Benefits for Employees ofBBB National Programs

Effective 6/1/2019—12/31/2019

Insurance Carrier Eligibility

Medical

CIGNA High Deductible Health Plan

Open Access Plan Open Access Plus—In-Network

Only Plan

Employee Spouse or Domestic Partner

Children to age 26

Dental United Concordia

Dental PPO Employee

Spouse or Domestic Partner Children to age 26

Life / AD&D Long Term Disability

Cigna Employee

Vision VSP

Employee Spouse or Domestic Partner

Children to age 26

This guide summarizes the benefit plans available to you as an employee of BBB National Programs. The details of these plans andthe de-tails of the Employee Retirement Income Security Act (ERISA) are contained in the official plan documents. If there is a conflict between the information in this guide and the formal language of the plan documents, the plan documents will govern.

May Also Elect Carrier / vendor Eligibility

Health FSA Dependent Care FSA

HSA Discovery Employee

Voluntary Short Term Disability Voluntary Life

Cigna Employee

Employee, Spouse or Domestic Partner Children to age 26

When can I change benefits during the year?

BBB National Programs holds an open enrollment period each December to allow you to make benefit and cost changes that go into effect on January 1. The. benefit elections that you make when you are initially eligible and during open enrollment will stay in effect through December 31, 2019. Due to certain IRS rules, you cannot change your election during the year unless you, your spouse or your child has an allowable change in status, such as a birth or adoption of a child, marriage, divorce, death of an eligible family member, loss of coverage, change in your dependent’s eligi-bility for benefits, or you or your family member becomes eligible for Medicare, Medicaid or CHIP.

If you have a change in status, you must notify BBB National Programs within 31 days (or 60 days due to Medicaid or CHIP eligibility) in order to change your election. BBB National Programs will notify you if your change in status is allowable. Any change you wish to make to yourbenefits must be consistent with your change in status.

*Please note that coverage for the domestic partner and his or her eligible children, if applicable, will be taxable to theemployee unless the domestic partner and/or his or her eligible children qualify as dependent(s) as defined in Section152 of the Internal Revenue Code.

Benefit Notes

Eligibility Requirements Group Benefits: Full-time employees working 30 hours or more per week are eligible to participate.

Your coverage becomes effective on the first day of the month following or coinciding with your date of hire.

Please refer to your plan documents for more detailed eligibility information.

Eligible Dependents Employees may add eligible dependents to certain plans, provided they meet the requirements below:

• Your legal spouse or domestic partner; or,

• The child(ren) of you, your spouse or domesticpartner up to their 26th birthday; unlessindicated otherwise

• No limiting age applies for medical coverage forchildren who are permanently and totallydisabled.

Benefit Elections Due to IRS regulations, all benefit elections are binding for the plan year. The BBB National Programs plan year is January 1—December 31.However, with supporting documentation, you may modify your benefit elections if you experience a life event such as:

• Birth, adoption, marriage, or involuntary loss ofother health coverage

• Divorce

• Death of a dependent

• Entitlement to Medicare or Medicaid

A benefit change must be consistent with the qualifying life event. You must notify Human Resources within 31 days of any change in status.

Payroll Deductions As permitted by Section 125 and/or Section 132 of the Internal Revenue Code, certain benefits described in this guide are provided on a tax-free basis, and you may pay for your share of the coverage with pre-tax payroll deductions.

Please note that coverage for a domestic partner and his or her eligible children, if applicable, will be taxable to the employee unless the domestic partner and/or his or her eligible children qualify as dependents as defined in Section 152 of the Internal Revenue Code.

Termination of Benefits When you terminate employment with BBBNational Programs, the medical and dentalbenefits automatically terminate at the end of the month, except when you choose to continue health benefits through COBRA. The FSAs, long-term disability, life and AD&D, and all other benefits terminate at the last day of employment.

CIGNA High Deductible Health Plan (Self-Refer to Specialists)

Summary of Services In-Network—You Pay Out-of-Network* - You Pay

Annual Deductible Per calendar year (Amounts do not cross-apply)

$1,500 Per Person

$3,000 Family **

$3,000 Per Person

$6,000 Family **

PCP / Specialist Office Visit Deductible Deductible, then 20%

Well Child Visit $0 Deductible, then 20%

Well Adult Visit $0 Deductible, then 20%

Lab / X-Ray Deductible Deductible, then 20%

Emergency Room Deductible In-network deductible

Urgent Care Facility Deductible Deductible, then 20%

Inpatient Hospital Deductible Deductible, then 20%

Outpatient Hospital Deductible Deductible, then 20%

Rehab Therapy (OT, Speech) - up to 60 visits combined per calendar year

PT & Chiropractic—up to 20 visits per calendar year

Deductible Deductible, then 20%

Durable Medical Equipment Deductible Deductible, then 20%

Home Health Care up to 60 visits per calendar year Deductible Deductible, then 20%

Hospice Care Deductible Deductible, then 20%

Skilled Nursing Facility up to 60 days per calendar year Deductible Deductible, then 20%

Inpatient Mental Health Deductible Deductible, then 20%

Outpatient Mental Health Deductible Deductible, then 20%

Prescription Drugs Generic / Preferred Brand /

Non-Preferred Brand

Deductible, then:

30 day supply: $10 / $35 / $50

90 day supply: $30 / $105 / $150

Retail Only: Deductible, then 20%

Out-of-Pocket Maximum Per Calendar Year

(Amounts do not cross-apply)

$2,500 Per Person

$5,000 Per Family

Including deductible & co-pays

$4,000 Per Person

$8,000 Per Family

Including deductible and coinsurance

*Note: Out-of-network reimbursement is based on Medicare fee schedule. You are responsible for any amounts over the allowable charge.

* *If you are enrolled with one or more dependents, you must meet the full family deductible before the plan will begin to pay

benefits. For out of network benefits you must meet the full family out-of-pocket maximum before the plan will begin to pay 100%.

To locate providers visit www.mycigna.com > Find a doctor > Plan is Open Access Plus

Frequently Asked Questions: Health Savings Accounts (HSAs)

4. What are the IRS contribution limits?

For 2019, the annual contribution limits are $3,500 ($291.66 per month) for single HDHP coverage and $7,000 ($583.33 per month) for family HDHP coverage. These limits are indexed. Contribution maximums include employer contributions.

BBB National Programs contributes $500 per year if youhave an HSA account through Discovery, the BBB National Programs administrator. These contributions arepaid semi-annually: $250 in January and $250 in July.

If you are age 55+, you can make a catch-up contribution in addition to the above limits. For 2018, the catch-up contribution is $1,000. You can only make one catch-up contribution per HSA (even if you and your spouse are both age 55+).

Once you are enrolled in Medicare, you will no longer be able to make contributions into your HSA. However, you can continue to use your funds in the HSA.

5. How do I make contributions into my HSA?

You can make contributions through a pre-tax payroll election. Or, you can make contributions directly to your HSA and deduct the contribution, up to IRS limits, on your federal income tax return.

You can only make contributions into an HSA for each month that you are enrolled in a qualified high deductible health plan (HDHP) and are not enrolled in any other non-HDHP health plan.

Your spouse and children can be covered by both your HDHP and another non-HDHP health plan, but then your spouse cannot make contributions towards your HSA or another HSA.

6. How do I use the funds in my HSA?

You can use your HSA to reimburse yourself for qualified out of pocket medical expenses incurred by you, your spouse, and tax dependents (even if they are not enrolled in the HDHP).

You access the funds by paying up front and using your online Discovery account to get reimbursed, or you can use the Discovery VISA debit card. The debit card will automatically withdraw money from your HSA to pay for an out of pocket expense.

You are responsible for getting receipts for medical care and keeping proof of medical expenses on file for the IRS. You do not file receipts to get funds from your HSA.

1. What is an HSA?

A Health Savings Account (HSA) is an account that allows you to set aside money for your future medical expenses when you are enrolled in a qualified high deductible health plan (HDHP). An HSA provides tax advantages to you, while you make decisions on how to spend your health care dollars.

The account is set up in your name, with a trustee. BBBNational Programs is using Discovery as the trustee for youraccount.

2. Who is eligible for an HSA?

You must be enrolled in the BBB National Programs qualifiedhigh deductible health plan (HDHP) in order to have an HSA.

The HDHP is a PPO and, in general, will cover the same services and benefits that any non-HDHP plan covers. There are several key provisions for the plan to be a qualified HDHP:

• The majority of expenses, including prescription drugs,will be subject to the deductible (in-network or out-of-network).

• After the deductible is met, most expenses are paid atthe in-network or out-of-network coinsurance level.Prescription drugs will be subject to a co-pay.

• If you are enrolled in family coverage, the familydeductible must be met before any expenses are eligiblefor reimbursement, even if only one family member hasexpenses.

• Preventive services, such as well-child care and routinecancer screenings, are the only benefit not subject tothe deductible.

You cannot have an HSA if you are enrolled in any other non-HDHP health coverage, including a health care FSA, except for limited FSA. These restrictions include coverage through your spouse’s employer. You can remain enrolled in certain other benefits with your employer or your spouse’s employer, such as disability, dental care and vision care.

3. What are the tax-advantages of an HSA?

In general, your contributions and any employer contributions are not taxable income to you, as long as you were enrolled in a qualified HDHP at the time contributions were made. (Please see questions 9 and 10 of this FAQ that explains potential taxation of contributions.)

The investment earnings on funds in your HSA grow tax-free. You do not pay taxes on distributions from your HSA when used for qualified medical expenses. (However, if you use the HSA for non-medical expenses, the distribution is taxable, plus a 20% penalty. If you are age 65 years or older, the 20% penalty is waived.

Frequently Asked Questions: Health Savings Accounts (HSAs)

10. Can I join the HSA mid-calendar year?

If you become eligible for the HDHP mid-year, you can have an HSA. You can contribute up to the monthly IRS limit, or even up to the full annual IRS limit.

If you contribute more than the monthly IRS limit, you may be taxed on the contributions allocated to the calendar months prior to your HDHP enrollment if you do not remain enrolled in the HDHP as of December 1 and for the next 12 months. For example, say you enroll in single HDHP coverage on July 1st, 2019. Your contributions plus your employer contributions through the end of the year equal the IRS annual limit of $3,500. If you terminate HDHP coverage before the end of the next full calendar year, you will be taxed and penalized on the contributions allocated to January 1 – June 30 of the year you first enrolled but were not covered by an HDHP, or $1,749.96 ($291.66 x 6 months).

If you join mid-year, remember you cannot be covered by any other non-HDHP plan if you wish to make contributions to your HSA. Other coverage includes health care FSA coverage that your spouse may have at his/her employer. You will need to be excluded from all health care FSA coverage or have limited “HSA compatible” health care FSA coverage.

11. What are my tax reporting requirements?

Your employer will report your pre-tax contributions and any employer contributions in Box 12 on your Form W-2.

Discovery will send you a Form 1099 for any distributions and Form 5498 for any contributions.

When you file your federal income tax return, you will have to complete and attach Form 8889, “Health Savings Accounts”.

12. Where can I get additional information?

Please contact BBB National Programs' Human Resources Department if you have additional questions. You may also refer to IRS Publication 502 (Medical and Dental Expenses) and IRS Publication 969 (Health Savings Accounts & Other Tax-Favored Health Plans), which are available online under “More Forms & Publications” at www.irs.gov.

HSA Account information:

Discovery HSA Customer Service: (866) 451-3399

Website: www.DiscoveryBenefits.com

7. What are qualified medical expenses?

Any “qualified medical expense” allowed by federal tax law is permitted, which includes any expense that goes towards your high deductible in the PPO plan. Please see IRS Publication 502 for a detailed list of eligible expenses. Health insurance premiums are not eligible expenses, unless the premiums are for (a) long term care insurance, (b) COBRA coverage, (c) Medicare premiums, or (d) healthcare coverage while you are receiving unemploymentbenefits.

8. What if I have an out of pocket medical expensethat is more than my HSA account balance?

You can only use what is in your HSA account balance. You will have to pay out of pocket for any expense that exceeds your HSA balance.

9. What happens to my HSA if I lose eligibility for theHDHP or terminate employment with BBB NationalPrograms?

The HSA is in your name and you remain the owner of the account. If you lose eligibility or terminate employment, you do not forfeit any balance in the account, and you can continue to use the funds in your account for medical expenses.

However, you can no longer contribute to the HSA unless you remain covered by a HDHP, either through COBRA or through another qualified HDHP. Also, you will be responsible for any banking fees that were previously paid by your employer.

There is potential taxation of HSA contributions if you terminate HDHP coverage before the end of the calendar year and your HSA contributions exceed the monthly IRS maximum. For example, say you contributed $1,200 to your HSA on January 1, and you only remain covered for 4 months. In 2019, the IRS only allows $291.66 per month of tax-free contributions while you are covered. Therefore only $1,166.64.00 ($291.66 x 4 months) is tax-free. You would be responsible for taxes on the excess contribution of $33.36 ($1,200.00-$1,166.64).

CIGNA Open Access Plus Plan (Self-Refer to Specialists)

Summary of Services In-Network—You Pay Out-of-Network* - You Pay

Annual Deductible Per Calendar Year)

(amounts cross apply)

$500 Per Person

2x Family Cap

$1,000 Per Person

2x Family Cap

PCP / Specialist Office Visit $30 PCP /

$40 Specialist Co-pay Deductible, then 20%

Well Child Visit $0 Deductible, then 20%

Well Adult Visit $0 Deductible, then 20%

Lab / X-Ray Advanced Imaging

$30 PCP / $40 Spec. Co-pay

$100 co-pay Deductible, then 20%

Emergency Room $200 co-pay $200 co-pay

Urgent Care Facility $50 co-pay Deductible, then 20%

Inpatient Hospital Deductible, then $250 Co-pay Deductible, then 20%

Outpatient Hospital Deductible, then $125 Co-pay Deductible, then 20%

Rehab Therapy (OT, Speech) - up to 60 visits combined per calendar year

PT & Chiropractic—up to 20 visits per

calendar year

$40 Specialist Co-pay Deductible, then 20%

Durable Medical Equipment Deductible Deductible, then 20%

Home Health Care up to 60 visits per calendar year Deductible Deductible, then 20%

Hospice Care Deductible Deductible, then 20%

Skilled Nursing Facility up to 100 days per calendar year Deductible Deductible, then 20%

Inpatient Mental Health Deductible, then $250 Co-pay Deductible, then 20%

Outpatient Mental Health $40 co-pay Deductible, then 20%

Prescription Drugs Generic / Preferred Brand / Non-Preferred

30 day supply: $15 / $35 / $50

90 day supply: $45 / $105 / $150

Out-of-Pocket Maximum (per calendar year)

(amounts cross-apply)

$2,000 Per Person

$4,000 Per Family Cap

Including Deductibles and

Medical / Rx Co-pays

$4,000 Per Person

$8,000 Per Family Cap

Including deductibles and coinsurance

* Out-of-network reimbursement based on Medicare fees. Members are responsible for any amounts over theallowable charge.

To locate providers visit www.mycigna.com > Find a doctor > Plan is Open Access Plus

CIGNA In-Network Only OAP Plan (Self-Refer to Specialists)

Summary of Services In-Network Only—You Pay

Annual Deductible $500 Per Person / 2X Family Cap

Out-of-Pocket Maximum $2,000 Per Person / 2x Family Cap

Including Medical and Rx Co-pays

PCP / Specialist Office Visit $30 PCP / $40 Specialist Co-pay

Well Child Visit $0

Well Adult Visit $0

Lab / X-Ray Deductible

Emergency Room $200 Co-pay

Urgent Care $50 Co-pay

Inpatient Hospital $250 Co-pay

Outpatient Hospital $125 Co-pay

Rehab Therapy (OT, Speech), up to 60 days per calendar year

PT & Chiropractic—up to 20 visits each per calendar year

$40 Co-pay

Durable Medical Equipment Deductible

Home Health Care Up to 60 visits per calendar year

Deductible

Hospice Deductible

Skilled Nursing Facility Up to 60 days per calendar year

$0

Inpatient Mental Health $250 Co-pay

Outpatient Mental Health $40 Co-pay

Prescription Drugs Generic / Preferred Brand / Non-Preferred

$15 / $35 / $50 for one month supply

$45 / $105 / $150 for 90 day supply via mail order

To locate providers To locate providers visit www.mycigna.com > Find a Doctor > Plan is OAP Network

United Concordia Dental PPO

Self-Refer to Any Dentist

Summary of Services In-Network

You Pay

Out-Of-Network* You Pay

Annual Deductible $25 Per Individual / $75 Per Family Cap

Calendar Year Maximum (combined in and out of network)

$2,000 (Preventive Services do not count toward annual maximum)

Preventive Services - Cleanings, X-Rays, Fluoride,

Sealants $0 $0

Basic Services —Fillings, Root Canals, Extractions,

Oral Surgery, Periodontics Deductible, then 10% Deductible, then 10%

Major Services - Crowns, Implants,

- Dentures, Bridges, Inlays/ OnlaysDeductible, then 40% Deductible, then 40%

Orthodontia $1,000 lifetime maximum

(Children to Age 19) 50% 50%

*In-network charges based on contracted fee. *Out-of-network reimbursement is based on in-network fee scheduleand members are responsible for amounts over the allowed benefit.

To Find Dental Providers: Visit www.unitedconcordia.com

Dental PPO Network is “Elite Plus”

VSP Vision Plan

Summary of Services

In-Network—You Pay Out-Of-Network

You Pay

Exams Once every 12

months $10 co-pay

$10 co-pay + amounts over

$50 allowance

Frames Once every 24

months

$25 co-pay + amounts over $130 allowance $25 co-pay + amounts over $70 allowance

Lenses Once every 12

months

Single Vision: $25 co-pay

Bifocal: $25 co-pay

Trifocal: $25 co-pay

Standard Progressive: $0 co-pay

Premium Progressives: $80-$90 co-pay

Custom Progressives: $120—$160 co-pay

Single: Amounts over

$50 allowance

Bifocal: Amounts over

$75 allowance

Lined Trifocal: Amounts over

$100 allowance

Progressive: Amounts over

$75 allowance

Lens Options (UV, Tint, Scratch

Resistance) 60-65% of retail price Not Covered

Contact Lens Fit & Follow-up $60 co-pay Not covered

Contact Lenses (in lieu of Eyeglass

Lenses) Amounts over $140 allowance Amounts over $105 allowance

Lasik Surgery 85% of retail or 95% of promotional pricing

U.S. Laser Network Not Covered

Allowances are one-time use benefits per year—no remaining balance.

To Find Vision Providers:

Visit www.vsp.com

Cigna Life Insurance / Accidental Death & Dismemberment

Employee Benefit 1x annual earnings to $250,000 (Full Guarantee issue)

Accelerated Benefit Up to 80%

Age Reduction Benefit reduces to 65% at age 70 and 50% at age 75

Long Term Disability (Paid by BBB National Programs)

Employee Benefit 60% of salary up to $10,000 per month

Benefit Begins 91st day of disability

Duration To Normal Social Security Retirement Age (Schedule applies for disabilities occurring at age 63 or greater—see certificate)

Mental & Nervous Limitation

Lifetime Maximum Benefit Period of 2 years, unless hospital confined

Pre-Existing Condition 3 month lookback for pre-existing condition / 12 month wait

Survivor Benefit In the event of Employee’s death, beneficiary receives lump LTD benefit of 3 months, provided the Employee had been continuously disabled and receiving benefits

Social Security Offset Any Social Security benefits received by Employee or Employee’s family will be subtracted from Employee’s monthly benefit

Voluntary Short Term Disability

Employee Benefit 60% of basic weekly earnings to $1,385

Benefit Begins 2 Options: 15th Day or 31st Day

Benefit Duration 11 weeks (with 14 day elimination) or 9 weeks (with 30 day elimination)

Voluntary Life and AD&D Insurance—Cigna

Benefit Amount Employee

Spouse

Child (Live birth to 6 months)

Child (6 months to age 26)

Increments of $10,000 to 5x annual earnings, or $250,000 max

Increments of $5,000 to 50% of Employee Life Amount or

$125,000 max

Flat $500 Benefit

Flat $10,000 Benefit

Guarantee Issue Amount Employee

Spouse Child

$100,000 $30,000 $10,000

Accelerated Benefit For Terminal Illness Employee: 80% of Life Amount to $187,500 maximum

Spouse: 80% of Life Amount to $75,000 maximum

Age Reduction

Employee Benefit Reduces to 45% at age 70, 30% at age 75,

20% at age 80, 15% at age 85, and 10% at age 90

Spouse Benefit Terminate at age 70

Waiver of Premium (Employee Only) Applicable to insured employees under age 60 who have been disabled for 9 months or more

Enrollment / Increasing Coverage

You must purchase coverage for yourself in order to purchase coverage for your spouse and/or child(ren)

During annual open enrollment, you may increase your coverage by one increment for yourself and your spouse each year up to the guarantee issue amount without evidence of insurability

Discovery Flexible Spending Accounts

Plan Year Effective January 1, 2019 through December 31, 2019

Health Care FSA Limited FSA for HSA Enrollees

Maximum Election: $2,700 per employee

Dependent Care FSA Maximum Election: $5,000 per household

You may roll over up to $500 in unused health FSA funds into the new plan year, as long as you enroll in the health FSA for the 2019 plan year. All unused amounts over $500 will be forfeited.

BBB National Programs Employee Costs Per Pay

Effective 1/1/2019—12/31/2019

Cigna Medical Plans

High Deductible Open Access Plus Open Access Plus OAP In-Network Plan

Employee $ 49.66 $ 105.94 $ 86.32

Employee + Spouse / DP $ 138.80 $ 273.30 $ 226.42

Employee + Child(ren) $ 112.68 $ 221.85 $ 183.80

Employee + Family $ 194.43 $ 367.75 $ 307.34

United Concordia Dental Plan

Employee $ 5.75

Employee + Spouse / DP $ 11.44

Employee + Child(ren) $ 11.45

Employee + Family $ 18.79

VSP Vision Plan

Employee $ 4.35

Employee + Spouse / DP $ 7.32

Employee + Child(ren) $ 7.47

Employee + Family $12.05

Cigna Voluntary Life (Employee, Spouse, Children)

Cigna Voluntary Short Term Disability

(Employee Only)

Age Employee

(Per $10,000) Spouse

(Per $5,000) 14 Day

Elimination Period 30 Day

Elimination Period

20-24 $ 0.369 $ 0.185 Age Bi-Weekly Rate per $10 of Benefit

Age Bi-Weekly Rate per $10 of Benefit

25-29 $ 0.369 $ 0.185 19-39 $.173 19-54 $.092

30-34 $ 0.369 $ 0.185 40-54 $.203 55-59 $.120

35-39 $ 0.508 $ 0.254 55-59 $.245 60-64 $.138

40-44 $ 0.600 $ 0.300 60-64 $.295 65-99 $.162

45-49 $ 0.969 $ 0.485 65-99 $.342

50-54 $ 1.754 $ 0.877

55-59 $ 2.954 $ 1.477

60-64 $ 5.862 $ 2.931

65-69 $ 7.662 $ 3.831

70-74 $ 12.831

75+ $ 34.662

Child Rate (Covers all children)

$ .51 (per $10,000)

Cigna Voluntary AD&D

Employee (per $10,000) Spouse (Per $5,000) Children (per $10,000)

$ .185 $ .092 $ .018

Additional Benefits Provided by BBB National Programs

Cigna Employee Assistance Program

www.cignabehavioral.com

Telephone: 877.622.4327 Employer ID: BBB NP

24/7 Employee Assistance and Work/Life Support Program offering phone line and web resources for BBB National Programs employees and household family members. Personal advocates will work with you to resolve issues such as stress management, parenting and childcare, eldercare, pet care, financial services, identity theft, 30 minute legal consultation and up to 25% discount off select fees for issues other than employment matters.

Services include up to 3 face-to-face counseling sessions.

Phone line and web resources to help employees and their families with issues such as depression, stress, drug/alcohol abuse, resiliency, grief, family/relationship issues, balancing work/home, legal referrals and discounts, financial planning assistance and discounts. Assistance available 24 hours a day, seven days a week with confidential support, guidance and resources. Includes in person sessions for short term problem resolution.

Travel Assistance

Emergency medical assistance and other emergency services for employees and their families when traveling 100 miles or more away from home, anywhere in the world. Plan offers a full range of professional 24-hour medical, legal and travel assistance services.

For assistance or more information, please contact Karin Brotherton, Director of Human Resources, (703) 247-9375, email: kbrotherton@bbbnp.org

This Brochure has been Prepared By

Health Insurance Marketplace Options and Your Health Coverage

The Health Insurance Marketplace is designed to help individuals find, compare, and purchase private individual health insurance. The Marketplace does not affect your eligibility for coverage in your employer’s group health plan.

Individuals may be eligible for a tax credit that lowers the monthly premium of coverage purchased in the Marketplace. However, if you are eligible for an employer’s group health plan, you may not be eligible for a tax credit through the Marketplace if the employer group health plan meets the "minimum value" and "affordability" standards set by the Affordable Care Act. Additionally, if you purchase your own health plan through the Marketplace instead of accepting health coverage offered by your employer, then you will lose the employer contribution towards coverage. This employer contribution - as well as your employee contribution towards coverage - is often excluded from income for Federal and State income tax purposes. Your payments for coverage you purchase through the Marketplace are made on an after-tax basis.

Open enrollment for individual health insurance coverage through the Marketplace occurs at the end of each calendar year for coverage effective the following January 1st. If you are interested, please visit HealthCare.gov for more information, including an online application for health insurance coverage and contact information for a Health Insurance Marketplace in your area.

Notice of Special Enrollment Rights

If you decline enrollment for yourself or an eligible dependent (including your spouse) while other health insurance or group health plan coverage is in effect, you may be able to enroll yourself and your dependents in the plans offered by the company if you or your dependents lose eligibility for that other coverage (or if the employer stops contributing toward your or your dependents’ other coverage). You must request enrollment within 31 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 a result of marriage, birth, adoption, or placement for adoption, you may be able to enroll yourself and your new dependents. You must request enrollment within 31 days after the marriage, birth, adoption, or placement for adoption.

You may also be able to enroll if you or your dependents lose eligibility for coverage under Medicaid or a state Children’s Health Insurance Plan (CHIP) and request enrollment within 60 days of losing Medicaid or CHIP. You may also be able to enroll if you or your dependents become eligible for state premium assistance from Medicaid or CHIP towards the cost of the group health plan, and request enrollment within 60 days of eligibility for state premium assistance.

Medicare Prescription Drug (Part D) Creditable Coverage

If you or one of your dependents is eligible for Medicare (or will be shortly), you may be able to purchase a Medicare Prescription Drug Plan or join a Medicare Advantage Plan that offers prescription drug coverage. All Medicare drug plans provide at least a standard level of coverage set by Medicare. Some plans may also offer more coverage for a higher monthly premium.

The employer has determined that the prescription drug coverage offered by the employer group health plan, on average for all plan participants, is expected to pay out as much as standard Medicare prescription drug coverage pays and is therefore considered “creditable coverage.” If you are covered by the employer group health plan, because your existing coverage is Creditable Coverage, you can keep this coverage and not pay a higher premium (a penalty) if you later decide to join a Medicare drug plan.

For more information, please contact us for the Notice of Creditable Coverage and refer to www.medicare.gov or call 1-800-MEDICARE (1-800-633-4227).

Important Annual Notices

COBRA

The Consolidated Omnibus Budget Reconciliation Act (COBRA) of 1986 is a federal law which gives employees and eligible dependents who lose their medical, dental, vision and health FSA (if positive balance in account) benefits, the opportunity for a temporary extension of coverage following a qualifying event. Under COBRA, the employee or family member may elect to continue his/ her group health benefits for a limited time period. COBRA participants are responsible for paying the total cost of these benefits.

This Brochure has been Prepared By

Important Annual Notices

Form 1095

Each year, you may receive one or more Forms 1095, due to new reporting requirements under the Affordable Care Act.

If you normally work here at least 30 hours per week, you will receive the Form 1095-C from us. This form is only helpful if you had an individual medical policy purchased through the Health Insurance Marketplace. If you were not covered by a plan that you purchased from the Health Insurance Marketplace, you do not need this form for your income tax return.

Separately, employees enrolled in medical coverage will receive a Form 1095-B from the insurance carrier that covered you and/or your family members during the prior year. You should save this form for your income tax return as proof that you had medical coverage in 2018.

Note that if you and/or your family members had medical coverage through a self-insured plan, you may receive a Form 1095-B or Form 1095-C from the employer that sponsored the self-insured plan. You should save this form with your income tax records as proof that you had medical coverage in 2018.

Forms 1095-C and Form 1095-B are not attached to your tax return.

Women’s Health and Cancer Rights Act (WHCRA)

The Women’s Health and Cancer Rights Act of 1998 provides benefits for mastectomy-related services, including reconstruction and surgery to achieve symmetry between breasts, prostheses, and complications resulting from a mastectomy (including lymphedemas). Please call your medical plan using the number on your identification card or contact the employer for more information.

Reminder of Availability of Notice of Privacy Practices

The Health Insurance Portability and Accountability Act of 1996 (“HIPAA”) requires health plans to protect the confidentiality of your personal health information (“PHI”). HIPAA also requires that health plans maintain privacy notices which provide a complete description of your rights under HIPAA’s privacy rules. The health care FSA privacy notice is maintained by your employer. The health insurance plan privacy notices are maintained by the insurance providers. In general, the plans will not use or further disclose PHI except as necessary for treatment, payment, health plan operations and plan administration or as permitted or required by law. Under HIPAA, you have certain rights with respect to your protected health information and the right to file a complaint with the plan or the Secretary of the U.S. Department of Health and Human Services if you believe your rights under HIPAA has been violated.

Premium Assistance Under Medicaid and the Children’s Health Insurance Program (CHIP)

If you or your children are eligible for Medicaid or CHIP and you’re eligible for health coverage from your employer, your state may have a premium assistance program that can help pay for coverage, using funds from their Medicaid or CHIP programs. If you or your children aren’t eligible for Medicaid or CHIP, you won’t be eligible for these premium assistance programs but you may be able to buy individual insurance coverage through the Health Insurance Marketplace. For more information,visit www.healthcare.gov.

If you or your dependents are already enrolled in Medicaid or CHIP and you live in a State listed on the DOL website (https://www.dol.gov/sites/default/files/ebsa/laws-and-regulations/laws/chipra/model -notice.pdf), contact your State Medicaid or CHIP office to find out if premium assistance is available.

If you or your dependents are NOT currently enrolled in Medicaid or CHIP, and you think you or any of your dependents might be eligible for either of these programs, contact your State Medicaid or CHIP office or dial 1-877-KIDS NOW or https://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).

For assistance or more information, please contact Karin Brotherton, Director of Human Resources, (703) 247-9375, email: kbrotherton@bbbnp.org