2020 benefits guide...example, if the court finds your claim is frivolous) the court may order you...

2020 BENEFITS GUIDE

Inside the

Guide

Page 1

Welcome ��2

Medical Plan ��3

Virtual Visits ��5

Real Appeal® ��6

Health Savings Account ��7

Dental Plan ��10

Vision Plan ��11

Basic Life & AD&D Plan ��12

Voluntary Term Life Plan ��12

Short-Term Disability ��13

Long-Term Disability ��13

Employee Assistance Program (EAP) ��14

Accident Plan ��15

Critical Illness ��16

Universal Life ��16

Carrier Contact Information ��17

Important Notices ��18

Flexible Spending Account ��.��.9

WelcomeThe MAPP Group, LLC knows how important it is to provide quality employee benefits to our employees and their dependents� We always strive to provide a total benefits package that meets your needs as well as the needs of the company�

Please take the time to read the following benefit summaries carefully� This information will help you in deciding the best benefit selections for you and your family�

At other times during the year, you may request changes ONLY when there is a Family Status Change, and the proposed change is consistent with the Family Status Change event� Family Status Changes include:

• Change in legal marital status (e�g�, marriage or divorce);

• Change in the number of dependents (e�g�, birth, adoption or placement for adoption, death);

• Change in employment status or residency of the employee, spouse or dependent that affects eligibility;

• Change in coverage under another employer’s plan�

Changes, additions or voluntary cancellations generally cannot be made during the plan year unless the employee experiences a Family Status Change� You have 30 days from a change in family status to make changes to your current coverage� Otherwise, the employee must wait until the annual enrollment period to change or cancel an election�

Any employee who has health, dental, or vision insurance through The MAPP Group, LLC who has a premium deducted from their pay, can have their insurance premiums paid through our Premium Conversion Plan� As allowed by the IRS Code- Section 125, this benefit allows you to pay your payroll deducted insurance premiums with “pre-tax” dollars� As a plan participant, the employee’s share of the health, dental, and vision premiums will be paid on a pre-tax basis through salary reduction� Under the Plan, once an election is made that election will continue unless a change in election is made due to a Family Status Change, annual enrollment, or termination of employment�

As a new employee, you have the opportunity to enroll in the Mapp Group, LLC employee benefits� The benefits you elect may be subject to carrier approval and will remain in effect until January 31, 2021�

Page 2

Medical PlanUnited HealthCare HDHP Plan

In-Network Out-of-Network

Deductible (Per Calendar Year)

Individual $3,000 $6,000

Family $6,000 $12,000

Out-of-Pocket (Per Calendar Year)


Family $8,000 $16,000

Lifetime Unlimited

Medical Coverage

Primary Care Office Visit 80% after deductible 60% after deductible

Specialty Care Office Visit 80% after deductible 60% after deductible

Virtual Visits 80% after deductible 60% after deductible

Urgent Care 80% after deductible 60% after deductible

Emergency Room 80% after deductible* 60% after deductible*

Inpatient Services 80% after deductible 60% after deductible

Outpatient Services 80% after deductible 60% after deductible

Most Other Services 80% after deductible 60% after deductible

Prescription Drug Coverage (30-day retail)

Tier 1 $10 Copay after deductible



* Non-emergency use of ER and that true emergencies are covered at network levels�

The MAPP Group, LLC will contribute toward the employee and the dependent premium for the Medical Plan�

Mapp Medical

Employee & Spouse

Mapp Savings Account

Contributions

HSA Weekly Distribution

Employee Only $17.50

Employee & Spouse

$26.25

Employee & Children

$23.75

Employee & Family $33.75

HDHP

Employee & Family $205

Contributions1/31/2021

Deduction 2/1/2020 to

2/1/2020 to 1/31/2021

HSA Weekly

Savings Account Employer ContributionsHDHP Medical Plan Cost

Page 3

Employee Only $35

Employee & Child(ren)

$128

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$119

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Medical Plan

In-Network Out-of-Network

Deductible (Per Calendar Year)

Out-of-Pocket (Per Calendar Year)


Family $8,000 $16,000

Lifetime Unlimited

Medical Coverage

* Non-emergency use of ER and that true emergencies are covered at network levels�

United HealthCare PPO Plan


Family $2,000 $4,000

Primary Care Office Visit $25 Copay, no deductible 40% after deductible

Specialty Care Office Visit $45 Copay, no deductible 40% after deductible

Virtual Visits $10 Copay, no deductible N/A

Urgent Care $50 Copay, no deductible 40% after deductible

Inpatient Services 80% after deductible 40% after deductible

Outpatient Services 80% after deductible 40% after deductible

Most Other Services 80% after deductible 40% after deductible

Emergency Room $350 Copay, no deductible* $350 Copay, no deductible*

Mapp Medical

Employee & Spouse

Employee & Child(ren)

Employee Only $50

$175

$165

Employee & Family $250

PPO 2/1/2020 to 1/31/2021

Copay (PPO) Medical Plan Cost

PPO Weekly Deduction

Contributions

Page 4

Prescription Drug Coverage (30-day retail)

Tier 1 $10 Copay

Tier 2 $35 Copay

Tier 3 $70 Copay

Virtual VisitsWith UnitedHealthcare, you no longer have to spend time or money assessing, selecting, and implementing an external virtual visit provider� We seamlessly integrate virtual visits into your health plan� The virtual visit provider groups we contract with deliver care using live audio and video technology based on quality standards aligned with American Medical Association (AMA) and Federation of State Medical Boards (FSMB) guidelines�

When employees are sick they often miss work� With virtual visits, their covered family members can see and speak to a doctor 24 hours a day/7 days a week using a mobile device or computer, wherever they are� If needed, employees and prescription drugs can also be sent to a local pharmacy� This service is especially beneficial to those members living rural areas who may have difficulty accessing care� In most scenarios, scheduling a virtual visit will save time and money� Virtual visits are covered under member health plans administered by UnitedHealthcare with some member cost share�

Conditions Commonly Treated Through A Virtual VisitDoctors can diagnose and treat a wide range of non-emergency medical conditions, including: • Bladder Infection/

Urinary Tract Infection

• Bronchitis

• Cold/Flu

• Diarrhea

• Fever

• Migraine/Headaches

• Pink Eye

• Rash

• Sinus Problems

• Sore Throat

• Stomach Ache

Access Virtual VisitsLog in to myuhc�com and choose from provider sites where you can register for a virtual visit� After registering and requesting a visit you will pay your portion of the service costs according to your medical plan, and then you will enter a virtual waiting room� During your visit you will be able to talk to a doctor about your health concerns, symptoms and treatment options�

Use Virtual Visits When:• Your doctor is not available

• You become ill while traveling

• You are considering visiting a hospital emergency room for a non-emergency health condition

Not Good For:• Anything requiring an exam or test

• Complex or chronic conditions

• Injuries requiring bandaging or sprains/ broken bones

Page 5

Real Appeal®

Real Appeal is a revolutionary 52-week, fun and engaging, interactive, intensive lifestyle intervention program, centered on weight loss and keeping it off� It is delivered face-to-face, live over the internet, through live virtual coaching, and online group participation�

Members get everything they need for success, except an excuse! Best of all, it’s offered at NO COST to members!

Adult members with at risk BMI (over 30) or BMI between 25-29 with a comorbidity (for example: Diabetes, High Blood Pressure, Tobacco User) are eligible for this 52-week program with UHC covering the claims cost. As the member participates, claims are filed with UHC at no member cost share.

The initial consultation is a behavioral assessment� After that, members engage in weekly group virtual coaching sessions made easy online or via smart phone app� After the first coaching session, members receive a success kit in the mail that includes a food scale, 14 exercise DVD set, pedometer, blender, and water bottle�

Real Appeal Includes:A personalized transformation coach for an entire year. Coaches guide participants through the program, step by step, customizing it to fit their needs, personal preferences, goals and medical history�

24/7 online support and mobile app.

• Customizable food, activity, weight and goal trackers�

• Unlimited access to digital content, including streaming workout videos�

• Success group support which lets participants chat with others who are doing the Real Appeal program�

• A weekly online TV show that is fun, engaging, and helps participants learn new ways to be healthy�

• Weekly analysis, feedback and goal reporting�

A Success Kit. All the tools participants need to help kick-start their weight loss and keep them going strong will be delivered to their door after they attend their first group coaching session� It includes these helpful tools:

• Digital food scale

• “Perfect” portion plate

• Resistance band

• Electronic body weight scale

• Exercise DVDs

• And more

Unique Approach• Year-long weight loss and maintenance program�

• Holistic approach, addressing diet, exercise, behaviors and willingness to change�

• Material is created with supervision from a Clinical Advisory Board of obesity experts�

• Approach drives outcomes: There were more than 100,000 registered participants in the Real Appeal program over the past year� Of the participants who completed the program:

• 82% of the participants lost weight�

• 38% had 5% or more weight loss�

• 10 pounds on average were lost per person�

Page 6

Health Savings AccountA Health Savings Account, or HSA, can be a valuable tool to help you save money for medical expenses for you and your family� An HSA is a tax-exempt account that can be used to pay or reimburse certain medical expenses you incur�

Employees who choose to participate in the HDHP (High Deductible Health Plan) may also open a Health Savings Account (HSA)� The MAPP Group, LLC will contribute to your HSA account to offset the high deductible plan� Please see MAPP contributions below� Health Savings Account Dollars will be accessible via an HSA debit card� The HSA debit card can be used for qualified medical, dental, and vision expenses as defined by the Internal Revenue Service Publication 502 (You may reference www�irs�gov for the complete list)� The HSA plan will be administered by Optum Bank�

HSA monies are exempt from federal income taxes and may be exempt from State income taxes as well� They belong to the employee and can be rolled over to subsequent years� HSA funds may also be invested in the same type of funds as IRA’s and 401(k)’s�

Employee Only Employee / Spouse Employee / Child(ren) Employee / Family

MAPP Weekly Contributions $17.50 $26.25 $23.75 $33.75

Important Notes:• If you or your spouse participate in a health FSA or an HRA that pays or reimburses qualified medical expenses

before the minimum annual HDHP deductible has been satisfied, you are not eligible to participate in an HSA�

• If you are enrolled in another plan that is a non-High Deductible Health Plan, including Medicare, you are not eligible to participate in an HSA�

maximum catch up contribution is $1,000 per account holder�

**NOTE: The maximum amount of money that can be deposited in 2020 for single HDHP coverage is $3,550 and $7,100 for family HDHP coverage� Individuals 55 or older may make additional catch up contributions� For 2020, the

Account Funding Schedule

Page 7

Health Savings Account cont.How to Open your HSA Account:It only takes minutes to enroll in a health savings account (HSA) from Optum Bank, Member FDIC�

1� Go to www�optumbank�com and select “Open an HSA”�

2� Read through the page to confirm your eligibility and select “Continue”�

3� Complete your online enrollment�

What you’ll need

• Your Social Security number

• Your primary email address

• An identification number from another form of ID, such as your driver’s license, state-issued identification or passport

Be on the lookout

When enrolling, you can choose to receive your welcome kit electronically or by mail� You will also receive a health savings account Debit Master Card by mail within ten days in an unmarked envelope�

If you need extra debit cards

If you have family coverage, you can order extra debit cards for your spouse and dependents on your plan when enrolling in your account� You’ll need each cardholder’s name, Social Security number and date of birth�

Page 8

Flexible Spending AccountThe MAPP Group, LLC offers you the opportunity to pay for out-of-pocket medical, dental, and dependent care expenses with pre-tax dollars through the Flexible Spending Account� The plan is administered by UnitedHealthcare.

B� Dependent Care Expense: The Internal Revenue Service allows you to set aside money BEFORE taxes to reimburse yourself for Dependent Care Expenses each plan year up to a maximum of $5,000, if your tax filing status is Single or Married Filing Jointly� You may elect up to $2,500 if Tax Filing Status is Married Filing Separate. Again, this results in a TAX SAVINGS to you!!!

Important to Remember• Any monies placed in the Medical Reimbursement Account or Dependent Care Account not spent within the plan year

are forfeited – “Use it or Lose it”�

• Should your employment terminate during the year, you have 30 days from your term date to file claims for eligible expenses received prior to your term date�

• Due to the Patient Protection and Affordable Care Act, employee will NOT be able to receive pre-tax reimbursements from their FSA for non-prescribed over-the-counter medications� OTC drugs, medicine and biologicals will be eligible for reimbursement only if the request is accompanied by a doctor’s prescription� This means items such as cough medicine, pain relievers, acid controllers, to name a few, will no longer be reimbursed unless there is a doctor’s prescription submitted along with the reimbursement request� Please contact your FSA administrator for more details�

This benefit is regulated by the Internal Revenue Service and consists of three parts to help you pay your premiums and out-of-pocket health and dependent care expenses with pre-tax dollars, which lowers your tax liability. The Cafeteria Plan

Enrollment� Employees are unable to enroll / change at any other time during the year unless a qualifying event occurs�

A� Medical Reimbursement: The Internal Revenue Service will allow you to “set aside” money from your paycheck BEFORE taxes to “reimburse yourself” for certain items not typically covered under your health, dental or vision insurance� This results in a TAX SAVINGS to you! Examples of things that you can claim for reimbursement include: Medical and drug deductibles and coinsurance, contacts or eyeglasses, hearing aids, dental expenses (whether you have dental insurance or not), etc� The maximum allowed for 2020 is $2,750.

Year is from February 1, 2020 to January 31, 2021. You will be required to make a new election every year during Annual

Page 9

Dental PlanThe MAPP Group, LLC offers a Dental Plan through Unum (Alwayscare)�

Unum (Alwayscare) Dental Plan

Deductible (per Calendar Year)

Applies to Basic & Major Services only $50 per personMaximum 3 per family

Annual Maximum $1,500

Preventive Services

Exams, Cleanings, X-Rays 100% coverage (deductible waived)

Basic Services

Fillings, Extractions, Repairs 80% coverage

Major Services

Root Canals, Crowns, Dentures, Bridges, Periodontics 50% coverage

Orthodontics

$500 Annual Max / $1,000 Lifetime Maximum 50% coverage

**LATE Entrants: Employees that waived coverage at initial enrollment or in the new employee eligibility period will have a twelve (12) month waiting period for basic, major and orthodontic services upon re-applying�

Employee pays the entire Dental Plan premium�

Employee Only $6.18

Employee & Spouse $12.37

Employee & Child(ren) $15.28


Weekly Deduction 2/1/2020 to 1/31/2021

Page 10

The MAPP Group, LLC offers a Vision Plan through Unum�

Unum Vision Plan

Services& Materials

Exam Copay $10

Materials Copay $25

Frequencies

Exam 12 Months

Lenses 12 Months

Frames 24 Months

Frames

Retail Frame Allowance $130, 30% discount on frame overage at participating providers

Contact Lenses

Contact Lens Benefit Fitting/evaluation fees, contacts, and up to 2 follow-up visits are covered-in-full (after applicable copay). For disposable lenses, up to 4 boxes are included

All Other Elective Contacts $125

Out-of-Network Allowance

Exam Up to $40

Single Vision Lenses Up to $40

Frames Up to $45

Contact Lenses Up to $125

Weekly Deduction

Employee Only $1.29




Employee pays the entire Vision Plan premium�

Vision Plan

2/1/2020 to 1/31/2021

Page 11

Basic Life & AD&D PlanThe MAPP Group, LLC provides full-time eligible employees with $10,000 Life and Accidental Death & Dismemberment Insurance� This policy is offered through UNUM and is 100% employer-paid� You will want to keep your Beneficiary information current at all times�

Benefits reduce 65% of original amount at age 70 and 50% of original amount at age 75�

Voluntary Term Life PlanEmployee: All full-time employees can purchase Voluntary Life and Accidental Death & Dismemberment (AD&D) coverage in increments of $10,000 to a maximum of 5 times salary not to exceed $500,000� This benefit is provided through UNUM and is 100% Employee paid� Elections in excess of the $110,000 guarantee issue amount will be subject to medical evidence of insurability and will be pended until approved by UNUM�

In order to purchase Life coverage for your spouse and/or child, you must purchase Life coverage for yourself�

Benefits reduce 65% of original amount at age 70 and 50% of original amount at age 75�

Weekly Voluntary Term Life Cost- 100% Employee Paid per $1,000 of Life Coverage

Age 15-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75 +

Employee Cost

$.027 $.030 $.033 $.041 $.053 $.076 $.113 $.166 $.252 $.427 $.751 $1.458

Spouse Cost

$.014 $.016 $.021 $.030 $.043 $.068 $.106 $.162 $.277 $.474 $.844 $1.691

Voluntary Life Premium Calculation Formula:

$ ÷ 1,000 x = $

VTL Coverage Amount Rate – see above table Weekly Cost

How Guaranteed Issue Works

Initial Enrollments Future Enrollments

If you enroll: You can select any coverage amount with no questions or health exams up to the guaranteed issue amount.

You can increase your coverage up to the guaranteed issue amount with no health questions or physical exams.

If you do not enroll: You will not benefit from this opportunity to obtain guaranteed coverage.

If coverage is offered again, you can apply for it, but will need to answer health questions, even for the minimum amount. You could be declined coverage

NOTE: Employee and Spouse rate is based on employee’s age �

Page 12

Child(ren): When you elect Voluntary Term Life coverage for yourself, you can also elect child Life coverage which does not include AD&D for children ages 14 days to 6 months in the amount of $1,000 and for child(ren) ages 6 months to 26 years in the amount of $10,000�

Spouse: When you elect Voluntary Term Life coverage for yourself, you can also purchase Life coverage which does not include AD&D for your spouse in increments of $5,000 up to employee coverage amount or maximum of $500,000� Amounts in excess of the $25,000 guarantee issue amount will be subject to medical evidence of insurability and will be pended until approved by UNUM�

Short-Term Disability The MAPP Group, LLC provides full-time employees an opportunity to purchase Short-Term Disability coverage through UNUM� In the event you become disabled as a result of a non-work related accident or illness, tax-free Disability Income Insurance benefits are provided as a source of income� You are not eligible to receive Short-Term Disability benefits if you are eligible to receive workers’ compensation benefits�

If you are enrolling in the STD coverage for the first time and you are not a new hire, you will be subject to evidence of insurability and must complete additional forms�

Short-Term Disability

Elimination Period 7 days

Benefits Period Up to 12 weeks

Percentage of Income Replaced 60% of weekly salary

Maximum Benefit $1,500 weekly

NOTE:

Weekly STD Cost per $10 of Covered Benefit - 100% Employee Paid

Age Under 39 40-49 50-54 55-59 60-64 65+

Employee Cost $0.39 $0.46 $0.60 $0.76 $0.94 $1.00

STD Premium Calculation Formula: $ ÷ 52 x x .60 = ÷ 10 = x = $

Annual Base Salary

Salary Weekly Benefit max = $1,500

Weekly Rate (above table)

Your Weekly Premium

Long-Term Disability The MAPP Group, LLC provides Long Term Disability insurance for eligible employees who are disabled because of a non-work related illness or injury� The benefit is fully paid by the company and enrollment is automatic�

Long-Term Disability

Benefit Begins The date you are legible for coverage, if you apply for insurance on or before that date The date you apply for insurance, if you apply within 31 days after your eligibility date

The date Unum approves your application, if evidence of insurability is required

Benefit Amount 60% of pre-disability earnings

Maximum Benefit Up to $8,000/month

Pre-Existing Conditions If you receive medical treatment, consultation, care, or services including diagnostic measures, or took prescription drugs or medicines in the 3 months prior to your effective date of coverage, this condition will not be covered until

you have been on the policy for 12 months.

Rate is based on employee’s age

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Employee Assistance Program (EAP)UNUM provides EAP assistance at no cost to you called Work-life balance EAP� They can help you find solutions for the everyday challenges of work and home as well as for more serious issues involving emotional and physical well-being� This includes: Childcare and/or eldercare referrals, personal relationship information, health information and online tools, legal consultations with licensed attorneys, financial planning assistance, stress management & career development. They offer telephone consultations, face-to-face meetings and educational materials� For assistance, contact UNUM at: English 800-854-1446, Spanish 877-858-2147� Or visit www�lifebalance�net — user ID and password; lifebalance�

Employee Assistance Program (EAP)Your EAP is designed to help you lead a happier and more productive life at home and at work. Call for confidential access to a Licensed Professional Counselor* who can help you.

EN-2055 (5-18) FOR EMPLOYEES

Help, when you need it mostWith your Employee Assistance Program and Work/Life Balance services, confidential assistance is as close as your phone or computer.

A Licensed Professional Counselor can help you with:

• Stress, depression, anxiety • Relationship issues, divorce• Job stress, work conflicts

• Family and parenting problems• Anger, grief and loss• And more

Work/Life BalanceYou can also reach out to a specialist for help with balancing work and life issues. Just call and one of our Work/Life Specialists can answer your questions and help you find resources in your community.

Ask our Work/Life Specialists about:

• Child care• Elder care• Legal questions• Identity theft

• Financial services, debt management, credit report issues• Even reducing your medical/dental bills!• And more

Always by your side • Expert support 24/7• Convenient website• Short-term help• Referrals for additional care• Monthly webinars• Medical Bill SaverTM

— helps you save on medical bills

Help is easy to access:Online/phone support: Unlimited, confidential, 24/7.

In-person: You can get up to 3 visits available at no additional cost to you with a Licensed Professional Counselor. Your counselor may refer you to resources in your community for ongoing support.

* The counselors must abide by federal regulations regarding duty to warn of harm to self or others. In these instances, the consultant may be mandated to report a situation to the appropriate authority.

Unum’s Employee Assistance Program and Work/Life Balance services, provided by HealthAdvocate, are available with select Unum insurance offerings. Terms and availability of service are subject to change. Service provider does not provide legal advice; please consult your attorney for guidance.

Services are not valid after coverage terminates. Please contact your Unum representative for details.Insurance products are underwritten by the subsidiaries of Unum Group.unum.com © 2018 Unum Group. All rights reserved. Unum is a registered trademark and marketing brand of Unum Group and its insuring subsidiaries.

Who is covered?

Unum’s EAP services are available to all eligible employees, their spouses or domestic partners, dependent children, parents and parents-in-law.

Turn to us, when you don’t know where to turn.

Employee Assistance Program — Work/Life Balance

Toll-free 24/7 access: 1-800-854-1446 (mulit-lingual)www.unum.com/lifebalance

Page 14

Accident PlanGroup Accident coverage is designed to help covered employees meet the out-of-pocket expenses and extra bills that can follow an accidental injury, whether minor or catastrophic� Indemnity lump sum benefits are paid directly to the employee based on the amount of coverage listed in the schedule of benefits� This policy is offered through Allstate and is 100% employee paid�

Employee Only $3.12




Weekly Deduction 2/1/2020 to 1/31/2021

Page 15

Critical IllnessCritical Illness coverage is designed to help employees offset the financial effects of a catastrophic illness with a lump sum benefit if an insured is diagnosed with a covered critical illness� The Critical Illness benefit is based on the amount of coverage in effect on the date of diagnosis of a critical illness or the date treatment is received according to the terms of the provisions of the policy that is offered through Allstate�

Benefit Amount

Wellness Benefit

Wellness Visit $75

Critical Illness Benefit

Heart Attack $10,000

Stroke $10,000

Major Organ Transplant $10,000

Coronary Artery Bypass surgery $2,500

End Stage Renal Failure $10,000

Advanced Alzheimer's $10,000

Loss of hearing, Sight or speech $10,000

Recurrent Critical Illness Benefit Included

Coma $10,000

Cancer Benefit

Invasive Cancer $10,000

Universal LifeUniversal Life insurance provides death benefits for your entire life� Benefits pay out a designated amount to your beneficiary at the time of death� The payout is guaranteed as long as premiums are paid to date� This policy also includes a Long Term Care rider, and may also hold a cash value which allows you to sell the policy back to the company for accrued funds�

Benefit Maximum

Employee $150,000

Spouse $100,000

Child Term Rider $10,000

Highlights:• Fully Portable

• Guaranteed Issue

• Guaranteed 4% Interest

• Includes a Long Term Care rider No physicals or blood work

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Carrier Contact InformationWe created this simple directory for you� It provides you with important contact information for each the covered services offered�

Medical Plan Flexible Spending Account (FSA)

Provider Name: United HealthCare Provider Name: United HealthCare

Phone Number: 866-314-0335 Phone Number: 866-755-2648

Website: www.myuhc.com

Health4me mobile app

Website: www.myuhc.com

Prescription Administrator Group Life & AD&D, Voluntary Life & Short-Term Disability Plans

Provider Name: Optum Rx Provider Name: UNUM


Website: www.myuhc.com Website: www.unum.com

Health Savings Account (HSA) Employee Assistance Program

Provider Name: Optum Bank Provider Name: UNUM

Phone Number: 866-755-2648 Phone Number: English 800-854-1446 Spanish 877-858-2147

Website: www.optumbank.com Website: www.lifebalance.net user ID and password; lifebalance

Dental & Vision Plan Group Accident & Critical Illness Plans

Provider Name: Unum Alwayscare Provider Name: Allstate


Website: www.alwaysassist.com Email: [email protected]

Provider Name: TaxSaver Provider Name: USI


Website: www.taxsaverplan.com Website: [email protected]

MAPP Benefits Enrollment Help Line:1 (844) 880-6774

HRA Administrator Benefits HelpLine

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Important Legal Notices Affecting Your Health Plan Coverage THE WOMEN’S HEALTH CANCER RIGHTS ACT OF 1998 (WHCRA)

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). For individuals receiving mastectomy-related benefits, coverage will be provided in a manner determined in consultation with the attending physician and the patient, for:

All stages of reconstruction of the breast on which the mastectomy was performed; Surgery and reconstruction of the other breast to produce a symmetrical appearance; Prostheses; and

NEWBORNS ACT DISCLOSURE - FEDERAL Group health plans and health insurance issuers generally may not, under Federal law, restrict benefits for any hospital length of stay in connection with childbirth for the mother or newborn child to less than 48 hours following a vaginal delivery, or less than 96 hours following a cesarean section. However, Federal law generally does not prohibit the mother’s or newborn’s attending provider, after consulting with the mother, from discharging the mother or her newborn earlier than 48 hours (or 96 hours as applicable). In any case, plans and issuers may not, under Federal law, require that a provider obtain authorization from the plan or the insurance issuer for prescribing a length of stay not in excess of 48 hours (or 96 hours).

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). However, you must request enrollment within 30 days after your or your dependents’ other coverage ends (or after the employer stops contributing toward the other coverage). In addition, if you have a new dependent as a result of marriage, birth, adoption, or placement for adoption, you may be able to enroll yourself and your dependents. However, you must request enrollment within 30 days after the marriage, birth, adoption, or placement for adoption. Further, if you decline enrollment for yourself or eligible dependents (including your spouse) while Medicaid coverage or coverage under a State CHIP program is in effect, you may be able to enroll yourself and your dependents in this plan if:

coverage is lost under Medicaid or a State CHIP program; or

Important Notices

you or your dependents become eligible for a premium assistance subsidy from the State. In either case, you must request enrollment within 60 days from the loss of coverage or the date you become eligible for premium assistance. To request special enrollment or obtain more information, contact person listed at the end of this summary.

Treatment of physical complications of the mastectomy, including lymphedema. These benefits will be provided subject to the same deductibles and coinsurance applicable to other medical and surgical benefits provided under these plans.

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MICHELLE’S LAW DISCLOSURE MICHELLE’S LAW DISCLOSURE Under the ACA, dependent children are covered by the group health plan until age 26. If your child has extended coverage as a student but loses their student status because they take a medically necessary leave of absence from school your child may continue to be covered under the plan for up to one year from the beginning of the leave of absence. This is available if, immediately before the first day of the leave of absence, your child was (1) covered under the plan and (2) enrolled as a student at a post-secondary educational institution (includes colleges and universities). To obtain more information, contact person listed at the end of this summary.

STATEMENT OF ERISA RIGHTS As a participant in the Plan you are entitled to certain rights and protections under the Employee Retirement Income Security Act of 1974 (“ERISA”). ERISA provides that all participants shall be entitled to: Receive Information about Your Plan and Benefits

Examine, without charge, at the Plan Administrator’s office and at other specified locations, the Plan and Plan documents, including the insurance contract and copies of all documents filed by the Plan with the U.S. Department of Labor, if any, such as annual reports and Plan descriptions.

Obtain copies of the Plan documents and other Plan information upon written request to the Plan Administrator. The Plan Administrator may make a reasonable charge for the copies.

Receive a summary of the Plan’s annual financial report, if required to be furnished under ERISA. The Plan Administrator is required by law to furnish each participant with a copy of this summary annual report, if any.

Continue Group Health Plan Coverage If applicable, you may continue health care coverage for yourself, spouse or dependents if there is a loss of coverage under the plan as a result of a qualifying event. You and your dependents may have to pay for such coverage. Review the summary plan description and the documents governing the Plan for the rules on COBRA continuation of coverage rights. Prudent Actions by Plan Fiduciaries In addition to creating rights for participants, ERISA imposes duties upon the people who are responsible for operation of the Plan. These people, called “fiduciaries” of the Plan, have a duty to operate the Plan prudently and in the interest of you and other Plan participants. No one, including the Company or any other person, may fire you or discriminate against you in any way to prevent you from obtaining welfare benefits or exercising your rights under ERISA. Enforce your Rights If your claim for a welfare benefit is denied in whole or in part, you must receive a written explanation of the reason for the denial. You have a right to have the Plan review and reconsider your claim. Under ERISA, there are steps you can take to enforce these rights. For instance, if you request materials from the Plan Administrator and do not receive them within 30 days, you may file suit in federal court. In such a case, the court may require the Plan Administrator to provide the materials and pay you up to $152 per day (up to a $1,527 cap per request), until you receive the materials, unless the materials were not sent due to reasons beyond the control of the Plan Administrator. If you have a claim for benefits which is denied or ignored, in whole or in part, and you have exhausted the available claims procedures under the Plan, you may file suit in a state or federal court. If it should happen that Plan fiduciaries misuse the Plan’s money, or if you are discriminated against for asserting your rights, you may seek assistance from the U.S. Department of Labor, or you may file suit in a federal court. The court will decide who should pay court costs and legal fees. If you are

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successful, the court may order the person you have sued to pay these costs and fees. If you lose (for example, if the court finds your claim is frivolous) the court may order you to pay these costs and fees. Assistance with your Questions If you have any questions about your Plan, this statement, or your rights under ERISA, you should contact the nearest office of the Employee Benefits and Security Administration, U.S. Department of Labor, listed in your telephone directory or the Division of Technical Assistance and Inquiries, Employee Benefits and Security Administration, U.S. Department of Labor, 200 Constitution Avenue N.W., Washington, D.C. 20210.

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CONTACT INFORMATION

CONTACT INFORMATION

Questions regarding any of this information can be directed to: Rhonda Badeaux

[email protected]

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THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

Your Information. Your Rights. Our Responsibilities. Recipients of the notice are encouraged to read the entire notice. Contact information for

questions or complaints is available at the end of the notice. Your Rights You have the right to:

• Get a copy of your health and claims records • Correct your health and claims records • Request confidential communication • Ask us to limit the information we share • Get a list of those with whom we’ve shared your information • Get a copy of this privacy notice • Choose someone to act for you • File a complaint if you believe your privacy rights have been violated

Your Choices You have some choices in the way that we use and share information as we:

• Answer coverage questions from your family and friends • Provide disaster relief • Market our services and sell your information

Our Uses and Disclosures We may use and share your information as we:

• Help manage the health care treatment you receive • Run our organization • Pay for your health services • Administer your health plan • Help with public health and safety issues • Do research • Comply with the law • Respond to organ and tissue donation requests and work with a medical examiner or funeral director • Address workers’ compensation, law enforcement, and other government requests • Respond to lawsuits and legal actions

Your Rights When it comes to your health information, you have certain rights. This section explains your rights and some of our responsibilities to help you.

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Get a copy of health and claims records • You can ask to see or get a copy of your health and claims records and other health

information we have about you. Ask us how to do this. • We will provide a copy or a summary of your health and claims records, usually within 30 days

of your request. We may charge a reasonable, cost-based fee. Ask us to correct health and claims records

• You can ask us to correct your health and claims records if you think they are incorrect or incomplete. Ask us how to do this.

• We may say “no” to your request, but we’ll tell you why in writing, usually within 60 days. Request confidential communications

• You can ask us to contact you in a specific way (for example, home or office phone) or to send mail to a different address.

• We will consider all reasonable requests, and must say “yes” if you tell us you would be in danger if we do not.

Ask us to limit what we use or share

• You can ask us not to use or share certain health information for treatment, payment, or our operations.

• We are not required to agree to your request. Get a list of those with whom we’ve shared information

• You can ask for a list (accounting) of the times we’ve shared your health information for up to six years prior to the date you ask, who we shared it with, and why.

• We will include all the disclosures except for those about treatment, payment, and health care operations, and certain other disclosures (such as any you asked us to make). We’ll provide one accounting a year for free but will charge a reasonable, cost-based fee if you ask for another one within 12 months.

Get a copy of this privacy notice You can ask for a paper copy of this notice at any time, even if you have agreed to receive the notice electronically. We will provide you with a paper copy promptly. Choose someone to act for you

• If you have given someone medical power of attorney or if someone is your legal guardian, that person can exercise your rights and make choices about your health information.

• We will make sure the person has this authority and can act for you before we take any action.

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File a complaint if you feel your rights are violated • You can complain if you feel we have violated your rights by contacting us using the

information at the end of this notice. • You can file a complaint with the U.S. Department of Health and Human Services Office for

Civil Rights by sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201, calling 1-877-696-6775, or visiting www.hhs.gov/ocr/privacy/hipaa/complaints/.

• We will not retaliate against you for filing a complaint. Your Choices For certain health information, you can tell us your choices about what we share. If you have a clear preference for how we share your information in the situations described below, talk to us. Tell us what you want us to do, and we will follow your instructions. In these cases, you have both the right and choice to tell us to:

• Share information with your family, close friends, or others involved in payment for your care • Share information in a disaster relief situation If you are not able to tell us your preference, for example if you are unconscious, we may go ahead and share your information if we believe it is in your best interest. We may also share your information when needed to lessen a serious and imminent threat to health or safety. • In these cases we never share your information unless you give us written permission:

Marketing purposes Sale of your information Our Uses and Disclosures How do we typically use or share your health information? We typically use or share your health information in the following ways. Help manage the health care treatment you receive We can use your health information and share it with professionals who are treating you. Example: A doctor sends us information about your diagnosis and treatment plan so we can arrange additional services. Pay for your health services We can use and disclose your health information as we pay for your health services. Example: We share information about you with your dental plan to coordinate payment for your dental work. Administer your plan We may disclose your health information to your health plan sponsor for plan administration. Example: Your company contracts with us to provide a health plan, and we provide your company with certain statistics to explain the premiums we charge. Run our organization

• We can use and disclose your information to run our organization and contact you when necessary.

• We are not allowed to use genetic information to decide whether we will give you coverage and the price of that coverage. This does not apply to long term care plans.

Example: We use health information about you to develop better services for you.

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How else can we use or share your health information? We are allowed or required to share your information in other ways – usually in ways that contribute to the public good, such as public health and research. We have to meet many conditions in the law before we can share your information for these purposes. For more information see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/index.html. Help with public health and safety issues We can share health information about you for certain situations such as:

• Preventing disease • Helping with product recalls • Reporting adverse reactions to medications • Reporting suspected abuse, neglect, or domestic violence • Preventing or reducing a serious threat to anyone’s health or safety

Do research We can use or share your information for health research. Comply with the law We will share information about you if state or federal laws require it, including with the Department of Health and Human Services if it wants to see that we’re complying with federal privacy law. Respond to organ and tissue donation requests and work with a medical examiner or funeral director

• We can share health information about you with organ procurement organizations. • We can share health information with a coroner, medical examiner, or funeral director when an

individual dies. Address workers’ compensation, law enforcement, and other government requests We can use or share health information about you:

• For workers’ compensation claims • For law enforcement purposes or with a law enforcement official • With health oversight agencies for activities authorized by law • For special government functions such as military, national security, and presidential protective

services Respond to lawsuits and legal actions We can share health information about you in response to a court or administrative order, or in response to a subpoena. Our Responsibilities

• We are required by law to maintain the privacy and security of your protected health information.

• We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information.

• We must follow the duties and privacy practices described in this notice and give you a copy of it.

• We will not use or share your information other than as described here unless you tell us we can in writing. If you tell us we can, you may change your mind at any time. Let us know in writing if you change your mind.

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For more information see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/noticepp.html. Changes to the Terms of this Notice We can change the terms of this notice, and the changes will apply to all information we have about you. The new notice will be available upon request, on our web site (if applicable), and we will mail a copy to you.

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Important Notice from The MAPP Group About Your Prescription Drug Coverage and Medicare Please read this notice carefully and keep it where you can find it. This notice has information about your current prescription drug coverage with The MAPP Group and about your options under Medicare’s prescription drug coverage. This information can help you decide whether or not you want to join a Medicare drug plan. If you are considering joining, you should compare your current coverage, including which drugs are covered at what cost, with the coverage and costs of the plans offering Medicare prescription drug coverage in your area. Information about where you can get help to make decisions about your prescription drug coverage is at the end of this notice. There are two important things you need to know about your current coverage and Medicare’s prescription drug coverage:

1. Medicare prescription drug coverage became available in 2006 to everyone with Medicare. You can get this coverage if you join a Medicare Prescription Drug Plan or join a Medicare Advantage Plan (like an HMO or PPO) that offers prescription drug coverage. All Medicare drug plans provide at least a standard level of coverage set by Medicare. Some plans may also offer more coverage for a higher monthly premium.

2. The MAPP Group has determined that the prescription drug coverage offered by the The

MAPP Group is, on average for all plan participants, expected to pay out as much as standard Medicare prescription drug coverage pays and is therefore considered Creditable Coverage. Because your existing coverage is Creditable Coverage, you can keep this coverage and not pay a higher premium (a penalty) if you later decide to join a Medicare drug plan.

When Can You Join A Medicare Drug Plan? You can join a Medicare drug plan when you first become eligible for Medicare and each year from October 15th to December 7th. However, if you lose your current creditable prescription drug coverage, through no fault of your own, you will also be eligible for a two (2) month Special Enrollment Period (SEP) to join a Medicare drug plan. What Happens To Your Current Coverage If You Decide to Join A Medicare Drug Plan? If you decide to join a Medicare drug plan, your current The MAPP Group coverage will be affected. If you joined a Medicare drug plan after a COBRA qualified event, your COBRA coverage may end. If you do decide to join a Medicare drug plan and drop your current The MAPP Group coverage, be aware that you and your dependents will not be able to get this coverage back.

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When Will You Pay A Higher Premium (Penalty) To Join A Medicare Drug Plan? You should also know that if you drop or lose your current coverage with The MAPP Group and don’t join a Medicare drug plan within 63 continuous days after your current coverage ends, you may pay a higher premium (a penalty) to join a Medicare drug plan later. If you go 63 continuous days or longer without creditable prescription drug coverage, your monthly premium may go up by at least 1% of the Medicare base beneficiary premium per month for every month that you did not have that coverage. For example, if you go nineteen months without creditable coverage, your premium may consistently be at least 19% higher than the Medicare base beneficiary premium. You may have to pay this higher premium (a penalty) as long as you have Medicare prescription drug coverage. In addition, you may have to wait until the following October to join. For More Information About This Notice Or Your Current Prescription Drug Coverage… Contact the person listed below for further information. NOTE: You’ll get this notice each year. You will also get it before the next period you can join a Medicare drug plan, and if this coverage through The MAPP Group changes. You also may request a copy of this notice at any time.

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For More Information About Your Options Under Medicare Prescription Drug Coverage… More detailed information about Medicare plans that offer prescription drug coverage is in the “Medicare & You” handbook. You’ll get a copy of the handbook in the mail every year from Medicare. You may also be contacted directly by Medicare drug plans. For more information about Medicare prescription drug coverage:

• Visit www.medicare.gov • Call your State Health Insurance Assistance Program (see the inside back cover of your copy

of the “Medicare & You” handbook for their telephone number) for personalized help • Call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048.

If you have limited income and resources, extra help paying for Medicare prescription drug coverage is available. For information about this extra help, visit Social Security on the web at www.socialsecurity.gov, or call them at 1-800-772-1213 (TTY 1-800-325-0778). Remember: Keep this Creditable Coverage notice. If you decide to join one of the Medicare drug plans, you may be required to provide a copy of this notice when you join to show whether or not you have maintained creditable coverage and, therefore, whether or not you are required to pay a higher premium (a penalty).

Name of Entity/Sender: The MAPP Group Contact--Position/Office: Rhonda Badeaux Address: 344 Third Street Baton Rouge, LA Phone Number: 225-408-7754

Date: 02/01/2020

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

If you or your children are eligible for Medicaid or CHIP and you’re eligible for health coverage from your employer, your state may have a premium assistance program that can help pay for coverage, using funds from their Medicaid or CHIP programs. If you or your children aren’t eligible for Medicaid or CHIP, you won’t be eligible for these premium assistance programs but you may be able to buy individual insurance coverage through the Health Insurance Marketplace. For more information, visit www.healthcare.gov. If you or your dependents are already enrolled in Medicaid or CHIP and you live in a State listed below, contact your State Medicaid or CHIP office to find out if premium assistance is available. If you or your dependents are NOT currently enrolled in Medicaid or CHIP, and you think you or any of your dependents might be eligible for either of these programs, contact your State Medicaid or CHIP office or dial 1-877-KIDS NOW or www.insurekidsnow.gov to find out how to apply. If you qualify, ask your state if it has a program that might help you pay the premiums for an employer-sponsored plan. If you or your dependents are eligible for premium assistance under Medicaid or CHIP, as well as eligible under your employer plan, your employer must allow you to enroll in your employer plan if you aren’t already enrolled. This is called a “special enrollment” opportunity, and you must request coverage within 60 days of being determined eligible for premium assistance. If you have questions about enrolling in your employer plan, contact the Department of Labor at www.askebsa.dol.gov or call 1-866-444-EBSA (3272). If you live in one of the following states, you may be eligible for assistance paying your employer health plan

eligibility –

ALABAMA – Medicaid FLORIDA – Medicaid Website: http://myalhipp.com/ Phone: 1-855-692-5447

Website: http://flmedicaidtplrecovery.com/hipp/ Phone: 1-877-357-3268

ALASKA – Medicaid GEORGIA – Medicaid The AK Health Insurance Premium Payment Program Website: http://myakhipp.com/ Phone: 1-866-251-4861 Email: [email protected] Medicaid Eligibility: http://dhss.alaska.gov/dpa/Pages/medicaid/default.aspx

Website: http://dch.georgia.gov/medicaid Click on Health Insurance Premium Payment (HIPP) Phone: 404-656-4507

ARKANSAS – Medicaid INDIANA – Medicaid Website: http://myarhipp.com/ Phone: 1-855-MyARHIPP (855-692-7447)

Healthy Indiana Plan for low-income adults 19-64 Website: http://www.in.gov/fssa/hip/ Phone: 1-877-438-4479 All other Medicaid Website: http://www.indianamedicaid.com Phone 1-800-403-0864

premiums. The following list of states is current as of July 31, 2019. Contact your State for more information on

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COLORADO – Health First Colorado (Colorado’s Medicaid Program) &

Child Health Plan Plus (CHP+) IOWA – Medicaid

Health First Colorado Website: https://www.healthfirstcolorado.com/ Health First Colorado Member Contact Center: 1-800-221-3943/ State Relay 711 CHP+: Colorado.gov/HCPF/Child-Health-Plan-Plus CHP+ Customer Service: 1-800-359-1991/ State Relay 711

Website: http://dhs.iowa.gov/hawk-i Phone: 1-800-257-8563

KANSAS – Medicaid NEW HAMPSHIRE – Medicaid

Website: http://www.kdheks.gov/hcf/ Phone: 1-785-296-3512

Website: http://www.dhhs.nh.gov/oii/documents/hippapp.pdf Phone: 603-271-5218 Hotline: NH Medicaid Service Center at 1-888-901-4999

KENTUCKY – Medicaid NEW JERSEY – Medicaid and CHIP Website: https://chfs.ky.gov Phone: 1-800-635-2570

Medicaid Website: http://www.state.nj.us/humanservices/ dmahs/clients/medicaid/ Medicaid Phone: 609-631-2392 CHIP Website: http://www.njfamilycare.org/index.html CHIP Phone: 1-800-701-0710

LOUISIANA – Medicaid NEW YORK – Medicaid Website: http://dhh.louisiana.gov/index.cfm/subhome/1/n/331 Phone: 1-888-695-2447

Website: https://www.health.ny.gov/health_care/medicaid/ Phone: 1-800-541-2831

MAINE – Medicaid NORTH CAROLINA – Medicaid Website: http://www.maine.gov/dhhs/ofi/public-assistance/index.html Phone: 1-800-442-6003 TTY: Maine relay 711

Website: https://dma.ncdhhs.gov/ Phone: 919-855-4100

MASSACHUSETTS – Medicaid and CHIP NORTH DAKOTA – Medicaid Website: http://www.mass.gov/eohhs/gov/departments/masshealth/ Phone: 1-800-462-1120

Website: http://www.nd.gov/dhs/services/medicalserv/medicaid/ Phone: 1-844-854-4825

MINNESOTA – Medicaid OKLAHOMA – Medicaid and CHIP Website: https://mn.gov/dhs/people-we-serve/seniors/health-care/health-care-programs/programs-and-services/other-insurance.jsp Phone: 1-800-657-3739

Website: http://www.insureoklahoma.org Phone: 1-888-365-3742

MISSOURI – Medicaid OREGON – Medicaid Website: https://www.dss.mo.gov/mhd/participants/pages/hipp.htm Phone: 573-751-2005

Website: http://healthcare.oregon.gov/Pages/index.aspx http://www.oregonhealthcare.gov/index-es.html Phone: 1-800-699-9075

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special enrollment rights, contact either: U.S. Department of Labor U.S. Department of Health and Human Services Employee Benefits Security Administration Centers for Medicare & Medicaid Services www.dol.gov/agencies/ebsa www.cms.hhs.gov 1-866-444-EBSA (3272) 1-877-267-2323, Menu Option 4, Ext. 61565

MONTANA – Medicaid PENNSYLVANIA – Medicaid Website: http://dphhs.mt.gov/MontanaHealthcarePrograms/HIPP Phone: 1-800-694-3084

Website: http://www.dhs.pa.gov/provider/medicalassistance/healthinsurancepremiumpaymenthippprogram/index.htm Phone: 1-800-692-7462

NEBRASKA – Medicaid RHODE ISLAND – Medicaid Website: http://www.ACCESSNebraska.ne.gov Phone: (855) 632-7633 Lincoln: (402) 473-7000 Omaha: (402) 595-1178

Website: http://www.eohhs.ri.gov/ Phone: 855-697-4347

NEVADA – Medicaid SOUTH CAROLINA – Medicaid Medicaid Website: http://dhcfp.nv.gov Medicaid Phone: 1-800-992-0900

Website: https://www.scdhhs.gov Phone: 1-888-549-0820

SOUTH DAKOTA - Medicaid WASHINGTON – Medicaid

Website: http://dss.sd.gov Phone: 1-888-828-0059

Website: http://www.hca.wa.gov/free-or-low-cost-health-care/program-administration/premium-payment-program Phone: 1-800-562-3022 ext. 15473

TEXAS – Medicaid WEST VIRGINIA – Medicaid

Website: http://gethipptexas.com/ Phone: 1-800-440-0493

Website: http://mywvhipp.com/ Toll-free phone: 1-855-MyWVHIPP (1-855-699-8447)

UTAH – Medicaid and CHIP WISCONSIN – Medicaid and CHIP

Medicaid Website: https://medicaid.utah.gov/ CHIP Website: http://health.utah.gov/chip Phone: 1-877-543-7669

Website: https://www.dhs.wisconsin.gov/publications/p1/p10095.pdf Phone: 1-800-362-3002

VERMONT– Medicaid WYOMING – Medicaid

Website: http://www.greenmountaincare.org/ Phone: 1-800-250-8427

Website: https://wyequalitycare.acs-inc.com/ Phone: 307-777-7531

VIRGINIA – Medicaid and CHIP

Medicaid Website: http://www.coverva.org/programs_premium_assistance.cfm Medicaid Phone: 1-800-432-5924 CHIP Website: http://www.coverva.org/programs_premium_assistance.cfm CHIP Phone: 1-855-242-8282

To see if any other states have added a premium assistance program since July 31, 2019, or for more information on

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Paperwork Reduction Act Statement According to the Paperwork Reduction Act of 1995 (Pub. L. 104-13) (PRA), no persons are required to respond to a collection of information unless such collection displays a valid Office of Management and Budget (OMB) control number. The Department notes that a Federal agency cannot conduct or sponsor a collection of information unless it is approved by OMB under the PRA, and displays a currently valid OMB control number, and the public is not required to respond to a collection of information unless it displays a currently valid OMB control number. See 44 U.S.C. 3507. Also, notwithstanding any other provisions of law, no person shall be subject to penalty for failing to comply with a collection of information if the collection of information does not display a currently valid OMB control number. See 44 U.S.C. 3512. The public reporting burden for this collection of information is estimated to average approximately seven minutes per respondent. Interested parties are encouraged to send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the U.S. Department of Labor, Employee Benefits Security Administration, Office of Policy and Research, Attention: PRA Clearance Officer, 200 Constitution Avenue, N.W., Room N-5718, Washington, DC 20210 or email [email protected] and reference the OMB Control Number 1210-0137.

OMB Control Number 1210-0137 (expires 12/31/2019)

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New Health Insurance Marketplace Coverage Options and Your Health Coverage

PART A: General Information When key parts of the health care law take effect in 2014, there will be a new way to buy health insurance: the Health

Insurance Marketplace. To assist you as you evaluate options for you and your family, this notice provides some basic

information about the new Marketplace and employment based health coverage offered by your employer.

What is the Health Insurance Marketplace? The Marketplace is designed to help you find health insurance that meets your needs and fits your budget. The

Marketplace offers "one-stop shopping" to find and compare private health insurance options. You may also be eligible

for a new kind of tax credit that lowers your monthly premium right away. Open enrollment for health insurance

coverage through the Marketplace begins in October 2013 for coverage starting as early as January 1, 2014.

Can I Save Money on my Health Insurance Premiums in the Marketplace? You may qualify to save money and lower your monthly premium, but only if your employer does not offer coverage, or

offers coverage that doesn't meet certain standards. The savings on your premium that you're eligible for depends on

your household income.

Does Employer Health Coverage Affect Eligibility for Premium Savings through the Marketplace? Yes. If you have an offer of health coverage from your employer that meets certain standards, you will not be eligible

for a tax credit through the Marketplace and may wish to enroll in your employer's health plan. However, you may be

eligible for a tax credit that lowers your monthly premium, or a reduction in certain cost-sharing if your employer does

not offer coverage to you at all or does not offer coverage that meets certain standards. If the cost of a plan from your

employer that would cover you (and not any other members of your family) is more than 9.5% of your household

income for the year, or if the coverage your employer provides does not meet the "minimum value" standard set by the

Affordable Care Act, you may be eligible for a tax credit.1

Note: If you purchase a health plan through the Marketplace instead of accepting health coverage offered by your

employer, then you may lose the employer contribution (if any) to the employer-offered coverage. Also, this employer

contribution -as well as your employee contribution to employer-offered coverage- is often excluded from income for

Federal and State income tax purposes. Your payments for coverage through the Marketplace are made on an after-

tax basis.

How Can I Get More Information? For more information about your coverage offered by your employer, please check your summary plan description or

contact Rhonda Badeaux.

The Marketplace can help you evaluate your coverage options, including your eligibility for coverage through the

Marketplace and its cost. Please visit HealthCare.gov for more information, including an online application for health

insurance coverage and contact information for a Health Insurance Marketplace in your area.

1 An employer - sponsored health plan meets the "minimum value standard" if the plan's share of the total allowed benefit costs covered

by the plan is no less than 60 percent of such costs.

Form Approved OMBNo.1210-0149

(expires 5-31-2020)

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PART B: Information About Health Coverage Offered by Your Employer This section contains information about any health coverage offered by your employer. If you decide to complete an

application for coverage in the Marketplace, you will be asked to provide this information. This information is numbered

to correspond to the Marketplace application.

Here is some basic information about health coverage offered by this employer:

• As your employer, we offer a health plan to:

All employees. Eligible employees are:

Some employees. Eligible employees are:

• With respect to dependents:

We do offer coverage. Eligible dependents are:

We do not offer coverage.

If checked, this coverage meets the minimum value standard*, and the cost of this coverage to you is

intended to be affordable, based on employee wages.

** Even if your employer intends your coverage to be affordable, you may still be eligible for a premium

discount through the Marketplace. The Marketplace will use your household income, along with other

factors, to determine whether you may be eligible for a premium discount. If, for example, your wages

vary from week to week (perhaps you are an hourly employee or you work on a commission basis), if

you are newly employed mid-year, or if you have other income losses, you may still qualify for a

premium discount.

If you decide to shop for coverage in the Marketplace, HealthCare.gov will guide you through the process. Here's the

employer information you'll enter when you visit HealthCare.gov to find out if you can get a tax credit to lower your

monthly premiums.

• An employer - sponsored health plan meets the "minimum value standard" if the plan's share of the total allowed benefit costs

covered by the plan is no less than 60 percent of such costs (Section 36 B(c)(2)(C)(ii) of the Internal Revenue Code of 1986)

3. Employer name The MAPP Group, LLC

4. Employer Identification Number (EIN) 20-0257574

5. Employer address 344 Third Street

6. Employer phone number 225-408-7754

7. City Baton Rouge

8. State LA

9. ZIP code 70810

10. Who can we contact about employee health coverage at this job? Rhonda Badeaux 11. Phone number (if different from above)

12. Email address [email protected]

X

X

Benefits are offered to all full time employees (30+ hours per week). The only difference in the pay groups is that salary exempt and salary non exempt employees have a 30 day waiting period with an enrollment date of the 1st of the month following 30 day waiting period. With hourly and part time there is a 60 day waiting period

The subscriber’s legal spouse or a child of the subscriber . All references to the spouse of a subscriber shall include a domestic partner

X

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Notes

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Notes

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Notes

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This summary is not a legal document and does not replace or supersede the “Evidence of Coverage”, policy, or the Summary Plan Description. Please refer to the Evidence of Coverage/insurance policy/Summary Plan Description for a complete description of the coverage, eligibility criteria, controlling terms, exclusions, limitations, and conditions of coverage. The MAPP Group, LLC reserves the right to terminate, suspend, withdraw, reduce, or modify the benefits described in the Evidence of Coverage/policy/Summary Plan Description in whole or in part, at any time. No statement in this or any other document and no oral representation should be construed as a waiver of this right. This summary is the confidential property of The MAPP Group, LLC.

2020 benefits guide...example, if the court finds your claim is frivolous) the court may order you...

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