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BENEFITS GUIDE An overview of the wide array of benefits provided XYZ COMPANY, to help you enjoy increased well-being and financial security PREPARED BY XYZ COMPANY FOR ABC COMPANY

WE’VE GOT YOU COVERED XYZ COMPANY is proud to offer a comprehensive benefits package for you and your family. This program is designed to take great care of you when you need it. Make sure to explore your options to help you make the selections that best meet your needs.

INTRO & OVERVIEW I

UPDATE ON HEALTH CARE REFORM INTRODUCTION For the 2022 plan year, XYZ COMPANY has worked hard to offer a competitive total rewards package that includes valuable and competitive benefits plans. These programs reflect our commitment to keeping our staff healthy and secure. We understand that your situation is unique, and XYZ COMPANY is offering an overall benefits package that can be shaped and molded by you to fit your needs. As an employee of XYZ COMPANY enjoying your work and making valuable contributions to business are equally vital. The health, satisfaction and security of you and your family are important, not only to your well-being, but ultimately, in terms of achieving the goals of our organization.

CHANGES AND QUALIFYING EVENTS WHEN COVERAGE BEGINS AND ENDS Your coverage under the benefits plans will end if you no longer meet the eligibility requirements, your contributions are discontinued or the Group Insurance Policy is terminated. QUALIFYING EVENTS • Eligible employees may enroll or make changes to their benefits elections during the annual open enrollment period. As with most benefits, once you elect an option you are bound to that choice for the entire plan year unless you experience a “Qualifying Event”. These may include, but are not limited to: • Changes in employment status • Changes in legal marital status • Changes in number of dependents • Taking an unpaid leave of absence • Dependent satisfies or ceases to satisfy eligibility requirement • Family Medical Leave Act (FMLA) leave. OVERVIEW OF BENEFITS

MEDICAL I

Plan Features MMI EPO 1000 2022 MMI EPO 2500 2021 MMI EPO 500 2022 IN NETWORK Calendar Year Deductibles (Indiv / Family) Preventive Care Primary Care Visit Specialist Visit Diagnostic Exam X-Rays Complex Images Outpatient Procedure Inpatient Visit Emergency Room Urgent Care Pharmacy / RX (30 Day Supply) Pharmacy / RX (90 Day Supply) Calendar Year Out-of-Pocket Max (Indiv / Family) OUT OF NETWORK Calendar Year Deductibles (Indiv / Family) Preventive Care Primary Care Visit Specialist Visit Diagnostic Exam MONTHLY PRICING Employee $0.00 $0.00 $0.00 Employee + Spouse $0.00 $0.00 $0.00 Employee + Child(ren) $0.00 $0.00 $0.00 Employee + Family $0.00 $0.00 $0.00 SUMMARY OF COVERAGE MEDICAL PLAN

OUT-OF POCKET MAXIMUM ANNUAL DEDUCTIBLE COPAYS AND COINSURANCE PLAN TYPES KEY TERMS TO REMEMBER MEDICAL PLAN

DENTAL I

Plan Features IN NETWORK Annual Deductible (Individual / Family) Preventive Care Basic Procedures (Extractions, fillings, etc.) Major Procedures (Crowns, dentures, etc.) Child Orthodontia Calendar Year Maximum Benefit OUT OF NETWORK Annual Deductible (Individual / Family) Preventive Care Basic Procedures (Extractions, fillings, etc.) Major Procedures (Crowns, dentures, etc.) Child Orthodontia Calendar Year Maximum Benefit SUMMARY OF COVERAGE DENTAL PLANS

VISION I

SUMMARY OF COVERAGE VISION PLAN Plan Features IN NETWORK Annual Deductible (Individual / Family) Preventive Care Basic Procedures (Extractions, fillings, etc.) Major Procedures (Crowns, dentures, etc.) Child Orthodontia Calendar Year Maximum Benefit OUT OF NETWORK Annual Deductible (Individual / Family) Preventive Care Basic Procedures (Extractions, fillings, etc.) Major Procedures (Crowns, dentures, etc.) Child Orthodontia Calendar Year Maximum Benefit

LIFE I

SUMMARY OF COVERAGE LIFE PLAN Plan Features IN NETWORK Annual Deductible (Individual / Family) Preventive Care Basic Procedures (Extractions, fillings, etc.) Major Procedures (Crowns, dentures, etc.) Child Orthodontia Calendar Year Maximum Benefit OUT OF NETWORK Annual Deductible (Individual / Family) Preventive Care Basic Procedures (Extractions, fillings, etc.) Major Procedures (Crowns, dentures, etc.) Child Orthodontia Calendar Year Maximum Benefit

DISABILITY I

SUMMARY OF COVERAGE DISABILITY PLAN Plan Features IN NETWORK Annual Deductible (Individual / Family) Preventive Care Basic Procedures (Extractions, fillings, etc.) Major Procedures (Crowns, dentures, etc.) Child Orthodontia Calendar Year Maximum Benefit OUT OF NETWORK Annual Deductible (Individual / Family) Preventive Care Basic Procedures (Extractions, fillings, etc.) Major Procedures (Crowns, dentures, etc.) Child Orthodontia Calendar Year Maximum Benefit

A health savings account (HSA) is a health care account and savings account in one. The main purpose of this account is to offset the cost of a qualifying high deductible health plan (HDHP) and provide savings for your out-of-pocket eligible health care expenses – those you and your tax dependents may have now, in the future, and during your retirement. WHY IS IT A GOOD IDEA TO HAVE AN HSA? HSAs benefit everyone who is eligible to have this account – single individuals, families, and soon-to-be retirees. You save money on taxes in three ways: FOR 2022 XYZ COMPANY IS OFFERING A HEALTH SAVINGS ACCOUNT (HSA). THIS IS HOW AN HSA WORKS: Setting aside pre-tax dollars into your HSA you pay fewer taxes and increase your take-home pay by your tax savings. You save money on eligible expenses that you are paying for out of your pocket. The amount you save depends on your tax bracket. For example, if you are in the 30 percent tax bracket, you can save $30 on every $100 spent on eligible health care expenses. HEALTH SAVINGS ACCOUNT (HSA)

18 XYZ COMPANY is offering a Flexible Spending Account (FSA) for 2022. This is how an FSA works: • You set aside money for your FSA from your paycheck before taxes are taken out. • Then use your pre-tax FSA funds throughout the plan year to pay for eligible health care or dependent care expenses. • You save money on expenses you’re already paying for. • Medical expenses: co-pays, co-insurance, and deductibles • Dental expenses: exams, cleanings, X-rays, and braces • Vision expenses: exams, contact lenses and supplies, eyeglasses, and laser eye surgery • Professional services: physical therapy, chiropractor, and acupuncture • Prescription drugs and insulin • Over-the-counter health care items: bandages, pregnancy test kits, blood pressure monitors, etc. • Care for your child who is under age 13 • Before and after-school care • Babysitting and nanny expenses • Day care, nursery school, and preschool • Summer day camp • Care for a relative who is physically or mentally incapable of self-care and lives in your home HEALTH FSA ELIGIBLE EXPENSES DEPENDENT CARE FSA ELIGIBLE EXPENSES FLEXIBLE SPENDING ACCOUNT (FSA)

LEGAL NOTICES I

LEGAL NOTICES Health Insurance Portability and Accountability Act of 1996 (HIPAA) The Health Insurance Portability and Accountability Act of 1996 (HIPAA) is a federal law that addresses the privacy and security of certain individually identifiable health information, called protected health information (or PHI). You have certain rights with respect to your PHI, including a right to see or get a copy of your health and claims records and other health information maintained by a health plan or carrier. For a copy of the Notice of Privacy Practices, describing how your PHI may be used and disclosed and how you get access to the information, contact Human Resources. Women’s Health and Cancer Rights Act Enrollment Notice If you have had or are going to have a mastectomy, you may be entitled to certain benefits under the Woman’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: 1. All stages of reconstruction of the breast on which mastectomy was performed. 2. Surgery and reconstruction of the other breast to produce a symmetrical appearance; prostheses. 3. Treatment of physical complications of the mastectomy, including lymphedema. These will be provided subject to the same deductibles and coinsurance applicable to other medical and surgical benefits provided under this benefits plan. Therefore, the following deductibles and coinsurance apply: [insert medical deductibles and coinsurance applicable to these benefits]. If you would like more information on WHCRA benefits, call your plan administrator at 646-300-7016.

BENEFITS GUIDE An overview of the wide array of benefits provided XYZ COMPANY, to help you enjoy increased well-being and financial security PREPARED BY XYZ COMPANY FOR ABC COMPANY