2020 AtlantiCare Benefits Workbook

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BENEFITSWORKBOOK

Important decisions deserve a little homework. When you enroll, make a commitment to take the time to understand all of your options and decide what’s best for you, your family and your health. The purpose of this Benefits Workbook is to provide you with important information to help you make the right choices that fit the needs of you and your family. AtlantiCare provides employees with a comprehensive and competitive benefits package to provide coverage to you and your family. It is important for you to make informed decisions and adopt healthy habits. This workbook highlights the 2020 benefits offered to you and your family. Please review all plans offered to recognize the difference in options offered so you can decide which is best for your needs. Before choosing a plan, please check with your providers to verify their participation in the plan you are considering. Many of the providers being utilized by AtlantiCare employees and their dependents participate in all three plans. Our own AtlantiCare providers and affiliates continue to be the cheapest option. Please visit the Human Resources portal on the Starfish for participating physicians, facilities and other services for all plans.

Dear AtlantiCare Family,

Thank you for your commitment to personal health and wellness. Each year, we take great care to research and design comprehensive, affordable, and meaningful wellness programs and benefits options for the members of our AtlantiCare family. Our goal is to assist you in planning for unforeseen emergencies, as well as take lifelong proactive measures to ensure a healthy future. Please review each plan option and select the 2020 benefits package that works best for you and your family. We continue to offer three plan options: Engaged Plan powered by Geisinger; Engaged Plan powered by Horizon; and Horizon PPO. Details about each plan are outlined in the pages that follow. Through our variety of benefits options and wellness programs, we support your commitment to leading healthier lives.

Thank you for engaging in your own health and that of your families. Modeling healthy behaviors helps us achieve our vision of building healthy communities together.

Keep making a difference,

Geisinger Health Options is a service of Geisinger Indemnity Insurance Company, an affiliate of Geisinger Health Plan.

Lori Herndon President and CEO AtlantiCare

What’s New

HOME TABL OF CONTENTS WELCOME.................2 WHAT’S NEW. ...........3 I E CENTERS AND EBSITES...................4 HO TO ENROLL.......5 MEDICAL..............6-12 PRESCRIPTION DRUG. ................13-15 ADDITIONAL MEDICAL PLAN RESOURCES........16-18 DENTAL...............19-21 VISION.....................22 LIFECENTER..............23 LIFE INSURANCE. .....24 LONG TERM DISABILITY...............25 VOLUNTARY OFFERINGS. ........26-29 SPENDING ACCOU TS. ............30 RETIREMENT B NEFITS..................31 WELLNESS. .........32-36 LEGAL NOTICES..37-39 CONTACTS.........40-41 GLOSSARY..........42-43 FAQs...................44-46 FORMS................47-56 WHAT’S NEW SERVICE CENTERS AND WEBSITES HOW TO ENROLL MEDICAL PRESCRIPTION DRUG ADDITIONAL MEDICAL PLAN RESOURCES DENTAL VISION LIFE INSURANCE LONG TERM DISABILITY VOLUNTARY OFFERINGS SPENDING ACCOUNTS RETIREMENT BENEFITS WELLNESS LEGAL NOTICES CONTACTS GLOSSARY

2020 Benefits Changes • Enhanced Acupuncture coverage • Changes to Out-of-Pocket Maximums • Employee contribution changes • New Flexible Spending (FSA)/COBRA Vendor • New Voluntary Benefits Offering • Wellness Activity Changes

New Voluntary Benefits Identity Theft Protection – ID watchdog protects employees and their families with credit and identity monitoring. Student Loan Refinancing – GradFin (Graduate Financial Solutions) refinances and consolidates employees’ student loans through their lending platform. 2020 Wellness Activity Checklist • New Wellness Credit Activity – Advance Directive – $150 • Revised Know Your Numbers Blood Pressure Improvement – from >140/90 to >135/85

Medical Plan Changes • Acupuncture scope of coverage is being expanded to treat more conditions. Additionally, more providers have been added to the AtlantiCare Tier 1 service area. • Changes to Out-of-Pocket Maximums – In keeping with the ACA, medical out-of-pocket maximums for single coverage will go up from $5,600 to $8,150 and family coverage will go up from $11,200 to $16,300. • Employee Contribution Changes – rates in all salary bands will increase by an average of 6%. Flexible Spending (FSA)/COBRA Administrator Effective January 1, 2020, AtlantiCare has partnered with Baker Tilly to administer FSA (medical and dependent care), HRA and COBRA services. Waived Benefits and LTD Update Effective January 1, 2020, AtlantiCare Behavioral Health Employees will be eligible for the $45 waived benefits funding if choosing to opt-out of benefits (see page 30 for details). Full-time ABH employees will also be eligible for Long Term Disability Coverage (see page 25 for additional LTD details).

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Service Centers and Websites

TABLE OF CONTENTS WELCOME.................2 WHAT’S NEW. ...........3 SERVICE CENTERS AND WEBSITES...................4 HOW TO ENROLL.......5 MEDICAL..............6-12 PRESCRIPTION DRUG. ................13-15 ADDITIONAL MEDICAL PLAN RESOURCES........16-18 DENTAL...............19-21 VISION.....................22 LIFECENTER..............23 LIFE INSURANCE. .....24 LONG TERM DISABILITY...............25 VOLUNTARY OFFERINGS. ........26-29 SPENDING ACCOUNTS. ............30 RETIREMENT BENEFITS..................31 WELLNESS. .........32-36 LEGAL NOTICES..37-39 CONTACTS.........40-41 GLOSSARY..........42-43 FAQs...................44-46 FORMS................47-56

AtlantiCare Benefits Service Center 1-800-211-3252 Monday through Friday, 8:00 am – 6:00 pm Saturday, 8:00 am – 5:00 pm

You can access the AtlantiCare Benefits Service/Enrollment Site to make your elections via MyOwnRecords ( www.portal.adp.com ). Navigate to the Benefits tab and click Health and Welfare. For more information, see How to Enroll on page 5.

FSA Employee Benefits Center 1-800-307-0230 Monday through Friday 8:30 am – 5:30 pm EST myflexdollars.com

See Contacts on page 40 for specific benefit policies.

ow To Enroll

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HOME TABL OF CONTENTS WELCOME.................2 WHAT’S NEW. ...........3 I E TERS AND EBSITES...................4 HO TO ENROLL.......5 MEDICAL..............6-12 PRESCRIPTION DRUG. ................13-15 ADDITIONAL MEDICAL PLAN RESOURCES........16-18 DENTAL...............19-21 VISION.....................22 LIFECENTER..............23 LIFE INSURANCE. .....24 LONG TERM DISABILITY...............25 VOLUNTARY OFFERINGS. ........26-29 SPENDING ACCOU TS. ............30 RETIREMENT B NEFITS..................31 WELLNESS. .........32-36 LEGAL NOTICES..37-39 CONTACTS.........40-41 GLOSSARY..........42-43 FAQs...................44-46 FORMS................47-56 WHAT’S NEW SERVICE CENTERS AND WEBSITES HOW TO ENROLL MEDICAL PRESCRIPTION DRUG ADDITIONAL MEDICAL PLAN RESOURCES DENTAL VISION LIFE INSURANCE LONG TERM DISABILITY VOLUNTARY OFFERINGS SPENDING ACCOUNTS RETIREMENT BENEFITS WELLNESS LEGAL NOTICES CONTACTS GLOSSARY

Spend time to learn about your benefit options so you can make the best decisions for you and your family based on your needs. Make Sure You… • Read this Benefits Workbook • Review your dependent information • Use the enrollment website to help you decide which plans are best for you and your family • Consider participating in flexible spending accounts and other voluntary offerings • Review the 2020 Wellness Activity Checklist The choices you make during Open Enrollment will go into effect on January 1, and remain until December 31, unless you have a qualified life event. The choices you make as a new hire are effective the first of the month after you are hired, until December 31. ! IMPORTANT Newly eligible employees must actively elect to either participate in or waive benefits. Those who fail to confirm enrollment will be automatically enrolled in the Engaged Plan Powered by Geisinger – ‘Employee Only,’ Tobacco surcharge and the Basic Dental Plan - ‘Employee Only.’

ADP Benefits Service/Enrollment Site – Easy Access • Login to MyOwnRecords ( www.portal.adp.com ) • Hover over Benefits tab, then click Health & Welfare. • Click Benefits on the left side. A New Hire tile will appear informing you how many days you have to enroll. • Click ENROLL NOW to make 2020 elections. • Confirm Your Elections. • Click Complete Enrollment. • Review Benefits Summary. Click Confirm Enrollment. A confirmation message will appear. • Read the message and click I AGREE. • Download to save or print confirmation statement.

? DID YOU KNOW? If recently hired or newly eligible for coverage this year, you must update any benefits you would like to change for the upcoming plan year during Open Enrollment.

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• Discounts on vision services through EyeMed Vision Care – Eyewear, mail order contact lenses, and eye exams (can be used separately but not in combination with benefits under the plan) • Discounts on LASIK vision correction through US Laser Network – 15% discount off regular price or 5% off promotional price for LASIK and PRK treatments • Discounts on child safety products through Safe Beginnings – 15% discount • Local discounts for amusement/attractions, and fitness centers (not available in all areas; primarily in Central, Northeastern and Southern Pennsylvania) The AtlantiCare Engaged Plan Powered by Horizon • Second lowest per pay period contribution • Wellness credits reduce the wellness deductible by up to $2,000 for single coverage and up to $4,000 for spouse/partner or family coverage • Two-tiered network of providers – the AtlantiCare Tier and the Blue Cross/Blue Shield Tier • Same services are covered in both tiers, but when you utilize AtlantiCare and its affiliates, you pay less out of pocket • When you utilize the Blue Cross/Blue Shield national network (Blue Card), you have some additional costs. In most cases, the additional costs are a $1,000 copay and then 30% of the cost of services. This applies even when AtlantiCare does not offer a comparable service. • Visit http://atlanticare.horizonblue.com to find a participating physician, facility or other service provider. Little Known Benefits About The Horizon Plans • Eye Exams – one eye exam per year, $70 maximum reimbursement • Vision hardware – one pair of eyeglasses or contacts every 2 years, $60 maximum reimbursement • The Horizon Plan Discounts through Blue 365 – weight loss programs, gym discounts, hearing aid discounts, vision discounts, travel, wellness discounts. • Fitness Your Way program offers special pricing on Fitbits. • Free identity theft protection • CareOnline telemedicine program • To access log on to www.Atlanticare.horizonblue.com

You have three choices in Medical Plan coverage: • Engaged Plan Powered by Geisinger • Engaged Plan Powered by Horizon • Horizon Preferred Provider (PPO) Plan

All three options include access to AtlantiCare Tier 1 physicians, facilities and services, and you pay less when you use these providers. Each plan was designed to meet your family’s healthcare needs. However, access to physicians and facilities varies with each plan. The amount you pay toward the cost of the plan also varies. As you review your medical plan option, be mindful of how often you visit the doctor, the flexibility you want when choosing a doctor for your care and the cost of coverage. The AtlantiCare Engaged Plan Powered by Geisinger • Lowest per pay period contribution • Wellness credits reduce the wellness deductible by up to $2,000 for single coverage and up to $4,000 for spouse/partner or family coverage • Two-tiered network of providers – the AtlantiCare Tier and the Geisinger Tier • Same services are covered in both tiers, but when you utilize AtlantiCare and its affiliates, you pay less out of pocket • When you utilize the Geisinger network, you have some additional costs. In most cases, the additional costs are a $1,000 deductible and then 20% of the cost of services. This applies even when AtlantiCare does not offer a comparable service. • Visit http://www.thehealthplan.com/atlanticare to find a participating physician, facility or other service provider. Little Known Benefits About The Geisinger Engaged Plan • Eye Exams – one eye exam per year, $70 maximum reimbursement • Vision hardware – one pair of eyeglasses or contacts every 2 years, $60 maximum reimbursement • Discounts on massage therapy through ASHN – 25% discount • Discounts on chiropractic care and acupuncture through ASHN – 25% discount (can be used separately but not in combination with benefits under the plan)

FORMS

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Medical

HOME TABL OF CONTENTS WELCOME.................2 WHAT’S NEW. ...........3 I E TERS AND EBSITES...................4 HOW TO ENROLL.......5 MEDICAL..............6-12 PRESCRIPTION DRUG. ................13-15 ADDITIONAL MEDICAL PLAN RESOURCES........16-18 DENTAL...............19-21 VISION.....................22 LIFECENTER..............23 LIFE INSURANCE. .....24 LONG TERM DISABILITY...............25 VOLUNTARY OFFERINGS. ........26-29 SPENDING ACCOU TS. ............30 RETIREMENT B NEFITS..................31 WELLNESS. .........32-36 LEGAL NOTICES..37-39 CONTACTS.........40-41 GLOSSARY..........42-43 FAQs...................44-46 FORMS................47-56 WHAT’S NEW SERVICE CENTERS AND WEBSITES HOW TO ENROLL MEDICAL PRESCRIPTION DRUG ADDITIONAL MEDICAL PLAN RESOURCES DENTAL VISION LIFE INSURANCE LONG TERM DISABILITY VOLUNTARY OFFERINGS SPENDING ACCOUNTS RETIREMENT BENEFITS WELLNESS LEGAL NOTICES CONTACTS GLOSSARY

• All services provided outside of the Blue Cross/Blue Shield network will usually be paid at 50% of the cost after a $2,000 copay is met. • Visit http://atlanticare.horizonblue.com to find a participating physician, facility or other service provider. See Wellness starting on page 32 for more information about wellness activities. See Spending Accounts on page 30 for information about how spending accounts coordinate with your health plan options. ? DID YOU KNOW? There is no copay or deductible for your Annual Preventive Care Visit. You are eligible to have one covered annual Preventive Care Visit each calendar year.

The AtlantiCare Horizon Preferred Provider Plan (PPO) • Most expensive per pay period contribution • Wellness credits can reduce your contributions by up to $750 for single coverage and up to an additional $1,500 for spouse/partner or family coverage. Your earned credits are applied to the total cost of your medical contribution and divided over 26 pay periods for the following year. • Includes same benefits and provider networks as those provided in the AtlantiCare Horizon Engaged Plan, but also offers coverage for physicians and facilities outside of the national Blue Cross/Blue Shield network. • Utilizing AtlantiCare and our affiliates for service will result in the lowest out-of-pocket cost. • Services performed through a Blue Cross/Blue Shield network provider will be covered at 70% after a $1,000 copay is met.

The Plans At A Glance

GEISINGER ENGAGED HORIZON ENGAGED HORIZON PPO

Has AtlantiCare Network

Has Geisinger Network

Has BC/BS Network

Has “Out-of-Network” Providers

Has $1,000 Deductible When Using Non-AtlantiCare Facilities

Lowest Contributions

Wellness Credits Reduce Deductible

Wellness Credits Reduce Contributions

Access to Telehealth Benefit

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Healthy Rewards Gym Reimbursement Program

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? DID YOU KNOW?

Spouse & Partner Preferred Choice Premium AtlantiCare continuously balances the need to offer meaningful and comprehensive employee benefits with the need to remain financially sound in the current healthcare environment. To achieve this balance, we require a Spouse and Partner Preferred Choice Premium. This premium will be applied to your bi-weekly contribution if your spouse/partner chooses to obtain medical coverage through AtlantiCare when they have the option of obtaining benefits through their own employer. This premium will not be applied if your spouse/partner is not offered benefits through their employer, is not currently employed or also works at AtlantiCare. The premium is $75 per paycheck if your base salary is less than $100,000 and $125 per paycheck if your base salary is $100,000 or more. AtlantiCare will conduct audits throughout the year in which you will be asked to supply documentation (i.e., a letter from employer or tax return showing no income) if you have indicated that your spouse/ partner is not eligible for medical coverage by their own employer. This acknowledgment is considered a legal process and should be treated as such. If your spouse is self-employed and not obtaining benefits through the business, they will need to supply proof of self-employment.

! IMPORTANT! Horizon plan members have access to a telehealth benefit. You can use Horizon CareOnline to talk to licensed, U.S. board-certified doctors via video, chat or phone 24 hours a day, seven days a week – no appointment is needed. With Horizon CareOnline, you can be treated for symptoms and conditions such as colds, flu, fever, rash, abdominal pain, sinusitis, ear infections and behavioral health.

Call 1-877-716-5657 , sign into member online services at Horizonblue.com/atlanticare or visit atlanticare.horizoncareonline.com .

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2020 Medical Plan Bi-Weekly Contribution Rates

Full-Time

Part-Time

$0-49,999k $50-99,999k $100k-149,999k

$150k+

$0-49,999k $50-99,999k $100k-149,999k $150k+

Engaged Plan Powered by Geisinger

Employee

$32.37 $37.47

$65.75

$67.29 $64.64 $71.26 $131.51 $134.56

Employee + Spouse

$55.41 $64.15 $112.58

$115.20 $116.36 $128.29 $225.15 $230.39

Employee + Child(ren)

$44.67 $51.71

$90.75

$92.86 $93.80 $103.41 $181.48 $185.72

Family

$88.52 $102.47 $179.76

$183.92 $185.78 $204.82 $359.49 $367.86

Engaged Plan Powered by Horizon

Employee

$46.88 $51.69

$77.56

$79.36 $93.77 $103.38 $155.14 $158.75

Employee + Spouse

$80.29 $88.51 $133.75

$136.87 $160.54 $177.00 $230.55 $235.90

Employee + Child(ren)

$64.71 $71.34 $122.35

$125.20 $129.42 $142.68 $244.69 $250.38

Family

$128.18 $141.32 $218.63

$223.72 $256.35 $282.62 $437.28 $447.45

Horizon PPO

Employee

$135.08 $148.92 $180.55

$184.75 $159.95 $176.35 $280.86 $287.39

Employee + Spouse

$231.32 $255.04 $309.19

$316.38 $273.93 $302.00 $480.99 $492.17

Employee + Child(ren)

$186.45 $205.57 $249.23

$255.04 $220.80 $243.43 $387.68 $396.69

Family

$369.38 $407.24 $493.74

$505.22 $437.42 $482.25 $768.05 $785.91

*$25 surcharge will be added to your bi-weekly contribution if you utilize tobacco products. A Spouse & Partner Preferred Choice Premium may also apply. See page 8 for details.

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Medical

HOME TABL OF CONTENTS WELCOME.................2 WHAT’S NEW. ...........3 I E TERS AND WEBSITES...................4 HOW TO ENROLL.......5 MEDICAL..............6-12 PRESCRIPTION DRUG. ................13-15 ADDITIONAL MEDICAL PLAN RESOURCES........16-18 DENTAL...............19-21 VISION.....................22 LIFECENTER..............23 LIFE INSURANCE. .....24 LONG TERM DISABILITY...............25 VOLUNTARY OFFERINGS. ........26-29 SPENDING ACCOU TS. ............30 RETIREMENT B NEFITS..................31 WELLNESS. .........32-36 LEGAL NOTICES..37-39 CONTACTS.........40-41 GLOSSARY..........42-43 FAQs...................44-46 FORMS................47-56 WHAT’S NEW SERVICE CENTERS AND WEBSITES HOW TO ENROLL MEDICAL PRESCRIPTION DRUG ADDITIONAL MEDICAL PLAN RESOURCES DENTAL VISION LIFE INSURANCE LONG TERM DISABILITY VOLUNTARY OFFERINGS SPENDING ACCOUNTS RETIREMENT BENEFITS WELLNESS LEGAL NOTICES CONTACTS GLOSSARY

Waiving Benefits If you waive your medical benefits, $45 per pay* will be deposited into a Healthcare Reimbursement Account (HRA). See Spending Accounts on page 30 for more information. In addition, your earned wellness credits from 2019 of up to $750 will also be deposited into this account. See Wellness starting on page 32 for a list of wellness activities and their values. Please visit https://myatlanticare.org to view your online wellness activity checklist or call Health Engagement at 1-609-677-7507 if you have questions about your wellness activities.

$ MAKE THE MOST OF... Your Medical Plan Benefits

• Consider one of the engaged plans. The contributions are lower than the PPO plan. If you receive most of your care from the AtlantiCare/Geisinger network, the Engaged Plan Powered by Geisinger should meet your needs. If not, and you have a lot of physicians who are outside of the AtlantiCare/Geisinger network, the Engaged Plan Powered by Horizon should meet your needs just as well as the PPO Plan. • Always check to see if AtlantiCare can perform the service before scheduling somewhere else. If it is a routine procedure, the AtlantiCare Access Center should be able to refer you appropriately. Never assume your physician is referring you to a tier one provider . • Contact your plan administrator (Geisinger or Horizon) before a procedure to determine what you can expect to pay and to ensure any pre-authorizations have been completed. • Consider participating in Flexible Spending Accounts to supplement your out-of-pocket expenses. • Complete wellness activities to earn credits to reduce your wellness deductible, buy down your bi-weekly contributions or apply to your FSA card. • Utilize an AtlantiCare Primary Care Plus provider. In all three medical plans, these providers are only a $10 copay for office visits, compared to a $50 copay for primary care providers that are not AtlantiCare Primary Care Plus designated. To earn this designation, our providers have shown commitment and have taken meaningful steps toward the patient-centered medical home model, which means offering same or next-day urgent appointments, implementing a common electronic medical record, collaborating with AtlantiCare Care Managers for complex patients, and allowing hospitalists to care for patients admitted to ARMC. To find an AtlantiCare Primary Care Plus provider, call the AtlantiCare Access Center at 1-888-569-1000 .

*If you are covered by another AtlantiCare employee and you waive medical coverage, you will not be eligible for the waiver benefit.

? DID YOU KNOW? Nutritional Counseling is a covered benefit, offering six visits per calendar year. Nutritional Counseling is an important part of the prevention and treatment of many diseases and conditions. Confirm network providers with your plan prior to scheduling an appointment.

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Medical

Compare 2020 Plan Choices

HOME TABL OF CONTENTS WELCOME.................2 WHAT’S NEW. ...........3 I E TERS AND WEBSITES...................4 HO TO ENROLL.......5 MEDICAL..............6-12 PRESCRIPTION DRUG. ................13-15 ADDITIONAL MEDICAL PLAN RESOURCES........16-18 DENTAL...............19-21 VISION.....................22 LIFECENTER..............23 LIFE INSURANCE. .....24 LONG TERM DISABILITY...............25 VOLUNTARY OFFERINGS. ..... A26-29 SPENDING ACCOU TS. ............30 RETIREMENT B NEFITS..................31 WELLNESS. .........32-36 LEGAL NOTICES..37-39 CONTACTS.........40-41 GLOSSARY..........42-43 FAQs...................44-46 FORMS................47-56 WHAT’S NEW SERVICE CENTERS AND WEBSITES HOW TO ENROLL MEDICAL PRESCRIPTION DRUG ADDITIONAL MEDICAL PLAN RESOURCES DENTAL VISION LIFE INSURANCE LONG TERM DISABILITY VOLUNTARY OFFERINGS SPENDING ACCOUNTS RETIREMENT BENEFITS WELLNESS LEGAL NOTICES CONTACTS GLOSSARY

Geisinger Engaged Plan

Horizon Engaged Plan

PPO Plan

Medical Services

Tier 1

Tier 2

Inner Circle/Tier 1

Tier 2

Inner Circle/Tier 1

Tier 2

Out-of-Network

Wellness Deductible (per person/per family)

$2,000/$4,000*

N/A

$1,000/$2,000

$2,000/$4,000

Out-of-Pocket Maximum after Deductible (per person/per family)

$8,150/$16,300

$8,500/$16,600

Facility Benefits

Covered 100% after $750 copay/visit and wellness deductible

Covered 100% after $1,000 copay/visit and wellness deductible

$2,000 copay/visit then covered 50%; no deductible

Covered 100% after wellness deductible

Covered 100% after deductible

Covered 100% after $750 copay/visit

Room & Board / Ancillary

Outpatient Facility Benefits

Covered 100% after $25 copay and wellness deductible Covered 100% after $25 copay and wellness deductible Covered 100% after wellness deductible Covered 100% after wellness deductible Covered 100% after wellness deductible

Covered 100% after $750 copay/visit and wellness deductible Covered 100% after $500 copay/visit and wellness deductible Covered 80% after wellness deductible Covered 80% after wellness deductible Covered 80% after wellness deductible

Covered 70% after $1,000 copay/visit and wellness deductible Covered 70% after $750 copay/visit and wellness deductible Covered 70% after wellness deductible Covered 70% after wellness deductible Covered 70% after wellness deductible Covered 100% after $50 copay/visit and wellness deductible; all other services rendered in the office covered 70% after wellness deductible Covered 100% after $65 copay/visit and wellness deductible; all other services rendered in the office covered 70% after wellness deductible

$2,000 copay/visit then covered 50%; no deductible

Outpatient Surgery (Hospital Based)

Covered 100% after $25 copay

Covered 100% after $750 copay/visit

Outpatient Surgery (Surgical Center)

Covered 100% after $25 copay

Covered 100% after $500 copay/visit

Covered 50% after deductible

Physician Services

Covered 70% after deductible Covered 70% after deductible Covered 70% after deductible Covered 100% after $50 copay/visit; all other services rendered in the office covered 70% after deductible Covered 100% after $65 copay/visit; all other services rendered in the office covered 70% after deductible

Covered 50% after deductible Covered 50% after deductible Covered 50% after deductible

Surgeon

Covered 100%

Anesthesia

Covered 100%

Inpatient Physician Visit

Covered 100%

Covered 100% after $40 copay/visit and wellness deductible; all other services rendered in the office covered 80% after wellness deductible Covered 100% after $55 copay/visit and wellness deductible; all other services rendered in the office covered 80% after wellness deductible

Covered 100% after $10 copay and wellness deductible

Physician Office Visits - Primary Care

Covered 100% after $10 copay/visit

Covered 50% after deductible

Covered 100% after $10 copay and wellness deductible

Physician Office Visits - Specialist

Covered 100% after $10 copay/visit

Covered 50% after deductible

Physician Office Visits - Routine Well Care

Covered 100%

Covered 100% Covered 100%

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This chart is meant as an overview only. For detailed information, please refer to the Summary Plan Description posted under “Benefit Information” on the HR Portal: Benefits Tab. * For Engaged Plans only, the wellness deductible can be reduced through wellness credits ** AtlantiCare also covers some services for gender assignment. Check the plan document for more information.

Medical

Compare 2020 Plan Choices

Geisinger Engaged Plan

Horizon Engaged Plan

PPO Plan

Medical Services

Tier 1

Tier 2

Inner Circle/Tier 1

Tier 2

Inner Circle/Tier 1

Tier 2

Out-of-Network

Supplemental Services

Covered 100% after $20 copay/visit

Covered 100% after $20 copay/visit Covered 100% after $50 copay/visit and deductible; all other services rendered in the office covered 70% after deductible Office and freestanding clinic: Covered 100% after $50 copay/visit and deductible Facility: Covered 70% after deductible Office and freestanding clinic: Covered 100% after $50 copay/visit and deductible Covered 100% after $150 copay

Covered 100% after $20 copay/visit

Telemedicine

N/A

Covered 100% after $40 copay/visit and wellness deductible; all other services rendered in the office covered 80% after wellness deductible Covered 100% after $150 copay and wellness deductible Office and freestanding clinic: Covered 100% after $40 copay/visit and wellness deductible

Covered 100% after $50 copay/visit and wellness deductible; all other services rendered in the office covered 70% after wellness deductible Covered 100% after $150 copay and wellness deductible Office and freestanding clinic: Covered 100% after $50 copay/visit and wellness deductible

Covered 100% after $20 copay and wellness deductible

Covered 100% after $20 copay and deductible

Covered 100% after $60 copay

Urgent Care

Covered 100% after $150 copay and wellness deductible

Covered 100% after $150 copay

Emergency Services

Covered 100% after $10 copay and wellness deductible

Covered 100% after $10 copay/visit

Covered 50% after deductible

Diagnostic X-ray

Facility: Covered 80% after wellness deductible

Facility: Covered 70% after wellness deductible

Office and freestanding clinic: Covered 100% after $40 copay/visit and wellness deductible

Office and freestanding clinic: Covered 100% after $50 copay/visit and wellness deductible

Covered 100% after $10 copay and wellness deductible

Covered 100% after $10 copay/visit

Covered 50% after deductible

Diagnostic hi-tech imaging

Facility: Covered 80% after wellness deductible

Facility: Covered 70% after wellness deductible

Facility: Covered 70% after deductible

Covered 100% after $10 copay/visit and wellness deductible

Covered 100% after $40 copay/visit and wellness deductible

Covered 100% after $10 copay/visit and wellness deductible

Covered 100% after $50 copay/visit and wellness deductible

Covered 100% after $10 copay/visit

Covered 70% after deductible

Covered 50% after deductible

Diagnostic Tests

This chart is meant as an overview only. For detailed information, please refer to the Summary Plan Description posted under “Benefit Information” on the HR Portal: Benefits tab.

Vision care expense benefit for all plans (no network limitations) Routine Vision Exam annually $70 Eyeglasses and/or Contact Lenses every two years $60 Must submit a claim form for reimbursement.

* For Engaged Plans only, the wellness deductible can be reduced through wellness credits ** AtlantiCare also covers some services for gender assignment. Check the plan document for more information.

FORMS

Prescription Drug

HOME TABL OF CONTENTS WELCOME.................2 WHAT’S NEW. ...........3 I E CENTERS AND WEBSITES...................4 HO TO ENROLL.......5 MEDICAL..............6-12 PRESCRIPTION DRUG. ................13-15 ADDITIONAL MEDICAL PLAN RESOURCES.........16-18 DENTAL...............19-21 VISION.....................22 LIFECENTER..............23 LIFE INSURANCE. .....24 LONG TERM DISABILITY...............25 VOLUNTARY OFFERINGS. ........26-29 SPENDING ACCOU TS. ............30 RETIREMENT B NEFITS..................31 WELLNESS. .........32-36 LEGAL NOTICES..37-39 CONTACTS.........40-41 GLOSSARY..........42-43 FAQs...................44-46 FORMS................47-56 WHAT’S NEW SERVICE CENTERS AND WEBSITES HOW TO ENROLL MEDICAL PRESCRIPTION DRUG ADDITIONAL MEDICAL PLAN RESOURCES DENTAL VISION LIFE INSURANCE LONG TERM DISABILITY VOLUNTARY OFFERINGS SPENDING ACCOUNTS RETIREMENT BENEFITS WELLNESS LEGAL NOTICES CONTACTS GLOSSARY

Regardless of which medical plan option you choose, you are eligible for prescription drug benefits through Geisinger. Refer to the table below for the copay amounts you will pay under the Prescription Drug plan. For more information about prescription benefits, see Prescription Plan FAQs on page 46 .

Non-Specialty Medications

AtlantiCare Pharmacy (Retail & Mail Order) Generic Brand Formulary/Preferred Brand Non-Formulary

Copays for 30/90-day supply $10/$20 $20/$40 $50/$100

Non-AtlantiCare Retail Pharmacy Generic Brand Formulary/Preferred Brand Non-Formulary Specialty Medications AtlantiCare Retail Pharmacy Generic Brand Formulary Brand Non-Formulary

Copays for 30-day supply 10% 20% 100%

Minimum $10 $25 N/A

Copays (up to 30-day supply) $10 $20 $50

*Other Specialty Pharmacy Generic Brand Formulary Brand Non-Formulary Maximum $150 $150 $150 *If the AtlantiCare Pharmacy is unable to fill your request, they will direct you to contact Geisinger Customer Service for assistance in obtaining your medication. Copays (up to 30-day supply) 10% 20% 30%

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Prescription Drug

Always consider using the AtlantiCare Pharmacy first, because it typically features the least out-of-pocket cost.

AtlantiCare Pharmacy (Retail and Mail Order) The AtlantiCare Pharmacy offers AtlantiCare employees and their covered dependents the opportunity to fill prescriptions at a reduced cost. Medications can be filled for as little as $10 (generic) or $20 (brand name formulary) for a 30-day supply. Medication copay costs will double for a 90-day supply. There are three AtlantiCare Pharmacy locations:

Atlantic City AtlantiCare HealthPlex, 1401 Atlantic Avenue

Tel: 1-609-441-7088 Fax: 1-609-441-7089

Galloway 54 West Jimmie Leeds Road

Tel: 1-609-404-7444 Fax: 1-609-404-7445

Manahawkin 517 Route 72W

Tel: 1-609-704-6800 Fax: 1-609-704-6801

? DID YOU KNOW?

Hours of Operation Monday through Friday, 8:00 am to 6:00 pm Saturday, 9:00 am to 4:00 pm (Galloway only)

AtlantiCare Pharmacy provides an online site to manage your prescription needs, order refills, transfer prescriptions from other pharmacies and much more. Visit https://atlanticare.refillmyrx.com to register and start managing your prescriptions today.

In the case of an emergency, you may use the AtlantiCare Community Pharmacy located inside ARMC City and Mainland Campuses. Hours of operation are 10:00 am to 10:00 pm daily. Please note, you may utilize these pharmacies for emergencies only. They do not carry enough supply for employees’ daily usage.

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Prescription Drug

HOME TABL OF CONTENTS WELCOME.................2 WHAT’S NEW. ...........3 I E CENTERS AND WEBSITES...................4 HO TO ENROLL.......5 MEDICAL..............6-12 PRESCRIPTION DRUG. ................13-15 ADDITIONAL MEDICAL PLAN RESOURCES.........16-18 DENTAL...............19-21 VISION.....................22 LIFECENTER..............23 LIFE INSURANCE. .....24 LONG TERM DISABILITY...............25 VOLUNTARY OFFERINGS. ........26-29 SPENDING ACCOU TS. ............30 RETIREMENT BENEFITS..................31 WELLNESS. .........32-36 LEGAL NOTICES..37-39 CONTACTS.........40-41 GLOSSARY..........42-43 FAQs...................44-46 FORMS................47-56 WHAT’S NEW SERVICE CENTERS AND WEBSITES HOW TO ENROLL MEDICAL PRESCRIPTION DRUG ADDITIONAL MEDICAL PLAN RESOURCES DENTAL VISION LIFE INSURANCE LONG TERM DISABILITY VOLUNTARY OFFERINGS SPENDING ACCOUNTS RETIREMENT BENEFITS WELLNESS LEGAL NOTICES CONTACTS GLOSSARY

Retail Pharmacies (non-AtlantiCare) You can utilize your Geisinger prescription card to access retail pharmacies nationwide. While most large chains participate in the network, we do have some exclusions, such as Walgreens and Rite Aid. When you utilize these pharmacies, please consider the following: • Your copay may be higher than what you would pay at your AtlantiCare pharmacy. • If your medications are not categorized as generic or formulary brand you may be responsible for the full cost of the prescription. • Any medication obtained from a non-AtlantiCare Pharmacy will only be filled for up to a 30-day supply (90-day supply not available) • Maintenance medications can only be refilled one time at a non-AtlantiCare pharmacy. To find a participating pharmacy or to see if your medication is covered, visit the Geisinger search tool at https://www.thehealthplan.com/atlanticare .

Specialty Medications AtlantiCare Pharmacy will process your specialty medications. Please note, specialty medications may require prior authorization, so please plan accordingly. If the AtlantiCare Pharmacy is unable to fill your request, they will direct you to contact Geisinger Customer Service for assistance in obtaining your medication. Pharmacy Copays The maximum amount that you will pay for prescriptions per year: Single $1,750/Family $3,500.

? DID YOU KNOW? AtlantiCare pharmacy offers mail order service for all active employees and their dependents at no additional cost. Medications are delivered within 2-3 days. Mail order forms can be found on the HR Portal: Benefits tab on the Starfish or by calling the Galloway pharmacy at 609-404-7444 .

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Additional Medical Plan Resources

HOME TABL OF CONTENTS WELCOME.................2 WHAT’S NEW. ...........3 I E CENTERS AND EBSITES...................4 HO TO ENROLL.......5 MEDICAL..............6-12 PRESCRIPTION DRUG. ................13-15 ADDITIONAL MEDICAL PLAN RESOURCES........16-18 DENTAL...............19-21 VISION.....................22 LIFECENTER..............23 LIFE INSURANCE. .....24 LONG TERM DISABILITY...............25 VOLUNTARY OFFERINGS. ........26-29 SPENDING ACCOU TS. ............30 RETIREMENT BENEFITS..................31 WELLNESS. .........32-36 LEGAL NOTICES..37-39 CONTACTS.........40-41 GLOSSARY..........42-43 FAQs...................44-46 FORMS................47-56 WHAT’S NEW SERVICE CENTERS AND WEBSITES HOW TO ENROLL MEDICAL PRESCRIPTION DRUG ADDITIONAL MEDICAL PLAN RESOURCES DENTAL VISION LIFE INSURANCE LONG TERM DISABILITY VOLUNTARY OFFERINGS SPENDING ACCOUNTS RETIREMENT BENEFITS WELLNESS LEGAL NOTICES CONTACTS GLOSSARY

AtlantiCare Special Care Center and Health Services

If you have a medical condition such as diabetes, congestive heart failure, cardiovascular disease or chronic obstructive pulmonary disease, you know how difficult it is to manage and coordinate all of the providers and finances involved in your care. Our staff is ready to help improve your health, simplify your life, and reduce your out-of-pocket medical expenses.

The resources described here are available to you and your family regardless of which medical plan you elect. • Your physician copays will be waived and most of your medications will be completely free. Medications include Levemir, Humira, Lantus, Novolog, Januvia, Enbrel and others. What’s different about receiving care at these locations? • You will be at the center of a team working together to coordinate and manage your care. • Your personal health coach will be by your side every step of the way, and will also keep the care team informed of your care plan and progress. • The sites listed feature a convenient, on-site pharmacy where you can fill your prescriptions right after your appointment.

There are two convenient locations to provide and coordinate care for you:

Special Care Center and Health Services 1401 Atlantic Avenue Suite 2500 and Suite 2600 Atlantic City, NJ 08401 Hours: Monday through Friday: 8:30 am to 6:30 pm 1-609-572-8800

Health Services

54 Jimmie Leeds Road Suite 8 Galloway, NJ 08205 Hours: Monday through Thursday: 8:00 am to 6:00 pm 1-609-404-7300

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Additional Medical Plan Resources

HOME TABL OF CONTENTS WELCOME.................2 WHAT’S NEW. ...........3 I E CENTERS AND EBSITES...................4 HOW TO ENROLL.......5 MEDICAL..............6-12 PRESCRIPTION DRUG. ................13-15 ADDITIONAL MEDICAL PLAN RESOURCES.........16-18 DENTAL...............19-21 VISION.....................22 LIFECENTER..............23 LIFE INSURANCE. .....24 LONG TERM DISABILITY...............25 VOLUNTARY OFFERINGS. ........26-29 SPENDING ACCOU TS. ............30 RETIREMENT B NEFITS..................31 WELLNESS. .........32-36 LEGAL NOTICES..37-39 CONTACTS.........40-41 GLOSSARY..........42-43 FAQs...................44-46 FORMS................47-56 WHAT’S NEW SERVICE CENTERS AND WEBSITES HOW TO ENROLL MEDICAL PRESCRIPTION DRUG ADDITIONAL MEDICAL PLAN RESOURCES DENTAL VISION LIFE INSURANCE LONG TERM DISABILITY VOLUNTARY OFFERINGS SPENDING ACCOUNTS RETIREMENT BENEFITS WELLNESS LEGAL NOTICES CONTACTS GLOSSARY

AtlantiCare Access Center Nurse Triage AtlantiCare offers telephonic nurse triage when your AtlantiCare Physician Group (APG) primary care provider practice is not available. After hours, a nurse is available to answer any questions related to medical care. The hours vary by practice. However, they are typically available from 4:00 pm – 8:30 pm daily, including holidays and weekends. When you call you will speak with a registered nurse (with an average of 30 years experience) who will assess and evaluate your symptoms or injury over the phone, provide physician-approved medical information so you can make an informed decision about where and when to seek treatment, recommend next steps and, if necessary, refer you to the appropriate care and resources. Care Management Also as part of your benefits, our Nurse Care Managers are available to help you understand your healthcare options by: • Coordinating your healthcare services • Helping you understand and use your benefits in the most efficient way • Directing you to community resources, support groups, and health and wellness programs when appropriate • Navigating the healthcare system when dealing with a complex medical illness This is a free benefit as part of your affiliation with our APG primary care practices.

Employee Assistance Program There are times when personal problems affect our ability to function productively both on the job and at home. The Employee Assistance Program (EAP) is a confidential program designed to help employees and their immediate family members 18 and older, prevent, identify and resolve problems before they affect job performance. EAP offers confidential, brief intervention services both over the phone and in person, seminars, conflict resolution, employee wellness trainings, coaching and support around treatment needs as well as referrals to treatment as necessary. Call 1-800-260-0808 for EAP assistance.

You may speak to a Care Manager by calling 1-609-272-6297 .

Both Nurse Triage and Care Management are offered as free benefits . All medical and personal information is confidential and may only be shared with those involved in your care.

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Additional Medical Plan Resources

HOME TABL OF CONTENTS WELCOME.................2 WHAT’S NEW. ...........3 I E CENTERS AND EBSITES...................4 HOW TO ENROLL.......5 MEDICAL..............6-12 PRESCRIPTION DRUG. ................13-15 ADDITIONAL MEDICAL PLAN RESOURCES........16-18 DENTAL...............19-21 VISION.....................22 LIFECENTER..............23 LIFE INSURANCE. .....24 LONG TERM DISABILITY...............25 VOLUNTARY OFFERINGS. ........26-29 SPENDING ACCOU TS. ............30 RETIREMENT B NEFITS..................31 WELLNESS. .........32-36 LEGAL NOTICES..37-39 CONTACTS.........40-41 GLOSSARY..........42-43 FAQs...................44-46 FORMS................47-56 WHAT’S NEW SERVICE CENTERS AND WEBSITES HOW TO ENROLL MEDICAL PRESCRIPTION DRUG ADDITIONAL MEDICAL PLAN RESOURCES DENTAL VISION LIFE INSURANCE LONG TERM DISABILITY VOLUNTARY OFFERINGS SPENDING ACCOUNTS RETIREMENT BENEFITS WELLNESS LEGAL NOTICES CONTACTS GLOSSARY

AtlantiCare Programs and Services • Livongo Diabetes Management • Telehealth – Online Medical Care • Ornish Cardiac Care Program • Women’s Health and Wellness • Cancer Care • LIFE Connection – All-inclusive Care for the Elderly • AtlantiCare Primary Care Plus • Urgent Care Centers • ...and many more

For more information please call the Access Center at 1-888-569-1000 .

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