Terms You Should Know All full-time employees working an average of at least 30 hours per week are eligible for benefits. For Benefit Eligible new hires, you are eligible as of your date of hire. For Medical, Dental and Vision your qualified dependents include your legal spouse and children to age 26. For Voluntary Dependent Life, your covered dependents include your spouse and children to age 25. Deductible The amount you pay for covered health care expenses before your insurance starts to pay. For example, with a $0,000 plan year deductible, you pay the first $0,000 covered services. Coinsurance The percentage of costs of a covered health care service you pay (for example 20%), after you have paid your plan year deductible. Out-of-Pocket The most you must pay for covered services in a plan year. After you spend this amount on Maximum deductibles, copayments, and coinsurance, your health plan pays 100% of the costs of covered benefits. In-Network In network providers agree to accept the UMR approved amount for their services. You will see these savings listed as the “discounted amount” on your Explanation of Benefits statements. Doctors or hospitals who are not in the network do not accept the UMR approved amount. You will Out-of-Network be responsible for paying the difference between the provider’s full charge and your plan’s approved amount. This is called balance billing. Preventive care is the care you receive to prevent illnesses or diseases. Providing these services at no Preventive Care cost is based on the idea that getting preventive care, such as screenings and immunizations, can help you and your family stay healthy. Services will be paid at 100% when you use a participating provider. Under family coverage, an embedded deductible plan means that each family member has an Embedded individual deductible in addition to the total family deductible. Everyone's deductible is much lower deductible plans than the total family deductible. When an individual meets their respective out-of-pocket total, the insurer begins to pay for that person's covered medical services, regardless of whether the family deductible has been fulfilled. Employees may add/remove/make benefit changes during the Open Enrollment period which is held annually. However, we understand that life happens. Employees have 30 days from the date of the Qualified Life qualified life event to make changes/updates. Examples of a life events include birth or adoption of a Status Changes child; marriage or divorce; death; loss of coverage; and employment status change. As the employee, you will log into the Paycom portal to request change(s). In addition, you will also need to provide documentation that reflects need for change(s) and must be submitted to HR before workflow can be approved. Federal required Notices including but not limited to the HIPAA Privacy and Security, Certificate of Plan Compliance Creditable Coverage for Medicare and Market “Exchange” Notices. Health Care Reform Notices are Notifications available online on the human resources internet site or via paper, free of charge, upon request. Please contact human resources with questions. Health Care Reform Notices are available on Paycom ESS under Benefit Forms & Links. Page 3 | ACME | Plan Year 2024 Open Enrollment This booklet provides only a summary of your benefits. All services described within are subject to the definitions, limitations, and exclusions set forth in each insurance carrier or provider’s contract.