You can enroll during your employer s open enrollment period, during your new hire window or during a qualifying event.

Transcription

1

2 ENROLLMENT We are very excited about our 2018 employee benefit package that is being offered to all eligible employees. The plan offers meaningful benefits including a Preventive Care Plan (Minimum Essential Coverage), which satisfies your obligation to maintain coverage under the individual mandate as required by The Affordable Care Act, the new health care reform law. 1) 2) TO ENROLL? You can enroll during your employer s open enrollment period, during your new hire window or during a qualifying event. If you are a new hire YOU MUST complete the enrollment process within 30 days from your hire date. IT IS OUR COMPANY POLICY THAT ALL EMPLOYEES COMPLETE THE ENROLLMENT PROCESS.

3 YOUR BENEFITS ARE GETTING AN Upgrade MEDICAL You now have three options to chose from: MEC Basic, MEC Plus, and our most comprehensive plan, MEC Enhanced LIFE So that you may protect your family from the unknown, we now offer a Term Life Insurance Policy

4 BENEFIT Stay Compliant and Covered with our Minimum Essential Coverage Options Understanding Your Minimum Essential Coverage Options The Health Care Reform Laws mandate you are covered by Minimum Essential Coverage (MEC) or pay a fine. Our MEC benefit package covers 100% of eligible preventative services when performed in-network. That means you pay nothing. Our MEC PLUS covers even more! We Offer THREE MEC Plans - Low, Medium and High (Choose ONE) Option 1: MEC BASIC Employee Only Employee + Spouse Employee + Child(ren) Employee + Family Weekly Deduction Option 2: MEC PLUS Employee Only Employee + Spouse Employee + Child(ren) Employee + Family Weekly Deduction Option 3: MEC ENHANCED Employee Only Employee + Spouse Employee + Child(ren) Employee + Family Weekly Deduction MEC BASIC Basic Plan Required by Law MEC PLUS All Covered MEC Services MEC ENHANCED All MEC & MEC+ Services 18 Covered Services for Adults Primary Care Office Visits Primary Care & Specialists 26 Covered Services for Women Specialist Office Visits Basic Labs & X-Rays 27 Covered Services for Children Urgent Care Emergency Room Benefit Prescription Drug Benefit Hospital and Surgery Minimum Essential Coverage covers 100% of the government s listed Preventive and Wellness Benefits when you visit a network provider (40% out-of-network). Self-insured by your employer, this coverage is required to satisfy your individual mandate under the new healthcare law.

5 Action Group Staffing Minimum Essential Coverage (MEC) Plan Schedule of Medical Benefits Option ID: CR18A Group ID: EFOHE This Plan covers routine preventive services only. This Plan does not cover medical illness or accidental injury claims. Claims Address P.O. Box 1807 Draper, Utah Emdeon Payor ID: PPO Provider Network: PHCS Specific Services Network- Nationwide Benefits and accumulations are based on a calendar year. Customer Service: Coverage begins the 1st day of the month following 60 days of employment. Coverage ends the last day of the month following termination. Minimum hours for full time: 130 per month/30 per week Covered Preventive Services for Adults as defined by CMS Preventive Services Wellness Office Visits and Lab Services Network Providers Non-Network Providers Benefit Limits Office Visit Exam & Includes Services For: Limited to preventive diagnosis only Abdominal Aortic Aneurysm One time screening for males of ages 65 to 75 who have ever smoked Alcohol Misuse Screening and Counseling Aspirin use for Men and Women Blood Pressure Screening Cholesterol Screening One Aspirin use consultation for women ages 45 to 79 and men 55 to 79 One screening every two years for ages 18 to 39 One Screening per plan year for ages 40 and over One screening per plan year for men 35 and older. Men under 35 who have heart disease or risk factors for heart disease or women who have heart disease or risk factors for heart disease Colorectal Cancer Screening Screening for adults over age 50 Depression Screening Type 2 Diabetes Screening Screening for adults with high blood pressure only. Diet Counseling Screening for adults at higher risk of chronic disease. Hepatitis B Screening For members at high risk, including members in countries with 2% or more hepatitis B prevalence, and US born people not vaccinated as infants and with at least one parent born in a region with 8% or more hepatitis B prevalence Hepatitis C Screening For adults at increased risk, and one time for everyone born between HIV Screening Screening for adults at higher risk Immunizations * Hepatitis A * Hepatitis B * Herpes Zoster * Human Papillomavirus * Influenza (Flu Shot) * Measles, Mumps, Rubella * Meningococcal * Pneumococcal * Tetanus, Diphtheria, Pertussis * Varicella Listed immunizations are once per plan year. Human Papillomavirus shots up to age 26. Pneumococcal shots for adults 65 and older Lung Cancer Screening For adults at high risk for lung cancer because they're heavy smokers or have quit in the past 15 years Obesity Screening and Counseling Sexually Transmitted Infection (STI) Screening and Counseling Prevention counseling for adults at higher risk, includes syphilis screening Syphilis Screening For all adults at higher risk Tobacco Use Screening Screenings for adults and cessation interventions for tobacco users

6 Covered Preventive Services for Women - Including Pregnant Women Wellness Office Visits and Lab Services Network Providers Non-Network Providers Benefit Limits Well-Women Visits Anemia Screening For pregnant women Bacteriuria urinary tract or infection Screening For pregnant women BRCA Counseling Includes genetic test for women at high risk Breast Cancer Mammography Screening Screenings every 1 to 2 years for women over 40 years old Breast Cancer Chemoprevention Counseling Counseling for women at high risk Breast Pumps One per delivery. Purchase Breast Pump at a local retail store and submit the receipt for reimbursement Breastfeeding Consultations Comprehensive support and counseling from trained providers, as well as access to breastfeeding supplies, for pregnant and nursing women Women ages 21 to 29 pap test every 3 years Cervical Cancer Screening Women ages 30 to 65 every 3 years if you only have a pap test Every 5 years if you have both a pap test and an HPV test Women age 66 and older consult your doctor Chlamydia Infection Screening For younger women and women at high risk Contraception Includes birth control pills and devices, injections and surgical sterilization (hospital, physician, anesthesia) Domestic and Interpersonal Violence Screening Folic Acid Supplements For pregnant women Gestational Diabetes Screening For women 24 to 28 weeks pregnant and / or at high risk of developing gestational diabetes Gonorrhea Screening For all women at higher risk Hepatitis B Screening For pregnant women at their first prenatal visit Human Immunodeficiency Virus (HIV) Screening and counseling For women sexually active Human Pailomavirus (HPV) DNA Test One test every 3 years for women with normal cytology results who are 30 or older Osteoporosis Screening For women over age 60 or at high risk Rh Incompatibility Screening For pregnant women and follow-up testing for women at higher risk Tobacco Use Screening and interventions Syphilis Screening For all pregnant women or other women at increase risk Sexually Transmitted Infection (STI) Screening and counseling, includes Gonorrhea & Syphilis Screening For sexually active women Urinary Tract or other Infection Screening for Pregnant Women Covered Preventive Services for Children Wellness Office Visits and Lab Services Network Providers Non-Network Providers Benefit Limits Alcohol and Drug Use Assessments Autism Screening For children at 18 months to 24 months Behavioral Assessments For children to age 18 Blood Pressure Screening For children to age 18 Cervical Dysplasia Screening For sexually active females Congenital Hypothyroidism Screening For newborns Depression Screening For teenagers ages 12 to 18

7 Developmental Screening For children under age 3 and surveillance throughout childhood Dyslipidemia Screening For children at high risk of lipid disorders Fluoride Chemoprevention Supplements For children without fluoride in their water sources Gonorrhea Preventive Medication for the Eyes of all Newborns Hearing Screenings For all newborns Height, Weight and Body Mass Index Measurements For children to age 18 Hematocrit or Hemoglobin Screening For children to age 18 Hemoglobinopathies of Sickle Cell Screening For all newborns HIV Screening For sexually active children Hypothyroidism Screening for Newborns Immunizations * Diphtheria, Tetanus, Pertussis * Haemophilus influenza type B * Hepatitis A * Hepatitis B * Human Papillomavirus * Inactivated Poliovirus * Influenza (Flu Shot) * Measles, Mumps, Rubella * Meningococcal * Pneumococcal * Rotavirus * Varicella For children to age 18 Iron Supplements For children ages 6 to 12 months at risk of anemia Lead Screening For children at risk of exposure Medical History For all children throughout development Obesity Screening and Counseling For children to age 18 Oral Health At risk assessment for your children ages newborn to age 10 Phenylketonuria (PKU) Screening For genetic disorders in newborns Sexually Transmitted Infection (STI) Screening and Counseling For children at higher risk, includes gonorrhea preventive medication for newborn eyes Tuberculin Testing For children at higher risk of tuberculosis to age 18 Vision Screening For children to age 18 Prescription Benefits Covered Prescription Drugs - SimpleSaveRx Customer Service: Rx Bin #: Rx PCN #: Generic Birth Control Pills and select prescriptions as identified by CMS Preventive Services 0 Co-pay Specialty Medications: No benefits All prescriptions are limited to 31 day supply and 150 per quarter. Dependents covered to age 26 regardless of student or marital status. Timely Filing: Claims must be filed within 12 months from the date the service incurred. Rural Area is defined as 30 miles. If preventive services are not available within 30 miles of your residence the provider will be paid in network. Coordination of Benefits: Non duplicating, Plan does not pay in excess of what the plan would have paid without other coverage. We believe this coverage is a Non-Grandfathered health plan under the Patient Protection and Affordable Care Act. (PPACA) Effective: 1/1/2018 Visit to view Schedule of Benefits, Plan Document, Enrollment information, claims history, link to the PPO Network and more. All claims are subject to Plan provisions at the time of service. Any benefits quoted telephonically or in writing is not a guarantee of payment. Claims are determined upon receipt of the claim and any additional information required to make a benefit determination.

8 Group ID: EFOHE Action Group Staffing Minimum Essential Coverage (MEC Plus) Plan Schedule of Medical Benefits Option ID: CR18I This Plan provides Minimal Essential Coverage for Medical Care. If the service is not listed on this Schedule of Benefits it is not covered. Claims Address P.O. Box 1807 PPO Provider Network: Draper, Utah PHCS Specific Services Network Emdeon Payor ID: Customer Service: Coverage begins the 1st day of the month following 60 days of employment. Coverage ends the last day of the month following termination. Minimum weekly hours for full time: 30 hours/130 per month Lifetime Max: None Network Providers Non-Network Providers Benefit Limits Per Calendar Year Annual Deductibles Does not include Co-pays. In-network and Out-of-network are separate accumulations and do not cross apply Annual Co-pay and Co-Insurance Out of Pocket Maximums (Medical and Rx Co-pays apply to the annual out of pocket maximums) Individual: None Family: None Individual: 7,150 Family: 14,300 Individual: None Family: None Individual: Unlimited Family: Unlimited Limits are per person per calendar year Office Visits - Primary Care (exam or consultation) 20 Co-pay, Limited to 3 visits annually. Office Visits - Specialist (exam or consultation) Network Discount Card applies Diagnostic Services - Basic labs/x-rays (related to office visit, LabCorp, etc.) Network Discount Card applies Included on 3 visits annually. Diagnostic Services - Major (Facility Charges) (MRI, CT, PET, Nuclear Medicine,etc.) Diagnostic Services - Major (Physician Charges) (MRI, CT, PET, Nuclear Medicine,etc.) Diagnostic Services - Minor (ultrasounds, bone density, ecography,etc) Network Discount Card applies Network Discount Card applies Network Discount Card applies Emergency Room Facilities Network Discount Card applies Emergency Room - All covered services other than facility charges Network Discount Card applies Urgent Care Center & 24 Hour Clinic 50 Co-pay, Limited to 1 visit annually. Covered Preventive Services for Adults as defined by CMS Preventive Services Wellness Office Visits and Lab Services Network Providers Non-Network Providers Benefit Limits Office Visit Exam & Includes Services For: Limited to preventive diagnosis only. Abdominal Aortic Aneurysm One time screening for males of ages 65 to 75 who have ever smoked Alcohol Misuse Screening and Counseling Aspirin use for Men and Women Blood Pressure Screening Cholesterol Screening One Aspirin use consultation for women ages 45 to 79 and men 55 to 79 One screening every two years for ages 18 to 39 One Screening per calendar year for ages 40 and over One screening per calendar year for men 35 and older. Men under 35 who have heart disease or risk factors for heart disease or women who have heart disease or risk factors for heart disease

9 Domestic and Interpersonal Violence Screening Folic Acid Supplements For pregnant women Gestational Diabetes Screening For women 24 to 28 weeks pregnant and/or at high risk of developing gestational diabetes Gonorrhea Screening For all women at higher risk Hepatitis B Screening For pregnant women at their first prenatal visit Human Immunodeficiency Virus (HIV) Screening and counseling For women sexually active Human Paillomavirus (HPV) DNA Test One test every 3 years for woment with normal cytology results who are 30 or older Osteoporosis Screening For women over age 60 or at high risk Rh Incompatibility Screening For pregnant women and follow-up testing for women at higher risk Tobacco Use Screening and interventions Syphilis Screening For all pregant woment or other women at increase risk Sexually Transmitted Infection (STI) Screening and Counseling. For sexually active women Urinary Tract or Other Infection Screening for Pregnant Women Covered Preventive Services for Children Wellness Office Visits and Lab Services Network Providers Non-Network Providers Benefit Limits Alcohol and Drug Use Assessments Autism Screening For children at 18 months to 24 months Behavioral Assessments For children to age 18 Blood Pressure Screening For children to age 18 Cervical Dysplasia Screening For sexually active females Congenital Hypothyroidism Screening For newborns Depression Screening For teenagers ages 12 to 18 Developmental Screening For children under age 3 and surveillance throughout childhood Dyslipidemia Screening For children at high risk of lipid disorders Fluoride Chemoprevention Supplements For children without fluoride in their water sources Gonorrhea Preventive Medicaiton for the Eyes of All Newborns Hearing Screenings For all newborns Height, Weight and Body Mass Index Measurements For children to age 18 Hematocrit or Hemoglobin Screening For children to age 18 Hemoglobinopathies of Sickle Cell Screening For all newborns HIV Screening For sexually active children

10 Hypothyroidism Screening for Newborns Immunizations * Diphtheria, Tetanus, Petussis * Haemophilus influenza type B * Hepatitis A * Hepatitis B * Human Papillomavirus * Inactivated Poliovirus * Influenza (Flu Shot) * Measles, Mumps, Rubella * Meningococcal * Pneumococcal * Rotavirus * Varicella For children to age 18 Iron Supplements For children ages 6 to 12 months at risk of anemia Lead Screening For children at risk of exposure Medical History For all children throughout development Obesity Screening and Counseling For children to age 18 Oral Health At risk assessment for your children ages newborn to age 10 Phenylketonuria (PKU) Screening For genetic disorders in newborns Sexually Transmitted Infection (STI) Screening and Counseling For children at higher risk, includes gonorrhea preventive medication for newborn eyes Tuberculin Testing For children at higher risk of tuberculosis to age 18 Vision Screening For children to age 18 Prescription Benefits Covered Prescription Drugs - SimpleSaveRx Customer Service: Rx Bin #: Rx PCN #: Negotiated best price for drugs: 0-20 (Tier 1) (Tier 2) (Tier 3) Specialty Medications: All prescriptions are limited to 31 day supply. Plan pays costs above 100 up to 150 per family per quarter. Telemedicine Sherpaa Go to for more information. Effective: 1/1/2018 Dependents covered to age 26 regardless of student or marital status. Timely Filing: Claims must be filed within 12 months from the date the service incurred. Rural Area is defined as 30 miles. If preventive services are not available within 30 miles of your residence the provider will be paid in network. Coordination of Benefits: Non duplicating, Plan does not pay in excess of what the plan would have paid without other coverage. We believe this coverage is a Non-Grandfathered health plan under the Patient Protection and Affordable Care Act. (PPACA) Visit to view Schedule of Benefits, Plan Document, Enrollment information, claims history, link to the PPO Network and more. All claims are subject to Plan provisions at the time of service. Any benefits quoted telephonically or in writing is not a guarantee of payment. Claims are determined upon receipt of the claim and any additional information required to make a benefit determination.

11 Action Group Staffing Minimum Essential Coverage (Enhanced MEC) Plan Schedule of Medical Benefits Option ID: CR18C Group ID: EFOHE This Plan provides Minimal Essential Coverage for Medical Care. If the service is not listed on this Schedule of Benefits it is not covered. Claims Address P.O. Box 1807 PPO Provider Network: Draper, Utah PHCS Specific Services Network Emdeon Payor ID: Customer Service: Coverage begins the 1st day of the month following 30 days of employment. Coverage ends the last day of the month following termination. Minimum weekly hours for full time: 30 hours/130 per month Lifetime Max: None Network Providers Non-Network Providers Benefit Limits Per Calendar Year Annual Deductibles Does not include Co-pays. In-network and Out-of-network are separate accumulations and do not cross apply Annual Co-pay and Co-Insurance Out of Pocket Maximums (Medical and Rx Co-pays apply to the annual out of pocket maximums) Individual: None Family: None Individual 7,150 Family 14,300 Individual 500 Family 1,000 Individual: Unlimited Family: Unlimited All benefits and accumulations are on a Calendar Year. Office Visits - Primary Care (exam or consultation) 20 Co-pay, Deductible, Plan pays 60% Office Visits - Specialist (exam or consultation) 40 Co-pay, Deductible, Plan pays 60% Diagnostic Services - Basic labs/x-rays (related to office visit, LabCorp, etc.) 50 Co-pay, Deductible, Plan pays 60% Diagnostic Services - Major (Facility Charges) (MRI, CT, PET, Nuclear Medicine,etc.) 400 Co-pay, 400 Co-pay, Plan pays 60% of Diagnostic Services - Major (Physician Charges) (MRI, CT, PET, Nuclear Medicine,etc.) of allowed amount Deductible, Plan pays 60% Diagnostic Services - Minor (ultrasounds, bone density, ecography,etc) 50 Co-pay, Deductible, Plan pays 60% Emergency Room Facilities 400 Co-pay, 400 Co-pay, Limited to 2 visits per year. Emergency Room - All covered services other than facility charges 400 Co-pay, Maximum: 1,000 Urgent Care Center & 24 Hour Clinic 50 Co-pay, Deductible, Plan pays 60% Covered Preventive Services for Adults as defined by CMS Preventive Services Wellness Office Visits and Lab Services Network Providers Non-Network Providers Benefit Limits Office Visit Exam & Includes Services For: Limited to preventive diagnosis only. Abdominal Aortic Aneurysm Alcohol Misuse Screening and Counseling Aspirin use for Men and Women Blood Pressure Screening Cholesterol Screening Colorectal Cancer Screening One time screening for males of ages 65 to 75 who have ever smoked One Aspirin use consultation for women ages 45 to 79 and men 55 to 79 One screening every two years for ages 18 to 39 One Screening per calendar year for ages 40 and over One screening per calendar year for men 35 and older. Men under 35 who have heart disease or risk factors for heart disease or women who have heart disease or risk factors for heart disease Screening for adults over age 50

12 Depression Screening Type 2 Diabetes Screening Diet Counseling Hepatitis B Screening Hepatitis C Screening HIV Screening Screening for adults with high blood pressure only Screening for adults at higher risk of chronic disease For members at high risk, including members in countries with 2% or more Hepatitis B prevalence, and U.S. Born people not vaccinated as infants and with at least on parent born in a region with 8% or more Hepatitis B prevalence For adults at increased risk, and one time for everyone born between Screening for adults at higher risk Immunizations * Hepatitis A * Hepatitis B * Herpes Zoster * Human Papillomavirus * Influenza (Flu Shot) * Measles, Mumps, Rubella * Meningococcal * Pneumococcal * Tetanus, Diphtheria, Pertussis * Varicella Listed immunizations are once per plan year. Human Papillomavirus shots up to age 26. Pneumococcal shots for adults 65 and older Lung Cancer Screening Obesity Screening and Counseling For adults at high risk for lung cancer because they're heavy smokers or have quit in the past 15 years Sexually Transmitted Infection (STI) Screening and Counseling Prevention counseling for adults at higher risk Syphilis Screening For all adults at higher risk Tobacco Use Screening Screenings for adults and cessation interventions for tobacco users Covered Preventive Services for Women - Including Pregnant Women Wellness Office Visits and Lab Services Network Providers Non-Network Providers Benefit Limits Well-Women Visits Anemia Screening BRCA Counseling Breast Cancer Mammography Screening Breast Cancer Chemoprevention Counseling Breastfeeding Consultations Cervical Cancer Screening Chlamydia Infection Screening Contraception For pregnant women Includes genetic test for women at high risk Screenings every 1 to 2 years for women over 40 years old Counseling for women at high risk Comprehensive support and counseling from trained providers, as well as access to breastfeeding supplies, for pregnant and nursing women Women ages 21 to 29 pap test every 3 years Women ages 30 to 65 every 3 years if you only have a pap test Every 5 years if you have both a pap test and an HPV test Women age 66 and older consult your doctor For younger women and women at high risk Includes birth control pills and devices, injections and surgical sterilization (hospital, physician, anesthesia)

13 Hypothyroidism Screening for Newborns Immunizations * Diphtheria, Tetanus, Petussis * Haemophilus influenza type B * Hepatitis A * Hepatitis B * Human Papillomavirus * Inactivated Poliovirus * Influenza (Flu Shot) * Measles, Mumps, Rubella * Meningococcal * Pneumococcal * Rotavirus * Varicella For children to age 18 Iron Supplements Lead Screening Medical History Obesity Screening and Counseling Oral Health Phenylketonuria (PKU) Screening For children ages 6 to 12 months at risk of anemia For children at risk of exposure For all children throughout development For children to age 18 At risk assessment for your children ages newborn to age 10 For genetic disorders in newborns Sexually Transmitted Infection (STI) Screening and Counseling For children at higher risk, includes gonorrhea preventive medication for newborn eyes Tuberculin Testing Vision Screening Prescription Benefits For children at higher risk of tuberculosis to age 18 For children to age 18 Covered Prescription Drugs - SimpleSaveRx Customer Service: Rx Bin #: Rx PCN #: Negotiated best price for drugs: 0-20 (Tier 1) (Tier 2) (Tier 3) Specialty Medications: All prescriptions are limited to 31 day supply Plan pays costs above 100 up to 150 per family per quarter. Telemedicine Sherpaa Go to for more information. Effective: 1/1/2018 Dependents covered to age 26 regardless of student or marital status. Timely Filing: Claims must be filed within 12 months from the date the service incurred. Rural Area is defined as 30 miles. If preventive services are not available within 30 miles of your residence the provider will be paid in network. Coordination of Benefits: Non duplicating, Plan does not pay in excess of what the plan would have paid without other coverage. We believe this coverage is a Non-Grandfathered health plan under the Patient Protection and Affordable Care Act. (PPACA) Visit to view Schedule of Benefits, Plan Document, Enrollment information, claims history, link to the PPO Network and more. All claims are subject to Plan provisions at the time of service. Any benefits quoted telephonically or in writing is not a guarantee of payment. Claims are determined upon receipt of the claim and any additional information required to make a benefit determination.

14 ABOUT MY BENEFITS Q1. What does the Network Discount Card Applies mean in the MEC Plus & MEC Enhanced? The MEC Plus does not cover services that state Network Discount Card Applies We still wanted to provide some type of benefit so we incorporated the Value Point program through Multiplan. The Value Point program allows you to access the Multiplan Network (same network in your MEC Plus) for the discounted provider rate. You get to pay the discounted provider rate I.E. The contractual rate your provider (Doctor) has with the network (Multiplan) - Keep in mind; You will receive a separate Value Point Card. Q2. What is Minimum Essential Coverage and why are there 3 options? Minimum Essential Coverage (MEC) is the coverage level every American must have as defined by the Affordable Care Act. Because a basic MEC doesn t cover that much we enhanced the offering with two other MEC s that cover more; MEC Plus and MEC Enhanced. Please keep in mind all three MECs do not cover services like Physical Therapy, Behavior Health, Mental Health and Rehabilitation Services. Q3. How does my prescription drug coverage work? The MEC Plus and MEC Enhanced come with a prescription drug plan through SimpleSaveRX Simpe Save RX has what is a rapidly growing practice in the industry known as pass through or transparent pricing. Every pharmacy you go to can offer their drugs at a different price depending on how much they acquire their drugs for. With Simple Save you can go to virtually any pharmacy and pay a co-pay depending on the pass through cost. For information on which pharmacies have a cheaper price you can call Simple Save RX directly Save4RX Q4. What is the Hospital Indemnity Benefit in the MEC Enhanced? Very simply put; the Hospital Indemnity Benefit puts money in your pocket when a claim is filed as per the schedule of benefits.

15 Group Limited Indemnity Ready for Whatever s Down the Line. ACTION A ADVANTAGE STAFFING Your employer is providing you access to a Group Limited Indemnity policy that will help protect you and your family if you incur certain medical expenses. Read on to learn more about what is covered. For plan specifics, see next page. What is Group Limited Indemnity Insurance? Group Limited Indemnity insurance provides coverage, based on a set schedule of benefits for basic medical services. Note: Group Limited Indemnity is NOT major medical insurance. What does the Group Limited Indemnity plan cover? The plan provides a benefit amount for a select set of benefits, such as inpatient hospitalization, surgeries, lab and x-ray, as well as physician s office/urgent care visits. You may opt for coverage for your spouse or child(ren). You are eligible for this coverage (regardless of your health status), and you do not have to answer any medical questions to qualify for coverage. (For plan specifics and coverage definitions, see next page.) Who is Beazley? Beazley provides a suite of gap protection products that helps protect employees against life s uncertainties. Beazley Insurance Company, Inc. is rated A by A.M. Best. It is a subsidiary of Beazley Group, which was founded in How does it work? Once you are enrolled, the premium amount will be deducted from each paycheck. You will receive an ID card to present to your medical provider, indicating you have coverage. To submit a claim for Group Limited Indemnity benefits, you will submit a copy of the itemized bill from the medical provider. Group Limited Indemnity at a Glance What is it? Covers basic medical services at a specific benefit amount for a specified number of days Why should I have it? To fill gaps and protect your income and assets. To take advantage of the opportunity to select benefit options offered at work. How does it help me? Here s a sample scenario to demonstrate how the product can help fill gaps: Jerry enrolled in the Group Limited Indemnity plan, offered by his employer. When Jerry became ill with pneumonia, he was admitted to the hospital for a few days to allow for medication and recovery. His plan paid out a lump-sum benefit for the hospital admission, as well as a daily amount for the short period of confinement. Later that year, Jerry and his wife welcomed a new baby to the family. Because the baby was delivered C-section, Jerry s wife had to remain in the hospital for 2 days. Again the plan paid a lump-sum amount for the admission, and a daily amount for her short hospital stay. GROUP LIMITED INDEMNITY INSURANCE IDENTIFICATION CARD PRESENT TO PROVIDERS FOR INSURANCE COVERAGE Provided by Beazley Insurance Company, Inc. XYZ COMPANY, Please submit claims to: Beazley Insurance Company, Inc. c/o HealthPlan Services, Inc. P.O. Box 3889 Seattle, Washington Fax: Attn: Claims For customer service: For customer service inquiries, please call: XXX-XXX-XXXX

16 GROUP LIMITED INDEMNITY PLAN FOR ACTION STAFFING BENEFITS BENEFIT DEFINITIONS BENEFIT AMOUNTS AND MAXIMUMS HOSPITAL INDEMNITY BENEFITS Hospital Confinement Hospital Admission SURGERY BENEFITS Inpatient Surgery Outpatient Major Surgery Outpatient Minor Surgery LAB AND X-RAY BENEFITS For treatment in a hospital due to sickness or injury for 23 or more continuous hours (i.e., not less than a day) Lump sum benefit for a hospital admission, due to sickness or injury For inpatient surgery in a hospital due to sickness or injury For outpatient surgery in hospital or freestanding surgery center, due to sickness or injury For minor outpatient surgery in hospital or freestanding surgery center, due to sickness or injury 100 per insured, per day 5 days per insured, per year 1,000 per insured, per admission 1 admission per insured, per year 1,500 per insured, per day 1 day per insured, per year 750 per insured, per day 1 day per insured, per year 75 per insured, per day 2 days per insured, per year Outpatient Lab Outpatient X-ray PHYSICIAN S OFFICE/URGENT CARE BENEFITS Physician s Office/Urgent Care For lab test, ordered by a physician For x-ray, ordered by a physician For services rendered by a physician at physician s office or urgent care facility 25 per insured, per day 7 days per insured, per year 75 per insured, per day 2 days per insured, per year 75 per insured, per day 6 days per insured, per year Beazley Accident & Health 8500 Normandale Lake Blvd Suite 955 Minneapolis, MN USA The Group Limited Indemnity policy is offered under form number AHGLIMM Ed. Benefits and range of options may vary by state. Premium will vary based on plan chosen. A waiting period for late entrants may apply. This policy is renewable at the option of Beazley. Pre-existing condition limitations may apply. (Pre-exiting condition means any sickness, disease, or physical condition for which the insured 1) had treatment, or 2) received a diagnosis or advice from a physician, during the pre-existing condition period.) This material is intended for informational purposes for brokers and other related distribution entities only. This material is not intended to be accessible in Arizona, Missouri, New Hampshire, Oregon, Washington and Wyoming until any required approvals have been obtained. The descriptions contained in this guide are for preliminary informational purposes only. Coverages will vary depending on individual state law requirements and may be unavailable in some states. The exact coverage afforded by the products described in this guide is subject to and governed by the terms and conditions of each policy issued. The publication and delivery of the information contained herein is not intended as a solicitation for the purchase of any US risk. Insurance underwritten by Beazley Insurance Company, Inc., 30 Batterson Park Road, Farmington, Connecticut, Beazley is rated A by A.M. Best. For the most current listing of our product offerings and their availability, visit beazley.com/accident&health. Beazley Insurance Company, Inc. is licensed to provide accident and health insurance in all 50 states and the District of Columbia. Administrative services on all accident and health products are provided by HealthPlan Services (HPS). For further details of the coverage, including all terms, conditions, exclusions, and limitations, please refer to the policy or contact sales@beazleybenefits.com Group Limited Indemnity (Action Staffing)-11/17

17 VOLUNTARY TERM LIFE AND AD&D INSURANCE Proposal for: Drake Nelson Group, LLC dba Action Group Staffing Alternate: 1.00 The following Voluntary Term Life and AD&D plan is being proposed on a fully-insured basis effective 01/01/18. This proposal assumes this coverage is underwritten by United of Omaha Life Insurance Company. For additional information about Mutual of Omaha's products and services, visit mutualofomaha.com. ELIGIBILITY CLASS DEFINITION(S) ELIGIBILITY REQUIREMENT MINIMUM WORK HOURS Class 1: All Eligible Employees This proposal provides coverage for all actively at work employees on the policy effective date working the minimum number of hours shown below in the United States, unless otherwise approved by Mutual of Omaha. Certain requirements apply. Class 1: 20 or more hours each week BENEFIT SUMMARY EMPLOYEE BENEFIT AMOUNTS Minimum Benefit Maximum Benefit Increments 10,000 5X Annual Salary, up to 250,000 10,000 *Guarantee Issue Amounts assume a participation rate of at least 25% of eligible employees. Guarantee Issue Amount* 5X Annual Salary, up to 150,000 BENEFIT REDUCTION SCHEDULE** DEPENDENT SPOUSE BENEFIT AMOUNTS*** DEPENDENT CHILD BENEFIT AMOUNTS AD&D BENEFIT AMOUNT At Age Benefits Reduce : 65 65% % ** All benefit reductions are a percentage of the original benefit amount. Coverage terminates at retirement. The Guarantee Issue Amount is reduced according to the reduction schedule. Minimum Benefit Maximum Benefit Increments Guarantee Issue Amount 100% of Employee's 100% of Employee's 5,000 5,000 Benefit, up to 250,000 Benefit, up to 35,000 *** Dependent Spouse and/or Child coverage is only available if the Employee has coverage under this plan. Spouse coverage terminates at age 70. Minimum Benefit Maximum Benefit Increments Guarantee Issue Amount 2,000 10,000 2,000 10,000 The AD&D Principal Sum amount is equal to the amount of voluntary term life insurance for employees and eligible dependents. PARTICIPATION AND COST SUMMARY PARTICIPATION ASSUMPTIONS Minimum Participation Number of Eligible Employees Contribution Structure 25% % employee paid Proposal ( ) Voluntary Term Life and AD&D Insurance 1

18 PARTICIPATION AND COST SUMMARY (CONT'D) COST SUMMARY* Voluntary Term Life Age Band Employee & Spouse Rate per 1,000 All Children Rate per 1,000 < * This plan is rated using the same rates for the employee and spouse. Employee and spouse rates are calculated based on the employee's current age as of the effective date of the plan. Employee and spouse rates are adjusted once each year on the plan anniversary date for employees advancing to the next age band. Spouse coverage terminates when the employee attains age 70 (regardless of the spouse's actual age). Voluntary AD&D RATE GUARANTEE Employee Spouse All Children Rate per 1,000 Rate per 1,000 Rate per 1, Years RATE GUARANTEE DATE 01/01/2020 ADDITIONAL BENEFITS OPEN ENROLLMENT WAIVER OF PREMIUM - DISABILITY ANNUAL INCREASE OPTION A one-time open enrollment is available for a period of up to 90 days prior to the effective date of the policy, subject to the enrollment strategy requirements. During this time, the employee/member may elect insurance for the first time or request increased insurance up to the Guarantee Issue amount for the employee/member and any dependents (if applicable) without providing health information. Definition of Disability - Any Occupation Elimination Period - 9 months Termination - Age 65 Once annually, the employee/member may increase their insurance amount by up to 10,000 without providing health information. LIVING CARE BENEFIT For employee and spouse, 75% to 250,000 PORTABILITY Included LAYOFF/LEAVE Temporary Layoff - 12 weeks Personal Leave - 12 weeks CONTINUATION FOR FEDERAL AND STATE LAWS AD&D Included The federal Family and Medical Leave Act (FMLA) and Uniformed Services Employment and Reemployment Rights Act (USERRA) and any amendments thereto, as well as other applicable federal or state laws, may allow continuation of insurance in certain instances for leaves of absence, layoff or termination. Insurance may be continued for the time period allowed by the applicable law, for the employee/member and any dependent(s). This provision applies to employer and union groups only, subject to certain conditions. 24 hour coverage for employees and eligible dependents Voluntary Term Life and AD&D Insurance (continued) Proposal ( ) 2

19 MINIMUM VALUE PLAN (MVP) Our Minimum Value Plan is an affordable way to help you meet the individual mandate required by the government Understand the Value The Minimum Value Plan (MVP) is a high deductible plan offering very limited coverage. The MVP plan does include the required MEC services and does prevent the employee from being taxed the Individual Mandate penalty tax by purchasing Minimum Essential Coverage through their employer. Unlike the plans being offered on the Exchange and individual market this MVP does have a list of services that are not covered by the plan. The MVP plan covers the following services after your 7,150 (individual) deductible is met; Emergency Room Services, Inpatient Hospital Services, Primary Care and Specialist visits, Imaging, Laboratory Services, X-rays and Diagnostic Imaging, and certain Generic and Preferred Brand drugs. Please pay close attention to the list of excluded benefit categories * Please note: If you elect the MVP a Personal Health Questionnaire is required.