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Health Savings AccountA Health Savings Account (HSA) provides additional options for paying medical expenses with tax-freesavings. LifeBridge contributes to your account to help offset some of your eligible expenses.Account TypeHealth Savings Account (HSA)EligibilityYou must be enrolled in the Health Saver Plan with HSA and meet these requirements: Not be claimed as a dependent on another person’s tax return. Not be covered under another medical plan that is not HSA-eligible Not be enrolled in Medicare Part A or B, or be in receipt of VA medical or prescription benefitswithin the previous three months.Your contributionsYou contribute on a pretax basis and you can change how much you contribute from each paycheck.The IRS maximum annual contribution is 3,500 for individual coverage and 7,000 for familycoverage. If you are age 55 or older, you may make a “catch-up” contribution of 1,000.Company’s contributionsLifeBridge Health contributes to your account (the first half is paid in January and the second half ispaid in July as long as you are still enrolled in the plan). 700 for individual coverage 1,400 for family coverageThe combination of your contribution and the company contribution cannot exceed the IRS maximumfor 2020 of 3,550 for individual coverage and 7,100 for family coverage.Eligible expensesMedical, dental, vision and prescription drug expenses incurred by you andyour covered family members.If you also wish to enroll in a Health Care FSA, you will only be eligible fora Limited-Purpose Health Care Flexible Spending Account (FSA).Using your accountUse the debit card linked to your HSA or submit a claim form to cover the expenses, or pay theexpenses out of pocket and save your HSA money for future health care expenses.Remaining FundsAny 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 LifeBridge Health or retire, you can take your HSA with you so you cancontinue to pay and save for eligible health care expenses.FeesThere is a monthly fee of 2 for the HSA. As long as you are enrolled in the Health Saver Plan, at theend of the year, LifeBridge Health reimburses the fee for you.Setting Up Your HSATo set up your HSA, you must complete the Customer Identification Program (CIP) process within 90 daysof enrolling. BNY Mellon will verify the information you provide, which is similar to the information you mustprovide when setting up any bank account. If additional information is needed, BNY Mellon will contact you viaU.S. mail, and you will have up to 90 days to respond.Once you pass the CIP process, you will receive a debit card from WageWorks in the mail. To view your balance,submit claims and more, set up a WageWorks account at www.wageworks.com.Remember to set up your beneficiary directly with WageWorks.8

Flexible Spending AccountsA Flexible Spending Account (FSA) helps you pay for eligible health care and dependent care costsusing tax-free dollars. You decide how much money you would like to contribute to each account on apretax basis.ProvisionHealth Care (FSA)Limited Purpose (FSA)Dependent Care (FSA)**BenefitsSaves on eligible expenses notcovered by insurance; reducesyour taxable incomeSpecifically for associates enrolled inthe Health Saver Plan. Saves on eligibleexpenses not covered by insurance;reduces your taxable incomeSave on eligible expenses forqualified dependent care; reducesyour taxable income.Yourcontributions*Maximum contribution is 2,700Maximum contribution is 2,700Maximum contribution is 5,000per year 2,500 if married and filingseparate tax returnsEligibleexpensesMost medical, dental and visioncare expenses that are notcovered by your health plan.Eligible expenses are limited toqualifying dental and vision expenses.Dependent care expenses (such asday care, after school programs orelder care programs) for children upto age 13 so you and your spousecan work or attend school full-time.When you incur expenses, youcan access account funds inyour account to pay for eligibleexpenses.Using youraccountUse It orLose ItUse the debit card linked toyour FSA to cover the expenses,or pay the expenses out ofpocket and submit a claim to bereimbursed by your FSA.When you incur expenses, you canaccess account funds in your accountto pay for eligible expenses.Use the debit card linked to your HSAto cover the expenses, or pay theexpenses out of pocket and submit aclaim to be reimbursed by your FSA.When you incur eligible expenses,you can access account fundsthat have been contributed andsubmit a “pay me back” claim withWageWorks.Reimbursable expenses must be incurred between January 1 and December 31. Claims for reimbursementmust be submitted by March 31, of the following year. Please plan your contributions carefully. With the exceptionof up to 500 in the Health Care FSA rolling over from year-to-year, any money remaining in your account as ofMarch 31, 2020 will be forfeited per Internal Revenue Service regulations. FSA elections do not automaticallycontinue from year to year; you must actively enroll each year.*You are not able to make changes to your annual contribution unless you experience a qualified life event.** Due to IRS testing requirements associates designated as highly compensated employees may have their Dependent Care election limited to lowerannual amount.9

Dental PlanRegular dental care is an important part of caring for your overall health. Your dental plan is the Cigna Preferred Dental Plan,with the DPPO network.ProvisionIn-NetworkOut-of-Network* 50/ 150 50/ 150 1,500 1,500You PayYou Pay 0, no deductible 0, no deductibleBasic services (includes fillings, periodontics,scaling and root planning, oral surgery)20% after deductible40% after deductibleMajor Services (includes crowns, bridges, fulland partial dentures)50% after deductible50% after deductibleMajor services (surgical)50% after deductible60% after deductibleAnnual deductible (Individual/Family)Annual maximum (per Individual)Diagnostic and preventive (includes cleanings,fluoride treatments, sealants and X-rays)Orthodontia (Child only up to age 19)50%, after deductible, up to 1,200 Lifetime MaximumNote: Additional cleanings are covered during pregnancy.Dental Bi-weekly RatesFull TimePart TimeIndividual 8.53 10.10Employee/Child(ren) 10.02 15.03Employee/Spouse 13.35 20.04Family 18.85 28.23* Out-of-Network may be subject to balance billing.10

Life Insurance & DisabilityWhat would your family do if your income was lost due to death or disability? Life and disabilityinsurance are important for you and your family’s financial security.Company-Provided InsuranceLifeBridge Health automatically provides the followinginsurance benefits at no cost to you.1 You do not needto enroll.1Account TypeBenefitBasic LifeInsurance 1x your base annual earnings, up toa maximum benefit of 200,000Basic AccidentalDeath andDismemberment(AD&D) Insurance 1x your base annual earnings, up toa maximum benefit of 200,000 Benefit is reduced beginning atage 70Long-TermDisability 50% of your base weekly earnings,up to 10,000 per month 90 calendar day elimination period Benefit begins on the 91st day ofdisability and normally continuesuntil the date that you are no longerdisabled, the date you reach SocialSecurity age or the date ofyour deathAssociate Paid InsuranceAccount TypeBenefitSupplementalLife and AD&DInsurancefor you Up to 5x your base annual salary, up to 2,000,000 Guaranteed issue of 3x your salary, upto 500,000 for new hires or newlyeligible employeesSupplementalLife and AD&DInsurance foryour spouse Increments of 15,000, 25,000 or 50,000 (not to exceed the amount ofthe Associates basic and supplementalcoverage) Guaranteed issue up to 50,000 fornew hires or newly eligible employeesSupplementalLife and AD&DInsurance foryour child(ren) 10,000 per child up to the age of 26,unless disabled before age 26 Must be added within 30 days of birthor adoption, as a new hire or at openenrollmentShort-TermDisabilityfor you* 60% of your weekly earnings, up to 1,500 per week 21 calendar day elimination period Benefits begin on the 22nd day ofdisability due to a non-work relatedinjury and illness, and are payable up tothe 90th day, if approvedBuy-upLong-TermDisabilityfor you Covers up to 60% of your base weeklyearnings up to 15,000 per month Pre-existing conditions apply, pleasereference Policy for detailed informationThe IRS requires you to be taxed on the value of employee-providedbasic life insurance coverage that is greater than 50,000. This amountappears as imputed income (GTL) on your paycheck.Reminder regarding Life Insurance: Keep yourbeneficiary information up-to-date in GHR.*EOI may apply11

Buy-up Long-Term DisabilitySupplemental Life and AD&D InsuranceYou may purchase additional long-term disability (LTD)coverage that provides up to 60% of your annual salary, upto a 15,000 maximum monthly benefit. If you are interestedin purchasing this coverage, you may do so withoutEvidence of Insurability (EOI) when you are first benefitseligible.You may choose to purchase additional life and AD&Dcoverage for yourself and your dependents at affordablegroup rates. Rates are based on age and the coveragelevel chosen.If you are interested in purchasing this coverage it isimportant that you understand if EOI will be required:You may purchase coverage for yourself through after-taxpayroll deductions as follows: New Hires or Newly Eligible - Guarantee issue, no EOIrequired Up to 5x your base annual salary, to a maximumof 2,000,000. Newly electing coverage and not a new hire or newlyeligible employee - Subject to EOI Guarantee issue is 3x salary, up to 500,000 for newhires or newly eligible employees.Employee earning 80,000 per year:EOI will be required during Annual Enrollment if: Monthly covered payroll: 6,667(annual salary divided by 12) You are newly enrolling in supplemental lifeSupplemental Life and AD&D Insurance for you Buy Up Rate: 0.382 per 100 of monthly covered payroll You are increasing your coverage by more than 1x yourannual salary 0.382 x 6,667/ 100 25.47 per month or 11.76per 26 pays You are electing coverage above 3x your annual salaryor 500,000Employee earning 100,000 per year:Supplemental Life and AD&D Insurance foryour dependents Monthly covered payroll: 8,333(annual salary divided by 12) Buy Up Rate: 0.382 per 100 of monthly covered payroll 0.382 x 8,333/ 100 31.83 per month x 12/ 26 or 14.69 per 26 paysYou may purchase coverage through payroll deductionsas follows:Spouse Increments of 15,000, 25,000, or 50,000 (cannottotal more than basic plus supplemental life and AD&Dinsurance coverage on the Associate)Important ConsiderationsFor Your Disability Plans Guarantee issue up to 50,000 for new hires or newlyeligible If approved by the carrier, your disabilitypayments begin after an elimination period. Theelimination period is the length of time you mustbe continuously disabled and unable to performyour primary position (due to a non-work relatedinjury or illness) and under the appropriate careof a physician before the disability benefitsbecome payable. Benefits may be reduced by other income, suchas Social Security. For Long-Term Disability, if in your first 12months of coverage, any disability arises froma condition for which you received treatment ortook medications to treat in the three monthsprior to your effective date will be excluded. If you are enrolling for the first time or increasing thecoverage during Annual Enrollment, EOI will be required.Please contact Employee Services with questions. To place a disability claim please contactCigna directly.Child(ren) 10,000 per child Must be added within 30 days of birth or adoption, as anew hire or at open enrollment Coverage up to age 26, or disabled childrenDependentCoverageBi-weekly RateSpouse 15,000 1.42Spouse 25,000 2.36Spouse 50,000 4.73Child* 10,000 1.06*Note: Rate is the same regardless of how many children are covered.12

Additional BenefitsEmployee Assistance Program – CareBridgeIf you find yourself in need of professional support todeal with personal, work, financial or family issues, theEmployee Assistance Program (EAP) can help. You andyour immediate family (spouse, dependent children) canuse the EAP for help with: Marriage and family problemsJob-related issuesStress, anxiety and depressionParent and child relationshipsLegal and financial counselingIdentity theft counselingFinancial planningVarious other issuesThe program is available 24/7, is completely confidentialand offered at no cost. If you need help or guidance,call a CareBridge counselor at 800-437-0911 or visitwww.myliferesource.com, access code: KKNH3.Hyatt LegalGroup Voluntary Critical Illness CoverageAttorney fees can be expensive. With this plan, attorneyfees for the legal services listed below are fully paid forwhen you use a network attorney. There is no limit on thenumber of times you may use the plan.Group Voluntary Critical Illness coverage through MetLifepays benefits for non-medical, critical illness-relatedexpenses that your medical plan might not cover. Benefitsare in the form of a lump sum payment, which is paid aftera diagnosis is made.Covered services include, but are not limited to: Wills, trusts, powers of attorney, guardianship Mortgages, home equity loans, deeds, propertytax assessments Small claims assistance Elder law Identity theft Immigration assistance Debt collection defense/consumer protection Bankruptcy issues Adoption Traffic ticket defense, restoration of driving privilegesBi-weekly RateHyatt Legal 8.54Critical Illness InsuranceEligible IndividualInitial BenefitEmployee 10,000 or 20,000Spouse100% of the employees Initial BenefitDependent Children50% of the employee's Initial BenefitYour initial benefit provides a lump-sum payment upon thefirst diagnosis of a covered condition. Your plan also paysa recurrence benefit for the certain covered conditions.The maximum amount that you can receive through yourCritical Illness Insurance is three times the amount of yourinitial benefit.MetLife will provide an annual benefit of 50 per calendaryear for taking one of the eligible screening/preventionmeasures. MetLife will pay only one health screeningbenefit per covered person per calendar year. More detailscan be found on BridgeNet.13

Group Voluntary Accident CoverageGroup Voluntary Accident coverage through MetLife can pay benefits for off-the-job accidents, plus some benefits thatcorrespond with medical care. The coverage can be used on its own or to fill a gap left by other coverage. It pays a benefitup to a specified amount for dislocation/fracture, initial hospitalization confinement, hospitalization confinement, intensivecare, ambulance service, medical expenses, outpatient physician’s treatment and more.The below chart shows a range of potential payment amounts for a given category of covered conditions. Actual paymentsare determined by the benefit type.Covered BenefitsLow PlanHigh PlanMetLife Accident Insurance Pays YouMetLife Accident Insurance Pays YouInjuries –12 covered injury typesRanging from 25 – 5,000 per injuryRanging from 50 – 10,000 per injuryMedical Services & Treatment –15 covered typesRanging from 15 – 1,000 per medicalservice/treatment typeRanging from 25 – 2,000 per medicalservice/treatment typeHospital Coverage (Accident) 500 (non-ICU) or 1,000 (ICU) per accident 1,000 (non-ICU) or 2,000 (ICU) per accidentAdmissions 100 per day (non-ICU), up to 31 days 200 per day (non-ICU), up to 31 daysConfinement 200 per day (ICU), up to 31 days 400 per day (ICU), up to 31 daysInpatient Rehab 100 per day, up to 15 days per accident and30 days per calendar year 200 per day, up to 15 days per accident and30 days per calendar yearAccidental Death 25,000 75,000 is passenger in common carrier 50,000 150,000 is passenger in common carrierDismemberment, Loss & Paralysis 250 - 10,000 per injury 500 – 50,000 per injuryLodging 100 per night, up to 31 nights;up to 3,100 in total lodging benefits availableper calendar year 200 per night, up to 31 nights;up to 6,200 in total lodging benefits availableper calendar yearHealth Screening (Wellness) 50 payable 1x per covered insured percalendar year, if covered insured takes acovered test 50 payable 1x per covered insured percalendar year, if covered insured takes acovered testBi-Weekly Group VoluntaryAccident RatesLow PlanHigh PlanEmployee Only 3.30 5.46Employee Plus Spouse 6.94 11.63Employee Plus Child 6.92 11.40Family 8.34 14.3414

Pet InsuranceHome and Auto Discount ProgramPet Insurance through PetFirst helps offset thecost of caring for your dog or cat, and coverseverything from preventive care to accidentsand illness, as well as the costs of X-rays, officevisits, medications, surgeries and hospital stays.You can receive special group discounts on auto, home,and renter’s insurance through Liberty Mutual. The policiesare tailored to suit your needs. Please contact LibertyMutual to inquire and/or enroll.Please note: Liberty Mutual will bill you directly. No payrolldeduction is offered.Identity Theft ProtectionThis service through InfoArmor is designed to protect youridentity and assets through identity, credit and social mediamonitoring. InfoArmor also extends dependent coverageto any dependent who lives in the same household as theemployee or who is financially dependent on them, with noage limit.PrivacyArmor is available in two comprehensive plans to fityour needs with PrivacyArmor Essential and PrivacyArmorPlus. Both products include: Identity and credit monitoringAnnual credit report and monthly credit score trackingThreshold monitoringSocial media reputation monitoringDigital wallet storage and monitoringFull-service identity restoration 1,000,000 identity theft insurance policyA digital exposure reportNote: If you are newly enrolling, you need to set up anaccount with InfoArmor. You will receive a home mailer andan email to your work email address.Le

Sinai, Northwest, Levindale (Non-Union) 2 Welcome to your benefits . with your new payroll deductions Make your benefit elections and enroll in GHR Review and print your benefits confirmation statement. 3 Benefit Basics Your 2020 Benefits Are Effective January 1 Through December 31