protecting what matters most

2022 Open EnrollmentOc t 25 - Nov 5, 2021

PROTECTING WHAT MAT TERS MOST

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Welcome to Your Benefits Program

Welcome to your Wexford Health 2022 benefits open enrollment guide. In this guide you will find an overview of the benefitsavailable to you. We are pleased to announce that open enrollment for our benefit programs will be held, Monday, October 25 -Friday, November 5, 2021. Since benefits are an important part of your total compensation package, Wexford Health strives to offerbenefits that protect your lifestyle and financial security. We encourage you to read this guide carefully and review your benefitoptions with your family and promote financial security.

How to EnrollWexford Health has again partnered with Willis Towers Watson (WTW), a benefits communication and enrollment firm. If you wouldlike to make changes to your benefit elections; add/delete dependents; or enroll in term life through Allstate; please speak to WTW’s professional Benefits Counselors. You can schedule your one-on-one enrollment call with a Benefit Counselor ahead of time through https://v3.rivs.com/37-67-33/ or simply call 877-552-4192, beginning Monday, October 25th - Friday, November 5th from 8:00 a.m. - 8:00 p.m. (Central). The Benefit Counselor will review your benefit options, help you understand the choices available to you, and enroll you and your dependents in coverage.

This year’s open enrollment is a “passive enrollment”, which means you DO NOT have to contact WTW. If you aren’t making any changes to your benefit elections, your 2021 benefit elections, except for FSA, will roll-over to 2022.

If you would like to participate in the flexible spending account or New Health Savings Account, please find and complete a FSA Data Collection Worksheet at http://enroll.aacbenefits.com/whsbenefits and email it to [email protected].

NEW for 2022 • Hospital Indemnity Plan - Hospital indemnity coverage will pay you a daily benefit amount if you are admitted to the hospital, but that is not all it covers. Turn to page 8 to find out more about how this coverage can help with costs for maternity, wellness, and other out of pocket expenses.

Welcom

e and Table of Contents

Table of Contents

Eligibility ........................................................................................................3

Medical Insurance ......................................................................................4

Health Spending Accounts ......................................................................6

The CDHP and HSA ...........................................................................7

Hospital Indemnity ....................................................................................8

Flexible Spending Accounts ...................................................................9

Dental Insurance .......................................................................................10

Vision Insurance .......................................................................................11

Supplemental Life Insurance ...............................................................13

Long Term Disability Insurance ...........................................................13

Accident Insurance .................................................................................14

Critical Illness Insurance ........................................................................15

Term Life Insurance .................................................................................16

Children’s Health Insurance Program (CHIP) ..................................17

Important Notifications .........................................................................19

Contact Information ................................................................................21

Making Careful Choices

Benefits you elect will be effective January 1, 2022 through December 31, 2022, unless you have a qualified family status change. Such changes include birth, death, marriage,divorce, adoption, ineligibility of a dependent, unpaid leave of absence by you or your spouse, or a significant change in health coverage for you or your spouse because of your spouse’s employment, so please choose your benefits carefully. If you have a qualifying event, you must notify Human Resources at (800) 903-3616 EXT. 384 within 30 days of that event to change your benefit elections.

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This guide provides a summary of benefits you may choose to elect as an eligible employee. Regular, full-time employees who are regularlyscheduled to work at least 30 hours per week are eligible for benefits, unless required by law.

Eligible dependents include: • Your lawful spouse (including same-sex spouses), regardless of the state in which you reside; • You or your spouse’s children and stepchildren, adopted children or children placed for adoption with the eligible employee or eligible employee’s spouse and any children whom you have legal custody. Any dependent children, which by court order must be provided healthcare coverage by the eligible employee or the eligible employee’s spouse. Court or government approval of guardianship is required.

Be sure to read this guide carefully. WTW Benefits Counselors are available to answer any questions you may have. The benefits you elect during the2022 Open Enrollment period will be effective beginning January 1, 2022 through December 31, 2022, unless you have a qualified life event duringthe year.

Qualified Life EventsGenerally, you may only change your benefit elections during the annual open enrollment period. However, you can change your benefit electionsduring the year if you experience a Qualified Life Event. If you have a Qualified Life Event during the year, you have 30 days to report it by contactingthe Human Resources Department at (800) 903-3616 Ext. 384. Qualified Life Events include: • Marriage • Divorce or legal separation • Death of spouse • Birth/death/adoption/legal guardianship of a child • Covered dependent status change • Loss or gain of other coverage

Unless required by law, regular, full-time employees scheduled and routinely working a minimum of 30 hours per week are eligible for benefits thefirst of the month following one month of employment. Your dependents are eligible for coverage in most plans you elect; the Benefits Counselorwill discuss the benefits available for your dependents during your call. Your eligible dependents include your legal spouse, children, and childrenfor whom you are a legal guardian up to the age of 26. Wexford Health’s definition of “spouse” includes same sex spouses regardless of the statewhere you live.

Eligibility

Dependent WorksheetTo enroll yourself and your dependents in coverage, you must have your personal, dependent, and beneficiary information ready. You will be asked to provide full names, dates of birth, and Social Security numbers. Any information you provide is confidential and for HR use only. To prepare for your enrollment appointment, fill out the table below.

Name Relation SSN DOB

_________________________ __________________________ ______________________ _____________________

_________________________ __________________________ ______________________ _____________________

_________________________ __________________________ ______________________ _____________________

_________________________ __________________________ ______________________ _____________________

_________________________ __________________________ ______________________ _____________________

If you do not have the above requested information on your enrolled dependents at the time you call, the WTW Benefits Counselor will NOT be able to enroll you in benefits.

ImportantAgain, if you miss the 30 day deadline to make a change due

to your life event, you cannot enroll a new dependent or makea change to your benefits until the next open enrollment period.

Eligibility

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Medical B

enefits

Medical Benefits

Because there’s nothing more important than your health, Wexford Health offers a Consumer Driven Health Plan (CDHP) with an HSA and two PPOplan options through Highmark BCBS. Although you may see any doctor you like, you will receive greater benefits and lower costs when you choosean in-network provider. The table on page 5 highlights the features of our medical plans and the pharmacy benefits.

New for 2022, you have the option to enhance your medical plan with additional hospital benefits through Lincoln Financial Group. These benefits are designed to provide financial protection by paying you a lump sum benefit for hospital admission, hospital confinement, and ICU confinement. You can use this benefit to pay for out-of-pocket expenses and extra bills that can occur relating to your hospitalization. Plus, the plan also includes an additional wellness benefit.

How the Plans WorkThere is no such thing as a one-size-fits-all health plan. Everyone has different health insurance needs depending on their health care requirementsalong with those of their dependents. While some prefer standard deductible health insurance (often called a PPO health insurance plan), people areincreasingly switching to a Consumer Driven Health Plan (CDHP) with a Health Savings Account (HSA) as a better way to reduce taxable income andmaximize their health care dollars.

• The Plan C (CDHP w/HSA) option is the medical plan that will cost you the least out of your paycheck. If elected, you can establish a Health Savings Account (HSA) to set aside payroll contributions on a triple tax advantaged basis into a bank account that you own. In addition, the company will deposit $500 for employee-only coverage and $1000 for employee plus dependent(s) coverage into your HSA for all who newly enroll or re-enroll in Plan C. Additional HSA details can be found on page 5 - 7 of this guide. With this plan, you will pay the carrier discounted cost for medical care and prescription drugs until you meet the deductible. Once you reach your deductible, the plan will begin to cover a portion of the costs. Note: Preventive care is covered at 100% and eligible preventive maintenance drugs are not subject to the deductible. More information about CDHPS/HSA, can be found here. http://enroll.aacbenefits.com/whsbenefits.

• The PPO B plan option is a more traditional approach to healthcare benefits. This plan has copays for office visits and various services along with deductible and coinsurance for hospital services. The PPO B option, does not qualify the member to contribute to a HSA. However, you may participate in a Flexible Spending Account (FSA) which is another way to pay for health expenses with tax-free dollars. Additional FSA details can be found on page 9 of this guide.

• The PPO A plan option is also a more traditional approach to healthcare benefits. However the deductible and out-of-pocket maximums are lower. Due to this plan having a richer benefit, the payroll deductions for this plan are higher than the other two options.

Each of the Highmark plans allow you to visit any doctor you choose. Although you may see a provider who doesn’t participate in the plan’s network,in most cases your benefits are greater (and your out-of-pocket expenses smaller) when you see an in-network provider. You are not required toselect a Primary Care Provider under any of these plans.

Using Health Care as a Consumer

To battle rising healthcare costs you can work to become a smart health care shopper as a way to manageyour out-of pocket expenses. The role you play in managing health care costs is simple: Spend your healthcare dollars wisely. Keep in mind that some types of health care products and services cost much more thansimilar items and the more expensive option may not be necessary for the treatment you require. There alsomay be a lower cost provider available for the same products and services.

For example, Plan C does not have copays. Instead you will pay the carrier negotiated cost of services forneeds like sick visits and prescription drugs. (Qualified preventive services are covered at 100% with Plan C.)

Therefore, choosing to see your family doctor or use Telemedicine instead of going to the ER when you havethe flu will save you money. Please review pages 5 - 7 of this guide to better understand benefit levels andways to save.

Good to KnowLook beyond your deductible! Many people fear the potential cost of a higher deductible. But that shouldn’t be your only consideration in choosing a health plan. Consider these potential savings as well:

• Employer Contribution – Wexford will put money in your HSA that you can use to pay for qualified medical expenses

• Lower Premiums – Pay less out of each paycheck than with the PPO plan options

• Tax Savings – Make tax free contributions, pay for qualified medical expenses tax free, and invest and grow your balance tax free

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Medical B

enefits

Medical Benefits

Plan A Plan B Plan C

In-Network Out-of-Network In-Network Out-of-Network In-Network Out-of-Network

Deductible (Individual/Family) $1,000/$2,000Embedded

$2,000/$4,000Embedded

$1,500/$3,000Embedded

$3,000/$6,000Embedded

$2,000/$4,000Aggregate


Out-of-Pocket Maximum * (Individual/Family)

$3,000/$6,000Embedded

$6,000/$12,000Embedded

$4,000/$8,000Embedded

$8,000/$16,000Embedded


$6,000/$12,000Aggregate

Total Out-of-Pocket Maximum **(Individual/Family) $6,850/$13,700 N/A/N/A $6,850/$13,700 N/A/N/A $6,900/$13,800 N/A/N/A

PCP Visit 100% after $25 copay

60% after deductible

100% after $40 copay




Specialist Visit 100% after $25 copay


100% after $40 copay




Hospitalization

80% after deductible and $50 copay per

admission


admission


admission


admission



Coinsurance 80% 60% 70% 50% 80% 60%

Preventive Care 100% (deductible does not apply)


100% (deductible does not apply)


100% (deductible does not apply)


Emergency Room 80% after deductible, $150 copay 70% after deductible, $150 copay 80% after deductible

Urgent Care 100% after $25 Copay


100% after $40 Copay




Inpatient Hospital Care80% after

deductible $50 copay

60% after deductible $100 copay





Outpatient Hospital Care 80% after deductible






Prescription Drugs - Retail

Generic Preferred Brand Non-Preferred Brand

National Pharmacy Network 30-/90-day Supply

$10/$25 copay $35/$87.50 copay

$75/$187.50 copay

National Pharmacy Network 30-/90-day Supply

$10/$25 copay $35/$87.50 copay

$75/$187.50 copay

National Pharmacy Network31/60/90-day Supply

Plan pays 80% after deductiblePlan pays 80% after deductiblePlan pays 80% after deductible

Prescription Drugs - Mail Order Generic Preferred Brand Non-Preferred Brand

90-day Supply$25

$87.50 $187.50

90-day Supply$25

$87.50 $187.50

90-day SupplyPlan pays 80% after deductiblePlan pays 80% after deductiblePlan pays 80% after deductible

Preventive Maintenance Rider N/A N/A Included***

Prescription Drugs - Specialty $200 copayment $200 copayment Plan Pays 80% after Deductible

Rx Out-of-Pocket Max (single/family) Included in Total Maximum OOP Included in Total Maximum OOP Included in Total Maximum OOP

*Once met, plan pays 100% for the rest of the benefit period, excluding deductibles and copayments.**Includes deductible, coinsurance, copays, prescription drug cost sharing, other qualified medical expenses, and for In-Network only. Once met, the plan pays 100% of covered services for the rest of the benefit period.*** Eligible preventive maintenance drugs are not subject to the deductible and will apply to coinsurance and out-of-pocket maximum. For additional information on qualifying medications please visit www.Highmarkbcbs.com.

Embedded – Once one family member meets the individual deductible limit the plan will begin to pay for a portion of the costs for that individual. Once one family member meets the individual out-of-pocket maximum, the plan pays all eligible expenses for that individual for the remainder of the year.

Aggregate – The entire family deductible must be met before the plan will begin to pay a portion of the costs for any family member. The entire family out-of-pocket maximum must be met before the plan will pay all eligible expenses in full for any family member for the remainder of the year.

Per Pay Employee Payroll Deductions Plan A Plan B Plan C

Employee $78.05 $58.25 $42.99

Employee + Spouse $256.28 $205.80 $155.25

Employee + Child(ren) $171.77 $132.53 $99.34

Family $311.01 $254.36 $192.53

Deductions are taken from the first and second pays per month (24 times per year)

GOOD NEWS!

Wexford is keeping the per pay contributions the same as in 2021!

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Health Savings A

ccount

Health Savings Account

An HSA is a personal savings account you can use to pay for qualified out-of-pocket medical expenses with pretax dollars – now or in the future. Once you’re enrolled in the HSA, you’ll receive a debit card to help manage your HSA reimbursements. Your HSA can also be used for your expenses and those of your spouse and dependents, even if they are not covered by a Consumer Driven Health Plan (CDHP) medical plan.

Eligibility You must be enrolled in a Plan C.

Set Up Your AccountACTION REQUIRED

After enrolling in an HSA through your employer, log into your Discovery Benefits account or mobile app to enable your personal account. Your HSA funds will not be available until the required agreements are agreed to and submitted.

Your Contributions

You make payroll contributions on a pretax basis and can change how much you contribute from each paycheck up to the IRS maximum of $3,650 if you enroll only yourself or $7,300 if you enroll in family coverage. You can make an additional catch-up contribution if you are age 55 or older.

The Company’s Contribution

Wexford Health Sources will contribute $500 if you enroll in employee-only coverage or $1000 if you enroll in employee plus dependent(s) coverage.

Eligible ExpensesMedical, dental, vision and prescription drug expenses incurred by you and your eligible family members. If you have an HSA, you are not eligible for a Health Care FSA.

Using Your Account

Use the debit card linked to your HSA to cover eligible expenses or pay for expenses out of your own pocket and save your HSA money for future health care expenses. You can also manually submit expenses to Discovery Benefits for reimbursement.

Remaining Funds

Money left in your HSA at the end of the year will roll over to the next year – you’ll never lose your HSA dollars. If you leave the Company or retire, you can take your HSA with you and continue to pay and save for future eligible health care expenses.

Your HSA is Always Yours — No Matter What!One of the best features of an HSA is that any money left in your HSA account at the end of the year rolls over so you can use it next year or sometime in the future. And if you leave the company or retire, your HSA goes with you! The Triple Tax Advantage1 Save money from your paycheck in the HSA tax free2 Pay for qualified medical, dental or vision expenses tax free3 Invest your savings and earn interest tax free

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CDH

P and HSA

The CDHP and HSA: How They Work Together

Together, your and the Company’s contributions can cover a portion of your deductible and coinsurance.

Free In-Network Preventive Care

To emphasize the importance of wellness, preventive care is covered at 100%, if you receive this care from in-network providers. Select preventative drugs are also covered at 100%.

Deductible You pay for your initial medical costs until you meet your annual deductible. This deductible is higher compared to the other medical plans, but is offset by HSA contributions you and the Company make.

CoinsuranceYou make payroll contributions on a pretax basis and can change how much you contribute from each paycheck up to the IRS maximum of $3,650 if you enroll only yourself or $7,300 if you enroll in family coverage. You can make an additional catch-up contribution if you are age 55 or older.

Out-of-Pocket Maximum The plan limits the total amount you’ll pay each year. Once you meet your out-of-pocket maximum, the plan pays 100% of your eligible, in-network expenses for the remainder of the year.

How the HSA WorksPlease note: Funds available for reimbursement are limited to the balance in your HSA. Choose Plan C during Open Enrollment and determine how much to contribute (tax-free) out of each paycheck. The company opens an HSA for you and contributes an initial deposit into your account. Use money in your HSA for eligible medical, dental and/or vision expenses. Money left over at the end of the year rolls over for future use.

HSA Example:Samantha enrolls in Plan C with employee-only coverage. She chooses to use her HSA to pay for covered services – this reduces her out-of-pocket amount needed to meet her deductible before her health plan begins to pay. Year 1The Company deposits $500 in Samantha’s HSA She contributes $2,700 ($112.50 per pay) for total of $3,200 She uses her HSA to pay $700 of eligible expenses She has $2,500 in her HSA to roll over to next year.

Year 2$2,500 rolls over from Year 1. She contributes $2,700 f ($112.50 per pay) or a total of $5,200. She uses her HSA to pay $1,200 of eligible expenses She has $4,000 in her HSA to roll over to next year.

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NEW

Hospital Indem

nity Insurance

Group Hospital Indemnity insurance is designed to help provide financial protection for covered individuals by paying a benefit due to a hospitalization and in some cases, for treatment received for an accident or sickness, even if that treatment occurs outside the hospital. Employees can use the benefit to meet the out-of-pocket expenses and extra bills that can occur. Indemnity lump sum benefits are paid directly to the employee based on the amount of coverage listed, regardless of the actual cost of treatment.

NEW Hospital Indemnity Insurance

Hospital Admission $1,000 per insured per calendar year

Daily Hospital Confinement $200 per day, to a maximum of 30 days per calendar year

Hospital Intensive Care Unit Confinement $400 per day, to a maximum of 30 days per calendar year

Wellness Benefit $50 per insured per calendar year

Family Coverage Options Employee, Spouse, Child Employee must have coverage in order for spouse and child to have coverage.

Evidence of Insurability (Health Questions)Employee/SpouseAt initial enrollment, health questions are not required for the employee or spouse when first eligible.

Maternity Hospital Confinement $100 per day in the first 10 months, standard benefit after 10 months

Semi-Monthly Premium(includes Wellness)

EmployeeEmployee

and Spouse

Employee and

Child(ren)

Employee, Spouse

and Child

$11.76 $22.80 $15.58 $26.62

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Flexible Spending Accounts

Flexible Spending Accounts (FSA) allow you to pay for certain medical and/or dependent care expenses with pre-tax dollars. By contributing pre-tax,you will lower your taxable income and increase your spendable income! Wexford Health offers you two options: a Medical FSA and a DependentCare FSA. • The maximum annual contribution to your medical FSA is $2,750 for 2022 • The maximum annual contribution to your dependent care FSA is $2,500 (married filing separately) $5,000 (married filing jointly) for 2022

The FSA vendor will remain Discovery Benefits. If you participated in the healthcare FSA in 2021 you can roll over up to $550.00 in unused funds foruse in 2022.

Medical FSAThe Medical FSA helps you pay for healthcare expenses not covered or only partially covered by your health, dental or vision insurance. The Medical FSA can be used to pay expenses for you or any of your qualified dependents, and the funds in the account are available on the first day of the benefit plan year.

Dependent Care FSAThe Dependent Care FSA will save you money on the cost of dependent care expenses, while you and your spouse (if applicable) work. Childcareexpenses like daycare centers or babysitters are eligible for children under the age of 13. Individuals with disabilities, child(ren) with disabilities orelder daycare expenses are eligible, regardless of age.

If you would like to participate in a flexible spending account, please find and complete a FSA Data Collection Worksheet athttp://enroll.aacbenefits.com/whsbenefits and email it to [email protected].

By completing the following information, you can calculate your annual reimbursement expenses.Take into consideration what you will be spending during the upcoming year for yourself and your dependents.

Medical Deductibles Copayments Doctor visits Prescriptions Other Total

$ ___________ $ ___________ $ ___________ $ ___________ $ ___________ $ ___________

Estimated Annual Expenses and Tax Savings Total Health Care Expenses (add 1 + 2 + 3) Total Dependent Expenses

Total Expenses

Tax Bracket Percentage (see below) Annual Tax Savings (multiply total expenses by tax bracket percentage)

Savings Amount Per Paycheck (divide total expenses by 24 paychecks per year)

$ ___________$ ___________

$ ___________

___________%$ ___________

$ ___________

Vision Exams Eye surgery Lenses/frames Contacts Other Total

$ ___________ $ ___________ $ ___________ $ ___________ $ ___________ $ ___________

Dental Routine checkups Fillings/crowns Orthodontics Other Total

$ ___________ $ ___________ $ ___________ $ ___________ $ ___________

These tax rates are estimations based on nationalaverages and may not reflect your actual tax rate.

Tax Estimate TableBased on a combination of Social Security,

federal, and state income taxes.

If your annual household earnings are: Tax rate is:

Less than $30,000 $30,000 to $40,000 $40,000 to $70,000

Greater than $70,000

25% 29% 31% 33%

The Internal Revenue Service (IRS) has relaxed the “use it or lose it” rule and allows participating employees to carry over up to

$550 in unused funds from one year to the next.

Dependent Day Care Expenses Children Adults Total

$ ___________ $ ___________ $ ___________

Flexible Spending Accounts

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Dental B

enefits

Dental Benefits

A glowing smile brightens anyone’s day. That is why we provide a dental plan, offered by United Concordia, to eligible employees. You have the option of seeing any provider you wish, but will pay less if you see a dentist that participates in the AdvantagePLUS network. Taking care of your teeth will help you maintain your dental health and prevent periodontal or gum disease from developing. Proper dental care at home, combined with regular dentist visits, is your ticket to good dental health. However, when a dental problem arises, our comprehensive dental benefits help you receive the treatment you need.

More specific information about the dental plan is available by calling United Concordia Customer Service at (800) 332-0366 or by visiting www.unitedconcordia.com.

In-Network

Deductible Individual/Family Annual Maximum

$100 per person$1,000 per person

Preventive Services Oral Exams X-rays Cleanings Fluoride Treatment Sealants

100% (excluded from maximum)100% (excluded from maximum) 100% (excluded from maximum) 100% (excluded from maximum) 100% (excluded from maximum) 100% (excluded from maximum)

Basic Services (Years 1 / 2 / 3) Fillings Periodontal Services Extractions Endodontic Services

80% / 90% / 100% 80% / 90% / 100% 80% / 90% / 100% 80% / 90% / 100%

Major Services Crowns Prosthodontics

50% 50%

Orthodontia (Children and adults to any age) Orthodontic treatment Lifetime maximum

50% $1,500

Per Pay Deduction * Employee Only Employee + 1 Employee + Family

$11.30 $22.36 $33.43

* Deductions are taken from the first and second pays per month (24 times per year)

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Vision Benefi

ts

Vision Benefits

Whether you are driving down the highway or reading a book, seeing clearly is important, which is why we are offering you a vision plan through Vision Benefits of America (VBA). From keeping an eyewear Rx up-to-date to preventing vision loss due to glaucoma, diabetes or macular degeneration, regular visits to a quality eye care professional are a must.

More specific information about the vision plan is available by calling Vision Benefits of America Customer Service at (800) 432-4966 or by visiting www.visionbenefits.com.

In-Network Out-of-Network

Eye Exam 100% (1 every 12 months) Reimbursement amount up to $40

Frames (Every 24 months) 100% if within wholesale allowance Up to $60

Lenses Single Bifocal Blended Bifocal Trifocal Lenticular Polycarbonate - Children to age 19 Polycarbonate - Adult Solid or Gradient Tint Scratch Coating

100% standard glass or plastic100%100%100%100%100%100%100%

Up to $40 depending on lens type Up to $60 Up to $60 Up to $80

Up to $120N/AN/AN/A

Contact Lenses Contact Lenses (Disposable, Conventional, Specialty)

Up to $160 (in lieu of glasses)

Up to $160 (in lieu of glasses)

Per Pay Deduction * Employee Only Employee + Spouse Employee + Child(ren) Employee + Family

$2.32$3.99$3.96 $5.51

* Deductions are taken from the first and second pays per month (24 times per year)

GOOD NEWS!

The per pay deductions are a slight decrease from 2021!

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Life can be tricky and unpredictable events can happen at any time, whichis why we want to make sure that you are covered in the event of a tragedy. In addition to the Basic Life and Accidental Death and Dismemberment (AD&D) insurance provided to regular, full-time employees by Wexford Health at no cost to them (1.5x your basic annual earnings, up to $250,000), you may purchase additional life insurance onyou and your dependents. The supplemental life is provided throughLincoln National Life Insurance. If you have family or others who dependon you for financial support, securing or increasing life insurance coverage is among the most important steps you will ever take. Lifeinsurance is one of the easiest and most affordable ways to protect yourloved ones should they lose you as a financial support.

Ask your Benefits Counselor for Supplemental Life Insurance per paydeductions amounts during your phone appointment.

For more information, please visit www.lfg.com or call 1-800-423-2765.

Supplemental Life InsuranceSupplem

ental Life Insurance

Supplemental Life Benefit Amount

Employee Benefit Amount $10,000 increments

Supplemental Life Maximum $500,000

Accelerated Benefit Included

Waiver of Premium Included

Conversion Included

Portability Included

Guaranteed Issue$150,000 or 700% of

salary whichever is less at initial enrollment

Dependent Life *

Spouse Benefit Amount $5,000 increments to 50% ofemployee amount or $100,000

Child Benefit Amount

14 Days to 6 months - $250 6 months to

26 years - $2,000 - $10,000 Increments of $2,000

Guaranteed Issue $30,000 Spouse / Childis always GI at initial enrollment

* Only available if you purchase supplemental insurance on yourself

In 2022, Wexford Health will continue to provide all eligible regular,full-time employees short term disability (STD) insurance at no costto them. If you would like additional income protection, you may electto purchase voluntary long term disability (LTD) insurance. Protectingyourself is important especially if others depend on you. That is why weare offering Long Term Disability insurance to eligible employees. In theevent you are unable to work due to serious illness or injury, LincolnNational Life Insurance Disability Insurance pays cash benefits that canhelp to compensate for lost income.

For more information please visit www.lfg.com or call 1-800-423-2765.

PRE-EXISTING CONDITION LIMITATION. This Policy will not cover any period of Disability:(1) which is caused or contributed to by, or results from a Pre-Existing Condition; and(2) which begins in the first 12 months after the Insured Person’s Effective Date.“Pre-Existing Condition” means a Sickness or Injury for which the Insured Person received Treatment within 24 months prior to his or her Effective Date. “Treatment” means consultation, care and services by a Physician. It includes diagnostic measures and the prescription, refill and taking of prescribed drugs or medicines.

Long Term Disability Insurance

Long Term D

isability Insurance

Benefits and features include:

Monthly Benefit Percentage 50%

Monthly Benefit Maximum $7,000

Minimum Monthly Benefit $100 or 10% of insured’s monthly benefit, whichever is greater

Benefit Duration Injury Sickness

To Age 65 or if employee is 60+ in age. Schedule included in certifi-

cate.

Elimination Period 120 Days

Pre-Existing Condition Limitation 24/12*

* The Long Term Disability benefit is subject to a 24/12 pre-existing condition limitation.

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Accident Insurance

Accident Insurance

Lincoln Accident insurance helps protect your savings from unexpectedexpenses related to an accident. The plan can pay you a lump-sum cash benefit– you decide the best way to use it.

Accident insurance is great for all lifestyles – families with active children,weekend warriors, or even those who like taking it easy. The cash benefit canhelp fill in the gaps and can be used for deductibles and co-pays and any otherliving expenses you have.

You’ll receive cash for covered injuries. You’ll even get benefits for multiplecovered injuries resulting from the same accident.

Additional Plan Benefits • Portability • Child Sports Injury Benefit

As a Wexford Health employee, you can take advantage of this accident insurance plan for less than $0.60 a day! Plus, you can add loved ones to the plan for just a little more.

Accident insurance pays you for covered injuriesBenefits for more than 70 covered

injury expenses and treatments include:

Emergency Treatment Your Cash Benefit

Ambulance $225

Air ambulance $1,125

Emergency care $150

X-ray $30

Initial care visit $75

Major diagnostic exam $150

For a complete list of benefits, refer to the benefit summary, available athttp://enroll.aacbenefits.com/whsbenefits.

This is an example of how Accident coverage can help you with your expenses

Kelly chooses Accident Insurance from the plan benefits her employer is offering. Six months later, she is traveling to work and is involved in a car accident where she is air lifted to the hospital.

The Accident insurance policy would provide the following benefits, in addition to what major medical insurance paid:

Air Ambulance Service: $600 Hospital Admission: $1,000 Open Abdominal/Thoracic Surgery: $1,000 Hospital Confinement: $200 Doctor Follow-up Visit: $50

Total Cash Benefits: $2,850

Monthly Premium

Employee only $18.12

Employee & spouse $29.84

Employee & child/children $32.85

Employee & family $44.33

15

Surviving a critical illness is becoming more common today thanks to advances in medicine. With Critical Illness Insurance benefits from Lincoln Financial Group, you and your family can face your financial future with confidence and concentrate on getting better when a critical illness strikes.

Important features include: • Our Lincoln CareCompassSM feature provides benefits for health screenings, and offers services for the unmet, often emotional needs of you and your family members. • Support services include health care advocacy services, a care manager to help you navigate the health care system, access to emotional counseling services, financial specialists and legal specialists. • Critical Illness benefits are paid directly to you and may be used according to your wishes. • You may keep your Critical Illness coverage should you leave the company.

Benefit amounts for the following categories include: • Heart coverage: Heart attack, heart transplant, stroke, Arteriosclerosis, Aneurysm • Cancer coverage: Invasive Cancer, Cancer In Situ, Benign Brain Tumor, Bone Marrow Transplant • Organ coverage: End Stage Renal Failure, Major Organ Transplant, Acute Respiratory Distress Syndrome • Quality of Life coverage: ALS/Lou Gehrig’s Disease, Advanced Alzheimer’s Disease, Advanced Parkinson ’s disease, Advanced MS, Loss of Sight, Hearing, or Speech

Some benefits and services include: • Advocate Services: Provides a health advocate to assist covered person in navigation through the health care system. • Support Services: Provides services to address the emotional and supportive service needs of claimants and their caregivers.

Benefit ExclusionsThe plan includes only covered conditions or losses that occur when the insurance is in force. Benefits are not payable for any covered conditions or loss caused or contributed to by: 1. suicide, attempted suicide, or any intentionally self-inflicted injury, while sane or insane; 2. committing or attempting to commit a felony; 3. war or any act of war, declared or undeclared; 4. participation in a riot, insurrection or rebellion of any kind; or 5. a covered condition sustained while residing outside the United States, U.S. Territories, Canada, or Mexico for more than 12 months.

Benefits will not be payable if the insured person is incarcerated in any type of penal or detention facility. A benefit for heart attack or sudden cardiac arrest is not payable if the event occurs during a medical procedure.

Pre-existing Condition exclusionBenefits are not payable for any covered condition or loss: 1. which is caused, contributed to by, or results from a pre-existing condition; and 2. which begins in the Exclusionary period after the covered person’s effective date (unless the condition was not treated during any treatment-free period, if applicable).

The pre-existing condition exclusion will also apply to any increase in coverage beginning on the effective date of the increase. A complete list of benefit exclusions is included in the policy. State variations apply. For a complete list of benefits and per pay deductions visit http://enroll.aacbenefits.com/whsbenefits.

Critical Illness InsuranceCritical Illness Insurance

Critical Illness Insurance Coverage For You

Guaranteed coverage amounts

$10,000, $15,000, $20,000, $25,000, and $30,000

You can choose from the coverage amounts above without providing evidence of insurability (documentation of your health history).

If you decline this coverage now and wish to enroll later, evidence of insurability may be required.

Critical Illness Insurance Coverage For Your Spouse


$5,000, $7,500, $10,000, $12,500, and $15,000 (up to 50% of the employee coverage amount)

You can choose from the coverage amounts for your spouse without providing evidence of insurability (documentation of your spouse’s health history).

If you decline this coverage now and wish to enroll later, evidence of insurability may be required.

Critical Illness Insurance Coverage For Your Dependent Children


$5,000, $7,500, and $10,000 (up to 50% of the employee coverage amount)

You can choose from the coverage amounts above for your dependent children.

16

Term Life Insurance

Term Life Insurance

A death not only leaves behind loved ones, but can also leave overwhelming financial obligations. And, if you’re like most people, you don’t have enough life insurance to keep your family afloat if an unexpected death occurs. Give yourself and your family one final gift – put yourself in Good Hands with Term to Age 100 Life Insurance. Allstate Benefits Life Insurance pays benefits that can ease the financial burden brought upon by the death of a family’s primary provider. Group Term Life Insurance pays a lump-sum cash benefit when you die before age 100.

How it WorksYou choose the coverage that’s right for you and your family. With planning, the death benefit can pass to your beneficiaries free from state or federal estate taxes. Consult with your tax advisor for specific information. Then, when life comes to an end, your beneficiary will receive a tax-free death benefit that can be used to help pay for funeral expenses, mortgage payments and more.

With Allstate Benefits, you gain peace of mind knowing your loved ones will receive a financial safety net when you die.

This policy can help meet the needs of you and your family.

Guaranteed Issue*: • Employee: Issue Ages 18-65: $20 per week up to $150,000 max Initial Death Benefit. Guaranteed minimum death benefit is level for 5 years; current non-guaranteed death benefit is projected to remain level to age 100 under current experience factors. • Spouse: • Working spouses Issue Ages 18-65: $8 per week up to $100,000 max Initial Death Benefit • Non-working spouse Issue Ages 18-65: $5 per week up to $100,000 max Initial Death Benefit • Children: Issue Ages 0-18; $2 per week for $20,000 • Child coverage available with standalone term life certificate or under Children’s Term Rider, but not both

*Coverage is subject to Exclusions and Limitations, as noted in the Certificate of Coverage.

Some Benefit Riders include: • Children’s Term: Level Term to Age 26 life insurance on Certificate insured’s children. Available as rider on either the Employee or Spouse certificate. Convertible to cash value life insurance for each covered child at age 26. • Accelerated Death Benefit for Terminal Condition: Advances a portion (up to 75%) of the insured’s death benefit if a covered person is diagnosed with a terminal condition. Waives future premiums when acceleration is paid.

Be sure to ask your Benefits Specialist for additional information, including per pay deduction amounts, regarding the Accident, Critical Illness and Term to 100 Life Insurance during your one-on-one phone appointment.

Benefits are provided by Group Term Life insurance policy form GPTLP, or state variations thereof. Rider benefits are provided by the following forms or state variations thereof: Children’s Term GTLPCTR and Accelerated Death Benefit for Terminal Illness GTLPLBR. Underwritten by American Heritage Life Insurance Company (Home Office, Jacksonville, FL). The coverage has limitations and exclusions. For cost and complete details, contact your Allstate Benefits Representative. Allstate Benefits is the marketing name used by American Heritage Life Insurance Company, a subsidiary of The Allstate Corporation.

17

IOWA – Medicaid and CHIP (Hawki)Medicaid Website: https://dhs.iowa.gov/ime/members

Medicaid Phone: 1-800-338-8366Hawki Website: http://dhs.iowa.gov/Hawki

Hawki Phone: 1-800-257-8563HIPP Website: https://dhs.iowa.gov/ime/members/medicaid-a-to-z/hipp

HIPP Phone: 1-888-346-9562

KANSAS – MedicaidWebsite: https://www.kancare.ks.gov/

Phone: 1-800-792-4884

KENTUCKY – MedicaidKentucky Integrated Health Insurance Premium Payment Program (KI-

HIPP) Website: https://chfs.ky.gov/agencies/dms/member/Pages/kihipp.aspx

Phone: 1-855-459-6328Email: [email protected]

KCHIP Website: https://kidshealth.ky.gov/Pages/index.aspx Phone: 1-877-524-4718

Kentucky Medicaid Website: https://chfs.ky.gov

LOUISIANA – MedicaidWebsite: www.medicaid.la.gov or www.ldh.la.gov/lahipp

Phone: 1-888-342-6207 (Medicaid hotline) or 1-855-618-5488 (LaHIPP)

MAINE – MedicaidEnrollment Website: https://www.maine.gov/dhhs/ofi/applica-

tions-formsPhone: 1-800-442-6003

TTY: Maine relay 711Private Health Insurance Premium Webpage:

https://www.maine.gov/dhhs/ofi/applications-formsPhone: -800-977-6740. TTY: Maine relay 711

MASSACHUSETTS – Medicaid and CHIPWebsite:

https://www.mass.gov/info-details/masshealth-premium-assistance-paPhone: 1-800-862-4840

ALABAMA - MedicaidWebsite: http://myalhipp.com/

Phone: 1-855-692-5447

ALASKA - MedicaidThe AK Health Insurance Premium Payment Program

Website: http://myakhipp.com/ Phone: 1-866-251-4861

Email: [email protected] Medicaid Eligibility: http://dhss.alaska.gov/dpa/Pages/medicaid/de-

fault.aspx

ARKANSAS – Medicaid Website: http://myarhipp.com/

Phone: 1-855-MyARHIPP (855-692-7447)

CALIFORNIA – Medicaid Website: Health Insurance Premium Payment (HIPP) Program

http://dhcs.ca.gov/hippPhone: 916-445-8322

Email: [email protected]

COLORADO – Health First Colorado (Colorado’s Medicaid Program) & Child Health Plan Plus (CHP+)

Health First Colorado Website: https://www.healthfirstcolorado.com/ Health First Colorado Member Contact Center:

1-800-221-3943/ State Relay 711CHP+: https://www.colorado.gov/pacific/hcpf/child-health-plan-plus

CHP+ Customer Service: 1-800-359-1991/ State Relay 711Health Insurance Buy-In Program (HIBI): https://www.colorado.gov/

pacific/hcpf/health-insurance-buy-program HIBI Customer Service: 1-855-692-6442

FLORIDA – MedicaidWebsite: https://www.flmedicaidtplrecovery.com/flmedicaidtplrecovery.

com/hipp/index.htmlPhone: 1-877-357-3268

GEORGIA – Medicaid Website: https://medicaid.georgia.gov/health-insurance-premium-pay-

ment-program-hippPhone: 678-564-1162 ext 2131

INDIANA – Medicaid Healthy Indiana Plan for low-income adults 19-64

Website: http://www.in.gov/fssa/hip/Phone: 1-877-438-4479

All other MedicaidWebsite: https://www.in.gov/medicaid/

Phone 1-800-457-4584

Children’s Health Insurance Program (CHIP)Children’s H

ealth Insurance Program (CH

IP)

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 below, contact your State Medicaid or CHIP office to find out if premium assistance is available.

If you or your dependents are NOT currently enrolled in Medicaid or CHIP, and you think you or any of your dependents might be eligible for either of these programs, contact your State Medicaid or CHIP office or dial 1-877-KIDS NOW or www.insurekidsnow.gov to find out how to apply. If you qualify, ask your state if it has a program that might help you pay the premiums for an employer-sponsored plan.

If you or your dependents are eligible for premium assistance under Medicaid or CHIP, as well as eligible under your employer plan, your employer must allow you to enroll in your employer plan if you aren’t already enrolled. This is called a “special enrollment” opportunity, and you must request coverage within 60 days of being determined eligible for premium assistance. If you have questions about enrolling in your employer plan, contact the Department of Labor at www.askebsa.dol.gov or call 1-866-444-EBSA (3272).

If you live in one of the following states, you may be eligible for assistance paying your employer health plan premiums. The following list of states is current as of July 31, 2021. Contact your State for more information on eligibility –

18

Children’s Health Insurance Program

(CHIP)

Children’s Health Insurance Program (CHIP)

MINNESOTA – MedicaidWebsite:

https://mn.gov/dhs/people-we-serve/children-and-families/health-care/health-care-programs/programs-and-services/other-insurance.jsp

Phone: 1-800-657-3739

MISSOURI – MedicaidWebsite: http://www.dss.mo.gov/mhd/participants/pages/hipp.htm

Phone: 573-751-2005

MONTANA – MedicaidWebsite: http://dphhs.mt.gov/MontanaHealthcarePrograms/HIPP

Phone: 1-800-694-3084

NEBRASKA – Medicaid Website: http://www.ACCESSNebraska.ne.gov

Phone: 1-855-632-7633Lincoln: 402-473-7000Omaha: 402-595-1178

NEVADA – MedicaidMedicaid Website: http://dhcfp.nv.gov

Medicaid Phone: 1-800-992-0900

NEW HAMPSHIRE – MedicaidWebsite: https://www.dhhs.nh.gov/oii/hipp.htm

Phone: 603-271-5218Toll free number for the HIPP program: 1-800-852-3345, ext 5218

NEW JERSEY – Medicaid and CHIPMedicaid Website:

http://www.state.nj.us/humanservices/dmahs/clients/medicaid/Medicaid Phone: 609-631-2392

CHIP Website: http://www.njfamilycare.org/index.htmlCHIP Phone: 1-800-701-0710

NEW YORK – MedicaidWebsite: https://www.health.ny.gov/health_care/medicaid/

Phone: 1-800-541-2831

NORTH CAROLINA – MedicaidWebsite: https://medicaid.ncdhhs.gov/

Phone: 919-855-4100

NORTH DAKOTA – MedicaidWebsite: http://www.nd.gov/dhs/services/medicalserv/medicaid/

Phone: 1-844-854-4825

OKLAHOMA – Medicaid and CHIPWebsite: http://www.insureoklahoma.org

Phone: 1-888-365-3742

OREGON – MedicaidWebsite: http://healthcare.oregon.gov/Pages/index.aspx

http://www.oregonhealthcare.gov/index-es.htmlPhone: 1-800-699-9075

PENNSYLVANIA – MedicaidWebsite: https://www.dhs.pa.gov/providers/Providers/Pages/Medical/

HIPP-Program.aspxPhone: 1-800-692-7462

RHODE ISLAND – Medicaid and CHIPWebsite: http://www.eohhs.ri.gov/

Phone: 1-855-697-4347, or 401-462-0311 (Direct RIte Share Line)

SOUTH CAROLINA – MedicaidWebsite: https://www.scdhhs.gov

Phone: 1-888-549-0820

SOUTH DAKOTA - MedicaidWebsite: http://dss.sd.gov

Phone: 1-888-828-0059

TEXAS – MedicaidWebsite: http://gethipptexas.com/

Phone: 1-800-440-0493

UTAH – Medicaid and CHIPMedicaid Website: https://medicaid.utah.gov/

CHIP Website: http://health.utah.gov/chipPhone: 1-877-543-7669

VERMONT– MedicaidWebsite: http://www.greenmountaincare.org/

Phone: 1-800-250-8427

VIRGINIA – Medicaid and CHIPWebsite: https://www.coverva.org/en/famis-select

https://www.coverva.org/en/hipp Medicaid Phone: 1-800-432-5924

CHIP Phone: 1-800-432-5924

WASHINGTON – MedicaidWebsite: https://www.hca.wa.gov/

Phone: 1-800-562-3022

WEST VIRGINIA – MedicaidWebsite: http://mywvhipp.com/

Toll-free phone: 1-855-MyWVHIPP (1-855-699-8447)

WISCONSIN – Medicaid and CHIPWebsite: https://www.dhs.wisconsin.gov/badgercareplus/p-10095.htm

Phone: 1-800-362-3002

WYOMING – MedicaidWebsite: https://health.wyo.gov/healthcarefin/medicaid/pro-

grams-and-eligibility/Phone: 1-800-251-1269

To see if any other states have added a premium assistance program since July 31, 2021, or for more information on special enrollment rights, con-tact either:

U.S. Department of Labor U.S. Department of Health and Human ServicesEmployee Benefits Security Administration Centers for Medicare & Medicaid Serviceswww.dol.gov/ebsa www.cms.hhs.gov 1-866-444-EBSA (3272) 1-877-267-2323, Menu Option 4, Ext. 61565

19

Notice of Special Enrollment RightsIf you are declining enrollment for yourself and your dependents(including your spouse) because of other health insurance or group health plan coverage, you may in the future be able to enroll yourself and your dependents in this plan if you or your dependents lose eligibility for that other coverage. However, you must request enrollment within 30 days after your or your dependents’ other coverage ends.

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 dependents. However, you must request enrollment within 30 days after the marriage, birth, adoption, or placement for adoption.

You have two additional special enrollment opportunities. If you oryour dependent’s Medicaid or Children’s Health Insurance Program (CHIP) coverage ends as a result of loss of eligibility, you may enroll in the benefit plan. If you or your dependent becomes eligible for a premium assistance subsidy under Medicaid or CHIP, you may elect to enroll in the subsidized plan and cancel coverage in the Wexford Health benefit plan. You must request enrollment within 60 days of the loss of eligibility of Medicaid or CHIP, or becoming eligible for the premium assistance subsidy. To request special enrollment or obtain more information, contact the Human Resources Department at (800) 903-3616 Ext. 384 or your local Medicaid or CHIP program.

COBRA NotificationThe Consolidated Omnibus Budget Reconciliation Act (COBRA) of 1985 was enacted to allow employees to extend coverage when status changes. A COBRA General Notice is provided to you when you are first covered under the medical, dental, or vision plan. The COBRA General Notice explains your right to participate in the Health Care Reimbursement Account. When you terminate coverage, a COBRA Election Notice will be provided.

If your status as a full-time employee changes, your dependent loses coverage, or you terminate employment, COBRA allows you to extend your coverage for up to 18 months (and longer under special circumstances) when you pay 102% of the full premium for medical, dental, and vision coverage.

Medicaid and the Children’s Health Insurance Program (CHIP) NoticeIf you are eligible for health coverage from your employer, but are unable to afford the premiums, some States have premium assistance programs that can help pay for coverage. These States use funds from their Medicaid or CHIP programs to help people who are eligible for employer-sponsored health coverage, but need assistance in paying their health premiums.

Once it is determined that you or your dependents are eligible forpremium assistance under Medicaid or CHIP, your employer’s health plan is required to permit you and your dependents to enroll in the plan - as long as you and your dependents are eligible, but not already enrolled in the employer’s plan. This is called a “special enrollment” opportunity, and you must request coverage within 60 days of being determined eligible for premium assistance.

Please refer to the attached chart for state specific information and phone numbers.

The Newborns’ and Mothers’ Health Protection ActThe Newborns’ and Mothers’ Health Protection Act (the Newborns’ Act) provides protections for mothers and their newborn children relating to the length of their hospital stays following childbirth. Group health plans and health insurance issuers generally may not, under Federal law, restrict benefits for any hospital length of stay in connection with childbirth for the mother or newborn child to less than 48 hours following a vaginal delivery, or less than 96 hours following a cesarean section.

Important Notifications

However, Federal law generally does not prohibit the mother’s or newborn’s attending provider, after consulting with the mother, from discharging the mother or her new-born earlier than 48 hours (or 96 hours as applicable). In any case, plans and issuers may not, under Federal law, require that a provider obtain authorization from the plan or the insurance issuer for prescribing a length of stay not in excess of 48 hours or 96 hours.

The Women’s Health and Cancer Rights ActThe Women’s Health and Cancer Rights Act (WHCRA) provides protections for individuals who elect breast reconstruction after a mastectomy. As required by law, the following is the Women’s Health and Cancer Rights Notice.

NOTICEIf you have had or are going to have a mastectomy, you may be entitled to certain benefits, under the Women’s Health and Cancer Rights Act of 1998 (WHCRA). For individuals receiving mastectomy-related benefits, coverage will be provided in a manner determined in consultation with the attending physician and the patient, for: 1. All stages of reconstruction of the breast on which the mastectomy was performed; 2. Surgery and reconstruction of the other breast to produce symmetrical appearance; 3. Prostheses; and 4. Treatment of physical complications of the mastectomy, including lymphedemas.

These benefits will be provided subject to the same deductible and coinsurance applicable to other medical and surgical benefits provided under this plan. If you would like more information on WHCRA benefits, please contact the Human Resources Department.

Genetic Information Nondiscrimination Act (GINA)The Genetic Information Nondiscrimination Act of 2008 makes it illegal for group health plans and health insurers to deny coverage to healthy individuals, impose a preexisting condition limitation, or charge higher premiums based solely on the basis of genetic information.

Additionally, group health plans cannot request any individual or family member to undergo genetic testing. GINA restricts the collection of genetic information and requires plans to treat genetic information as “protected health information”.

Paperwork Reduction Act StatementAccording to the Paperwork Reduction Act of 1995 (Pub. L. 104-13) (PRA), no persons are required to respond to a collection of informa-tion unless such collection displays a valid Office of Management and Budget (OMB) control number. The Department notes that a Federal agency cannot conduct or sponsor a collection of information unless it is approved by OMB under the PRA, and displays a currently valid OMB control number, and the public is not required to respond to a collection of information unless it displays a currently valid OMB control number. See 44 U.S.C. 3507. Also, notwithstanding any other provi-sions of law, no person shall be subject to penalty for failing to comply with a collection of information if the collection of information does not display a currently valid OMB control number. See 44 U.S.C. 3512.

The public reporting burden for this collection of information is estimat-ed to average approximately seven minutes per respondent. Interest-ed parties are encouraged to send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the U.S. Department of Labor, Employee Benefits Security Administration, Office of Policy and Re-search, Attention: PRA Clearance Officer, 200 Constitution Avenue, N.W., Room N-5718, Washington, DC 20210 or email [email protected] and reference the OMB Control Number 1210-0137.

Important N

otifications

20

Important Notifications

Important Notice from Wexford Health Sources About Your Prescription Drug Coverage and MedicarePlease read this notice carefully and keep it where you can find it. This notice has information about your current prescription drug coverage with Wexford Health Sources and about your options under Medicare’s prescription drug coverage. This information can help you decide whether or not you want to join a Medicare drug plan. If you are con-sidering joining, you should compare your current coverage, including which drugs are covered at what cost, with the coverage and costs of the plans offering Medicare prescription drug coverage in your area. In-formation about where you can get help to make decisions about your prescription drug coverage is at the end of this notice.

There are two important things you need to know about your current coverage and Medicare’s prescription drug coverage: 1. 1. Medicare prescription drug coverage became available in 2006

to everyone with Medicare. You can get this coverage if you join a Medicare Prescription Drug Plan or join a Medicare Advantage Plan (like an HMO or PPO) that offers prescription drug coverage. All Medicare drug plans provide at least a standard level of cover-age set by Medicare. Some plans may also offer more coverage for a higher monthly premium.

2. Wexford Health Sources has determined that the prescription drug coverage offered by the Highmark BSBS Plan is, on average for all plan participants, expected to pay out as much as standard Medi-care prescription drug coverage pays and is therefore considered Creditable Coverage. Because your existing coverage is Creditable Coverage, you can keep this coverage and not pay a higher premi-um (a penalty) if you later decide to join a Medicare drug plan.

When Can You Join A Medicare Drug Plan?You can join a Medicare drug plan when you first become eligible for Medicare and each year from October 15th to December 7th.

However, if you lose your current creditable prescription drug cover-age, through no fault of your own, you will also be eligible for a two (2) month Special Enrollment Period (SEP) to join a Medicare drug plan.

What Happens To Your Current Coverage If You Decide to Join A Medicare Drug Plan?If you decide to join a Medicare drug plan, your current Wexford Health Sources coverage will not be affected.

If you do decide to join a Medicare drug plan and drop your current Wexford Health Sources coverage, be aware that you and your depen-dents will not be able to get this coverage back.

When Will You Pay A Higher Premium (Penalty) To Join A Medicare Drug Plan?You should also know that if you drop or lose your current coverage with Wexford Health Sources and don’t join a Medicare drug plan within 63 continuous days after your current coverage ends, you may pay a higher premium (a penalty) to join a Medicare drug plan later.

If you go 63 continuous days or longer without creditable prescription drug coverage, your monthly premium may go up by at least 1% of the Medicare base beneficiary premium per month for every month that you did not have that coverage. For example, if you go nineteen months without creditable coverage, your premium may consistently be at least 19% higher than the Medicare base beneficiary premium. You may have to pay this higher premium (a penalty) as long as you have Medicare prescription drug coverage. In addition, you may have to wait until the following October to join.

For More Information About This Notice Or Your Current Prescrip-tion Drug CoverageMore detailed information about Medicare plans that offer prescription drug coverage is in the “Medicare & You” handbook. You’ll get a copy of the handbook in the mail every year from Medicare. You may also be contacted directly by Medicare drug plans.

For more information about Medicare prescription drug coverage: Visit www.medicare.gov Call your State Health Insurance Assistance Program (see the inside back cover of your copy of the “Medicare & You” handbook for their telephone number) for personalized help Call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048.

If you have limited income and resources, extra help paying for Medi-care prescription drug coverage is available. For information about this extra help, visit Social Security on the web at www.socialsecurity.gov, or call them at 1-800-772-1213 (TTY 1-800-325-0778).

Contact the person listed below for further information.

Wexford Health SourcesMark Blewett501 Holiday DriveFoster Plaza FourPittsburgh PA 15220Phone Number: (800) 903-3616 Ext. 255

You will also get it before the next period you can join a Medicare drug plan, and if this coverage through Wexford Health Sources changes. You also may request a copy of this notice at any time.

Remember: Keep this Creditable Coverage notice. If you decide to join one of the Medicare drug plans, you may be required to provide a copy of this notice when you join to show whether or not you have maintained creditable coverage and, therefore, whether or not you are required to pay a higher premium (a penalty).

Important N

otifications

21

Contact InformationContact Inform

ation

Benefit Carrier Phone Number Website

Medical Insurance Highmark 1-800-241-5704 www.highmarkbcbs.com

Dental Insurance UCCI 1-800-332-0366 www.unitedconcordia.com

Vision Insurance VBA 1-800-432-4966 www.vbaplans.com

Hospital Indemnity Lincoln 1-800-423-2765 www.lfg.com

Supplemental Life Insurance Lincoln 1-800-423-2765 www.lfg.com

Long Term Disability Lincoln 1-800-423-2765 www.lfg.com

Accident Lincoln 1-800-423-2765 www.lfg.com

Critical Illness Lincoln 1-800-423-2765 www.lfg.com

Permanent Life Insurance Allstate 1-800-521-3535 www.allstatebenefits.com/mybenefits

Flexible Spending Account (FSA) WEX Health 1-866-451-3399 www.wexinc.com

Health Spending Account (HSA) WEX Health 1-866-451-3399 www.wexinc.com

Wexford Health Benefits Hotline 1-877-822-6879

DON’T FORGET THE BENEFITS OPEN ENROLLMENTPERIOD ENDS NOVEMBER 5th!!

CONTACT WTW AT 877-552-4192 TO MAKE CHANGES.

OPEN ENROLLMENT IS YOUR ONLY OPPORTUNITY TOENROLL IN OR WAIVE COVERAGE, ELECT A NEW TIER

OF COVERAGE, AND ENROLL IN VOLUNTARY BENEFITS.

IF YOU HAVE ANY QUESTIONS ABOUT THE INFORMATIONIN THIS GUIDE, PLEASE CALL THE WEXFORDHEALTH BENEFITS HOTLINE AT 877-822-6879.

For more information about all of the 2022 benefit offerings visit:http://enroll.aacbenefits.com/whsbenefits

* Disclaimer: This Benefits Enrollment Guide is a brief summary of your benefits and does not constitute a policy. Wexford Health may amend the benefits program at anytime, with or without advanced notice. Your Summary Plan Description (SPD) or Insurance Policy will contain the actual detailed provisions of your benefits. If there is a discrepancy between the information contained in this Guide and the SPD/Insurance Policy, the SPD/Insurance Policy will prevail.

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Notes

Willis Towers Watson has prepared this document for the benefit of Wexford. This document contains proprietary material and should not be reproduced, either in total or in part, circulated or quoted from without the express permission of Willis Towers Watson.

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