Akron Children’s Hospital 2021 Benefits Program Overview

Children’s offers a quality benefits program that meets the varying needs of our employees and their families. You have the flexibility to choose different types and levels of benefits coverage and, in many cases, your benefits costs can be paid with pre-tax dollars.

Who is eligible for benefits? • Regular full-time employees (budgeted for 36 – 40 hours per week)• Regular part-time employees (budgeted for 16 – 35 hours per week)

When will my benefits start? • Most benefits start on the first day of the month coinciding with or following your hire date.• For example,

• If your hire date is May 11, your benefits are effective on June 1.• If your hire date is May 1, your benefits are effective on May 1.

• Short Term Disability (STD) and Long Term Disability (LTD) start three months after your other benefits are effective.

How will I pay for my benefits? • Benefit payments will automatically be deducted from your paycheck each pay period.

Who can I cover? • Yourself• Your legal spouse• Dependent children up to age 26

What benefits can I elect? • Medical which includes Prescription

- Preventive Care is paid at 100% for all Medical plans and includes routine physical exams, routine pap andmammograms, all immunizations, and well child care services. Also routine lab, X-ray, and medical testing associatedwith annual physicals (not diagnostic).- Certain medications used to manage chronic conditions such as high blood pressure, diabetes, high cholesterol,COPD/asthma, multiple sclerosis, seizures, stroke, heart arrhythmia, women’s health including breast cancer agentsand prenatal vitamins, and mental health conditions such as depression are covered at 100%. To qualify, themedications must be listed on the $0 copay drug list.- Medical plans offered by Children’s are subject to a spousal restriction: Working spouses must elect medicalthrough their employer if coverage is available at 49% or less of the total cost of single coverage and can then becovered as secondary on Children’s plan.

• Dental• Vision• Life Insurance• Dependent Life Insurance• Short Term Disability• Long Term Disability• Healthcare Flexible Spending Account• Dependent Care Flexible Spending Account• Employee Assistance Program

• Voluntary Benefits:- Critical Illness- Accident Insurance- Universal Life- Home and Auto- Identity Theft- Pet Insurance

Benefits Enrollment: Steps and Important Tips

You must enroll in your Children’s benefits coverage within 31 days of your hire date. -With exception of the disability plans, your coverage is effective the first day of the month coinciding with or following your first date of active employment in a benefits-eligible status. LTD and STD are effective 3 months later. -If you do not submit your benefits choices within 31 days of your hire date, you will not be entitled to Akron Children’s health benefits until the next Open Enrollment period unless you have a qualifying life event. Enrollment is easy—Access the online benefit site directly from myKidsnet with no additional login required or login from home.

1. Go to myKidsnet and choose “HR” Tab, then Benefits from the drop down. -Select the Login to Your Benefits button in the top right corner and you will be logged into the benefits site.

2. When not logged into myKidsnet: -Go to www.akronchildrens.bswift.com -Login credentials: Children’s Network User ID preceded by: chmca\ (e.g., chmca\abc0123) -Password is your Children’s Network Password 3. Be sure to “Save” your elections before closing out. Enrollment Checklist

1. Review your benefit options

2. Gather information for each dependent before you enroll. You will need to provide the following information: ---Social Security Number --Legal Name --Date of Birth

3. Compare the medical plans. Use the comparison tools, HSA calculators and other resources to determine whether the Children’s Health Plus Plans and HSA will fit your needs.

4. Ask questions. HR/Benefits representatives are available to answer your questions before you make your elections. -Email: benefits@akronchildrens.org -Benefits Call Center: 888-261-1525 5. If you are enrolling your legal spouse under one of the hospital’s medical plans and he/she is employed, you must complete all relevant sections of the Spouse Medical Eligibility Form. You can find the form on myKidsnet and the bswift website. Section B must be completed by your spouse’s employer. Return the completed form to HR/Benefits within 30 days of your eligibility date. For more information, visit the HR/Benefits site on myKidsnet.

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DENTAL PLAN BENEFITS

Network Non-NetworkAnnual Deductible per Individual* $50 $50Preventative Services/Diagnostic Services 100% 100%Basic Services 80% 75%Major Services 50% 45%Orthodontic Services (Dependent Child to Age 19) 50% 45%Lifetime Maximums:

Periodontal $1,000 $1,000Orthodontia $1,000 $1,000

Annual Maximum per Person $2,000 $2,000

*Does not apply to Preventive/Diagnostic Services

Partial List of Plan Provisions Network Non-NetworkPreventativeOral Examinations, 2 per calendar year 100% 100%Cleanings, including scaling and polishing, 2 per calendar year 100% 100%Fluoride ** 100% 100%Sealants ** 100% 100%Space Maintainers ** 100% 100%Bitewing X-rays, 2 per calendar year 100% 100%Palliative Treatment 100% 100%

BasicSurgical Removal of Erupted Tooth 80% 75%Surgical Removal of Impacted Tooth (soft tissue) 80% 75%Surgical Removal of Partial & Complete Bony Impaction 80% 75%Root Canal 80% 75%Amalgam Restorations, Primary & Permanent Teeth 80% 75%Silicate Restoration 80% 75%Stainless Steel Crowns (when tooth cannot be restoredwith a filling material)

80% 75%

Local Anesthesia 80% 75%Major

Inlays 50% 45%Onlays 50% 45%Crowns 50% 45%Full & Partial Dentures 50% 45%

50% 45%

** Limited to a child to age nineteen (19)You can reduce your dental care expenses by using the services of GUARDIAN Dental Providers in the DentalGuard Preferred network. Contact Guardian at 1 (800)541-7846. Participating Guardian DentalGuard Preferred Providers have negotiated fees that reduce the cost to both the Hospital and you.

Refer to the Summary Plan Description for complete plan details. If any conflict arises, the Plan Document governs.

BridgeworkImplants

50% 45%

2021

Version 7

Vision Care Services Out-of-Network Reimbursement*

Exam with Dilation as Necessary $30

Retinal Imaging Benefit $10

Exam Options:

Contact lens fit and two follow-up visits for members under 19 are available once a comprehensive eye exam has been completed.

Members under 19: Standard Contact Lens Fit and Follow-Up $10

Members under 19: Premium Contact Lens Fit and Follow-Up $10

Adults: Standard Contact Lens Fit and Follow-Up N/A

Adults: Premium Contact Lens Fit and Follow-Up: N/A

Frames:

Any available frame at provider location

Standard Plastic Lenses

Single Vision $25

Bifocal $40

Trifocal $55

Standard Progressive Lens** $40

Premium Progressive Lens** $40

Lens Options:

UV Treatment $5

Tint (Solid and Gradient) $5

Standard Plastic Scratch Coating $5

Standard Polycarbonate - Adults N/A

Standard Polycarbonate - Kids under 19 $5

Standard Anti-Reflective Coating N/A

Polarized N/A

Photochromic / Transitions Plastic - Adults N/A

Contact Lenses

(Contact lens allowance includes materials only)

Conventional $104

Disposable $104

Medically Necessary $200

Laser Vision Correction

Lasik or PRK from U.S. Laser Network N/A

Frequency: Members >= 19 Years of Age Members under 19 Years of Age

Examination Once every 12 months Twice every 12 months

Lenses (in lieu of contact lenses) Once every 12 months Twice every 12 months ****

Contact Lens (in lieu of lenses) Once every 12 months Once every 12 months

Frame Once every 24 months Once every 24 months

**** For members under 19 years of age, if vision prescription changes within the benefit period, the member is entitled to an additional standard eyeglass lens benefit.

Additional Discounts:

Member receives a 20% discount on items not covered by the plan at network Providers. Discount does not apply to EyeMed Provider's professional services, or contact lenses. Plan discounts cannot be combined with any other

discounts or promotional offers.

Members also receive 15% off retail price or 5% off promotional price for Lasik or PRK from the US Laser Network, owned and operated by LCA Vision.

After initial purchase, replacement contact lenses may be obtained via the Internet at substantial savings and mailed directly to the member. Details are available at www.eyemedvisioncare.com.

Plan Exclusions:

1) Orthoptic or vision training, subnormal vision aids and any associated supplemental testing; Aniseikonic lenses; 2) Medical and/or surgical treatment of the eye, eyes or supporting structures;

3) Any eye or Vision Examination, or any corrective eyewear required by a Policyholder as a condition of employment; Safety eyewear

4) Services provided as a result of any Workers’ Compensation law, or similar legislation, or required by any governmental agency or program whether federal, state or subdivisions thereof;

5) Plano (non-prescription) lenses and/or contact lenses; 6) Non-prescription sunglasses; 7) Two pair of glasses in lieu of bifocals;

8) Services or materials provided by any other group benefit plan providing vision care;

9) Services rendered after the date an Insured Person ceases to be covered under the Policy, except when Vision Materials ordered before coverage ended are delivered,

and the services rendered to the Insured Person are within 31 days from the date of such order.

10) Lost or broken lenses, frames, glasses, or contact lenses will not be replaced except in the next Benefit Frequency when Vision Materials would next become available.

$0 Copay; $130 allowance, 15% off balance over $130

$0 Copay; $130 allowance, plus balance over $130

EyeMed Vision Care in conjunction with Fidelity Security Life Insurance Company

Members also receive a 40% discount off complete pair eyeglass purchases and a 15% discount

off conventional contact lenses once the funded benefit has been used.

$0 Copay, Paid-in-Full

15% off Retail Price or 5% off promotional price

N/A

$90 Copay

$90 Copay, 80% of Charge less $120 Allowance

$0 Copay

$45

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80% of Retail

Additional Pairs Benefit:

$20 Copay

$0 Copay

$0 Copay

$0 Copay

$40

$65

$25 Copay

$25 Copay

$25 Copay

$0 Copay, Paid-in-Full and two follow-up visits

10% off Retail Price

$0 Copay; $130 Allowance, 20% off balance over $130

$0 Copay, 10% off retail price, then apply $40 allowance

Up to $40

Akron Children's HospitalEyeMed Select Plan H,

BASIC

Member Cost

$10 Copay

2021

Vision Care Services Out-of-Network Reimbursement*

Exam with Dilation as Necessary $30

Retinal Imaging Benefit N/A

Contact Lens Fit and Follow-Up:

(Contact lens fit and two follow-up visits are available once a comprehensive eye exam has been completed.)

Members under 19: Standard Contact Lens Fit and Follow-Up $40

Members under 19: Premium Contact Lens Fit and Follow-Up $40

Adults: Standard Contact Lens Fit and Follow-Up $40

Adults: Premium Contact Lens Fit and Follow-Up: $40

Frames:

Any available frame at provider location

Standard Plastic Lenses

Single Vision $25

Bifocal $40

Trifocal $55

Lenticular $33

Standard Progressive Lens** $40

Premium Progressive Lens** $40

Lens Options:

UV Treatment $5

Tint (Solid and Gradient) $5

Standard Plastic Scratch Coating $5

Standard Polycarbonate - Adults $20

Standard Polycarbonate - Kids under 19 $20

Standard Anti-Reflective Coating $23

Polarized N/A

Photochromic / Transitions Plastic - Adults N/A

Contact Lenses

(Contact lens allowance includes materials only)

Conventional $128

Disposable $128

Medically Necessary $210

Laser Vision Correction

Lasik or PRK from U.S. Laser Network N/A

Frequency: Members >= 19 Years of Age Members under 19 Years of Age

Examination Once every 12 months Twice every 12 months

Lenses (in lieu of contact lenses) Once every 12 months Twice every 12 months ****

Contact Lens (in lieu of lenses) Once every 12 months Once every 12 months

Frame Once every 12 months Once every 12 months

**** For members under 19 years of age, if vision prescription changes within the benefit period, the member is entitled to an additional standard eyeglass lens benefit.

Additional Discounts:

Member receives a 20% discount on items not covered by the plan at network Providers. Discount does not apply to EyeMed Provider's professional services, or contact lenses. Plan discounts cannot be combined with any other

discounts or promotional offers.

Members also receive 15% off retail price or 5% off promotional price for Lasik or PRK from the US Laser Network, owned and operated by LCA Vision.

After initial purchase, replacement contact lenses may be obtained via the Internet at substantial savings and mailed directly to the member. Details are available at www.eyemedvisioncare.com.

The contact lens benefit allowance is not applicable to this service.

Benefit Allowances provide no remaining balance for future use within the same Benefit Frequency.

Certain brand name Vision Materials in which the manufacturer imposes a no-discount practice.

Rates are valid only when the quoted plan is the sole stand-alone vision plan offered by the group

Rates are valid for groups domiciled in the State of OH.

Fees quoted will be valid until the 1/1/2019 plan implementation date. Date quoted: 12/21/2017.

Rates assume Employer contribution of 20% or less for employees and dependents

Insured Plans are underwritten by Fidelity Security Life Insurance Company of Kansas City, Missouri, except in New York

Policy number VC-19/VC-20, form number M-9083

Plan Exclusions:

1) Orthoptic or vision training, subnormal vision aids and any associated supplemental testing; Aniseikonic lenses; 2) Medical and/or surgical treatment of the eye, eyes or supporting structures;

3) Any eye or Vision Examination, or any corrective eyewear required by a Policyholder as a condition of employment; Safety eyewear

4) Services provided as a result of any Workers’ Compensation law, or similar legislation, or required by any governmental agency or program whether federal, state or subdivisions thereof;

5) Plano (non-prescription) lenses and/or contact lenses; 6) Non-prescription sunglasses; 7) Two pair of glasses in lieu of bifocals;

8) Services or materials provided by any other group benefit plan providing vision care;

9) Services rendered after the date an Insured Person ceases to be covered under the Policy, except when Vision Materials ordered before coverage ended are delivered,

and the services rendered to the Insured Person are within 31 days from the date of such order.

10) Lost or broken lenses, frames, glasses, or contact lenses will not be replaced except in the next Benefit Frequency when Vision Materials would next become available.

Akron Children's HospitalEyeMed Select Plan

Enhanced

Member Cost

$0 Copay

$0 Copay, Paid-in-Full and two follow-up visits

$0 Copay, 10% off retail price, then apply $40 allowance

$0 Copay; $160 Allowance, 20% off balance over $160

$0 Copay, 10% off retail price, then apply $40 allowance

$0 Copay, Paid-in-full fit and two follow-up visits

Up to $39

$0 Copay

$0 Copay

$0 Copay

$0 Copay

$80

$10 Copay

$10 Copay

$10 Copay

$10 Copay

$0 Copay

$0 Copay

20% off Retail Price

80% of Retail

Additional Pairs Benefit:

$0 Copay; $160 allowance, 15% off balance over $160

$0 Copay; $160 allowance, plus balance over $160

EyeMed Vision Care in conjunction with Fidelity Security Life Insurance Company

Members also receive a 40% discount off complete pair eyeglass purchases and a 15% discount

off conventional contact lenses once the funded benefit has been used.

$0 Copay, Paid-in-Full

15% off Retail Price or 5% off promotional price

N/A

$10 Copay

$10Copay, 80% of Charge less $120 Allowance

2021

2021 Rates (Employee Per Pay Deductions)

FULL-TIME EMPLOYEES

Children’s Health Plus Gold Plan

Children’s Health Plus Silver Plan

Children’s Conventional

PlanAultCare

Plan Dental Plan Vision PlanEnhanced Vision Plan

Single

Regular Rate $57.00 $15.00 $101.92 $104.46 $5.16 $2.56 $7.98

Wellness Rate $42.00 $0.00 $86.92 $89.46 $5.16 $2.56 $7.98

Employee + Child(ren)

Regular Rate $86.00 $42.00 $164.45 $170.07 $8.26 $5.33 $16.59

Wellness Rate $71.00 $27.00 $149.45 $155.07 $8.26 $5.33 $16.59

Employee + Spouse

Regular Rate $102.00 $55.00 $198.37 $194.80 $10.33 $4.87 $15.17

Wellness Rate $87.00 $40.00 $183.37 $179.80 $10.33 $4.87 $15.17

Family

Regular Rate $140.00 $89.00 $277.87 $282.20 $15.49 $7.82 $24.35

Wellness Rate $125.00 $74.00 $262.87 $267.20 $15.49 $7.82 $24.35

PART-TIME EMPLOYEES

Children’s Health Plus Gold Plan

Children’s Health Plus Silver Plan

Children’s Conventional

PlanAultCare

Plan Dental Plan Vision PlanEnhanced Vision Plan

Single

Regular Rate $65.49 $15.00 $128.97 $129.06 $5.16 $2.56 $7.98

Wellness Rate $50.49 $0.00 $113.97 $114.06 $5.16 $2.56 $7.98

Employee + Child(ren)

Regular Rate $100.09 $47.73 $208.25 $212.72 $8.26 $5.33 $16.59

Wellness Rate $85.09 $32.73 $193.25 $197.72 $8.26 $5.33 $16.59

Employee + Spouse

Regular Rate $120.66 $65.49 $253.84 $244.24 $10.33 $4.87 $15.17

Wellness Rate $105.66 $50.49 $238.84 $229.24 $10.33 $4.87 $15.17

Family

Regular Rate $165.54 $106.63 $356.91 $355.68 $15.49 $7.82 $24.35

Wellness Rate $150.54 $91.63 $341.91 $340.68 $15.49 $7.82 $24.35

Retirement Benefits

Children’s Retirement Security Plan (401(a))

Your personal savings are an important part of your retirement planning, and Children’s Hospital provides several ways to help you save for retirement. One is the Children’s Retirement Security Plan, a 401(a) defined contribution plan that provides benefits when you’re no longer working. Here are several highlights:

• You participate in the plan after one year of eligible service

• Children’s makes contributions to your account. The contribution is equal to a percentage of your pay based on your age and years of eligible service. The contribution will be between 2% and 5% of covered wages.

• You do not contribute to this account

• The contributions are directed into investment choices that you select

• You become 100% vested in your account after three years of eligible service.

• The 401(a) benefit is payable at retirement

Children’s Retirement Income Benefit (CRIB) plan (403(b)) We encourage every employee to save for retirement, and the Children’s Retirement Income Benefit (CRIB) Plan is designed to do just that. Eligible employees are automatically enrolled in the 403(b) Plan. There are two ways to save:

• The traditional 403(b) In the traditional 403(b), your contributions are tax deferred from state and federal tax and the accumulation

and earnings on those contributions are deferred from taxation until withdrawn.

• The Roth 403(b).

In the Roth 403(b), your contributions are after-tax money. Qualified distributions from Roth accounts are tax exempt.

You will also receive matching contributions into your account after meeting the eligibility requirements.