Benefit Guide 2021 - LifeBridge Health

BenefitGuide 2021

Sinai Union

Welcome to Your BenefitsWith CARE BRAVELY at our core, LifeBridge Health team members care for our

patients, their families and communities day in and day out. But, we also need to

be sure we’re taking care of ourselves and our own families.

LifeBridge Health is excited to be able to provide competitive benefits packages

for our team members to ensure their loved ones are covered, no matter the

circumstance. And as we face a “new normal” with the COVID-19 pandemic, now it is

more important to ensure you’re getting the most out of your benefits coverage.

Please use this benefits guide as a resource for the plans offered by LifeBridge

Health for the 2021 calendar year. We want to ensure you understand the

benefits and the packages we offer, so you can get the most out of them.

Take the time to review the options outlined in this guide and select coverage

that works best for you and your family. Typically, unless you have a qualified

status change, the selections that you make will stay in place for the entire

2021 calendar year.

If you have any questions, please visit http://www.lifebridgehealth.org/benefits

for more information.

As a LifeBridge Health team member, your health and well-being are important

to us. We are excited to CARE BRAVELY for you.

Best,

Neil

Enrolling in Your Benefits

New Hires

You have 30 days to enroll in your benefits. If you do

not enroll during this time, you will not be eligible to

enroll until the next annual enrollment period unless

you experience a qualified life event.

What’s Inside: 3 Your Benefits 5 Medical Plan 6 Resources for Navigating Your Healthcare 7 Prescription Drug Coverage 8 Medical & Prescription Drug Rates 9 Health Savings Account (HSA) 10 Flexible Spending Accounts11 Dental Plan12 Vision Plan13 Life Insurance & Disability15 Additional Benefits16 Metlife Legal Plans with Plus Parents Option20 403(b) Retirement Savings Plan21 Dependent Verification Process22 Glossary of Terms23 Special Notices24 Contact Information

Review this guide and the information on the

Benefits Website.

Collect any dependent/spouse documentation

required and submit to the Benefits Team at

[email protected] or via fax

at 410-469-5161.

Make your benefit elections and enroll in GHR.

Review and print your benefits confirmation

statement.

Pay close attention to your first paycheck with

your new payroll deductions.

About Your Benefits

2 | 2021 OPEN ENROLLMENT: OCTOBER 26 – NOVEMBER 6, 2020

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Covering Yourself and Your FamilyWhen Coverage Begins

Medical, prescription, dental and Spending Account benefits are

effective 60 days after the day of hire (effective 61st day). All other

benefits are effective the first of the month following 60 days

of employment.

The following dependents are eligible:• Your legal spouse

• Children up to age 26 (regardless of their student status or if they are

claimed as a dependent for income tax purposes), or your disabled

children if disabled before age 26* *Note: Voluntary benefits may have different age requirements so please review the

materials carefully.

When Coverage Ends

For Medical, Dental, Vision, and Life Insurance, coverage will end on the

last day of the month in which your employment ends or you move to

a position not eligible for benefits. All other voluntary benefits coverage

ends on the last day of employment or on date you move to a position

not eligible for benefits.

For Flexible Spending Accounts (Health, Dependent and Limited

Purpose) coverage ends on the last day of employment. You have

60 days to spend your contributed funds. After 60 days the funds are

forfeited unless you elect to continue coverage under COBRA.

If you have a Health Savings Account the monthly fee will become your

responsibility at the beginning of the month after your benefits end.

You will see this reflected on your monthly statement from Health

Equity. All funds posted to your account are yours to continue using for

qualified expenses until exhausted.

Your dependent coverage ends when your coverage ends or on the

last day of the month in which your dependent turns age 26.

Are You Providing Coverage to a New Dependent?If you enroll a new dependent for benefits, you will be required to provide

documentation to confirm their eligibility. All documentation should be

submitted to the Benefits Team at [email protected].

If you do not provide the required documents within 30 days,

your dependents will not have coverage. View page 20 for

detailed requirements.

You and the Affordable Care ActUnder the Affordable Care Act (ACA), an employee who works an

average of 30 hours per work (1,560 hours annually) are eligible for

medical coverage. Employees who have hours that vary from week

to week are referred to as “variable hour” (under 0.6 FTE) employees

and all variable hour employees have a 12-month “measurement period”

to determine the average number of hours worked per week. If your

average is 30 hours or more per week, you’ll be eligible for LifeBridge

Health’s medical coverage for the full 2021 plan year. If your average is

less than 30 per week, you won’t be eligible for the LifeBridge Health’s

medical coverage and will need to find other coverage elsewhere,

such as through a spouse, parent, or the Health Insurance Marketplace.

The measurement period occurs annually, so your eligibility could change

each plan year. Employees eligible for medical coverage under ACA will

receive a separate enrollment letter notifying them of their eligibility.

Making Changes During the Plan YearThe IRS provides strict regulations about changes to pre-tax elections

during the plan year. If you experience a qualified IRS family status

change mid-year, you are permitted to make a change within 30 days of

the event. If the change request is not completed within 30 days of the

event, you will not be able to change your elections until the following

year’s benefits annual enrollment period or you experience another

qualified life event. Below is a list of some of the more commonly known

qualified status changes:

• Marriage, divorce or legal separation

• Birth or adoption of a child

• Death of your spouse or dependent child

• Change in employment status of team member, spouse or

dependent child

• Loss or gain of insurance coverage

To make changes, contact the Benefits Team within 30 days of a

qualifying life event. You may need to provide proof of the event,

such as a marriage license. If you don’t take action, you’ll have to

wait until the next enrollment period to make changes unless you

experience another qualifying life event.

Your BenefitsYour 2021 Benefits Are Effective January 1 Through December 31

LifeBridge Health pays the full cost of many of your benefits. For others, LifeBridge Health and you share the cost or you pay the full cost.

Pretax means the cost comes out of your pay before taxes are deducted. After-tax means your cost comes out of your pay after taxes are deducted.

The chart shows who pays for each benefit and the related tax treatment.

Benefit Who Pays Tax Treatment

Medical LifeBridge Health/You Pretax

Dental LifeBridge Health/You Pretax

Vision You Pretax

Basic Life and Accidental Death & Dismemberment (AD&D) Insurance

LifeBridge HealthN/A, except on

Life Insurance greater than $50,000

Short-Term Disability Coverage LifeBridge Health N/A

Buy-up Short-Term Disability Coverage You After-tax

Voluntary Benefits (Accident, Critical Illness, ie.)

You After-tax

Employee Assistance Plan LifeBridge Health N/A

403(b) Retirement Savings Plan LifeBridge Health/You Pretax

About Your Benefits

4 | 2021 OPEN ENROLLMENT: OCTOBER 26 – NOVEMBER 6, 2020

Medical PlanLifeBridge Health offers two medical plan options - administered by CareFirst BlueCross BlueShield (CareFirst). Each plan offers comprehensive

health care benefits, including free preventive care services and coverage for prescription drugs. Here’s how the plans compare.

 Plan ProvisionHealth Saver Plan (with HSA) Premium Health Plan

LBH Network

CareFirst In-Network

Out-of-Network

LBH Network

CareFirst In-Network

Out-of-Network

Company Contribution to HSA1 Individual Family

$7001 $1,4001 N/A

Calendar Year Deductible Individual Family

$2,800 $5,200

$3,000 $6,000

$3,000 $6,000

$100 $300

$600 $1000

$600 $1000

Annual Out-of-Pocket Maximum (Includes deductible, copays and coinsurances)Individual Family

$4,000 $8,000

$5,000 $10,000

$6,600 $13,200

$1,000 $3,000

$2,000 $6,000

$5,600 $11,200

You Pay

Primary Physician Office Visit 20%* 40%* 50%* $25 30%* 40%*

Specialist Office Visit 20%* 40%* 50%*$35 for first6 visits then

100%30%* 40%*

Preventive Care – one per calendar year (includes annual physicals, immunizations, routine cancer screenings and well child visits)

$0Plan pays

100%

$0Plan pays

100%50%*

$0Plan pays

100%

$0Plan pays

100%40%*

Diagnostic Service (includes Advanced imaging (PET, MRI, CT), other imaging (X-ray, sonogram), Lab and other services)

20%* 40%* 50%*$02

Plan pays 100%

30%* 40%*

Emergency Care3 20%* 20%* 20%* $100 copay per visit

$100 copay per visit

$100 copay per visit

Urgent Care 20%* 40%* 50%* $25 copay $35 copay 40%

Outpatient Facility and AmbulatorySurgical Facility 20%* 40%* 50%* $0* 30%* 40%*

Inpatient Hospitalization4 20%* 40%* 50%* $0* $500 copay + 30%*

$500 copay + 40%*

*After Deductible. 1 If enrolling in the Health Saver Plan; the first half of funding is provided in January and the second half is provided in July as long as you are still enrolled in the plan.2 Must be performed by LifeBridge Health Provider, designated LifeBridge health Lab or Facility.3 Emergency Room copay waived only if admitted; Emergency services available out-of-network.4 Pre-authorization required.

Important Considerations• You may use in- or out-of-network providers. You will always pay the least if you use the LifeBridge Provider Network. Using a provider in the CareFirst

network, instead of an out-of-network provider, will also help you save.• You must meet an annual deductible before the medical plan begins to cover a portion of the cost for most care. • Deductibles and Out-of-Pocket Maximums cross apply. Anything spent in either the LifeBridge Health Network, CareFirst In-Network or Out-of-Network

levels will accumulate toward all deductibles and out-of-pocket maximums for the year.• Out-of-pocket maximums apply to both plans. This is the maximum amount you will pay for health care costs in a calendar year. Your bi-weekly

contribution rates will continue.• You may be required to obtain pre-authorization from the plan prior to receiving certain services. If either you or your provider does not pre-authorize

care when necessary, you may not have coverage for that service.

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Blue Rewards This program, sponsored by CareFirst, leverages a digital health

company – Sharecare – to help you live a healthier lifestyle and earn

rewards for healthy behavior, all customized to your needs and goals.

Blue Rewards has a RealAge® test, quarterly challenges and biometric

screenings that will earn you up to $200 in reward money by the end

of 2021.

Wellness Resources:

Access motivating digital resources anytime, anywhere:

• RealAge®: Learn the physical age of your body, compared to your

calendar age with the online health assessment

• A personalized health timeline: Receive recommendations,

content and programs

• Trackers: Connect your wearable devices or enter your own data to

monitor sleep, steps, nutrition and more

• Challenges: Provide extra motivation for achieving your health goals

• A health profile: Access your important health data all in one place

• Inspirations and Relax 360°: Break free from stress, unwind at the

end of the day or ease into a restful night of sleep with meditation,

streaming music and videos

As part of your wellness program, you have access to additional

support resources like:

• Health coaching

• Tobacco cessation

• Weight management

• Financial well-being

If you have questions about the program or incentive, please email

[email protected].

Ready to Get Started?

Visit carefirst.com/sharecare

You’ll need to:

• Enter your CareFirst My Account username and password .

• Complete the one-time registration with Sharecare.

Locating A Medical Provider Searching for a medical provider and/or service has never been easier.

Utilize our provider locator tool listed below to help you find a provider

and/or facility that is in the LifeBridge Health (Tier 1) Network.

https://member.carefirst.com/mos/#/fadsdpublic/search/lifebridge

• All LifeBridge Health (Tier 1) providers and facilities are identified

as Best Value $

• CareFirst In-Network (Tier 2) are identified as Better Value $$

• Out-of-Network (Tier 3) are identified as Good Value $$$

Using the LifeBridge Health (Tier 1) Network will always save you

money by offering a lower deductible and co-pays.

Blue Cross Blue Shield Global As a Blue Cross and Blue Shield member, you take your healthcare

benefits with you when you are abroad. Through the Blue Cross Blue

Shield Global® Core program, you have access to doctors and hospitals

around the world.

Before you travel, contact your Blue Cross and Blue Shield company for

coverage details. Coverage outside the United States may be different.

If you need to locate a doctor or hospital, call the Service Center for

Blue Cross Blue Shield Global Core at 1.800.810.2583 or collect at

1.804.673.1177, 24 hours a day, seven days a week. An assistance

coordinator, in conjunction with a medical professional, will arrange a

physician appointment or hospitalization if necessary.

Elevation of Services When the LifeBride Health medical plan does not offer or provide eligible

services or providers an elevation of services may be requested. You can

submit your inquires to [email protected].

Resources for Navigating Your Healthcare

Preventive CareRemember, your preventive care with an in-network provider is

at no cost to you.

• Annual adult physical

• Routine immunizations

• Well child exams

• Annual GYN check up

• Routine cancer screenings (mammogram, cervical cancer screening,

prostate cancer screening, colonoscopy, skin cancer screening)

• Routine prenatal maternity services

About Your Benefits

6 | 2021 OPEN ENROLLMENT: OCTOBER 26 – NOVEMBER 6, 2020

Prescription Drug CoverageThis chart provides information about your prescription drug coverage. You can save on your prescriptions by using a LifeBridge Health Pharmacy

(Sinai Pharmacy, Northwest Outpatient Pharmacy or Anchor Pharmacy, the on-site location at Carroll Hospital) or Mail Order.

Save With a LifeBridge Health Pharmacy No Cost Preventive Medications: There is no copay ($0) for generics

used to treat high blood pressure, cholesterol, depression and diabetes

if the prescription is filled at a LifeBridge Health Pharmacy.

Long-term Medications: You have two options to receive a 90-day

supply if you are taking a long-term medication. Long-term

medications are those taken regularly for chronic conditions such as

high blood pressure, asthma, diabetes or high cholesterol, and must

be filled using one of these options:

• Option 1: A LifeBridge Health Pharmacy, including Sinai Outpatient

Pharmacy, Northwest Outpatient Pharmacy or Anchor Pharmacy, the

on-site location at Carroll Hospital.

• Option 2: Mail Order through a LifeBridge Health Pharmacy or CVS

Caremark. For LifeBridge Health, please call 410-601-7100 or visit

lifebridgehealth.org/outpatientpharmacy. For CVS Caremark,

call 866-294-2110 or visit www.caremark.com.

Definitions Generic – A drug that offers equivalent uses, doses, strength, quality

and performance as a brand-name drug, but is not trademarked.

Formulary – A drug with a patent and trademark name that is

considered “preferred” by the drug plan administrator because it is

appropriate to use for medical purposes and is usually less expensive

than other brand-name drugs.

Non-formulary – This type of drug is “not preferred” and is usually

more expensive than generic and formulary brand drugs.

Specialty – These drugs are typically the most expensive options,

may require special handling, can be difficult to administer and often

require additional clinical monitoring.

Plan ProvisionHealth Saver Plan (With HSA) Premium Health Plan

Retail and Mail Order LBH Pharmacy1 CVS/Other Retail Pharmacies

Annual Deductible

Individual Family

Included in Medical (see page 5)

$75 per person$225 per family

Annual Out-of-Pocket Maximum

Individual Family

Included in Medical (see page 5)

$1,000 per person$2,000 per family

Retail Prescription Drugs (30-day supply)

• Generic• Formulary• Non-formulary• Specialty

20%* 30%*40%*

50%* (LifeBridge Health Pharmacy only)

$10*2 $30*$50* $0*

$10*$40*$70*

Not Covered

Mail Order Prescription Drugs (90-day Supply)3

• Generic • Formulary• Non-formulary• Specialty

20%* 30%*40%*

50%* (LifeBridge Health Pharmacy only)

$20*2

$60*$100*

$0*

$20*$80*

$140*Not Covered

*After deductible. 1 LifeBridge Health Pharmacies: Sinai, Northwest, and Anchor Pharmacy (at Carroll Hospital Location only).2 $0 copay for generics to treat high blood pressure, cholesterol, depression and diabetes, if the prescription is filled at LifeBridge Health Pharmacy.3 Long Term Medications (Maintenance) must be filled at a LifeBridge Health Pharmacy or through CVS Mail Order.

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Medical & Prescription Drug RatesBi-Weekly Rates Associate Only Employee + Child Employee + Spouse Family

Premium Health Plan

Full Time $72.92 $117.23 $162.00 $205.85

Part-Time $150.92 $240.92 $330.00 $420.92

Health Saver Plan

Full Time $37.85 $60.00 $83.08 $105.23

Part Time $51.23 $82.15 $112.15 $143.08

Surcharges If applicable, there are two surcharges:

• Smoker Surcharge – $30 per pay period

• Spousal Surcharge – $30 per pay period, if your spouse has access to other health coverage through their employer and that employer is not

LifeBridge Health. Note: Surcharges are applicable only to enrollments in the Medical Plans.

About Your Benefits

8 | 2021 OPEN ENROLLMENT: OCTOBER 26 – NOVEMBER 6, 2020

Health Savings Account (HSA) A Health Savings Account (HSA) provides additional options for paying medical expenses with tax-free savings. LifeBridge contributes to your

account to help offset some of your eligible expenses.

Account Type Health Savings Account (HSA)

Eligibility You 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 benefits within the previous three months.

Your contributions You contribute on a pretax basis and you can change how much you contribute from each paycheck. The IRS maximum annual contribution is $3,600 for individual coverage and $7,200 for family coverage. If you are age 55 or older, you may make a “catch-up” contribution of $1,000.

Company’s contributions LifeBridge Health contributes to your account (the first half is paid in January and the second half is paid 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 maximum for 2021 of $3,600 for individual coverage and $7,200 for family coverage.

Eligible expenses Medical, dental, vision and prescription drug expenses incurred by you and your covered family members.

If you also wish to enroll in a Health Care FSA, you will only be eligible for a Limited-Purpose Health Care Flexible Spending Account (FSA).

Using your account Use the debit card linked to your HSA or submit a claim form to cover the expenses, or pay the expenses out-of-pocket and save your HSA money for future health care expenses.

Remaining Funds Any 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 can continue to pay and save for eligible health care expenses.

Fees There is a monthly fee of $2 for the HSA. As long as you are enrolled in the Health Saver Plan, LifeBridge Health pays the fee for you.

Setting Up Your HSATo set up your HSA, log on to HealthEquity and register your account. To view your balance, submit claims and more log on to https://healthequity.com/.

Once you pass the CIP process, you will receive a debit card from HealthEquity in the mail. To view your balance, submit claims and more, set up a

HealthEquity account at https://healthequity.com/.

Remember to set up your beneficiary directly with HealthEquity.

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Flexible Spending AccountsA Flexible Spending Account (FSA) helps you pay for eligible health care costs using tax-free dollars. You decide how much money you would like

to contribute to the account on a pretax basis.

Provision Limited Purpose (FSA)

BenefitsSpecifically for associates enrolled in the Health Saver Plan. Saves on eligible expenses not covered by insurance; reduces your taxable income.

Your contributions* Maximum contribution is $2,750.

Eligible expenses Eligible expenses are limited to qualifying dental and vision expenses.

Using your accountWhen you incur expenses, you can access account funds in your account to pay for eligible expenses.

Use the debit card linked to your HSA to cover the expenses, or pay the expenses out of pocket and submit a claim to be reimbursed by your FSA.

Use It or Lose It Reimbursable expenses must be incurred between January 1 and December 31. Claims for reimbursement must be submitted by March 31, of the following year. Please plan your contributions carefully. FSA elections do not automatically contribute 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.

About Your Benefits

10 | 2021 OPEN ENROLLMENT: OCTOBER 26 – NOVEMBER 6, 2020

Dental Plan

ProvisionSilver Plan Gold Plan

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

Annual Deductible N/A N/A N/A N/A

Annual Maximum N/A N/A N/A $1,000 combined

Periodic Oral Evaluation $5 copay N/A $5 copay $12 allowance

Dental Bi-weekly Rates Silver Plan Gold Plan

Individual $0.00 $8.80

Employee + Child $0.00 $15.45

Employee + Spouse $0.00 $17.59

Family $0.00 $24.16

Regular dental care is an important part of caring for your overall

health. Your dental plan is the United Concordia Dental Plan.

Detailed information regarding benefit coverage can be found on

the Schedule of Benefits posted on the Benefits Website,

http://www.lifebridgehealth.org/benefits.

Please note: You must select a United Concordia Primary Dental Office

(PDO) to receive covered services.

Treatment by an Out-of-Network Dentist is covered as described in the

Certificate of Coverage and Point of Service (POS) Rider, subject to a

maximum of $1,000 per Member per Contract year.

Only procedures listed on the Schedule of Benefits are Covered Services.

For services not listed (not covered), you are responsible for the full fee

charged by the dentist. Procedure codes and member Copayments may

be updated to meet American Dental Association (ADA) Current Dental

Terminology (CDT) in accordance with national standards.

For a complete description of your plan, please refer to the Certificate

of Coverage and the Schedule of Exclusions and Limitations.

If you have any questions about your United Concordia dental plan,

please call UCCI’s Customer Service Department toll-free at

1-866-357-3304 or access their website at www.UnitedConcordia.com.

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Vision PlanGetting your eyes checked every year can help maintain your vision and identify the early signs of certain health conditions, including diabetes.

Benefit Description Copay Frequency

Your Coverage with a VSP Provider

WellVision Exam Focuses on your eyes and overall wellness $0 Every calendar year

Prescription Glasses

Frame • $150 allowance for a wide selection of frames• $170 allowance for featured frame brands• 20% savings on the amount over your allowance• $80 Costco® frame allowance

$0 Every calendar year

Lenses • Single vision, lined bifocal, and lined trifocal lenses Polycarbonate lenses for dependent children

$0 Every calendar year

Lens Enhancements • Standard progressive lenses • Premium progressive lenses Custom progressive lenses• Average savings of 35-40% on other lens enhancements

$0$80–$90

$120–$160

Every calendar year

Contacts (instead of glasses)

• $130 allowance for contacts; copay does not apply Contact lens exam (fitting and evaluation)

Up to $60 Every calendar year

Diabetic Eyecare Plus Program

Services related to diabetic eye disease, glaucoma and age-related macular degeneration (AMD). Retinal screening for eligible members with diabetes. Limitations and coordination with medical coverage may apply. Ask your VSP doctor for details.

$20 As needed

Computer Vision Care

Computer Vision Exam Evaluates your needs related to computer use $0 Every calendar year

Frame • $100 allowance for a wide selection of frames• $120 allowance for featured frame brands• 20% savings on the amount over your allowance

$0 Every calendar year

Lenses Single vision, lined bifocal, lined trifocal, and occupational lenses $0 Every calendar year

Extra Savings Glasses and Sunglasses• Extra $20 to spend on featured frame brands. Go to vsp.com/specialoffers for details.• 30% savings on additional glasses and sunglasses, including lens enhancements, from the same VSP provider on the same day as your WellVision Exam. Or get 20% from any VSP provider within 12 months of your last WellVision Exam.

Retinal ScreeningNo more than a $39 copay on routine retinal screening as an enhancement to a WellVision Exam

Laser Vision Correction• Average 15% off the regular price or 5% off the promotional price; discounts only available from contracted facilities • After surgery, use your frame allowance (if eligible) for sunglasses from any VSP doctor

Vision Bi-weekly Rates Full or Part Time

Individual $4.11

Associate & Child(ren) $7.70

Associate & Spouse $7.26

Family $11.73

Your Coverage with Out-of-Network Providers Get the most out of your benefits and greater savings with a VSP

network doctor. Call Member Services for out-of-network plan details.

Krieger Eye DiscountsAs a LifeBridge Health team member you still have access to discounts with Krieger Eye at the Quarry Lake and Northwest Hospital locations. Be sure to

contact their office directly for applicable discounts.

To locate a VSP provider for In-Network Coverage please visit - https://www.vsp.com/eye-doctor

About Your Benefits

12 | 2021 OPEN ENROLLMENT: OCTOBER 26 – NOVEMBER 6, 2020

Company-Provided InsuranceLifeBridge Health automatically provides the following insurance

benefits at no cost to you.1 You do not need to enroll.

Account Type Benefit

Basic Life Insurance • 1x your base annual earnings, up to a maximum benefit of $50,000

Basic Accidental Death and Dismemberment (AD&D) Insurance

• 1x your base annual earnings, up to a maximum benefit of $50,000

Short-Term Disability for you

• 66.7% of your weekly earnings, up to $350 per week

• 14 calendar day elimination period • Benefits begin on the 15th day of

disability due to a non-work related injury and illness, and are payable up to the 26 weeks, if approved

Associate Paid Insurance

Account Type Benefit

Buy-up Short-Term Disability for you

• Ability to purchase buy up to a maximum of $700 per week.

• Benefits begin on the 15th day of disability due to injury or illness, and are payable up to 26 weeks.

Life Insurance & DisabilityWhat would your family do if your income was lost due to death or disability? Life and disability insurance are important for you and your family’s

financial security.

Reminder regarding Life Insurance: Keep your beneficiary information up-to-date in GHR.

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Important Considerations For Your Disability Plans• If approved by the carrier, your disability payments begin

after the benefit waiting period. The benefit waiting period is

the period of time an employee must be continuously disabled

before disability benefits may be payable through Cigna. Employees

are able to use available earned paid time off to cover time out of

work while they are satisfying the benefit waiting period. Disability

benefits may begin being paid out at the end of benefit waiting

period.

• Short Term Disability for maternity leave is supported for

six weeks’ postpartum for normal deliveries and eight weeks’

postpartum for cesarean section deliveries. Cigna’s claim managers

review pregnancies with complications on a case by case basis.

Please note that before disability benefits are payable for maternity

leave, you must satisfy the benefit waiting period.

• Benefits may be reduced by other income, such as Social Security.

• To place a disability claim please contact Cigna directly.

Life Insurance & DisabilityBasic Life Insurance:As a benefit eligible employee, you are automatically enrolled into the employer paid Basic Life insurance. This plan provides you with access to a

number of services at no additional cost! For any questions, please contact MetLife directly.

• Grief Counseling - Provides you and your dependents up to five private counseling sessions, in-person or by phone, with a professional grief counselor—

per event—to help cope with a loss, no matter the circumstances, whether it’s a death, an illness or divorce.

• Life Settlement Account - The Total Control Account (TCA) is a settlement option that provides your loved ones with a safe and convenient way to

manage life insurance proceeds. They’ll have the convenience of immediate access to any or all of their proceeds through an interest-bearing account

with unlimited check-writing privileges. The Total Control Account also allows beneficiaries time to decide what to do with their proceeds.

• Funeral Discounts and Planning Services - Helps alleviate the burden of making funeral arrangements from your loved ones. Get access to the

largest network of funeral homes and cemeteries to pre-plan with a counselor and receive discounts on funeral services.

Important Life Insurance Considerations: To open a claim for life insurance please contact Human Resources

About Your Benefits

14 | 2021 OPEN ENROLLMENT: OCTOBER 26 – NOVEMBER 6, 2020

Additional Benefits

Employee Assistance Program – CareBridge If you find yourself in need of professional support to deal with

personal, work, financial or family issues, the Employee Assistance

Program (EAP) can help. You and your immediate family

(spouse, dependent children) can use the EAP for help with: • Marriage and family problems

• Job-related issues

• Stress, anxiety and depression

• Parent and child relationships

• Legal and financial counseling

• Identity theft counseling

• Financial planning

• Various other issues

The program is available 24/7, is completely confidential and offered

at no cost. If you need help or guidance, call a CareBridge counselor at

800-437-0911 or visit www.myliferesource.com, access code: KKNH3.

Make Emotional Well-Being A Priority

Confidential Mental Health Assistance

Access to 24/7 guidance and counseling with licensed clinicians to assist

with concerns such as stress, anxiety, depression, grief, substance abuse,

and relationship conflicts. Support options include six in-person or

telehealth referrals, text and chat.

Life Management Solutions

Experienced life management specialists can provide qualified referrals

and resources for everyday concerns including child and eldercare, legal,

wellness support groups, transportation, relocation, and pet care.

Personal Money Management

Financial experts can provide you with the educational information and

resources you need to create a budget, pay off debt and establish savings.

Your mental health contributes towards happiness in your personal life. It also enhances your ability to be productive at work. At times, particular

life experiences and conditions can challenge one’s emotional and mental well-being. Present day conditions caused by the pandemic and social

injustices may have influenced feelings of fear, anxiety, and sadness, as well as, relationship conflicts. Your Employee Assistance Program (EAP) benefit

provides confidential consultations and referrals for counseling at no expense to you and members of your immediate family. Work-life support is

available to help you with information and resources for childcare, eldercare, personal money management, convenience services including pet

services, and education planning. Carebridge can help. Call 800.437.0911, 24/7. Educational resources are available on myliferesource.com and the

Carebridge EAP App. You will need to use the access code, KKNH3, during your first visit to the website.

Education Planning

Useful educational guidance and information to assist from infancy

through retirement. Obtain support to help your child learn while also

identifying programs to develop your personal interests and skills.

Virtual Resources and Support

Carebridge EAP App and mylifersource.com make it easy for you to access

a wide array of mental health and life management resources including

articles, trainings, calculators, self-care tips, mindfulness practices, discount

shopping program, and more.

| 15

MetLife Legal Plans with Plus Parents Option Metlife Legal Plans helps you navigate life’s planned and unplanned events Attorney fees can be expensive. With this plan, attorney fees for the legal services listed below are fully paid for when you use a network attorney. There

are no waiting periods, no deductibles, and no claim forms when using a network attorney for a covered matter.

With network attorneys available in person, by phone, or by email and online tools to do-it-yourself or plan your next move – MetLife makes it easy

to get legal help. And, you will always have a choice in which attorney to use. You can choose from their network of prequalified attorneys or use an

attorney outside of the network and be reimbursed some of the cost.1

Best of all, you have unlimited access to the MetLife attorneys for all legal matters covered under the plan. All services below are to available

employees, spouses, and eligible dependents. Services highlighted in bold are available to parents and parents-in-law.

Money Matters • Debt Collection Defense • Identity Theft Defense • Identity Management Services2

• Negotiations with Creditors• Personal Bankruptcy

• Promissory Notes• Tax Audit Representation• Tax Collection Defense

Home & Real Estate • Boundary & Title Disputes • Deeds • Eviction Defense • Foreclosure

• Home Equity Loans • Mortgages • Property Tax Assessments • Refinancing of Home

• Sale or Purchase of Home • Security Deposit Assistance • Tenant Negotiations • Zoning Applications

Estate Planning • Codicils • Complex Wills • Healthcare Proxies • Living Wills

• Powers of Attorney (Healthcare, Financial, Childcare, Immigration)• Revocable & Irrevocable Trusts • Simple Wills

Family & Personal • Adoption • Affidavits • Conservatorship • Demand Letters • Divorce - 20 hours • Garnishment Defense • Guardianship• Immigration Assistance

• Juvenile Court Defense, • Including Criminal Matters • Name Change • Parental Responsibility • Matters • Personal Property Protection• Prenuptial Agreement

• Protection from Domestic Violence • Review of ANY Personal Legal Document • School Hearings

Civil Lawsuits • Administrative Hearings • Civil Litigation Defense

• Disputes Over Consumer Goods & Services • Incompetency Defense

• Pet Liabilities • Small Claims Assistance

Elder-Care Issues Consultation & Document for your parents: • Deeds • Leases

• Medicaid • Medicare • Notes • Nursing Home Agreements

• Powers Of Attorney • Prescription Plans • Wills

Vehicle & Driving • Defense of Traffic Tickets3 • Driving Privileges Restoration

• License Suspension Due to DUI • Repossession

Bi-weekly Rate

MetLife Legal Plans with Parent Plus $8.50

1You will be responsible to pay the difference, if any, between the Plan’s payment and the out-of-network Attorney’s charge for services.2This benefit provides the Participant with access to LifeStages Identity Management Services provided by CyberScout, LLC. CyberScout is not a corporate affiliate of MetLife Legal Plans.3Does not cover DUI.

About Your Benefits

16 | 2021 OPEN ENROLLMENT: OCTOBER 26 – NOVEMBER 6, 2020

Group Voluntary Critical Illness CoverageGroup Voluntary Critical Illness coverage through MetLife pays benefits

for non-medical, critical illness-related expenses that your medical

plan might not cover. Benefits are in the form of a lump sum payment,

which is paid after a diagnosis is made.

Your initial benefit provides a lump-sum payment upon the first

diagnosis of a covered condition. Your plan also pays a recurrence

benefit for the certain covered conditions. The maximum amount that

you can receive through your Critical Illness Insurance is three times

the amount of your initial benefit.

Attained Age Employee Employee/Spouse Employee/Children Family

<25 $0.36 $0.72 $0.68 $1.05

25-29 $0.38 $0.78 $0.70 $1.10

30-34 $0.47 $1.00 $0.80 $1.32

35-39 $0.62 $1.34 $0.94 $1.66

40-44 $0.68 $1.90 $1.18 $2.23

45-49 $1.22 $2.75 $1.54 $3.07

50-54 $1.67 $3.88 $1.99 $4.21

55-59 $2.24 $5.40 $2.57 $5.73

60-64 $3.16 $7.81 $3.48 $8.13

65-69 $0.67 $11.61 $4.99 $11.93

70+ $7.20 $17.31 $7.52 $17.64

Employee Only Coverage, Age 55 with $10,000 coverage: • $10,000/1000 = 10

• 10 * $2.24 = $22.40 Monthly Rate

• $22.40 * 12 (months in the year) = $268.80/26 (pays in the year) =

$10.34 per pay

Family Coverage, Age 30 with $20,000 coverage:• $20,000/1000 = 20

• $20* $1.32 = $26.40 Monthly Rate

• $26.40 * 12 (months in the year) = $316.80/26 (pays in the year) =

$12.18 per pay

MetLife will provide an annual benefit of $50 per calendar year for

taking one of the eligible screening/prevention measures. MetLife

will pay only one health screening benefit per covered person per

calendar year. More details can be found on BridgeNet.

Eligible Individual Initial Benefit

Coverage Options

Employee $10,000 or $20,000

Spouse 100% of the employees Initial Benefit

Dependent Children3 50% of the employee's Initial Benefit

Insurance RatesMetLife offers competitive group rates and convenient payroll deduction, so you don’t have to worry about a check or missing a payment!

Your employee rates are outlined below.

Monthly Premium/ $1,000 of Coverage

| 17

Group Voluntary Accident Coverage Group Voluntary Accident coverage through MetLife can pay benefits for off-the-job accidents, plus some benefits that correspond with medical

care. The coverage can be used on its own or to fill a gap left by other coverage. It pays a benefit up to a specified amount for dislocation/fracture,

initial hospitalization confinement, hospitalization confinement, intensive care, 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 payments are determined by the

benefit type.

Covered BenefitsLow Plan High Plan

MetLife Accident Insurance Pays You MetLife Accident Insurance Pays You

Injuries – 12 covered injury types Ranging from $25 – $5,000 per injury Ranging from $50 – $10,000 per injury

Medical Services & Treatment – 15 covered types

Ranging from $15 – $1,000 per medical service/treatment type

Ranging from $25 – $2,000 per medical service/treatment type

Hospital Coverage (Accident) $500 (non-ICU) or $1,000 (ICU) per accident $1,000 (non-ICU) or $2,000 (ICU) per accident

Admissions $100 per day (non-ICU), up to 31 days $200 per day (non-ICU), up to 31 days

Confinement $200 per day (ICU), up to 31 days $400 per day (ICU), up to 31 days

Inpatient Rehab$100 per day, up to 15 days per accident and 30 days per calendar year

$200 per day, up to 15 days per accident and 30 days per calendar year

Accidental Death$25,000 $75,000 is passenger in common carrier

$50,000 $150,000 is passenger in common carrier

Dismemberment, Loss & Paralysis $250 - $10,000 per injury $500 – $50,000 per injury

Lodging$100 per night, up to 31 nights; up to $3,100 in total lodging benefits available per calendar year

$200 per night, up to 31 nights; up to $6,200 in total lodging benefits available per calendar year

Health Screening (Wellness)$50 payable 1x per covered insured per calendar year, if covered insured takes a covered test

$50 payable 1x per covered insured per calendar year, if covered insured takes a covered test

Bi-Weekly Group Voluntary Accident Rates Low Plan High Plan

Employee Only $3.30 $5.46

Employee Plus Spouse $6.94 $11.63

Employee Plus Child $6.92 $11.40

Family $8.34 $14.34

About Your Benefits

18 | 2021 OPEN ENROLLMENT: OCTOBER 26 – NOVEMBER 6, 2020

PetFirst Pet Insurance, a MetLife CompanyPet Insurance through PetFirst helps

offset the cost of caring for your dog or

cat, and covers everything from preventive

care to accidents and illness, as well as the

costs of X-rays, office visits, medications,

surgeries and hospital stays.

Please note: To enroll in Petfirst Pet Insurance you need to contact

Petfirst directly.

Home and Auto Discount Program You can receive special group discounts on auto, home, and renter’s

insurance through Liberty Mutual. The policies are tailored to suit your

needs. Please contact Liberty Mutual to inquire and/or enroll.

Please note: Liberty Mutual will bill you directly. No payroll

deduction is offered.

Identity Theft Protection This service through Allstate is designed to protect your identity and

assets through identity, credit and social media monitoring. Allstate also

extends dependent coverage to any dependent who lives in the same

household as the employee or who is financially dependent on them,

with no age limit.

Allstate Identity Protection is available in two comprehensive plans to

fit your needs with Allstate Identity Protection Pro and Allstate Identity

Protection Pro Plus. Both products include:

• Identity and credit monitoring

• Annual credit report and monthly credit score tracking

• Threshold monitoring

• Social media reputation monitoring

• Digital wallet storage and monitoring

• Full-service identity restoration

• $1,000,000 identity theft insurance policy

• A digital exposure report

Note: If you are newly enrolling, you need to set up an account with

Allstate. You will receive a home mailer and an email to your work

email address.

Learn more at www.myaip.com

Questions? Contact Allstate

Allstate Identity Protection Pro

Allstate Identity Protection Pro Plus

$3.66 per Individual per Paycheck $4.59 per Individual per Paycheck

$6.43 per Family per Paycheck $8.28 per Family per Paycheck

FeatureAllState Identity Protection Pro

Allstate Identity Protection Pro Plus

Credit Monitoring

Tri-Bureau Credit Monitoring

Annual Credit Report

Monthly Credit Score Tracking

Social Media Reputation Monitoring

Digital Wallet Storage & Monitoring

Full-Service Identity Restoration

Privacy Advocate Assistance

$1,000,000 Identity Theft Insurance Policy

Expanded Data Sources for Transactions on Financial Accounts

Additional Proactive Alerts on Financial Account Transactions

Threshold Monitoring on all Financial Accounts

| 19

403(b) Retirement Savings PlanLifeBridge Health offers 403(b) Retirement Savings Plan giving you an easy way to save for your future through payroll deductions.

For More InformationFor additional details about the 403(b) Retirement

Savings Plan or to enroll or change your contribution

rates or investment elections, please refer to

Transamerica Retirement Solutions at 800-755-5801,

or Transamerica.com/portal/lbh.

Remember: you can make changes to your 403(b)

plan at anytime during the plan year.

EligibilityYou are eligible to participate in the plan on your date of hire.

Your ContributionsContributions from your pay are made on a pretax basis up to the

IRS annual limit ($19,500 for 2020). If you are 50 years of age or older,

(or if you will reach age 50 by the end of the year), you may make

an additional catch-up contribution of $6,500, in addition to the

IRS annual limit.

Vesting Vesting refers to your right of ownership to the money in your

account. You are immediately vested in all of your contributions and

earnings on your contributions.

About Your Benefits

20 | 2021 OPEN ENROLLMENT: OCTOBER 26 – NOVEMBER 6, 2020

Dependent Verification Process You are required to complete the Dependent Verification Process for any dependent or spouse that will be newly covered with LifeBridge Health Benefits.

If you are not sure if you have the required dependent verification on file, please contact the Benefits Team. Your dependent(s) will not have coverage until

you complete this process.

As part of our commitment to control health care costs, LifeBridge Health (LBH) is taking steps to ensure that only eligible dependents are covered under

our medical, dental and/or vision plans. To accomplish this, LBH has implemented a dependent verification program. This process is intended to ensure

that each dependent enrolled in the LBH medical, dental and/or vision plans is accurately listed and eligible for coverage.

There are three (3) steps to the verification program clearly detailed below. Please complete all 3 steps for the dependents you enrolled in benefits,

if applicable.

1. Make sure that you provide legible copies of all required documentation.

2. Write your name and employee ID number on each piece of documentation.

3. Write “Not For Official Use” on each document and cross out the first five digits of any social security number.

Disabled Dependent:• A copy of the child’s birth certificate,

naming you or your legally married spouse

as the child’s parent, or appropriate court

order/adoption decree naming you or your

legally married spouse as the child’s legal

guardian AND

• A copy of a physician certification confirming

the child’s disability status.

Required Documentation:

Spouse:• A copy of your marriage certificate AND

• One form of documentation establishing

current marital status such as a joint

household bill, joint bank/credit account,

joint mortgage or lease, or front page of

your jointly filed federal tax return.

Child:• A copy of the child’s birth certificate,

naming you or your legally married spouse

as the child’s parent, or appropriate court

order/adoption decree naming you or

your legally married spouse as the child’s

legal guardian.

All required documentation must be received by the Benefits Team as soon as possible. You can submit documentation via email at

[email protected].

Your dependent(s) will not have coverage until we receive the documentation. If documentation is not received within 30 days of your hire date,

your dependent will not be eligible for coverage until the next open enrollment period unless they experience a qualifying life event.

If you have any questions regarding this process please contact your site HR team or the Benefits Team at [email protected].

| 21

Glossary of TermsAfter-tax – The contributions you make for benefits such as Life and AD&D insurance and Disability insurance are subject to Social Security tax, federal income tax and, in most cases, state and local income taxes.

Calendar Year Maximum – The benefit amount paid each year for each family member enrolled in the dental plan.

Coinsurance – The sharing of cost between you and the plan. For example, 80 percent coinsurance means the plan covers 80 percent of the cost of service after a deductible is met, and you will be responsible for the remaining 20 percent of the cost.

Copay – A fixed amount (for example $15) you pay for a covered health care service, usually when you receive the service. The amount can vary by the type of covered health care service.

Deductible – The amount you have to pay for covered health care services before your health plan begins to pay.

Benefit Waiting Period – The benefit waiting period is the period of time an employee must be continuously disabled before disability benefits may be payable through Cigna. Employees are able to use available earned paid time off to cover time out of work while they are satisfying the benefit waiting period. Disability benefits may begin being paid out at the end of benefit waiting period.

Health Savings Account (HSA) – An HSA is a personal health care account for those enrolled in an HDHP. You may use your HSA to pay for qualified medical expenses such as doctor’s office visits, hospital care, prescription drugs, dental care, and vision care. You can use the money in your HSA to pay for qualified medical expenses now, or in the future. Your HSA can be used for your expenses and those of your spouse and dependents, even if they are not covered by the HDHP.

High Deductible Health Plan (HDHP) – A qualified High Deductible Health Plan (HDHP) is defined by the Internal Revenue Service (IRS) as a plan with a minimum annual deductible and a maximum out-of-pocket limit. These minimums and maximums are determined annually and are subject to change.

In-network – A designated list of health care providers (doctors, dentists, etc.) with whom the health insurance provider has negotiated special rates. Using in-network providers lowers the cost of services for you and the Company.

LifeBridge Health (LBH) Network – LifeBridge Health Provider Network.

Out-of-network – Health care providers that are not in the Plan’s network and who have not negotiated discounted rates. The cost of services provided by out-of-network providers is much higher for you and the Company. Additional deductibles and higher coinsurance will apply.

Out-of-pocket maximum – The most you will pay of your own money before services are 100 percent covered by the medical plan. Your annual deductible is included in your out-of-pocket maximum.

Pretax – The contributions you make for medical, dental, vision, HSA, FSA health care spending and FSA dependent care spending are not subject to Social Security tax, federal income tax or, in most cases, state and local income taxes.

Reasonable & Customary Charges (R&C) – Prevailing market rates for services provided by health care professionals within a certain area for certain procedures. Reasonable and Customary rates apply to out-of-network charges.

About Your Benefits

22 | 2021 OPEN ENROLLMENT: OCTOBER 26 – NOVEMBER 6, 2020

Special NoticesAccess these LifeBridge Health Special Notices at http://www.lifebridgehealth.org/benefitsCertificate of Credible Coverage for Medicare Part D This notice has information about your current prescription drug coverage with LifeBridge Health and about your options under Medicare’s prescription drug coverage.

Women’s Health and Cancer Act of 1998 If 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).

CHIPRA Notice 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.

Mental Health Parity Act The Mental Health Parity law applies to group health insurers and to fully insured and self-insured ERISA groups of 51 or more employees that include mental health/substance use disorder benefits. It mandates equalization of copays, coinsurance, deductibles and the elimination of day and visit limits and financial maximums.

Healthcare Reform Notification This notice includes information about the Patient Protection and Affordable Care Act that was recently passed and provides you with important information that you need to know.

Newborn’s Act Disclosure The Newborns’ and Mothers’ Health Protection Act requires that group health plans and health insurance issuers who offer childbirth coverage 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.

LifeBridge Health 2018 PN501 Summary Annual Report This is a summary of the annual report of the LifeBridge Health, Inc., a health, life insurance, dental, vision, temporary disability and longterm disability plan.

Notice of Special Enrollment Rights If you are declining enrollment for yourself or your dependents (including your spouse) because of other health insurance or group health plan coverage, you may be able to enroll yourself and your dependents in this plan if you or your dependents lose eligibility for that other coverage (or if the employer stops contributing toward your or your dependents’ other coverage).

| 23

Contact InformationPlan Provider Phone Number Website

Medical CareFirst 866-595-6245 www.carefirst.com

Prescription Drugs CVS 866-294-2110 http://caremark.com/wps/portal

Dental UCCI 866-357-3304 www.unitedconcordia.com

Vision VSP 800-877-7195 www.vsp.com

Flexible Spending Accounts WageWorks 877-924-3967 www.wageworks.com

FMLA/LOA Requests FMLA Source 877-462-3652 www.fmlasource.com

Credit Union First Financial Federal

Credit Union410-321-6060 www.firstfinancial.org

Health Savings Account (HSA) HealthEquity 877-924-3967 https://healthequity.com/

Life Insurance and AD&D MetLife 800-438-6388 www.mybenefits.metlife.com

Disability Cigna 800-781-2006 www.cigna.com

Employee Assistance Program Carebridge800-437-0911

Company Access Code: KKNH3www.myliferesource.com

Critical Illness/Accident Insurance MetLife 800-438-6388 www.mybenefits.metlife.com

Legal Assistance MetLIfe Legal 800-821-6400

Company access code: 9900019info.legalplans.com

Identity Theft Protection Allstate 800-789-2720 www.myaip.com

Home and Auto Insurance Liberty Mutual 800-295-3549 www.libertymutual.com

Pet Insurance PetFirst 866-937-7387 www.petfirst.com/lifebridge

403(b) Retirement Savings PlanTransamerica Retirement

Solutions800-755-5801 Transamerica.com/portal/lbh

Additional Resources Service Phone Number Website

Mobile Wallet Card

Provides you access to plan contact information,

group numbers and benefit guides anywhere from your computer or mobile phone

— mymobilewalletcard.com/lifebridge

Enrollment Counselors

Additional support in understanding your

benefits and/or to make enrollment elections

855-736-1446 —

Global Human Resources (GHR)

Access online the enrollment area and view your current

benefit elections throughout the year

—https://lbhprd-law.cloud.infor.com/

SitePages/InforSuite.aspx

*Must be within the LBH Network to access the Benefit area. *Must use updated Microsoft Edge Browser.

Provider Locating Tool

Carefirst United Concordia Vision Services Plan

https://member.carefirst.com/mos/#/fadsdpublic/search/lifebridge

http://www.unitedconcordia.com/ https://www.vsp.com/eye-doctor

About Your Benefits

24 | 2021 OPEN ENROLLMENT: OCTOBER 26 – NOVEMBER 6, 2020

About this Guide: This benefit summary provides selected highlights of the LifeBridge Health employee benefits program. It is not a legal document and shall not be construed as a guarantee of benefits nor of continued employment at the company. All benefit plans are governed by master policies, contracts and plan documents. Any discrepancies between any information provided through this summary and the actual terms of such policies, contracts and plan documents shall be governed by the terms of such policies, contracts and plan documents. LifeBridge Health reserves the right to amend, suspend or terminate any benefit plan, in whole or in part, at any time. The authority to make such changes rests with the Plan Administrator.