or
benefits. If a discrepancy exists between the benefits and descriptions within this summary and the legal documents governing each
benefit, the legal documents will prevail. For more detailed information on the plans and your legal rights under each plan, please refer
to the summary plan descriptions or request a copy of the applicable plan documents.

Summary provided courtesy of Insurance Solutions
www.insursol.com

12


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