Valent-2018-BenefitsGuide-VBC MA-R9-103117

2018

EMPLOYEE BENEFITS

Valent BioSciences

January 1, 2018 – December 31, 2018

Products That Work, From People Who Care®

VBC MA – Osage

Table of Contents

Your Carrier Contacts.................................................................................................................2
Our Benefits Philosophy.............................................................................................................3
Eligibility & Changes...................................................................................................................4
Your Medical Plan Choices.........................................................................................................8
Medical Plan Comparison........................................................................................................10
Your Dental Plan Choices.........................................................................................................12
Your Vision Plan.......................................................................................................................14
Your Life and AD&D Plan Choices ..........................................................................................15
Your Disability Plan Choices.....................................................................................................17
Your Long-Term Care (LTC) Plan.............................................................................................19
Your Business Travel Accident Plan.........................................................................................20
Your Flexible Spending Accounts (FSA) Choices.....................................................................21
Your 401(k) Savings Plan.........................................................................................................24
Your Employee Assistance Program........................................................................................25
Benefits Online Enrollment Information....................................................................................26
LifeLock Identity Theft Protection.............................................................................................28
Your Benefit Resources............................................................................................................29
Important Annual Notices.........................................................................................................30
Notes........................................................................................................................................ 31

About This Guide

This guide highlights certain components of the Valent Benefits program, but it is only an overview. Separate legal
contracts and documents control the operation of any specific plan. This guide does not take the place of the official
plan documents (or Summary Plan Description) and contracts, which are the final authority on plan provisions used to
determine how and when benefits are paid. Valent reserves the rights to change, amend, suspend, withdraw, or terminate
any or all of the plans, in whole or in part, at any time. Further, neither the plans nor this guide are an employment
contract. They do not guarantee you the right to continued employment at Valent. Valent, at its option, may change,
delete, suspend, or discontinue parts or the policy in its entirety, at any time without prior notice.

Employee Benefits 2018 1

Your Carrier Contacts

FOR ALL BENEFIT RELATED QUESTIONS CONTACT:

Valent Benefits Helpdesk: 888.732.1635 Cigna Life and Disability
[email protected] Group Numbers

Blue Shield Premier PPO & Blue Shield High Deductible • Life: #FLX964481
PPO/Health Savings Account (HSA) • AD&D: #OK966071
www.blueshieldca.com • STD: #LK751080
Electronic Claims go to Blue Shield of CA (BSC) • LTD Core: #LK963159
Outside of CA: Electronic Claims go to BCBS plan • LTD Buy Up: #FLK960612
All Paper claims go to Blue Shield of CA • Vol Life: #FLX964481
Customer Service........................................ 888.256.1915 Customer Service.................... 800.362.4462 (36-CIGNA)
Provider Finder in CA..................................888-256-1915
Provider Finder outside of CA....................800.810.BLUE Additional Services by Cigna
Pre-Certification Review...... 800.541.6652 (Providers only) Cigna’s Will Preparation Program............... 800.901.7534
NurseHelp................................................... 877.304.0504 www.CIGNAWillCenter.com
Cigna Healthy Rewards............................... 800.258.3312
Blue Shield Group: #W0002608 Cigna Identity Theft Program....................... 888.226.4567
Blue Shield Policy Numbers (all): #W0002608
MHN Employee Assistance Program - Effective January 1, 2018
Blue Shield Plans – Prescription Drug Services www.mhn.advantageengagement.com
P.O. Box 7168, San Francisco, CA 94120-7168 Company Code: valent
Pre-Authorization................. 800.535.9481 (Providers only) Customer Service........................................ 800.227.1060

HealthEquity – HSA Administrator Unum Long-Term Care
www.healthequity.com Group: #577081
Customer Service........................................ 877.857.6810 www.unum.com
Customer Service........................................ 800.421.0344
Aetna Dental Plan
Group: #837088 Ameriflex Flexible Spending Account
www.aetna.com www.myameriflex.com
Customer Service........................................ 877.238.6200 Customer Service....................................... 888.868.3539

VSP Vision Plan A.C. Newman & Co. Business Travel Accident
Group: #30005544 Group: #BTA-122316
www.vsp.com Reference: #01-AA-ACN-06048
P.O. Box 997105, Sacramento, CA 95899-7105 Assist America Within USA.......................... 800.872.1414
Customer Service........................................ 800.877.7195 Assist America Outside USA....................... 609.986.1234

Travel Assistance Program
Cigna Secure Travel
Customer Service........................................ 888.226.4567

LifeLock
www.lifelock.com
Member Services........................................ 800.607.9174

2 VBC MA – Osage

Our Benefits Philosophy

At Valent, our employees are the key to our continued success. That is why Valent
proudly offers you and your family a comprehensive benefits program designed with
the following objectives in mind:

• Are aligned with the company’s financial objectives
• Are competitive with market practices and cost effective on an overall basis
• Positively contribute to and support Valent’s culture
• Provide choice and flexibility for employees based on individual needs
• Empower an educated and self-reliant population

Your benefits are a significant part of your total compensation here at Valent and represent a large
investment Valent makes in our employees. The company invests a great deal in your health and financial
security, but it is ultimately up to you to get the most from them by taking the time to understand your choices
and by selecting the best coverage for you and your family.

This guide provides an overview of the benefits available to you as an eligible employee. We encourage
you to carefully review this material and keep it handy for future reference.

If you have any questions, please contact: 3
Rose Santos

925.256.2826 | [email protected]
or

Valent Benefits Helpdesk
888.732.1635 | [email protected]

Employee Benefits 2018

Eligibility & Changes

If you’re classified as an active, regular employee working 30 or more hours per week, you can
participate in the benefits described in this guide. If you are a newly eligible employee, benefit coverage
will begin coinciding with or on the first of the month following your date of hire. If you are enrolling or
making changes during the annual enrollment, your coverage becomes effective January 1.
You must make your benefit elections within your enrollment period, which begins on the date you are
hired and runs for 31 consecutive calendar days.
Your eligible dependents include:

• Your spouse (as defined by applicable state law)
• Your same-sex or opposite sex domestic partner who meets certain criteria

(listed on the next page)
• Your dependent children up to age 26
• Your dependent children age 26 or older with a physical or mental disability as defined by the

Social Security Administration
Your children include:

• Your or your domestic partner’s natural or adopted children who can be claimed as your tax
dependents

• Your stepchildren whom you support and who live with you in a parent-child relationship
• Children placed in your home for adoption
• Any other children you support for whom you are the legal guardian or for whom you are

required to provide coverage as the result of a qualified medical child support order

DOMESTIC PARTNERS

You may enroll an opposite-sex or same-sex domestic partner as a dependent if all requirements have
been met.
If you are covering your legally married same-sex spouse, there will be no federal imputed income, as
the federal government now recognizes same-sex marriage. If you are covering your legally married
same-sex spouse, you will be charged state imputed income if you reside in a state that does not
recognize same-sex marriage, and your state of residence has a personal income tax. 

4 VBC MA – Osage

All federal and state requirements should be reviewed to ensure you understand the requirements of your
specific state and to ensure you are in compliance with federal and state laws.

The term “domestic partnership” shall mean a relationship between an employee and a person of the
opposite sex or the same sex (“domestic partner”) in which all of the following requirements are met:

1. Both individuals are at least eighteen (18) years of age and are mentally competent to
consent to a contract

2. Neither individual is married to, legally separated from, or a domestic partner of, another
person either under statutory or common law

3. The individuals are not related to each other in any way that would prohibit a legal marriage
between the individuals in the state in which the individuals reside

4. The individuals reside together in the same residence and share the common necessities of life.
5. The individuals must be financially interdependent
6. The individuals have not entered into the domestic partnership relationship solely for the

purpose of obtaining health coverage under the company’s plan

Enrollment of ineligible or unqualified individuals as a dependent is not permitted and may result in
disciplinary action up to and including termination.

ENROLLING IN YOUR BENEFITS

What you need to do:
• Review the materials included in this Enrollment Guide
• Make your personal decisions by logging on to ADP at https://workforcenow.adp.com
• If you have any questions during your enrollment, please contact the Valent Benefits
Helpdesk at 888.732.1635
• You must make your benefit elections within 31 days from your date of hire

Once you have completed your enrollment, you can expect the following:
• If you are enrolling in a medical plan for the first time or have changed plans, you will receive ID
cards for the benefit plans you elected within approximately 5-7 business days of your
enrollment. You should verify that all information on the card is correct, including your name and
the plan you selected. If you need to access any benefit/provider prior to receiving your ID card
please have your provider (doctor, dentist, etc.) contact the carrier’s 800# to verify eligibility.
• No ID cards are issued for the Aetna Dental or VSP Vision plans. Although it is not needed for
your appointment, you may print a copy of the ID card online by logging onto the Aetna or
VSP website.

Employee Benefits 2018 5

CHANGES IN BENEFIT ELECTIONS

You can enroll in benefits as a new hire or during annual enrollment. Your elections are binding for the
entire 2017 calendar year, and you cannot change your elections unless you have a qualified life status
event as defined by the IRS. If you experience a qualified life status event, you have 30 days to report
the event and request applicable benefit changes. Qualified life status events include:

• Legal marital status – marriage, death of spouse, divorce, legal separation or annulment.

• Declaration of Domestic Partner Status – declaration or termination of partnership.

• Number of dependents – including birth, adoption, dependent child reaching age 26,
acquiring stepchild or death.

• Employment status – you, your spouse or your child either start or stop working and gain or
lose coverage through another health plan.

• Work schedule – standard working hours for you, your spouse or your child either increase
or decrease. Switch from full-time to part-time employment or vice versa.

• Dependent satisfies or ceases to satisfy dependent eligibility requirements.

• Residence or work site – you move in or out of your medical plan’s service area as the
result of a change in the place where you or spouse live or work.

If you experience one of these events and want to make a benefit change, you must make your election
within 30 days of the event by logging on to ADP at https://workforcenow.adp.com. From your ADP
home page, go to Myself/Dependents/Beneficiaries to add or remove your dependents. Then, go to
Benefits/Enrollments to enroll or cancel your dependent’s benefits coverage. You may be asked to
provide appropriate documentation and any benefit changes you make must be directly related to the
qualifying event. For example, if you adopt a child, you may add the child to your health care plan, but
not drop health care coverage for your spouse.

WHEN YOUR BENEFITS END

Your health benefits terminate once your employment ends as outlined below:

PLAN COVERAGE ENDS

Medical – Blue Shield Last day of the month in which you terminate
Dental – Aetna Last day of the month in which you terminate
Vision – Vision Service Plan Last day of the month in which you terminate
Flexible Spending Accounts – Ameriflex The date of termination
Basic Life/AD&D – Cigna The date of termination
Supplemental Life – Cigna The date of termination
Supplemental STD – Cigna The date of termination
LTD – Cigna The date of termination
LTC – Unum The date of termination
Employee Assistance Program – MHN The date of termination

6 VBC MA – Osage

You and your dependents that are covered under your medical, dental and vision coverage have the
right to continue participation in group health coverage as allowed under the Consolidated Omnibus
Budget Reconciliation Act (commonly referred to as “COBRA”). You have 60 days from your notification
date or coverage-end date to enroll in COBRA. If you enroll in COBRA, you will pay monthly payments
for the full premium plus a 2% administration fee. COBRA coverage is generally available for up to 18
months, with additional extensions available under certain circumstances.

Employee Benefits 2018 7

Your Medical Plan Choices

Choosing a medical plan is often a difficult decision to make because of its direct impact on you and
your family. It is important to look at your budget, preferences, the age and health of you and your
covered dependents, expected medical expenses and the cost of the choices. You should consider the
key differences between plan types and choose one that best suits you and your family.

The plans differ in the following areas:
• Cost of coverage, including payroll contributions and how you and the plan pay for services
throughout the year.
• Convenience, covered services, access to providers, ease of use.

You can always contact the Valent Benefits Helpdesk with any questions. Assistance is available to walk
you through the various options based on your individual needs.

BLUE SHIELD PREMIER PPO AND BLUE SHIELD HSA-QUALIFIED
HIGH DEDUCTIBLE PPO PLAN

The Blue Shield of California partnership with the national Blue Cross/Blue Shield Association enables
you to take advantage of the largest network of hospitals and physicians in the country. The relationship
allows you total freedom of choice about whom to see for your health care needs. When you use
network providers you save, because network providers agree to accept the negotiated rate as payment
for covered services. Members who use participating providers are not responsible for charges over the
negotiated rate.

HEALTH SAVINGS ACCOUNTS (HSA)

If you enroll in the HSA-qualified medical plans through Blue Shield, a Health Savings Account (HSA)
that allows you to save tax-free* for health care expenses will be opened for you.

In addition to tax-free* contributions, the HSA offers several other big savings advantages:
• Tax-free interest and investment earnings*
• Tax-free* withdrawals to pay for eligible health care expenses
• No “use it or lose it” - your balance rolls over from year to year so your savings grow all the
way through to retirement
• Employees age 55 and older can contribute an additional $1,000 each year
• You can invest your balance

You must enroll in the HealthEquity HSA in order to receive the Valent contribution. If you don’t make a
contribution of your own, you must elect $0 to receive the Company contribution.

8 VBC MA – Osage

WHAT YOU NEED TO KNOW ABOUT YOUR HEALTH SAVINGS
ACCOUNT (HSA):

You can only contribute to the Health Savings Account if you are enrolled in a HSA-Qualified Health
Plan. If you are covered under any other medical plan, including your spouse’s plan, you cannot
contribute to an HSA. In addition, if you are enrolled in Medicare, are receiving veterans’ benefits, can
be claimed as a dependent on someone else’s tax return or don’t have a valid U.S. address, you are
not eligible for an HSA. As an HSA plan is a tax-advantaged plan and everyone’s individual situation
is different, please consult with your Tax and/or Legal Advisor to review what enrolling in an HSA plan
would mean for you.

If you have an HSA, you cannot be enrolled in a Health Care Flexible Spending Account (FSA).
Your spouse cannot have a FSA either unless it is a limited purpose FSA (covers only dental and vision
expenses). However, you can still enroll in the Dependent Care Flexible Spending Account.

Valent will contribute to your HSA each paycheck. You will receive $28.85 per paycheck for single
coverage (for a total annual contribution of up to $750) and $57.69 per paycheck for family coverage
(for a total annual contribution of up to $1,500).

All contributions to your HSA must not exceed the maximums set by the IRS each year. The
maximum contribution (including the amount Valent contributes) for 2018 per IRS regulations is $3,450
if you cover yourself and $6,900 if you cover dependents. You may contribute an additional $1,000
“catch up” of $1,000 if you are age 55 or older.

What happens to the money in your HSA once you become enrolled in Medicare? Contributions
to your HSA must cease (including any contributions by Valent). However, the acumulated funds in
your HSA can still be used for the same types of healthcare expenses as before and those withdrawals
remain tax-free*.

*This is federal tax information; state taxes may apply for residents of CA, NJ and AL. For more detailed information about the tax implications of an
HSA, please contact your professional tax advisor.

Employee Benefits 2018 9

Medical Plan Comparison

Blue Shield PPO Blue Shield HSA-Qualified

High Deductible PPO

Plan Features Network Non-Network Network Non-Network

GENERAL

Calendar Year Deductible $250 Individual $2,250 Individual;
$500 Family $4,500 Family

Calendar Year Out $1,000 Individual $3,000 Individual $2,750 Individual 1 ;
of Pocket Maximum $2,000 Family $6,000 Family $5,500 Family 1
(Includes Deductible)
None
Lifetime Maximum Benefit None

OFFICE VISITS

Physician Office Visits $15 PCP / $30 Plan pays 70% Plan pays 80% Plan pays 50%
specialist (not subject

to deductible)

Preventive Care Covered at 100% Not covered Covered at 100% Not covered
(not subject to (not subject to
deductible) deductible) Plan pays 50%
Plan pays 50%
OUTPATIENT SERVICES Plan pays 80%
Plan pays 80%
Diagnostic Lab and X-ray $15 copay Plan pays 70%

Outpatient Surgery Plan pays 90% Plan pays 70%
Services

INPATIENT SERVICES

Hospital/Facility Services Plan pays 90% Plan pays 70% Plan pays 80% Plan pays 50%

Emergency Room Plan pays 90% Plan pays 80%
(not subject to deductible)

MENTAL HEALTH SERVICES

Inpatient Services Plan pays 90% Plan pays 70% Plan pays 80% Plan pays 50%
Plan pays 80% Plan pays 50%
Outpatient Services $15 copay Plan pays 70%
(not subject to Plan pays 80% Plan pays 50%
Plan pays 80% Plan pays 50%
deductible)

CHEMICAL DEPENDENCY/SUBSTANCE ABUSE SERVICES

Inpatient Services Plan pays 90% Plan pays 70%

Outpatient Services $15 copay Plan pays 70%
(not subject to

deductible)

1 When members use non-participating providers, they must pay the applicable deductibles, copayments or coinsurance plus any amount that
exceeds Blue Shield’s allowable amount. Charges above the allowable amount do not count toward the calendar year medical deductible or
out-of-pocket maximum and continue to be the Member’s responsibility after the Calendar Year Out of-Pocket Maximum is reached.
Under the Blue Shield of California HSA Plan, if you are covering dependents, you must pay the total, or aggregate, family deductible - rather than
just the individual deductible - before the plan starts to share costs with you. In addition, you must meet an aggregate family out-of-pocket maximum
before the plan pays 100% of covered services for the remainder of the calendar year.

10 VBC MA – Osage

Blue Shield PPO Blue Shield HSA-Qualified

High Deductible PPO

Plan Features Network Non-Network Network Non-Network

OTHER SERVICES

Acupuncture $25 per visit Plan pays 70% Plan pays 80% Plan pays 50%
(up to 20 visits per (up to 20 visits per (up to 20 visits per (up to 20 visits per

calendar year) calendar year) calendar year) calendar year)

Chiropractic Care $25 per visit Plan pays 70% Plan pays 80% Plan pays 50%
(up to 12 visits per (up to 12 visits per (up to 20 visits per (up to 20 visits per

calendar year) calendar year) calendar year) calendar year)

Physical Therapy $15 per visit Plan pays 70% Plan pays 80% Plan pays 50%

Durable Medical Plan pays 90% Plan pays 70% Plan pays 80% Plan pays 50%
Equipment

PRESCRIPTION DRUGS

Retail (30 day supply) $10 per prescription 25% of billed amount + $10 per prescription 25% of billed amount +
Formulary Generic $30 per prescription $10 per prescription $25 per prescription $10 per prescription
Formulary Brand Name $50 per prescription $30 per prescription $40 per prescription $25 per prescription
Non-Formulary Brand Name Please note: PPO $50 per prescription (copays apply once $40 per prescription
Rx copays are not deductible is met) (copays apply once
subject to deductible deductible is met)

Mail Order (90 day supply) $20 per prescription Not covered $20 per prescription Not covered
Formulary Generic $60 per prescription $50 per prescription
Formulary Brand Name $100 per prescription $80 per prescription
Non-Formulary Brand Name (copays apply once
deductible is met)

Specialty Pharmacies Plan pays 70% Not covered Plan pays 70% Not covered
(30 day supply) (up to $150 per (up to $150 per

prescription) prescription)

Non-Network claims are paid based on Blue Shield’s Allowed Amounts. You will be responsible for all charges above Allowed Amounts.

Unless otherwise stated, all medical and pharmacy services are subject to the calendar year deductible.

This chart provides a brief overview of benefits and coverage. Refer to the detailed disclosure/summary plan documents for each plan or questions
about a specific procedure, service or provider. In the event of a conflict, the official plan document prevails.

Please be advised that the Blue Shield of CA summary of benefits and evidence of coverage (EOC) supersede any other document and are the final
expression of what and how benefits are covered

(continued on next page)

Employee Benefits 2018 11

Your Dental Plan Choices

Our benefits program provides you and your dependents comprehensive dental benefits through the
Aetna PPO plan. Depending on where you live, you may also have the choice of a dental maintenance
organization plan through the Aetna DMO Plan.

AETNA DENTAL PPO

The Aetna Dental PPO gives you the freedom of choice to use any dentist you like, but you can
maximize your opportunity to save by using a dentist in the Aetna network. You will generally see lower
out-of-pocket costs because Aetna network dentists have agreed to offer their services at reduced fees.
By making use of the Predetermination of Benefits, you can obtain a pre-treatment estimate of your out-
of-pocket expenses so you can discuss treatment alternatives or make a financial arrangement with your
dentist before receiving dental care. An advanced claim review is recommended whenever a course of
dental treatment is likely to cost more than $350. This is a voluntary service in which Aetna will review
the proposed treatment plan and provide you and your dentist with a statement outlining the benefits
payable by the plan. In determining the amount of benefits payable, Aetna will take into account alternate
procedures, services, or courses of treatment for the dental condition in question in order to accomplish
the anticipated result.
If you choose to use a dentist that is not part of the Aetna network, your benefit will be based on
the Reasonable and Customary (R&C) allowance for the dental procedure performed. You will be
responsible for the charges over the R&C allowance in addition to your portion of the coinsurance.

AETNA DENTAL DMO

The Aetna dental maintenance organization (DMO) plan provides benefits through a network of
contracted dental offices. You and your covered dependents select from a list of participating dental
offices that meet your dental needs. By utilizing the Aetna DMO Plan, you pay less in cost sharing out
of your paycheck and less out-of-pocket for your dental care.
Under the Aetna DMO, there are no referrals required to visit an orthodontist within Aetna’s network.
However, referrals are required for care received from a DMO specialist. Also, there are no calendar
year deductible and no annual maximums. The Aetna DMO plan does not provide coverage if you seek
services from a provider that is not in the network.

12 VBC MA – Osage

Steps for Finding an Aetna Dental Provider
The DMO plan option may not be available in all states. Verify if your dental provider is in the Aetna
network or locate an in-network dental provider by using DocFind:

1. Log on to www.aetna.com/docfind/home.do?site_id=docfindpublic
2. You can search by location, name or complete an advance search
3. Select a Plan – either Dental Maintenance Organization (DMO) or Dental PPO/PDN for the PPO

Dental PPO Plan

Plan Features Network Non-Network Dental DMO

Calendar Year Deductible $50 Individual None
$150 Family

Calendar Year Maximum $1,500 per person None

Preventive Services Plan pays 100% of Plan pays 100% of Plan pays 100%
Includes oral exams, cleanings, fluoride negotiated fees R&C fees
treatments, diagnostic x-rays and dental
sealants. Exams and cleanings limited to (deductible waived) (deductible waived)
one every six months.

Basic Services Plan pays 80% of Plan pays 80% Plan pays 100%
Includes procedures such as fillings, negotiated fees after of R&C fees after
extractions, other oral surgery services,
endodontics, and periodontics. deductible deductible

Major Services Plan pays 50% of Plan pays 50% Scheduled copays
Includes bridgework, crowns, onlays, negotiated fees after of R&C fees after
inlays and dentures
deductible deductible

Orthodontia Services Plan pays 50% of Plan pays 50% $2,400 copay
Children and adults negotiated fees after of R&C fees after

deductible deductible

Orthodontia Lifetime Maximum $1,500 Up to 24 months
of comprehensive

treatment

Non-Network claims are paid based on Reasonable & Customary (R&C) amount. You will be responsible for all charges above the R&C.

This chart provides a brief overview of benefits and coverage. Refer to the detailed disclosure/summary plan documents for each plan or questions
about a specific procedure, service or provider. In the event of a conflict, the official plan document prevails.

Employee Benefits 2018 13

Your Vision Plan

The vision plan provider is Vision Service Plan (VSP). VSP offers convenient access to a variety of
qualified providers with over 40,000 preferred provider access points nationwide. In addition, VSP is
contracted with Costco and other high quality retail chains including VisionWorld and EyeMasters.

The VSP plan does not issue ID cards and one is not necessary to access vision care. Just visit the
provider of your choice (whether VSP or non-VSP) to receive services, and let the provider know you are
a VSP member. Also, VSP offers its members discounts at Laser Vision correction, and 20% off additional
glasses from the VSP doctor on the same day as your exam or within 12 months of last vision exam.

At www.vsp.com members can instantly view their benefits and savings, check eligibility, and find a
provider. Members can also call VSP directly at 800.877.7195.

Benefits Participating Provider Non-Participating Provider

Copays: $10 copay
• Exam $25 copay
• Frames/Lenses
Once every 12 months
Frequency: Once every 12 months
• Exam Once every 12 months
• Lenses Once every 12 months
• Frames
• Contacts (instead of glasses) Covered in full Up to $45 allowance

Exam Covered in full Up to $30 allowance
(Every Calendar Year) Up to $50 allowance
Up to $65 allowance
Lenses:
• Single
• Bifocal
• Trifocal

Frames $150 allowance (20% off amount Up to $70 allowance
over allowance)

Contacts $135 allowance Up to $105 allowance
(instead of glasses) Up to $60 copay for contact lens

exam (fitting and evaluation)

This chart provides a brief overview of benefits and coverage. Refer to the detailed disclosure/summary plan documents for each plan or questions
about a specific procedure, service or provider. In the event of a conflict, the official plan document prevails.

14 VBC MA – Osage

Your Life and AD&D Plan Choices

BASIC LIFE AND ACCIDENTAL DEATH & DISMEMBERMENT
(AD&D) INSURANCE

Valent automatically provides you with Basic Life and AD&D insurance coverage, through Cigna, equal
to two times your base annual salary to a maximum of $400,000. There is no cost to you for this
coverage, but you will be responsible for paying taxes on the cost of life coverage that exceeds $50,000

(imputed income). Section 79 of the Internal
Revenue Code requires that employees pay
taxes on the value of employer paid life insurance
coverage over $50,000.

Accidental Death and Dismemberment (AD&D)
insurance also provides a benefit when an injury
resulting from an accident causes a death or
other covered bodily losses. You are automatically
enrolled in AD&D coverage which provides a
benefit of one times your base annual salary to a
maximum of $400,000. Again, there is no cost to you for this coverage.

SUPPLEMENTAL LIFE INSURANCE

In addition to the Basic Life and AD&D insurance plans paid for by Valent, you are eligible to purchase
additional amounts of individual term Life insurance through Cigna for yourself, your spouse or
domestic partner, and your child(ren).

• Employees may purchase one to four times your annual earnings to a maximum of $600,000
(this maximum does not include your Basic Life coverage which is paid for by Valent).
The guaranteed issue amount (not requiring evidence of insurability) is $200,000. Excess
coverage can be declined and is not effective until approved by Cigna.

• Spouse/Domestic Partner may elect up to 50% of employee’s amount or $100,000,
whichever is less; in increments of $10,000. Evidence of Insurability is required for amounts
in excess of $30,000 (guaranteed issue level). Employees must purchase Supplemental Life
for themselves in order to purchase coverage for their spouse/domestic partner.

• Child(ren): Live birth to 14 days: $1,000. For children age 14 days or older, you may elect a
flat $10,000 benefit.

Benefits for an employee or spouse age 65 and over will reduce to 65% of the Life Insurance Benefit at
age 65 and to 50% of the Life Insurance Benefit at age 70.

Employee Benefits 2018 15

EVIDENCE OF INSURABILITY

If you and your dependents apply within 31 days after you are eligible to elect coverage, you are
entitled to choose any coverage offered up to the guaranteed issue amount without providing evidence
of good health. If you apply for an amount of coverage for yourself or your spouse greater than
the guaranteed issue amount, the additional amount will be subject to Cigna’s approval. Medical
underwriting includes a medical history questionnaire/statement and may also require an exam or blood
test.

Employee:
During the annual enrollment period, or within 31 days of a Life Status Change, an employee may increase
his or her Voluntary Life Insurance Benefit by one Benefit Level up to $100,000, as long as the total benefit
does not exceed the Guaranteed Issue Amount without satisfying the Evidence of Insurability requirement.
All coverage amounts that exceed the Guaranteed Issue amount, $200,000, will require approval through
medical underwriting.

Dependents:
At annual re-enrollment, your spouse/domestic partner will be required to complete Evidence of
Insurability (EOI) if you are electing after your initial eligibility period or if you elect coverage over
$30,000. Evidence of Insurability is not required for children.

If you elected Supplemental Life Insurance above the guaranteed issue amount or enrolled for the first
time after initial enrollment, or increased coverage at open enrollment, you will need to complete an
Evidence of Insurability form. Until satisfactory approval from Cigna:

• For new employees: Payroll will deduct the premium cost up to the guaranteed issue. The
additional cost for amounts in excess of the guaranteed issue will be payroll deducted the first
of the month following approval from Cigna.

• For current participants: The additional costs for any increase in coverage will be payroll
deducted the first of the month following approval from Cigna.

• For new enrollees at open enrollment: Costs for the entire amount elected will be payroll
deducted the first of the month following approval from Cigna.

Note: Premiums will be funded with after-tax dollars to generate a non-taxable benefit.

NAMING YOUR BENEFICIARY

You may name anyone you wish as the beneficiary to receive your Life and AD&D benefits in case of
your death. Once you have selected your beneficiary, your designation will remain unchanged until you
submit a new beneficiary designation in the Valent system. You may change your beneficiary as often
as you wish.

Log on to ADP self service, https://workforcenow.adp.com. Go to Myself/Dependents/Beneficiaries to
add your beneficiary. Then, go to Benefits/Enrollment/Life or AD&D to elect your beneficiary.

16 VBC MA – Osage

Your Disability Plan Choices

Disability benefits are designed to meet your needs for income replacement in the event of an illness or
injury that results in your inability to continue working. The amount of income you receive varies based
on the length of your disability.

SUPPLEMENTAL SHORT-TERM DISABILITY (STD)

You can elect to purchase Cigna Supplemental STD coverage to provide you with a portion of income
replacement should you be disabled as a result of an illness or injury (non-occupational). The Cigna
Supplemental STD plan provides replaces 66.67% of your earnings up to $1,465 weekly. Benefits begin
after you have been disabled for more than 7 days due to an illness and immediately after an accident.
Benefits are payable up to a maximum of 26 weeks. The benefit is non-taxable and will be offset by any
benefits you may receive from a state mandated disability plan.

IMPORTANT NOTE: If you do not elect STD coverage when first eligible for benefits, Evidence of Insurability will be
required and must be approved by Cigna if you enroll at a later date.

LONG-TERM DISABILITY (LTD) PLAN OPTIONS

Long-Term Disability (LTD) benefits help to provide you a stream of income if you become disabled and
are unable to work for an extended period of time. Benefits begin after 180 days of disability. Valent
offers two LTD plans through CIGNA to all benefit eligible employees.

BASE LTD PLAN

Because Valent believes income protection is important should you become disabled, the Base LTD
plan provides a benefit of 60% of monthly base salary to $1,250 per month to all eligible employees.
The premium for this plan is paid by Valent and all benefit eligible employees are automatically enrolled.
You must elect whether you want a taxable or non-taxable benefit election for the Cigna Base LTD plan.
Please consult with your tax advisor based on your individual situation.

• Taxable Benefit Election – Valent pays the premium and you will see no additional cost on
your paycheck. However, should you have a disability and need to access the benefit; your
benefit payment will be taxed.

• Non-Taxable Benefit Election – Valent pays the premium for the Cigna Core LTD benefit.
However, you would pay taxes on the premium so that your disability benefit will be non-
taxable should you need to access it.

IMPORTANT: If you do not make an election in ADP, your enrollment will automatically default to the Base Long Term Disability Taxable Benefit
Election in which Valent pays 100% of the premium and any disability benefits from the LTD plan will be taxable to you if you become disabled.

Employee Benefits 2018 17

LTD BUY-UP PLAN

If you want to purchase additional income protection, you can elect the LTD Buy-up plan which provides
a benefit of 60% of monthly base salary to $9,000 per month. The premium for this plan is entirely paid
for by you on a post-tax basis so that the disability benefit is non-taxable should you need to access it.

18 VBC MA – Osage

Your Long-Term Care (LTC) Plan

Long-Term Care provides a variety of services that includes medical and non-medical care to people
who have a chronic illness or disability. It can be provided at home, in the community, in assisted
living, or in nursing homes. You can purchase coverage through Unum for yourself, your spouse/
domestic partner, your parents and grandparents, and/or your spouse/domestic partner’s parents and/
or grandparents.

Long-Term Care insurance is designed to provide you with a monthly benefit when you and/or a family
member need assistance with any two of the six activities of daily living (i.e. bathing, eating, walking,
toileting, transferring, and dressing). Long-Term Care policies pay for care in institutions such as:

• Skilled Nursing Facilities and Assisted Living Facilities
• At home for home health care, personal care and homemakers’ services
• Hospice care and respite care
• In the community for Adult Day Care, Adult Day Health Care, or Alzheimer’s Day Care.

This type of care is often called custodial care or personal care. Medicare does not pay for this type of
care, but Long-Term Care insurance policies do.

Premiums are determined by an applicant’s age, as well as the level of cash benefit elected ($3,000 -
$8,000 per month, in $1,000 increments) and benefit duration (3 years, 6 years or unlimited duration).
A medical questionnaire must be completed for employees electing amounts above the $6,000
guaranteed issue level and the Unlimited Benefit Duration. A medical questionnaire is required for:

• Any coverage amount for eligible dependents;
• Employees who did not enroll when first eligible;
• Any increases in existing coverage.

Unum will determine whether the applicant is insurable under the Plan. The “Long-Term Care Benefit
Election Form” and “Long-Term Care Insurance Application” form must be completed and submitted to
Unum. Premiums will be deducted following approval from Unum.

Employee Benefits 2018 19

Your Business Travel Accident Plan

The A.C. Newman & Co. Business Travel Accident plan offers worldwide accidental death and
dismemberment coverage if you are traveling on business. All active full-time employees in the United
States and Canada are automatically covered under this program.

The plan pays a benefit to your beneficiary if you should accidentally die while traveling on company
business. It pays a benefit to you if you should lose the use of one or more limbs, a hand, a foot,
speech, hearing or eyesight from an accident during such travel.

THE BUSINESS TRAVEL ACCIDENT PLAN PROVIDES:

• Accidental Death Benefit (Principal Sum) of 3 times your Base Annual Earnings, subject to a
minimum of $200,000 and a maximum of $450,000

• Accidental Dismemberment and Paralysis Benefit up to 3 times your Base Annual Earnings,
subject to a maximum of $450,000

• Rehabilitation Expense Benefit of 1% of your Principal Sum up to $500 per month for 12 months

• Coma Benefit of 1% of your Principal Sum to a maximum of $1,000 per month for 12 months

• Seat Belt Benefit provides an additional 10% of your Principal Sum, up to $25,000

• Air Bag Benefit provides an additional 5% of your Principal Sum, up to $10,000

• Therapeutic Counseling Benefit provides $500 per month for up to 12 months while under the
care of a licensed therapist

• Adaptive Home and Vehicle Benefit provides 10% of you Principal Sum to a maximum of $25,000
for alterations to a principal residence or personal automobile as a result of a covered accident

Assist America is a 24-Hour Travel Assistance program that includes a broad level of services and/or
protection for employees when traveling on business 100 miles or more away from home.

Travel Assistance Services Include: Personal Assistance Services Include:

Medical Consultation Emergency Message Transmission

Evaluation and Referral Transportation to Join Patient

Hospital Admission Guarantee Care for Minor Children

Emergency Medical Evacuation Return of Mortal Remains

Critical Care Monitoring Emergency Trauma Counseling

Medically Supervised Repatriation Pre-trip information, Lost Luggage or Document Assistance

Prescription Assistance Interpreter and Legal Referrals

If you are age 70 or older when you suffer the loss, the amount payable for a loss will be based on a reduced schedule. Your beneficiaries for the
Business Travel Accident plan will be the same beneficiaries you designate for the life insurance plans, unless requested otherwise in writing.

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Your Flexible Spending Accounts
(FSA) Choices

Valent offers Flexible Spending Accounts (FSA) which are voluntary accounts that allow you to set
aside pre-tax dollars to reimburse yourself for certain health care and dependent care expenses. Your
participation is optional and you can choose to make an election to contribute to one or both of the
accounts available. Deductions are taken directly out of your paycheck pre-tax, and reimbursements for
eligible expenses are non-taxable to you.

You should estimate your expenses carefully before deciding how much to contribute to a Flexible
Spending Account. IRS rules mandate that you forfeit any unused money left in your accounts each
year. After you elect the annual amount you will put into these accounts, you cannot change your
decision during the year unless you have a Qualified Status Change.

HEALTH CARE SPENDING ACCOUNT (HCSA)

Your Health Care Flexible Spending Account reimburses you for eligible health care expenses, including
dental and vision, not covered by any insurance plan covering you or your dependents. By anticipating your
health care related expenses and contributing pre-tax dollars to your FSA, you lower your taxable income.
Therefore, you will increase your disposable income by paying these expenses with pre-tax dollars.

You can elect to contribute up to the IRS maximum of $2,650 annually into the Health Care Spending
Account. If you also participate in a Health Savings Account, you can contribute to the limited purpose
FSA for dental and vision expenses only.

Many health care expenses you currently pay for with after-tax dollars are eligible for reimbursement
with this benefit; examples include:

• Deductibles and co-payments under your medical, dental and vision plans.
• Charges in excess of the allowable amount for medical, dental or vision benefits.
• Charges not covered by your medical, dental and vision plans.
• Health care expenses that exceed group insurance maximums, such as state mental health

expenses, charges for private room hospitalization, and chiropractic care.

This is just a partial listing of eligible and ineligible expenses. For information about what specific
expenses are eligible for reimbursement from your HCSA, you can refer to IRS Publication 502 online
at www.irs.gov. You can also contact the plan administrator, Ameriflex, at 888.868.3539.

Employee Benefits 2018 21

DEPENDENT CARE SPENDING ACCOUNT (DCSA)

The Dependent Care Spending Account (DCSA) pays for eligible expenses that you incur while you and
your spouse (if applicable) are at work or attending school full-time. Eligible expenses include child care
for children under age 13 or for the care of an adult dependent living with you who is unable to care for
themselves, such as an invalid parent.
After you pay for eligible day care expenses, you can submit claims and be reimbursed from your account
during the year. As a result, your day care expenses are funded with tax-free dollars.
You can elect to contribute from $25 to the IRS maximum of $5,000 annually (subject to marital and
tax filing requirements). If you are married, the amount you set aside may not exceed your spouse’s
income. (If your spouse is disabled or a full-time student, he or she will be considered to have an
income of $250-$500 per month for this purpose, depending on how many dependents you have).
If your spouse also has a Dependent Care Spending Account, the combined amount you and your
spouse may set aside cannot exceed $5,000. If you are married and file separate tax returns, the
maximum contribution amount is $2,500 per spouse.
Your eligible dependents include:

• Child(ren) under age 13 whom you claim as dependents on your federal income tax return
(special rules apply in the case of a divorce or separation)

• A spouse or other IRS dependent (for example, a parent) that is physically or mentally
incapable of self-care, as long as the dependent spends at least eight hours a day in your home

The following types of care are reimbursable to the Dependent Care Spending Account:
• Care provided inside or outside your home by anyone other than: your spouse, a person you
list as your dependent for income tax purposes, or one of your children under age 19
• A dependent care center or childcare center (if the center cares for more than six children, it
must comply with all applicable state and local regulations)
• A housekeeper, au pair or nanny whose services include, in part, providing care for a
qualifying dependent
• Day care costs while in day camps (NOTE: Overnight camp costs are not reimbursable)

For information about what specific expenses are eligible for reimbursement from your DCSA, you
can refer to IRS Publication 503 online at www.irs.gov. You can also contact the plan administrator,
Ameriflex, at 888.868.3539 or www.flex125.com.

22 VBC MA – Osage

USE IT OR LOSE IT

There is an important federal government regulation about using these accounts that you must keep in mind
as you decide how you will use them. All expenses for the Health Care and Dependent Care Spending
Accounts must be incurred during the plan year (January 1 through December 31). For new hires, expenses
incurred from your hire date through the end of the plan year are eligible. However, you have until 90 days
after the end of the plan year (March 31) to submit eligible expenses for reimbursement.

Once you have ceased participation in the Plan (e.g., termination of employment), Health Care
Spending Account expenses incurred during the Plan Year and prior to your termination date shall be
reimbursed if the submission of the claim occurs no later than 90 days after your termination date. With
respect to the Dependent Care Spending Account, you may receive reimbursement for any allowable
“employment-related” dependent care expenses you incurred during the plan year prior to your
termination date. However, those submitted expenses cannot exceed the actual amount of contributions
remaining in your Dependent Care Spending Account as of the date you ceased to participate.

Note: The Plan must pass the IRS guidelines by performing a non-discrimination test, which reviews the amounts elected
and the number of highly compensated executives who are enrolled in the Plan. If the Plan does not pass the non-
discrimination test, it may result in adjustments to your elected deductions

AMERIFLEX CONVENIENCE CARD

The MasterCard you receive comes loaded with your yearly election. You may use Ameriflex MasterCard or
pay with a different method of payment and submit a receipt for reimbursement. Please, save receipts for
non-pharmacy transactions; Ameriflex will request substantiation as required by the IRS.

HOW TO REGISTER YOUR AMERIFLEX ACCOUNT

Go to myameriflex.com. On the left-hand side of the main login screen, click on the link that reads “New
User? Please click here to create username and password.” Enter your personal information. Your
Employee ID will be your full SSN with no spaces or dashes.

1. You will be asked to choose your Ameriflex ID. If you have not yet received your Ameriflex
Card, you can use the Employer ID. Your Employer ID is AMFVALENT.

2. Next check the box to accept the terms of use.
3. Last, you must complete our Secure Authentication setup.
4. Select a Security Question option and follow the instructions.
5. Once you are done, click “Submit Setup Information”.
6. Your registration is complete.
If you have any questions, contact Ameriflex’s Participant Services team at 888-868-FLEX (3539).

Employee Benefits 2018 23

Your 401(k) Savings Plan

The 401(k) Plan offers employees a convenient way to save for retirement on a regular, long-term
basis. The plan offers both pre-tax and Roth Contribution options. Upon participation, employees are
fully vested in all employee and Company contributions. Employees are eligible to participate the first
day of the month following or coinciding with their hire date.

All new eligible employees will be automatically enrolled on their eligibility date. This is done to make
saving and investing for your future easy and convenient. Once enrolled, 5% of your before-tax pay will
be deducted from your paycheck and invested in a pre-assembled T. Rowe Price Retirement Fund with
the target date that is closest to the year you will turn 65, unless you choose a different fund option. If
you would like to change the contribution amount or opt out of participating in the plan before your first
contribution is deducted, call T. Rowe Price at 1-800-922-9945 or visit rps.troweprice.com.

EMPLOYER MATCHING CONTRIBUTION

Valent will provide a “Matching Contribution” of 100% of your contribution up to 5% of pay on a per pay
period basis.

If you are contributing less than 5% to your 401(k) account, consider increasing your deferral rate to
5% to take full advantage of the Company Match. A periodic review of your savings and investment
elections will help you stay on track to reach your retirement goals.

EMPLOYER DISCRETIONARY CONTRIBUTION

The Company may make a quarterly discretionary contribution that is equal to 1% to 5% of your pay.
You are eligible on the first day of the next calendar quarter coinciding with or following your eligibility
date. You do not need to contribute to the plan to be eligible. You must be employed as of the last
day of the quarter to be eligible for this contribution. Contributions are deposited into the Age-targeted
Retirement Fund unless you choose a different fund option.

HOW TO BECOME A 401(K) PARTICIPANT

Employees who want to contribute into the Plan must enroll either online or over the phone with T.
Rowe Price. T. Rowe Price, our Plan Trustee and Record Keeper sends new employees a Welcome Kit
containing information about plan features, rollover contributions, investment options and strategies,
performance history, beneficiary designations, etc.

1. Call T. Rowe Price at 800.922.9945 or visit the T. Rowe Price Website, myRetirementPlan,
at http://rps.troweprice.com. First-time users click “Register.” Choose “Register” and follow
the prompts to create a username and password. You will only need your date of birth,
Social Security number, and ZIP code.

2. Be sure to complete the beneficiary information for your 401(k) account.

24 VBC MA – Osage

Your Employee Assistance Program

The MHN Employee Assistance Program (EAP) provides you and your family with confidential, personal
assessment and referral services. There is no cost for this resource and all employees and their eligible
dependents are automatically covered.

The EAP is a service designed to help manage your life’s challenges and help you resolve emotional
health, family and work issues. You can access the service whenever you need it—at any time, day or
night. If you need face to face counseling, the EAP provides five in-person visits per issue per year with
a local EAP affiliate counselor.

The EAP offers assistance and support for all these concerns and more:
• Depression, anxiety and stress
• Substance abuse
• Relationship problems
• Workplace conflicts
• Parenting and family issues
• Grief, loss or responses to traumatic events
• Concerns about alcohol or drug use
• Child and elder care
• Wellness Coaching
• Financial fitness
• Legal Asistance

To arrange a CONFIDENTIAL appointment call: 800.227.1060 January 1, 2018 or after
Website: https://www.mhn.advantageengagement.com
Company Code: valent

Employee Benefits 2018 25

Benefits Online Enrollment Information

ADP is a web-based software system that allows employees to access information securely online from
anywhere in the world using their ADP username and password.

ADP SELF SERVICE USER REGISTRATION INSTRUCTIONS:

New Hires: Once you are set up in ADP, you will receive an email to register. Go to the ADP Self-Service
portal at https://workforcenow.adp.com and select “Register Here” where it says “First Time User.”
Please refer to the ADP self-service registration information provided in your new hire packet.
Once your registration is complete, ADP will send you an email with instructions on how you can
activate your account. Once your account is activated, you can use your user ID and password to
access ADP self-service and Benefits Enrollment. Manage your account information to keep it accurate.
Open Enrollment: Please log on to the ADP self-service portal at https://workforcenow.adp.com to make
your benefits changes.

BENEFITS ENROLLMENT INSTRUCTIONS:

New Hires: To enroll in benefits, click on the Benefits Enrollment link on your ADP home page in the My
Benefits section. Then, click on the ‘start’ button in the New Hire Enrollment Profile to begin your enrollment.
Open Enrollment: To make changes to your benefits, click on the Benefits Enrollment link on your
ADP home page in the My Benefits section. Then, click on the ‘start’ button in the Open Enrollment
Profile to make your changes.
You can view your current benefit plan information, make certain changes, and access enrollment resources.

26 VBC MA – Osage

Then, click the individual plan type to make your selections. Once you select the type of plan in which to
enroll, the page displays changes so that you can now enter the enrollment details for this plan. You can
also waive benefit plan coverage. If you waive coverage, you must select a reason in the Reason list.

View all of your enrollment information before you submit your changes. Click on “Complete Enrollment”
to finalize your enrollment elections.

Employee Benefits 2018 27

LifeLock Identity Theft Protection

In today’s world of online shopping, using public Wi-Fi and giving out Social Security numbers as a form
of ID, one in four people have their identities stolen every year. Unfortunately, free credit monitoring
simply alerts you to credit score changes. LifeLock not only has proprietary technology to detect a
variety of identity threats. If you do have an ID problem, their US-based team of specialists can fix it.
That’s why it pays to protect with the best.

LifeLock Benefit Elite protection is designed to help you protect your identity and your investment
accounts. LifeLock searches over a trillion data points every day for potential threats to its members’
personal identity, including suspicious uses of name, address, phone number, birth date and Social
Security number to obtain loans, credit and services or to commit crimes.

QUESTIONS TO CONSIDER

Do I really need to worry about identity theft?
Yes. Identity theft is America’s fastest growing crime. Simply put, it’s when someone uses your personal
information for their gain and your loss.

Why is restoring my identity so difficult?
Proving that ‘you are you’ can be time-consuming and expensive. Filing paperwork, disputes, and
insurance claims can take weeks, months and even years. LifeLock’s team of specialists will work with
you to help clear your name, retain lawyers and other experts if needed, and pay court fees.

Doesn’t my bank’s credit card service have me covered?
Your bank monitors transactions on your existing account. They may not see accounts opened using
your identity at another bank – or an application for a student loan, welfare check, or cellular plan in
another state either.

Can’t I just wait for identity theft before getting LifeLock® protection?
Your identity is exposed every day, If your personal information is stolen, it may show up on the dark
web months before you’re notified of a data breach. Plus, thieves may wait years before using your
personal info.

You and your dependents are eligible to enroll on a voluntary basis through payroll deduction. The rates
are discounted 15% off retail pricing.

28 VBC MA – Osage

Your Benefit Resources

BENEFITS INFORMATION PORTAL

Access benefits information at your convenience 24 hours a day, 7 days a week.
• Learn about all the benefit options at Valent.
• Download forms.
• Review plan summaries.
• Explore additional value added programs available to you through our insurance vendors.

To access, go to: www.benefitstream.net
Log-in: valent
Password: valent

You can also access the BenefitStream link from CornerStone and ADP home page in the My Benefits
section. Or, you can download the BenefitStream App for convenient access from your smartphone
whenever you need it.

VALENT BENEFITS HELPDESK

At Valent, we are constantly looking for ways to provide a higher level of service to our employees when
it comes to your benefits questions. In partnership with our benefits broker, Woodruff-Sawyer & Co., we
are happy to provide you with the Valent Benefits Helpdesk. This valuable resource will save you time
and provide you with added support with your benefits related questions and issues.

The Valent Benefits Helpdesk is here to assist you with managing and navigating through your health
benefits. Support services include:

• Explanation of your benefit plans and coverage.
• Assistance with your online enrollment process.
• Resolve eligibility and claims issues.
• Review and determine the right resource for resolving provider issues.

ASSISTANCE BY PHONE OR EMAIL

You or your dependents can call the Valent Benefits Helpdesk at 888.732.1635 to speak live with a
licensed representative, or email your inquiries to [email protected].

The Valent Benefits Helpdesk is available between 8:00 am and 4:30 pm (PST) but you may also leave a
voice message anytime. Emails and voice messages receive same-day or next-business day response.

Employee Benefits 2018 29

Important Annual Notices

We recommend that you review the required annual notices to determine if any of them apply to you. In
some cases, you might need to return a signed form to HR. You are able to access these notices on our
CornerStone portal or by requesting a copy from the Human Resources Department.

Medicare Part D
• Group health plans providing prescription drug coverage must provide a notice to any
individual covered by or eligible for the group health plan who is eligible for Medicare (an
“eligible individual”). The notice must explain whether the plan’s prescription drug coverage is
creditable. Coverage is creditable if it is actuarially equivalent to coverage available under the
standard Medicare Part D program. In order to satisfy the distribution timing requirements, the
notice is generally distributed upon an individual’s enrollment in the plan, each year during
open enrollment and during the plan year if the status of the coverage changes (either for the
plan as a whole or for the individual).

Women’s Health & Cancer Rights Act (WHCRA)
• Notification that your health plan offers coverage for mastectomies and provides certain
additional mastectomy-related benefits.

Health Insurance Marketplace Coverage Notice
HIPAA Notice of Privacy Practices
Patient Protection Notice
Children’s Health Insurance Program Reauthorization Act of 2009 (CHIPRA)
The Employer Notice requirements include the following:

1. The Notice must be provided annually;
2. The Notice must be provided on an automatic basis and free of charge; and
3. The Notice must inform each employee (regardless of enrollment status) of potential

opportunities for premium assistance in the state in which the employee resides. Note that
a separate mail requirement is not necessary. Plans can furnish the notice along with open
enrollment materials or a Summary Plan Description

Grandfathered Plans
• Provides that this plan has opted to remain grandfathered under PPACA.

Certification of Federal Tax Dependent Status
Summary of Tax Treatment of Coverage Provided for Spouses, Domestic Partners, and Children
of Domestic Partners

30 VBC MA – Osage

Notes

Employee Benefits 2018 31

Notes

32 VBC MA – Osage