Benefits. Guide. reference. Your Looking ahead to a future rooted in good health.

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1 Your 2016 Benefits reference Guide Looking ahead to a future rooted in good health. Go to to choose your benefits for U.S. - based Salaried and Fremont Non-union Hourly Employees

2 2016: Changes and Reminders For your convenience, below is a summary of key information for which more detail is provided throughout this Benefits Reference Guide. Consumer Driven Health Plans (CDHP): A second CDHP option is being offered in The new plan, known as the CDHP-Basic, offers the lowest premium of any plan. The higher deductible and out of pocket limits, make this a catastrophic coverage type of plan. The current CDHP offered in 2015 will be renamed the CDHP-Premier beginning in The Premier plan will have no plan design changes in See the summary of benefits section for details. If you enroll in either Consumer Driven Health Plan in 2016, Glatfelter will once again contribute into your HSA, $600 for individual and $1,200 for family coverage. This contribution will be spread out on a per payroll basis in The wellness incentives of $300 for individual and $600 for family can also be earned in PPO and PCP Plan Design Changes: These plan deductibles, out of pocket maximums and copayments increase in Please see the summary of benefits section for information on the increases for each plan. Prescription Plan Design Changes: Effective in 2016, the prescription benefit plan coinsurance rates will be increased. Fixed copayment amounts are not changing in Please see the Prescription Drug Plan section for details. Employee Medical Plan Premium Increases: Employee premiums increase for health plan coverage in The 2016 Benefit Options & Costs section at the end of the Benefits Guide provides the new rates. Employee Vision (VSP) Plan Premium Increases: Employee premiums increase for VSP vision plan coverage in The 2016 Benefit Options & Costs section at the end of the Benefits Guide provides the new rates. Wellness Program Expanded: In 2016, we remain committed to providing wellness opportunities for all employees and rewarding employees who participate in sustaining or improving good health habits. We are continuing the clearer, simpler process we introduced in The Disease Management Track is expanding in 2016 to provide new health support options that are more specific to your health needs. More details are provided in the Guide s Wellness section. NEW Weight Management Program: Beginning in 2016, employees and covered spouses ( members ) may voluntarily choose to participate in a weight management program offered by our Wellness Program vendor, Carewise Health. Members are eligible to utilize this telephonically based program if they are overweight or obese based upon their body mass index (BMI). Contact Carewise Health if you think you may benefit from and be eligible for this program. Tobacco User Surcharge: The surcharge which began in 2015 will continue in You must self-identify each year during this open enrollment period. Employees who use tobacco products must log on to the benefits enrollment site and selfidentify during the benefits Open Enrollment period. A person is considered a tobacco products user if he/she has used tobacco an average of four or more times per week within the past six months. This includes, but is not limited to, cigars, cigarettes, chewing tobacco, snuff, and other tobacco products, but excludes religious and ceremonial uses of tobacco. Those who self-identify will be charged an additional $180 per year that will be added to your medical plan premium. Employees having completed or currently engaged in a smoking cessation program within the last six months can consider themselves a non-tobacco user. The tobacco user surcharge does not apply to dependents. Free Tobacco Cessation Pharmacotherapy: For employees wishing to end tobacco usage, the Glatfelter prescription plan will continue to provide certain medications without cost, to assist in the cessation of tobacco usage. Also, a tobacco cessation program continues to be offered by our wellness vendor Carewise Health at no cost to you. Annual FSA Elections and Health FSA Roll-over: If you enrolled in the Health Care FSA in 2015, you will have the opportunity to roll-over up to $500 of unused funds to the next plan year, but only if you enroll in the FSA for To participate in either Health Care or Dependent Care FSA programs, you must make a new election each year. These elections do not carry forward from year to year.

3 What s Inside Changes and Reminders for Inside Cover Enrolling in Your Benefits Eligibility & General Information Family/Life Status Events Wellness Medical Plans Prescription Drug Plan Preventive Care Services Dental Plan Vision Plans Flexible Spending Accounts Basic Life and AD&D Optional Life Disability Employee Assistance Program Glossary of Terms COBRA Important Notices Benefit Options & Costs Important Contact Information Need Assistance? Follow these steps if you require assistance: For claim issues, call the specific benefits insurance provider listed below. You will need your ID number or Social Security number along with date of service and provider name. Do you need an ID card? If you do not have an ID card, please contact the specific benefits insurance provider to order your ID card. If you require further assistance, contact the Glatfelter Benefits Service Center for expert assistance with enrollment or benefit related questions, plan procedures and life events. GLATFELTER BENEFITS SERVICE CENTER glatfelter@crawfordadvisors.com PAPER ( ) Benefits insurance providers: MEDICAL CoreSource PRescription drugs CVS Caremark General Questions FastStart for Members (Mail Order Prescriptions) FastStart for Physicians (Mail Order Prescriptions) Specialty Pharmacy DENTAL Delta Dental VISION National Vision Administrators, L.L.C. (NVA) Vision Service Plan (VSP) FLEXIBLE SPENDING ACCOUNTS TASC Fax: LIFE / AD&D / DISABILITY UNUM Life / AD&D Claims Disability Claims STD Claim Submission Portability & Conversion Employee assistance program WellSpan HSA Fund administrator Fidelity WELLNESS Carewise Please Note: This booklet provides a summary of the benefits available but is not your Summary Plan Description. Glatfelter reserves the right to modify, amend, suspend, or terminate any plan at any time, and for any reason without prior notification. The plans described in this book are governed by insurance contracts and plan documents, which are available for examination upon request. We have attempted to make the explanations of the plans in this booklet as accurate as possible. However, should there be a discrepancy between this booklet and the provisions of the insurance contracts or plan documents, the provisions of the insurance contracts or plan documents will govern. In addition, you should not rely on any oral descriptions of these plans, since the written descriptions in the insurance contracts or plan documents will always govern. 1

4 Enrolling in Your Benefits The enrollment process is similar for annual Open Enrollment and for new employees enrolling for the first time. Please have the following information available before you log on to the web site: The social security numbers of any eligible dependents you wish to enroll Dates of birth for all dependents Beneficiary names and social security numbers Open Enrollment Key Points 1) All employees are encouraged to log on to the web site in order to make benefit elections, review and confirm current benefit elections, or waive benefits if you do not wish to be covered. You are also encouraged to review beneficiary information and update as needed. 2) If you are a tobacco product user, you must log on to the website to complete the tobacco product user selfidentification. 3) If you wish to enroll in the Flexible Spending Account (FSA) plan you must log on to complete that election for ) If you participate in the Health Savings Account as part of the Consumer Directed Health Plan, your election carries forward from year to year and can be changed at any time, including during open enrollment. New Hires Even if you do not want to enroll in any Glatfelter benefits, you must log into the system to Waive those benefits and provide beneficiary information for your company provided benefits. Accessing the Benefits Enrollment Site Log on to You also have Mobile Access to the benefits site on ios and Android systems. Just follow the same instructions to log on using your browser on your phone or tablet. Click the benefits enrollment link. You will be prompted to enter the following: Username-Enter your last name and the last four digits of your social security number (no spaces, e.g. smith1234) Password-Enter your date of birth (no slashes, e.g ) You will be prompted to change your password Begin your enrollment by clicking Change my Elections (annual open enrollment) or Enroll Now (new hires). A series of easy to follow instructions will lead you through the enrollment process. The enrollment screen consists of four steps (tabs). You will be taken through each tab to make changes or confirm your information on file and choose your benefit elections. (continued on next page) Need Help Enrolling? Contact the Glatfelter Benefits Service Center. Call: PAPER ( ) Monday through Friday, 8 AM - 5:30 PM ET glatfelter@crawfordadvisors.com Enrollment Notes Requirements: Microsoft Internet Explorer version 9.0 or higher, or Mozilla Firefox version 35.0 and higher, Safari version 8.0 or Google Chrome version m and higher. You must have the following enabled: Cookies, JavaScript and Style Sheet. Note: The system will automatically log you out if you leave your system idle for more than 30 minutes. 2

5 Enrolling in Your Benefits continued 1) Verify your Personal Information Verify accuracy of all information and notify your local HR representative of any changes that need to be made. Add an address which will allow you to yourself a copy of your benefits confirmation statement. 2) Add or Verify Dependent Information You are able to add, edit and review dependent information as necessary. Please remember to include social security numbers and dates of birth for all dependents. If you are enrolling a dependent(s) in the medical, dental and/or vision plan for the first time, you will be required to provide proof of dependent eligibility status. 3) Enroll in Your Benefits The first benefit option will automatically open and guide you through the enrollment process. Company paid benefits will be checked off as completed. Proceed through each benefit plan screen and complete your elections. Please remember to add the dependents you want covered under each plan. For example, you may want your children covered under the medical plan, but they may not need the vision plan. 4) Save and Confirm After you have made your benefit elections and verified them for accuracy, click Save My Enrollment. You will then have the option to yourself and/or print a copy of the confirmation statement for your records. For current employees during Open Enrollment, if you do not click Save My Enrollment, your current benefit elections will continue in 2016, with the exception of the 2015 Flexible Spending Accounts, which require a new election each year. For new hires, if you do not click Save My Enrollment, no plan elections will be made. A confirmation statement confirming your benefit elections will not be automatically provided. It is strongly recommended that you print the confirmation sheet for your records. 3

6 Eligibility & General Information Newly Hired/Eligible Employees Newly hired or newly eligible employees must complete an online or paper enrollment form even if they choose to waive coverage. Health coverage, if elected, will begin on your 31st day of employment, provided you enroll within 30 days from your date of hire. Completed enrollment serves as a request for coverage and authorizes any payroll deductions necessary to pay for that coverage. Coverage for eligible dependents generally begins on the same day your coverage is effective. Any elections made will remain in effect and cannot be changed or revoked until the next annual Open Enrollment period, unless the change is due to and consistent with a Family/Life Status Change. Eligibility Requirements You are eligible to participate in the benefits program if you are a regular full-time or regular part-time employee scheduled to work a minimum of 30 hours per week. Section 125 Certain benefits described in this guide may be purchased with pre-tax payroll deductions as permitted by Section 125 of the Internal Revenue Code. When you purchase benefits with pre-tax dollars, you reduce your taxable income, so less taxes are taken out of your paycheck. You can actually have more spendable income than if the same deductions were taken on an after-tax basis. Pre-tax Note: When you pay for your dependent s benefits on a pre-tax basis, you are certifying that the dependent meets the IRS definition of a dependent [IRC 152, 21(b) (1) and 105(b)]. Dependents that do not satisfy the IRS definition will result in a tax liability to you, such as changing that dependent s election to a post-tax election, or receiving imputed income on your W-2 for the ineligible dependent s pre-tax coverage. Eligible Dependents Your eligible dependents for Medical, Dental and Vision coverage include: Legally married spouse. This includes same-sex and opposite-sex spouses; A dependent child under the age of 26 who is your natural, adopted, stepchild, foster child, if not a ward of the state, a child for whom you have legal guardianship, a grandchild who lives with you in a parent-child relationship. If a dependent child is mentally or physically challenged, coverage may be extended beyond the age limit. Verification of Eligible Dependents Enrolled In The Medical, Dental and/or Vision Plan In order to enroll new dependents in the medical, dental, and/or vision plans, you will be required to submit proper documentation that provides proof of eligible dependents. This documentation must be received by the Glatfelter Benefits Service Center within 30 days of the effective date or dependent coverage can be denied. Acceptable documentation includes birth certificates, marriage certificates, adoption decrees and court documents. If these documents are not available, employees may submit other supporting documentation for review. If it is determined that an employee has an ineligible dependent enrolled on these plans, it will be treated as fraud and penalties will be imposed. (continued on next page) 4

7 Eligibility & General Information continued Benefit Changes The benefit elections you make during Open Enrollment will remain in effect for the entire year. You will not be able to change or revoke your elections once they have been made unless a Family/Life Status change occurs. For purposes of health, dental, vision and Flexible Spending Accounts, you will be deemed to have a Family/Life Status Change if: your marital status changes through marriage, the death of your spouse, divorce, legal separation, or annulment; your number of dependents changes through birth, adoption, placement for adoption, or death of a dependent; you, your spouse or dependents terminate or begin employment; you, your spouse or dependents experience an increase or reduction in hours of employment (including a switch between part-time and full-time employment; strike or lock-out; commencement of or return from an unpaid leave of absence) that corresponds with a change in group health coverage; gain or loss of eligibility under a plan offered by your employer, or your spouse s or dependent s employer (e.g., if your dependent switches from hourly to salaried employment and your dependent s employer s plan covers only salaried employees); your dependent is no longer eligible due to attainment of age, or similar circumstance; or a change in residence for you, your spouse or your dependent resulting in a gain or loss of eligibility. In order to be permitted to make a change of election relating to your health, dental, vision or FSA coverage due to a Family/ Life Status Change, the Status Change must result in you, your spouse or dependent gaining or losing eligibility for health, dental, vision or FSA coverage under this Plan or a plan sponsored by another employer by whom you, your spouse, or dependent are employed. The election change must correspond with that gain or loss of eligibility. You may also be permitted to change your elections for health coverage under the following circumstances: a court order requires that your child receive accident or health coverage under this plan or a former spouse s plan; you, your spouse or dependent become entitled to Medicare or Medicaid; you have a Special Enrollment Right: 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. 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. there is a significant change in the cost or coverage of you or your spouse attributable to your spouse s employment. (Not applicable to Health Care FSAs) You must communicate your Family/Life Status Change to the Glatfelter Benefits Service Center and make your benefit elections within 30 days of the Family/Life Status Change. YEAR ROUND ACCESS TO FORMS & BENEFITS The benefit enrollment system allows you to print a copy of your enrollment confirmation statement. If you did not print or yourself a copy of your enrollment confirmation statement when you completed your open enrollment session, you can do so now or anytime throughout the year in just a few short steps. Log into your account: Click the benefits enrollment link to view and print your Benefits Confirmation Statement. Username: your last name plus last 4 digits of your social security number. Password: your date of birth or the new password you create at open enrollment (passwords will be reset to the date of birth prior to open enrollment each year). For a PDF, from the home page click on Personalized Forms under My Profile. Type in the correct effective date and then click View. You should see your completed confirmation statement, which you can print or save for your record. For a current, up-to-date view of your benefits click on Current Benefits under My Benefits from the home page or click on View All at the bottom of the Benefits Quicklook section. To access benefit information, click on Library. 5

8 Family/Life Status Events Lifestyle changes will require you to notify the Glatfelter Benefits Service Center at within 30 days of the change. (Documentation is needed to validate a change in family status event) Lifestyle Event Action Required Results If Action Not Taken Timely New Hire Enroll electronically at You and your dependents are not eligible to enroll until the annual Open Enrollment within 30 days of your hire date. Click on the link period. New Hire Employee Enrollment. Marriage Contact the Benefits Service Center Your spouse is not eligible to enroll until within 30 days of the the annual Open Enrollment period. marriage date to add your new spouse. Divorce Contact the Benefits Service Center to remove Benefits are not available for the divorced the former spouse within 30 days of the divorce. spouse and will be recouped if paid Proof of the divorce will be required. erroneously. Birth or Adoption of Contact the Benefits Service Center to enroll the The new dependent will not be eligible a child new dependent within 30 days of the birth or to enroll until the annual Open Enrollment adoption even if you already have family period. coverage. Death of a spouse/domestic Notify the Benefits Service Center to You could pay a higher premium than partner or dependent remove the dependent within 30 required. days of the date of death. Your spouse/domestic partner Contact the Benefits Service Center You need to wait until the annual Open gains or loses employment within 30 days of the event date to Enrollment period to make any change. that provides health benefits add or drop health benefits. Loss of Coverage from a Contact the Benefits Service Center You will be unable to enroll in the benefits spouse s/domestic partner s within 30 days from the loss of until the annual Open Enrollment period. Group Health Plan coverage. Changing from full-time to Contact the Benefits Service Center Benefits will end and may be reinstated part-time employment within 30 days of the employment by a timely COBRA election and (less than 30 hours per week) status change in order to receive payment. COBRA information. Termination No action required on your part. If you do not receive a COBRA notice COBRA notification will be sent to within 30 days of your last day worked, your home. please contact the Glatfelter Benefits Service Center at

9 Glatfelter Wellness Glatfelter Wellness Program The Glatfelter Wellness program, administered by Carewise Health, is available to you at no cost. It is designed to help eligible Glatfelter employees and spouses navigate the healthcare system, and make choices that will promote better health for today and tomorrow. To encourage participation, an incentive is once again offered in How the Program Works Carewise Health analyzes your health care claims and related data in order to place you and your spouse (if covered under a Glatfelter medical plan) into either the Disease Management Track or the Wellness Track. It is possible that you and your spouse will be placed in different tracks. 1) Disease Management Track: If identified for this program, you and/or your spouse (if enrolled in a Glatfelter medical plan) will be asked to participate in a telephonic coaching program of support and engagement with a Carewise nurse. This year we have expanded the program to three different programs within the Disease Management Track. They are: Case Management Disease Management Lifestyle Management (known as the Shine program) Each focuses on a different aspect of supporting your good health. If identified for Disease Management Track, you will be asked to participate in only one of the programs shown above. You earn the incentive by staying engaged with the nurse until you reach graduation. Your nurse determines your level of engagement and ultimately whether you have earned the incentive by June 30, This program typically consists of monthly telephonic meetings with your nurse and activities that you and your nurse agree upon. It can take four to six months to complete; therefore, it is important that you engage right away if you would like to earn the incentive by June 30, ) Wellness Track: If identified for this program, you and/ or your spouse (if enrolled in a Glatfelter medical plan) must complete five activities by June 30, 2016 to earn the incentive. There will be two groups of activities from which to choose. You must complete at least two activities from each group. A few sample activities are provided below. A full list of the activities will be provided in a letter to your home in late December/early January. Please note that you and your spouse could potentially receive two different letters based on your identification as a Disease Management or Wellness participant. Wellness Program Sample Activities 1. Start an exercise activity that involves at least 90 minutes/ week, minimum 6 weeks. 2. Participate in a: a) Tobacco cessation program b) Weight loss program c) Alcohol cessation program d) Nutrition program 3. Complete an annual physical with biometric screening 4. Complete an age-based test (e.g., mammogram or colonoscopy) 5. Complete a Personal Health Assessment (If it has been more than one year since your last PHA) 6. Participate in 2 community wellness events Wellness Program Track Notification You and your covered spouse will receive a letter in late December/early January telling you which track, Disease Management or Wellness, you have been placed in. Must Complete Incentive Activities By June 30, 2016 If you do not complete the activities required by the program under which you are identified by June 30, 2016, you will not earn the incentive and you will not have a future opportunity to complete the 2016 program in order to earn the incentive. (continued on next page) 7

10 Glatfelter Wellness continued Wellness Incentives The Glatfelter Wellness Program includes an incentive for participation in your designated disease management or wellness program. Both you and your spouse (if applicable) will need to complete your designated program to be eligible for the incentive. For those enrolled in the PPO, PCP, or GFMC plans, you begin 2016 paying the with Wellness rates shown on the Benefits Options and Costs pages in the back of the Guide. If you and/or your spouse choose not to participate in the program for which you have been identified, your premiums will increase on August 1 to the without Wellness rates shown in this Benefits Guide. For those enrolled in the CDHP, your premium remains the same with or without Wellness participation. If you complete the program for which you have been identified, by June 30, 2016, you will earn an additional contribution from Glatfelter into your HSA in August 2016 (subject to eligibility noted below). Those with employee only coverage will receive $300. Those with any other coverage will receive $600. Wellness Contribution Eligibility Notice: To be eligible to receive the HSA incentive, you must be actively employed by Glatfelter at the time the incentive is paid in August. Incentive Timing Current Employees: All current employees will begin 2016 paying the with Wellness premium. To earn the incentive and maintain your with Wellness rates all year, you must engage in and graduate from a disease management program or complete the required wellness activities by June 30, 2016, depending upon the program for which you have been identified. Employees (or employees and their spouses, if the spouse is covered) who do not complete the five Wellness Program activities, or graduate from the disease management program will have their premium raised to the higher without Wellness rate, effective August 1, Those in the CDHP who do not satisfy the Wellness Program requirement will not receive the additional wellness contribution to their health savings account in August New Employees: New employees joining Glatfelter on or after November 1, 2015 will be treated as having satisfied the wellness incentive requirements for 2016, therefore will pay the with Wellness rates all year or receive the CDHP wellness incentive contribution to their Health Savings Account. Complete Confidentiality Carewise Health, Inc. is a personal disease management program administrator. Any health information you share with the program is completely confidential, protected by federal law, and cannot be divulged to anyone (including Glatfelter) without your permission. 8

11 Medical Overview - Consumer Driven Health Plans (CDHP) with HSA Eligibility Note: Salaried employees and Non-Union Hourly employees in Fremont are eligible for this plan. Plan Highlights Consumer Driven Health Plan (CDHP) that satisfies the IRSmandated minimum deductible. Health Savings Account with pre-tax company contributions, and optional employee pre-tax contributions. Deductible must be met before the insurance coverage begins. Certain preventive care services are covered at 100% and not subject to the deductible (see the Preventive Care Schedule on pages 21 & 22 for more information). Provides in-network and out-of-network benefits so you may use any provider of your choice. However, benefits are higher if you use an in-network provider. The Claim Administrator is CoreSource. Your network is determined based upon where you live. Those living in specific counties (York, Adams, Franklin, Cumberland, Dauphin, Lebanon and Perry) in central Pennsylvania, will have the South Central Preferred network when seeking care in those counties. All others, and central Pennsylvania residents when seeking care outside of those counties, will have the national Aetna Signature Administrators network. Those local to Chillicothe, OH also have the option of using the GFMC facility. What is a Consumer Driven Health Plan? The CDHP is a traditional medical plan that allows you to pay a lower premium in exchange for a higher deductible. The CDHP includes a Health Savings Account (HSA) that you can use to save money to pay for medical expenses. What is a Health Savings Account (HSA)? A Health Savings Account (HSA) works with a CDHP, and lets you set aside a portion of your paycheck before taxes into an account (in addition to a contribution from Glatfelter) to help you pay for medical expenses before you reach your deductible or for expenses that aren t covered by your plan. It can also help you save for future medical expenses. A Health Savings Account (HSA): Is yours. Funds in your HSA account stay with you, even if you change jobs. And, if you re no longer covered by a CDHP, your account stays active and you can use remaining funds for medical expenses. Reduces your taxable income. The money is tax-free both when you put it in, and when you take it out to cover qualified medical expenses. Helps you plan for the future. Until you turn 65, withdrawals used for eligible expenses are tax free. Withdrawals used for noneligible expenses will be subject to taxes plus a 20% penalty. After you turn 65, or if you become disabled, withdrawals you use for non-eligible expenses will be taxed at your regular income tax rate but won t incur additional penalties. How the CDHP and HSA Work Together You and Glatfelter can deposit money into your HSA up to an annual per person or family limit set by the IRS. Glatfelter will deposit the company contribution evenly throughout the year based upon your pay cycle. (For new hires, Glatfelter s contribution will be prorated.) If enrolling in the CDHP with an HSA for the first time, you will receive information by mail on how to open your HSA account. You must complete the action of opening the account for the funds to be deposited. HSA Contributions Assuming Wellness Completion individual family 2016 IRS Maximum Contribution $3,350 $6,750 (under age 55) Glatfelter Basic Contribution $600 $1,200 Glatfelter Wellness Contribution $300 $600 (if earned and eligible) EE pre-tax Contribution Maximum $2,450 $4,950 (under age 55) Additional EE pre-tax Contribution $1,000 $1,000 (age 55+) (continued on next page) 9

12 Medical Overview - Consumer Driven Health Plans (CDHP) with HSA continued HSA Management When you enroll online and set up your HSA account, you ll be given access to a secure, easy-to-use web portal where you can track your account balance, manage your investment accounts and submit requests for reimbursements. You can change your contribution amount at any time throughout the year by accessing the benefits web site home page as described on page 5. If you do not have access to a computer you may complete a paper enrollment form and submit it to the Glatfelter Benefits Service Center. Changes made throughout the year will be effective as soon as administratively practicable. In addition, you ll be issued a debit card you can use at point-of-sale to pay for approved medical expenses. You can request reimbursement distributions online for any purchases not made with your debit card. Important Considerations Eligibility If you are claimed as a dependent on someone else s taxes or are covered by any other health insurance policies that are not considered Consumer Driven Health Plans, including Medicare and Flexible Spending Accounts, you are not eligible for an HSA. If you participate in a health care FSA or Health Reimbursement Account through your employer or your spouse s employer, you are not eligible for an HSA. You and your spouse can each have an HSA if you both have high deductible coverage. If you have family Consumer Driven Health Plan coverage, the maximum contribution is split equally unless you and your spouse agree on a different division. Notice Regarding Spending HSA Funds on an Adult Dependent Child For group health plans the healthcare reform law has made it possible for parents to keep children up to age 26 on their health plans if they have no other coverage. However, there are special tax laws to consider when using your HSA to pay for expenses of your dependents. HSA funds can only be spent on family members who qualify as tax dependents and who meet the IRS dependent definition of age 19 or up to age 24 if a full time student. 10 If you list a dependent on your federal income tax, then you can use money from your HSA for their eligible expenses. However, if your plan covers adult dependents that are not listed as tax dependents, then you cannot use the tax-free money from your HSA. When the adult dependent child does not qualify as a tax dependent, then any HSA distributions for the child would be taxable, and subject to an IRS penalty. The penalty for using your HSA for expenses that are not qualified will be 20% of the amount you spend. It is very important that you use your HSA only for qualified expenses. Also, be sure you save your receipts and prescriptions for over-the-counter medicines. For additional information about this and other impacts of health care reform, please visit Reimbursement Unlike a Health Care Flexible Spending Account, reimbursement for eligible expenses from an HSA is based solely on the balance in your HSA, not your annual election. You don t have to submit receipts to receive your reimbursement. However, you need to keep receipts and documentation for each year s federal tax return (Form 8889 attached to Form 1040). You can make a withdrawal at any time. Reimbursements for qualified medical expenses are tax-free. If you are disabled or reach age 65, you can receive non-medical distributions without penalty, but you must report the distribution as taxable income. You may also use your funds for a spouse or dependent not covered under your Consumer Driven Health Plan. Timing You are eligible to begin an HSA plan starting on the first day of any month in which you are covered under a qualified high deductible health plan such as the CDHP. If your Consumer Driven Health Plan coverage begins mid-month, your HSA eligibility starts on the first of the following month. An HSA must be set up and the contributions must be made by your tax return due date for the year, not including extensions.

13 NEW PLAN OPTION! CDHP-Basic: Summary of Benefits Service In-Network Out-of-Network You Pay You Pay Calendar Year Deductible $2,500 Individual $5,000 Individual (Medical & Prescription claims apply to deductible) $5,000 2-Party $10,000 2-Party $5,000 Family $10,000 Family The annual deductible does not apply to pediatric and adult preventive care services. The deductibles cross accumulate between In- and Out-of-Network. Annual Out-of-Pocket Maximum $5,000 Individual / $10,000 Family $10,000 Individual / $20,000 Family When you reach the Out-of-Pocket maximum, medical and prescription benefits for the remainder of the calendar year will be paid at 100% of the allowable amount, unless noted. The Out-of-Pocket maximum does not include preauthorization penalties, charges exceeding the allowable amount, expenses incurred after a benefit period is exhausted. The Out-of-Pocket maximum includes deductibles & co-insurance. Lifetime Maximum Unlimited Most Commonly Used Benefits Physician s Office Services Primary Physician Office Visit 10% after Deductible 30% after Deductible Specialist Physician Office Visit 10% after Deductible 30% after Deductible Preventive Care Services Well Child Care 0% No Deductible 30% after Deductible Childhood Immunizations 0% No Deductible 30% after Deductible Adult Physical Exam 0% No Deductible 30% after Deductible Screening GYN Exam 0% No Deductible 30% after Deductible Routine Mammography, Pap, PSA test 0% No Deductible 30% after Deductible Urgent Care Center Services 10% after Deductible 10% after Deductible Emergency Health Services - Outpatient 10% after Deductible 10% after Deductible Hospital - Inpatient Stay 10% after Deductible 30% after Deductible Additional Core Benefits Ambulance Service 10% after Deductible 10% after Deductible Non-emergency not covered Diabetic Supplies & Education 10% after Deductible 30% after Deductible 3 visit maximum Durable Medical Equipment 10% after Deductible 30% after Deductible Home Health Care * 10% after Deductible 30% after Deductible Limited to 90 days per calendar year Health Care Facility - Inpatient * 10% after Deductible 30% after Deductible Hospice Care * 0% after Deductible 30% after Deductible Infusion/IV Therapy 10% after Deductible 30% after Deductible Lab, X-Ray and Diagnostics - Outpatient 10% after Deductible 30% after Deductible Maternity Services - Delivery 10% after Deductible 30% after Deductible Mental Health & Substance Abuse Inpatient * 10% after Deductible 30% after Deductible Outpatient 10% after Deductible 30% after Deductible Therapy Services - Outpatient * 10% after Deductible 30% after Deductible Limited to 90 days per calendar year combined except Chiropractic & Cardiac Rehab. Chiropractic limited to 20 days per calendar year; Cardiac Rehab unlimited days. Surgery 30% after Deductible Physician Office 10% after Deductible Procedure (including anesthesia & related services) * 10% after Deductible * Preauthorization is required. Failure to follow preauthorization requirements will result in a 20% penalty to facility charges. This summary is for descriptive purposes only and should not be relied upon to fully determine coverage. It is not an agreement or a contract. For more detailed information, refer to the Summary Plan Description. 11

14 CDHP-Premier: Summary of Benefits (formerly the Consumer Driven Health Plan) Service In-Network Out-of-Network You Pay You Pay Calendar Year Deductible $1,300 Individual $2,600 Individual (Medical & Prescription claims apply to deductible) $2,600 2-Party $5,200 2-Party $2,600 Family $5,200 Family The annual deductible does not apply to pediatric and adult preventive care services. The deductibles cross accumulate between In- and Out-of-Network. Annual Out-of-Pocket Maximum $3,000 Individual / $6,000 Family $6,000 Individual / $12,000 Family When you reach the Out-of-Pocket maximum, medical and prescription benefits for the remainder of the calendar year will be paid at 100% of the allowable amount, unless noted. The Out-of-Pocket maximum does not include preauthorization penalties, charges exceeding the allowable amount, expenses incurred after a benefit period is exhausted. The Out-of-Pocket maximum includes deductibles & co-insurance. Lifetime Maximum Unlimited Most Commonly Used Benefits Physician s Office Services Primary Physician Office Visit 10% after Deductible 30% after Deductible Specialist Physician Office Visit 10% after Deductible 30% after Deductible Preventive Care Services Well Child Care 0% No Deductible 30% after Deductible Childhood Immunizations 0% No Deductible 30% after Deductible Adult Physical Exam 0% No Deductible 30% after Deductible Screening GYN Exam 0% No Deductible 30% after Deductible Routine Mammography, Pap, PSA test 0% No Deductible 30% after Deductible Urgent Care Center Services 10% after Deductible 10% after Deductible Emergency Health Services - Outpatient 10% after Deductible 10% after Deductible Hospital - Inpatient Stay 10% after Deductible 30% after Deductible Additional Core Benefits Ambulance Service 10% after Deductible 10% after Deductible Non-emergency not covered Diabetic Supplies & Education 10% after Deductible 30% after Deductible 3 visit maximum Durable Medical Equipment 10% after Deductible 30% after Deductible Home Health Care * 10% after Deductible 30% after Deductible Limited to 90 days per calendar year Health Care Facility - Inpatient * 10% after Deductible 30% after Deductible Hospice Care * 0% after Deductible 30% after Deductible Infusion/IV Therapy 10% after Deductible 30% after Deductible Lab, X-Ray and Diagnostics - Outpatient 10% after Deductible 30% after Deductible Maternity Services - Delivery 10% after Deductible 30% after Deductible Mental Health & Substance Abuse Inpatient * 10% after Deductible 30% after Deductible Outpatient 10% after Deductible 30% after Deductible Therapy Services - Outpatient * 10% after Deductible 30% after Deductible Limited to 90 days per calendar year combined except Chiropractic & Cardiac Rehab. Chiropractic limited to 20 days per calendar year; Cardiac Rehab unlimited days. Surgery 30% after Deductible Physician Office 10% after Deductible Procedure (including anesthesia & related services) * 10% after Deductible * Preauthorization is required. Failure to follow preauthorization requirements will result in a 20% penalty to facility charges. 12 This summary is for descriptive purposes only and should not be relied upon to fully determine coverage. It is not an agreement or a contract. For more detailed information, refer to the Summary Plan Description.

15 Medical Overview - PPO Eligibility Note: Salaried employees and Non-Union Hourly employees in Fremont are eligible for this plan. Plan Highlights Preferred Provider Organization (PPO) plan Provides in-network and out-of-network benefits so you may use any provider of your choice. However, benefits are higher if you use an in-network provider. The Claim Administrator is CoreSource. Your network is determined based upon where you live. Those living in specific counties (York, Adams, Franklin, Cumberland, Dauphin, Lebanon and Perry) in central Pennsylvania, will have the South Central Preferred network when seeking care in those counties. All others, and central Pennsylvania residents when seeking care outside of those counties, will have the national Aetna Signature Administrators network. How the Plan Works A PPO is a form of managed care that gives you the flexibility to use any in-network or out-of-network provider of your choice. In-Network Providers Certain doctors, laboratories, hospitals and other providers have agreed to accept set fees for their services, so your out-of-pocket expenses are typically lower. In-network providers will also file claims for you automatically. Out-of-Network Providers You and your covered dependents are free to visit any health care provider you choose. When you use out-of-network providers, you have coverage for most services; however, some services may not be covered. Your out-of-pocket costs may be higher since the Plan pays benefits based on Maximum Reimbursable Charges. * NOTE: The provider may bill you for the difference between the provider s normal charge and the Maximum Reimbursable Charge, in addition to applicable deductibles, copayments and co-insurance. Specialist Referrals You do not need a referral to see a specialist. If your primary physician refers you or a covered dependent to an out-of-network provider, services will be covered at the out-of-network level. You are responsible for ensuring services are performed by in-network providers. Primary Care Provider - The PPO Plan allows the designation of a primary care provider. You have the right to designate any primary care provider who participates in our network and who is available to accept you or your family members. For children, you may designate a pediatrician as the primary care provider. Obstetric or Gynecological Care You do not need prior authorization from the group health plan or from any other person (including a primary care provider) in order to obtain access to obstetrical or gynecological care from a health care professional in our network who specializes in obstetrics or gynecology. The health care professional, however, may be required to comply with certain procedures, including obtaining prior authorization for certain services, or following a pre-approved treatment plan. * Maximum Reimbursable Charge is determined based on the lesser of the provider s normal charge for a similar service or supply; or a percentage of charges made by providers of such service or supply in the geographic area where the service is received. For information on how to select a primary care provider, and for a list of the participating primary care providers and participating health care professionals, visit 13

16 PPO: Summary of Benefits Plan changes are indicated in red. Service In-Network Out-of-Network You Pay You Pay Calendar Year Deductible $800 Individual $1,600 Individual $1,600 2-Party $3,200 2-Party $2,400 Family $4,800 Family The annual deductible does not apply to emergency or urgent care services, pediatric and adult preventive care services and office visits with a copay as noted. The deductibles cross accumulate between In- and Out-of-Network. Annual Out-of-Pocket Maximum Individual 2-Party/Family Individual 2-Party/Family Medical $2,800 $6,000 $5,400 $10,800 Prescription $4,050 $7,700 N/A N/A Lifetime Maximum Unlimited Most Commonly Used Benefits Physician s Office Services Primary Physician Office Visit $30 copay 50% after Deductible Specialist Physician Office Visit $60 copay 50% after Deductible Preventive Care Services Well Child Care 0% 0% Childhood Immunizations 0% 0% Adult Physical Exam 0% 0% Screening GYN Exam 0% 0% Routine Mammography, Pap, PSA test 0% 0% Urgent Care Center Services $75 copay $75 copay Emergency Health Services - Outpatient $125 copay $125 copay (except if not a true emergency, then 50% after Deductible) Hospital - Inpatient Stay * 20% after Deductible 50% after Deductible Additional Core Benefits Ambulance Service 0% 0% (except if not a true emergency, then 50% after Deductible) Diabetic Supplies & Education 20% after Deductible 50% after Deductible 3 visit maximum Durable Medical Equipment 20% after Deductible 50% after Deductible Home Health Care * 20% No Deductible 50% No Deductible Limited to 90 days per calendar year Health Care Facility - Inpatient * 20% after Deductible 50% after Deductible Hospice Care * 0% No Deductible 50% after Deductible Infusion/IV Therapy 20% after Deductible 50% after Deductible Lab, X-Ray and Diagnostics - Outpatient 20% after Deductible 50% after Deductible Maternity Services - Delivery 20% after Deductible 50% after Deductible Mental Health & Substance Abuse Inpatient * 20% after Deductible 50% after Deductible Outpatient $30 copay 50% after Deductible Therapy Services - Outpatient * $30 copay Primary / $60 Specialist 50% after Deductible Limited to 90 days per calendar year combined except Chiropractic & Cardiac Rehab. Chiropractic limited to 20 days per calendar year; Cardiac Rehab unlimited days. Surgery Physician Office $30 copay Primary / $60 Specialist 50% after Deductible Procedure (including anesthesia & related services) * 20% after Deductible 50% after Deductible 14 * Preauthorization is required. Failure to follow preauthorization requirements will result in a 20% penalty to facility charges. When you reach the Out-of-Pocket maximum, medical and prescription benefits for the remainder of the calendar year will be paid at 100% of the allowable amount, unless noted. The Out-of-Pocket maximum does not include preauthorization penalties, charges exceeding the allowable amount, expenses incurred after a benefit period is exhausted. Out-of- Pocket maximums cross accumulate between In- and Out-of-Network. The Out-of-Pocket maximum includes copays, deductibles & co-insurance. This summary is for descriptive purposes only and should not be relied upon to fully determine coverage. It is not an agreement or a contract. For more detailed information, refer to the Summary Plan Description.

17 Medical Overview - PCP Eligibility Note: Only Salaried employees in Pennsylvania are eligible for this plan. Plan Highlights Primary Care Plan (PCP) Provides in-network benefits only. If you choose an out-ofnetwork provider, there is no coverage and you will pay the full cost of the services received. The Claim Administrator is CoreSource. Your network is determined based upon where you live. Those living in specific counties (York, Adams, Franklin, Cumberland, Dauphin, Lebanon and Perry) in central Pennsylvania will have the South Central Preferred network when seeking care in those counties. All others, and central Pennsylvania residents when seeking care outside of those counties, will have the national Aetna Signature Administrators network. How the Plan Works A PCP is a form of managed care where you can use any innetwork provider only. Primary Care Provider The PCP Plan allows the designation of a primary care provider. You have the right to designate any primary care provider who participates in our network and who is available to accept you or your family members. For children, you may designate a pediatrician as the primary care provider. Obstetric or Gynecological Care You do not need prior authorization from the group health plan or from any other person (including a primary care provider) in order to obtain access to obstetrical or gynecological care from a health care professional in our network who specializes in obstetrics or gynecology. The health care professional, however, may be required to comply with certain procedures, including obtaining prior authorization for certain services, or following a pre-approved treatment plan. For information on how to select a primary care provider, and for a list of the participating primary care providers and participating health care professionals, visit In-Network Providers Certain doctors, laboratories, hospitals and other providers have agreed to accept set fees for their services, so your out-of-pocket expenses are typically lower. In-network providers will also file claims for you automatically. Out-of-Network Providers There is no coverage for outof-network providers. You will pay the full cost for services received. Specialist Referrals You do not need a referral to see a specialist. If your primary physician refers you or a covered dependent to an out-of-network provider, services will not be covered. You are responsible for ensuring services are performed by in-network providers. 15

18 PCP: Summary of Benefits Plan changes are indicated in red. Service In-Network Out-of-Network You Pay You Pay Calendar Year Deductible $300 Individual N/A $600 2-Party $900 Family The annual deductible does not apply to emergency or urgent care services, pediatric and adult preventive care services and office visits with a copay as noted. Annual Out-of-Pocket Maximum Individual 2-Party/Family Individual 2-Party/Family Medical $2,400 $4,800 N/A N/A Prescription $4,450 $8,900 N/A N/A Lifetime Maximum Unlimited Most Commonly Used Benefits Physician s Office Services No coverage Primary Physician Office Visit $20 copay Specialist Physician Office Visit $50 copay Preventive Care Services No coverage Well Child Care 0% Childhood Immunizations 0% Adult Physical Exam 0% Screening GYN Exam 0% Routine Mammography, Pap, PSA test 0% Urgent Care Center Services (Copay waived if admitted) $50 copay $50 copay Emergency Health Services - Outpatient (Copay waived if admitted) $100 copay $100 copay (except if not a true emergency, then 50% after Deductible) Hospital - Inpatient Stay 20% after Deductible No coverage Additional Core Benefits Ambulance Service 0% 0% (except if not a true emergency, then 50% after Deductible) Diabetic Supplies & Education 20% after Deductible No coverage 3 visit maximum Durable Medical Equipment 20% after Deductible No coverage Home Health Care * 20% No Deductible No coverage Limited to 100 days per calendar year Health Care Facility - Inpatient * 20% after Deductible No coverage Hospice Care * 0% No Deductible No coverage Infusion/IV Therapy 20% after Deductible No coverage Lab, X-Ray and Diagnostics - Outpatient 20% after Deductible No coverage Maternity Services - Delivery 20% after Deductible No coverage Mental Health & Substance Abuse Inpatient * 20% after Deductible No coverage Outpatient Physician Office $20 copay No coverage Outpatient Facility 20% after Deductible No coverage Therapy Services - Outpatient * $20 copay Primary / $50 Specialist No coverage Limited to 90 days per calendar year combined except Chiropractic & Cardiac Rehab. Chiropractic limited to 20 days per calendar year; Cardiac Rehab unlimited days. Surgery No coverage Physician Office $20 copay Primary / $50 Specialist Procedure (including anesthesia & related services) * 20% after Deductible 16 * Preauthorization is required. Failure to follow preauthorization requirements will result in a 20% penalty to facility charges. When you reach the Out-of-Pocket maximum, medical and prescription benefits for the remainder of the calendar year will be paid at 100% of the allowable amount, unless noted. The Out-of-Pocket maximum does not include preauthorization penalties, charges exceeding the allowable amount, expenses incurred after a benefit period is exhausted. The Out-of- Pocket maximum includes copays, deductibles & co-insurance. This summary is for descriptive purposes only and should not be relied upon to fully determine coverage. It is not an agreement or a contract. For more detailed information, refer to the Summary Plan Description.

19 Medical Overview - GFMC Eligibility Note: Only Salaried employees in Chillicothe, Ohio are eligible for this plan. Plan Highlights Managed care plan provided to Ohio Operations employees who work or reside in the Chillicothe area. The Plan uses the providers of the Glatfelter Family Medical Center with services you receive being covered 100 percent after you pay a $5 copay. Services received at the Center are not subject to the deductible. Provides in-network benefits only. The network is the national Aetna Signature Administrators. If you choose an out-of-network provider, there is no coverage and you will pay the full cost of the services received. The Claim Administrator is CoreSource. Preventive services provided by the Glatfelter Family Medical Center or Aetna Signature Administrators providers are covered 100 percent by the Plan. How the Plan Works You and your covered family members must designate a primary care physician (PCP). Your PCP will manage your overall care and recommend you to specialist care when needed. At least one covered person from your family must designate the Glatfelter Family Medical Center as your primary care practice. Then, other family members may designate a physician or practice from the Aetna Signature Administrators network. If a physician is not designated within 60 days after enrolling in the Family Medical Center Plan, the Plan will designate the Glatfelter Family Medical Center as your PCP. In-Network Providers Doctors, laboratories, hospitals and other providers who participate in the Plan s designated network (Aetna Signature Administrators) have agreed to provide services at set fees, referred to as the maximum reimbursable charge. In-network providers will also file claims for you automatically. Out-of-Network Providers There is no coverage for outof-network providers. You will pay the full cost for services received. Specialist Referrals You do not need a referral from your PCP to see a specialist. If your primary care physician refers you or a covered dependent to an out-of-network provider, services will not be covered. You are responsible for ensuring services are performed by in-network providers. Obstetric or Gynecological Care You do not need prior authorization from the group health plan or from any other person (including a primary care provider) in order to obtain access to obstetrical or gynecological care from a health care professional in our network who specializes in obstetrics or gynecology. The health care professional, however, may be required to comply with certain procedures, including obtaining prior authorization for certain services, or following a pre-approved treatment plan. For information on how to select a primary care provider, and for a list of the participating primary care providers and participating health care professionals, visit 17

20 GFMC: Summary of Benefits Service In-Network, You Pay Out-of-Network, You Pay Calendar Year Deductible $400 Individual N/A $800 2-Party $1,200 Family The annual deductible is waived for services provided by the Glatfelter Family Medical Center. The annual deductible does not apply to most in-network primary care physician services or preventive/wellness care if provided by the Glatfelter Family Medical Center or Aetna Signature Administrators providers. Unless otherwise specified in this chart, you must satisfy the deductible for all other services. Annual Out-of-Pocket Maximum Individual 2-Party/Family Individual 2-Party/Family Medical $2,400 $4,800 N/A N/A Prescription $4,200 $8,400 N/A N/A Lifetime Maximum Unlimited Covered Physician Services Family Aetna Signature Medical Center Administrators Out-of-Network Network Most Commonly Used Benefits Physician s Office Visit $5 copay Primary $20 copay Primary / $50 Specialist No coverage Lab, X-Ray and Diagnostics - Outpatient 0% 20% after Deductible No coverage Preventive Care Services No coverage Well Child Care 0% 0% Childhood Immunizations 0% 0% Adult Physical Exam 0% 0% Screening GYN Exam 0% 0% Routine Mammography, Pap, PSA test 0% 0% Covered Facility & Professional Services In-Network, You Pay Out-of-Network, You Pay Urgent Care Center Services (Copay waived if admitted) $75 copay $75 copay (non-emergency: 50% after Ded.) Emergency Health Services - Outpatient (Copay waived if admitted) $125 copay $125 copay Hospital - Inpatient Stay * 20% after Deductible No coverage Additional Core Benefits Ambulance Service 0% 0% after Deductible (non-emergency: 50% after Ded.) Diabetic Supplies & Education 20% after Deductible No coverage 3 visit maximum Durable Medical Equipment 20% after Deductible No coverage Home Health Care * 20% No Deductible No coverage Limited to 90 days per calendar year Health Care Facility - Inpatient * 20% after Deductible No coverage Limited to 100 days per calendar year, combined Hospice Care - Inpatient & Outpatient * 0% No Deductible No coverage Infusion/IV Therapy 20% after Deductible No coverage Maternity Services - Delivery 20% after Deductible No coverage Mental Health & Substance Abuse Inpatient * 20% after Deductible No coverage Outpatient Physician Office $20 copay No coverage Outpatient Facility 20% after Deductible No coverage Therapy Services - Outpatient * $20 copay Primary / $50 Specialist No coverage Limited to 90 days per calendar year combined except Chiropractic & Cardiac Rehab. Chiropractic limited to 20 days per calendar year; Cardiac Rehab unlimited days. Surgery No coverage Physician Office $20 copay Primary / $50 Specialist Procedure (including anesthesia & related services) * 20% after Deductible * Preauthorization is required. Failure to follow preauthorization requirements will result in a 20% penalty to facility charges. 18 When you reach the Out-of-Pocket maximum, medical and prescription benefits for the remainder of the calendar year will be paid at 100% of the allowable amount, unless noted. The Out-of-Pocket maximum does not include preauthorization penalties, charges exceeding the allowable amount, expenses incurred after a benefit period is exhausted. The Outof-Pocket maximum includes copays, deductibles & co-insurance. This summary is for descriptive purposes only and should not be relied upon to fully determine coverage. It is not an agreement or a contract. For more detailed information, refer to the Summary Plan Description.

21 Prescription Drug Plans Plan Highlights You automatically receive prescription drug coverage when you enroll in the Medical Plan. The Plan provides quality, cost-effective prescription drug benefits through CVS Caremark or the GFMC. Because of a health care reform law change, your innetwork prescription claims costs are subject to a maximum amount. (See Annual Out-of-Pocket Maximum under each Plan Summary of Benefits.) There is no annual deductible (except in the case of the CDHP). Retail and mail-order services are available at the Glatfelter Family Medical Center Pharmacy and through CVS Pharmacies. How the Plan Works Retail Service Prescriptions can be filled at the Glatfelter Family Medical Center Pharmacy or any participating CVS Caremark network pharmacy. Participating pharmacies include many large chain pharmacies, such as Wal-Mart and Walgreen s, as well as many independent pharmacies. When you use the retail service, you receive up to a 30-day supply and pay a copay or percentage of the total cost. Mail-Order Service The CVS Caremark mail-order pharmacy provides a convenient and cost-effective way to purchase prescriptions of maintenance drugs, such as those used on a regular basis, usually over a long period of time. Examples include, but are not limited to, drugs used to treat high blood pressure, high cholesterol or diabetes. You must either use the mail-order pharmacy, a local CVS Pharmacy or the Glatfelter Family Medical Center pharmacy in Ohio for up to 90-day supplies of maintenance prescriptions. However, you will be allowed up to two 30-day supplies through retail service before you are required to transition to mail-order service or a CVS Pharmacy. If you use mail order, the prescriptions are mailed to your home, or any address requested, postage paid. How to File a Prescription Claim You will receive an ID card that will contain information regarding prescription benefits. Present your ID card to the pharmacist. Both retail and mail-order prescriptions are processed at time of purchase. If you purchase a retail prescription without your drug card or from a nonparticipating pharmacy, you will need to file a paper claim for reimbursement. Contact CVS Caremark at or log on to for a copy of the claim form, as well as instructions on filing a claim. You must submit a completed claim form within one year from the date the services are rendered or the claim will be denied. medicare PART d The prescription drug benefit under the PPO, PCP and GFMC plans is creditable coverage. Prescription drug coverage is considered to be creditable when, on average for all plan participants, the plan s drug coverage is expected to pay out as much as the standard Medicare prescription drug coverage will pay. Medicare-eligible participants need not enroll in a separate Medicare D drug plan. The prescription drug benefit under the Consumer Driven Health Plan is not creditable coverage. Prescription drug coverage is considered to be non-creditable when, on average for all plan participants, the plan s drug coverage is NOT expected to pay out as much as the standard Medicare prescription drug coverage will pay. Please plan accordingly as this may affect your cost should you select a Medicare D plan in the future. (continued on next page) 19

22 Prescription Drug Plans continued Plan changes are indicated in red. You automatically receive prescription drug coverage when you enroll in a medical plan. CVS Caremark Note: Two 30-day fills are allowed at retail pharmacy first; then required to use mail order or a CVS Pharmacy for maintenance drugs. Retail Pharmacy (30-day maximum supply) Generic $10 copay Preferred 25% co-insurance, $15 minimum Non-preferred 35% co-insurance, $30 minimum Lifestyle 100% copay Mail-Order or CVS Pharmacy Maintenance Drugs (90-day maximum supply) Generic $25 copay Preferred 25% co-insurance, $30 minimum Non-preferred 35% co-insurance, $60 minimum Lifestyle 100% copay Specialty Medications - Caremark Specialty Drug (30-day maximum supply) $100 per prescription maximum or $1,200 annual maximum, whichever comes first Glatfelter Family Medical Center Pharmacy (Available with the CDHP, PPO or GFMC plans in Ohio) Note: Two 30-day fills are allowed at retail pharmacy first; then required to use mail order or a Glatfelter Family Medical Center Pharmacy for maintenance drugs. Up to 30-day Supply Generic $5 copay Preferred $15 copay Non-preferred 35% co-insurance, $30 minimum Lifestyle 100% copay 90-day Supply Generic $10 copay Preferred $30 copay Non-preferred 35% co-insurance, $60 minimum Lifestyle 100% copay For those enrolled in the Consumer Driven Health Plan with HSA, your prescription drugs are subject to your deductible before your applicable copay/co-insurance applies. 20

23 Preventive Care Services Your plan focuses on helping to keep you well, not just providing coverage for illness or injury. Preventive care such as physician exams, immunizations and screenings are covered at 100% when you receive these services from a participating doctor. Adult Care (Ages 19 and over) SERVICE Routine History and Physical Exam Includes pertinent patient education and counseling; prenatal visits Counseling Sexually Transmitted Infections HIV Counseling Contraceptive Education and Counseling Interpersonal and Domestic Violence Breastfeeding Support Screenings Pap Smear / Pelvic Exam Gestational Diabetes Human Papillomavirus (HPV) DNA testing Chlamydia / Gonorrhea Tests (women) HIV Test Fasting Lipid Profile Fasting Glucose Fecal Occult Blood Test Flexible Sigmoidoscopy or Colonoscopy Prostate Specific Antigen (PSA) Bone Mineral Density (women) Mammogram Abdominal Ultrasound (to screen for abdominal aortic aneurysm) Immunizations (as age appropriate) Includes: Tetanus/Diphtheria (Td); Hepatitis A; Hepatitis B; Meningococcal (MCV4/MPSV4); Measles/Mumps/Rubella (MMR); Chickenpox (VZV); Influenza; Pneumococcal (PPV); Human Papillomavirus (HPV); Herpes Zoster (Shingles) PREVENTIVE BENEFIT COVERAGE Per doctor s recommendations Per doctor s recommendations Per doctor s recommendations Per doctor s recommendations Per doctor s recommendations Per doctor s recommendations Per doctor s recommendations Per doctor s recommendations Age 30+, per doctor s recommendations Per doctor s recommendations Per doctor s recommendations Age 20+, per doctor s recommendations Age 45+, per doctor s recommendations Age 50+, per doctor s recommendations Age 50+, per doctor s recommendations Age 50+, per doctor s recommendations Age 60+, per doctor s recommendations Age 40+, per doctor s recommendations Ages 65-75, one-time screening for high risk men These preventive health services are based upon recommendations from the Advisory Committee on Immunization Practices, U.S. Preventive Services Task Force, American Academy of Pediatrics, and other nationally recognized authorities. Other FDA approved contraceptive methods and sterilization procedures. Breast feeding supplies, including cost of renting breast feeding equipment. (continued on next page) 21

24 Preventive Care Services continued Pediatric Care (Birth through age 18)* SERVICE Routine History and Physical Exam Exams may include: newborn screening; height, weight and blood pressure measurements; sensory screening for vision and hearing Screenings May include, but is not limited to: newborn screenings for PKU, sickle cell, hemoglobinopathies, and hypothyroidism; lead screening, hemoglobin and hematocrit, urinalysis, lipid screening, tuberculin test, Pap test and screening for sexually transmitted disease (when indicated). Immunizations Includes: Tetanus/Diphtheria (Td); Hepatitis A; Hepatitis B; Meningococcal (MCV4/MPSV4); Measles/Mumps/Rubella (MMR); Chickenpox (VZV); Influenza; Pneumococcal (PPV); Human Papillomavirus (HPV); Herpes Zoster (Shingles) PREVENTIVE BENEFIT COVERAGE - As a newborn and within 3 to 5 days of birth and within 48 to 72 hours after discharge from the hospital; - At months 1, 2, 4, 6, 9, 12, 15, 18, 24 and 30; and - Ages 3 18 annually. These preventive health services are based upon recommendations from the Advisory Committee on Immunization Practices, U.S. Preventive Services Task Force, American Academy of Pediatrics, and other nationally recognized authorities. These preventive health services are based upon recommendations from the Advisory Committee on Immunization Practices, U.S. Preventive Services Task Force, American Academy of Pediatrics, and other nationally recognized authorities. *Mandated childhood immunizations are covered through age 20, in accordance with state law. These charts contain only highlights of preventive health services and do not guarantee coverage for all preventive services. Remember, ONLY preventive screenings are covered at 100% at a participating provider. Diagnostic services fall under the diagnostic services benefit and may be subject to a deductible and co-insurance. For example, if you have a routine (screening) colonoscopy and during the procedure a condition is discovered, it then becomes diagnostic and you may owe the diagnostic deductibles and coinsurance. The specific terms of coverage, exclusions and limitations, is included in the Summary Plan Description or Insurance Certificate. 22

25 Dental - Delta Dental Plan Highlights Provides comprehensive dental coverage with both innetwork and out-of-network coverage. The Dental Plan is administered by Delta Dental of Pennsylvania. How the Plan Works The Dental Plan allows you to see any dentist you choose, but to receive the highest level of savings you should use a dental provider from the Delta Dental PPO SM network of preferred provider dentists. How to Find Network Providers There are several ways to find network providers: Go online to Call customer service at Call the Glatfelter Benefits Service Center at PAPER ( ). It is recommended that you call your provider s office prior to services being performed to verify the provider belongs to the Delta Dental PPO and/or Premier network. Claim Administrator Delta Dental of Pennsylvania One Delta Drive Mechanicsburg, PA Phone: or Services In-Network, You Pay Out-of-Network, You Pay (Delta Dental PPO or (Non-participating) Delta Dental Premier) Maximums and Deductibles Lifetime Orthodontic Per Person Maximum $1,500 Annual Per Person Maximum $1,500 Calendar Year Per Person Deductible $50 Individual/$150 Family Diagnostic & Preventive Services 0% of Allowed Amount, 20% of Allowed Amount, Exams, X-rays, Cleanings, Space Maintainers not subject to deductible not subject to deductible Sealants (to age 14) 0% of Allowed Amount, 10% of Allowed Amount, not subject to deductible not subject to deductible Basic 20% of Allowed Amount, 40% of Allowed Amount, Basic Restorative, Endodontics, Periodontics, after deductible after deductible Oral Surgery, General Anesthesia, Repair & Relining of Existing Dentures, Repair & Recementation of Existing Crowns Major 50% of Allowed Amount, 60% of Allowed Amount, Inlays, Onlays, Crowns, Prosthodontics, Bridges, after deductible after deductible Dentures, Major Restorative Orthodontics (dependents to age 19) 50% of Allowed Amount, 50% of Allowed Amount, not subject to deductible not subject to deductible 23

26 Vision Plans - NVA & VSP Plan Highlights The Vision Plan is an optional benefit. If you choose to enroll in vision, you must select one of the two networks available: National Vision Administrators (NVA) or Vision Service Plan (VSP). Provides coverage for eye exams and most frames and lenses, as well as services from in-network or out-ofnetwork providers. Coverage is also available toward your contact lenses and fitting if you choose contacts instead of glasses. Discounts are available on additional supplies and services if received from a network provider. How the Plans Work Vision benefits are designed to protect your visual wellness by offering eye exams and prescription eyewear. Participating providers if your provider is a participating provider, you will have a higher benefit. The participating private practitioner or retail provider will be responsible for applying the plan allowances and copays. Non-participating providers if you use a nonparticipating provider for your vision care services, your benefit will be reduced. You will be responsible for all charges payable at the time of service. You must submit an itemized receipt to your vision carrier to be reimbursed according to the out-of-network reimbursement schedule. How to Find Network Providers To find an NVA participating provider, visit the NVA Web site at or call If you are not yet registered on the NVA web site, enter the group number found on your NVA Member ID card, or use the group number where prompted. To find a VSP participating provider, visit the VSP website at or call To register on the VSP website, enter the last four digits of your social security number. Filing a Claim If you use an out-of-network provider, you must submit a claim to be reimbursed. You may obtain a claim form through the Web site. Submit the claim form with the original copy of the provider s bill. You must submit a completed claim form within one year from the date the services are rendered or the claim will be denied. NVA VSP NVA Claims Dept. VSP PO Box 2187 PO Box Clifton, NJ Sacramento, CA (continued on next page) 24

27 Vision Plans Summary of Benefits continued Plan changes are indicated in red. NVA Plan Services From NVA Provider From Non-Network Provider Eye Exam One per calendar year Plan pays 100% after $15 copay Plan reimburses up to $45 Lenses One per calendar year Plan pays 100% after $15 copay Plan reimburses up to: Single Vision $45 Bifocal Standard $65 Trifocal Standard $85 Aphakic/Lenticular $80 Frames One per calendar year Plan pays up to $120 Plan reimburses up to $47 Contacts One per calendar year Plan pays maximum $120 toward Plan reimburses up to $105 In lieu of glasses contact lens fitting & contacts Value Added Discount on additional glasses, Plan provides 20% discount No discount sunglasses, safety glasses, contact lens solution, and/or optical supplies. Lasik Surgery Plan provides retail discount No discount VSP Plan Services From VSP Provider From Non-Network Provider Eye Exam One per calendar year Plan pays 100% after $15 copay Plan reimburses up to $45 Lenses One per calendar year Plan pays 100% after $15 copay Plan reimburses up to: Single Vision $45 Bifocal Standard $65 Trifocal Standard $85 Aphakic/Lenticular $100 Frames One per calendar year Plan pays up to $120 Plan reimburses up to $70 Contact Lens Exam & Fitting One per calendar year $60 copay In lieu of glasses Contact Lenses One per calendar year Plan pays maximum $120 In lieu of glasses Plan reimburses up to $105 for exam and contacts Value Added Discount on additional glasses, sunglasses Plan provides 20% discount No discount Lasik Surgery Plan provides retail discount No discount 25

28 Flexible Spending Accounts (FSAs) How the Plan Works FSAs are a way for you to pay for certain health care and dependent care expenses with before-tax dollars. You pay no federal, Social Security and, depending on where you work and live, no state, or local income taxes on the money you set aside to pay these expenses. (In Pennsylvania, you pay state income tax on dependent care FSA contributions.) The Internal Revenue Service (IRS) determines which expenses are eligible for FSAs. Use or Lose It Your health care and dependent care FSAs are separate accounts. You cannot use the money from your dependent care FSA to pay for health care expenses, or vice versa. Federal regulations require that if at the end of the year you have not spent all the money in your FSA for eligible expenses, you must forfeit your remaining balance. The money left in one account cannot be used to cover expenses in the other. Health Care FSA Rollover: Specific to the Health Care FSA (HCFSA) program, and for each subsequent plan year, HCFSA plan participants will have the ability to roll-over up to $500 of unused HCFSA funds to the next HCFSA plan year. The roll-over will happen after the end of the claims submission deadline and will only happen for participants that continue to participate in the HCFSA in the subsequent plan year. This rollover will not affect your annual limit of $2,550. You may still elect the maximum limit of $2,550, and spend that during the plan year as well as any roll-over funds. Health Care FSA A health care FSA can be used to pay for eligible health care expenses for your spouse (determined under federal law), or for anyone who qualifies as your dependent for federal income tax purposes. In addition, for this purpose only, dependent also includes anyone who would qualify as your dependent for federal income tax purposes except that he or she files a joint income tax return with another person for the current year, or has income in excess of the IRS personal exemption amount (refer to for the current year s amount). Examples of eligible health care expenses include charges applied to your or your dependent s deductible, co-insurance amounts, dental, vision, hearing expenses, and other outof-pocket costs. Your FSA cannot be used to pay medical premiums. Note: Your spouse and dependents eligible FSA expenses can be covered regardless of whether they are enrolled in your medical coverage or not. Maximum Contribution Amount The maximum amount you may contribute to a health care FSA is $2,550 per year (minimum of $240 per year). Your FSA election is effective for one calendar year, from January 1 through December 31, or in the case of a new hire, from the date of election until December 31. Reimbursement of Health Care Expenses You may submit claims through March 31 of the following year for eligible health care expenses that were incurred any time during the prior Plan year. The entire amount you elect is available on the first day of coverage. However, federal regulations require that, if at the end of the year you have not spent all the money in your account for eligible health care expenses, you will forfeit your remaining balance, subject to the $500 rollover previously noted. Dependent Care FSA A dependent care FSA can be used to pay eligible, nonmedical dependent care expenses incurred for the care of eligible dependents while you and your spouse work, or attend school full time. An eligible dependent for purposes of the dependent care FSA (as defined under federal law) is someone who is: your child (including a stepchild), brother, sister, stepbrother or stepsister (or a descendent of any of those, such as your 26 Employees enrolled in the Consumer Driven Health Plan with HSA are not eligible to enroll in a Health Care FSA.

29 Flexible Spending Accounts (FSAs) continued grandchild, niece or nephew) who is under the age of 13, has the same principal residence as you for at least half of the tax year, and depends on you for at least half of his or her own support for the current calendar year; your spouse (for purposes of federal law) who is physically or mentally incapable of taking care of himself or herself and who has the same principal residence as you for at least half of the tax year; or anyone who is your dependent for federal income tax purposes and who is physically or mentally incapable of taking care of himself or herself and who has the same principal residence as you for at least half of the tax year. For the dependent care FSA, dependent also includes anyone who would qualify as your dependent for federal income tax purposes except that he or she files a joint income tax return with another person for the current year, or has income in excess of the IRS personal exemption amount (refer to for the current year s amount). You are responsible for determining if someone is your dependent for purposes of the FSA. If you have any question about whether someone qualifies as your dependent, you should consult a tax advisor. Note that the determination of whether someone is an eligible dependent must be made each time expenses are incurred. For example, if your child is age 12 at the start of the calendar year, otherwise eligible expenses for that child can be reimbursed under the dependent care FSA only for services provided before the child s 13th birthday (unless the child is mentally or physically incapable of taking care of himself or herself). Dependent Care IRS Code Limitations The Internal Revenue Code governs the maximum contribution amount to a dependent care FSA. Your maximum contribution amount cannot be more than the smaller of: your income or your spouse s income, whichever is smaller (Note: for any month in which your spouse is a full-time student or is incapable of self-care, your spouse is considered to earn $250 per month with one dependent, or $500 per month with two or more dependents); $5,000 per year if your tax filing status is married filing jointly or single head of household ; or $2,500 per year if your tax filing status is married filing separately ; Minimum of $240 per year. Reimbursement of Dependent Care Expenses You may submit claims through March 31 of the following year for eligible dependent care expenses incurred any time during the prior Plan year. However, the timing of your reimbursement will depend on whether there is enough money in your dependent care FSA to cover the full amount of your claim at the time the claim is processed and when the services are rendered. If there is enough money based on contributions you have made to that date, you will receive a check reimbursing you for the full amount of your claim assuming the dates of service you paid for have already occurred. If you pre-pay your dependent care expenses, your reimbursement will not be issued until the dates of service occur. If you do not have enough money in your dependent care FSA to be reimbursed the full amount requested, you will receive a partial payment, and the balance will be paid automatically as new contributions are posted to your account from your before-tax payroll deductions. How to File an FSA Reimbursement Reimbursement requests can be submitted by toll-free fax, or mail. Choose direct deposit for fast and convenient reimbursement. Manage your FSA account(s) online at You may view detailed information such as your account balance, claim status and reimbursement information. Simply submit a Request for Reimbursement via the online MyTASC Mobile App or Request for Reimbursement form in MyTASC (click Request a Reimbursement Form from the home page), or fax or mail your personalized Request for Reimbursement Form with substantiation to TASC. (continued on next page) 27

30 Flexible Spending Accounts (FSAs) continued MyTASC Mobile App The MyTASC Mobile app provides the simplest and quickest method to request a reimbursement. Simply enter the required information as prompted and attach your receipt to the Request for Reimbursement by taking a photo using your mobile device camera. Online Request for Reimbursement It s easy to submit reimbursement requests along with substantiation online! Follow these steps: 1. Log in to your MyTASC account and click Request a Reimbursement. 2. Enter all required information (Service Type, Submitted For [select your name if the dependent that incurred the expense is not listed], Date [of service], Description, Provider, Amount Requested). 3. Add documentation by drag and drop or upload receipts (attach a scanned document: jpg, png, tif, or pdf). 4. Review your request carefully to ensure its accuracy, then Add Another Request or click Submit Request(s). FSA claim forms can be obtained from the TASC Benefits Web site when you log into your account at Completed forms can be mailed to: TASC PO BOX 7308 Madison, WI or Faxed to: FSA reimbursements can be made only for expenses incurred in the year in which contributions were made to the FSA. Expenses are considered incurred on the date the service was performed, not the date the bill was received or paid. Debit Card Processing If you are newly enrolled in the health care FSA, you will receive a TASC Card pre-loaded with your calendar year health care FSA amount. If you enrolled in a prior year, your new election will be loaded onto your existing card. Full instructions for use will be included when you receive the card. The TASC Card can be used to pay for eligible medical expenses with health care FSA dollars at the point of service. The TASC Card gives you the convenience of immediate reimbursement, but it can only be used to pay eligible medical expenses that have not been reimbursed under any other health plan. Make Note! When you use the TASC Card you need to save your receipts. The Claim Administrator is required to audit card usage and, therefore, will request that you submit documentation confirming the date of the expense, service or purchase and the name of the provider. If you fail to submit the required documentation, your TASC Card may be deactivated. Additionally, your TASC Card may be suspended if you use the card for ineligible medical expenses. The debit card may only be used at non-healthcare related merchants that have an Inventory Information Approval System (IIAS). When using the card at merchants utilizing IIAS, the card may only be used for eligible expenses as defined by IRS Code Section 213(d). There are no changes for any other type of merchant (doctors, dentists, chiropractors, vision centers, etc.). You may find a list of non-healthcare related merchants who utilize the Inventory Information Approval System at Your debit card cannot be used for over the counter medicines or drugs. The TASC Card is good for three years from the date of issuance. You should retain the card for those three years. 28

31 Basic Life and AD&D Insurance - Unum Plan Highlights Company-provided benefit at no cost to you. Pays a benefit in the event of your death or accidental dismemberment. Coverage is equal to one time your annual base pay, rounded up to the next $1,000 not to exceed $1 million. Provides equal amounts of life and AD&D insurance. Coverage over $50,000 is treated as imputed income for Federal tax purposes. How the Plan Works In the event of your death, Basic Life provides a benefit to your beneficiary in an amount equal to one time your annual base pay, unless you elect to reduce your coverage to avoid imputed tax. If your death is the result of an accident, AD&D provides an additional benefit to your beneficiary equal to your Basic Life benefit. Benefits are also payable for accidental loss of sight, speech, hearing or limb. Death benefits are paid to the designated beneficiary. Loss of limb, sight, speech and hearing benefits are paid to you. Beneficiary When you enroll in the life insurance plans, you must name a beneficiary to receive the benefit in the event of your death. You do not need to name the same beneficiary(ies) for each Plan. You may name any one person, or you may have more than one beneficiary. Also, you may change your beneficiary by contacting the Glatfelter Benefits Service Center or by accessing the benefits website home as described on page 5. Click Beneficiaries located under the heading My Profile. If you have not named a beneficiary, or if your beneficiary is not living, at the time of your death, the death benefit will be paid in accordance with the policy provisions. Accelerated Death Benefit The accelerated death benefit provision enables eligible, covered employees to receive a portion of the life insurance benefit if a terminal illness has been diagnosed with a life expectancy of 12 months or less. The accelerated death benefit is available only after a licensed physician has certified that the covered individual s life expectancy is less than twelve months. The accelerated death benefit pays a lump sum benefit equal to 80 percent of your Basic Life and Optional Life coverage, up to $500,000. An accelerated death benefit payment permanently reduces your life insurance coverage amounts. Portability Plan If your coverage under the Basic Life plan ends for a reason other than disability, failure to pay premiums, or termination of the group contract, you may apply to continue your coverage under the Portability Plan. Certain conditions apply. Conversion Option During the 31 days following a termination of coverage, you may convert Basic Life (without the AD&D feature), to an individual whole life policy available from the insurance company, without having to furnish evidence of insurability. The policy will be effective at the end of the 31-day period, and the premiums will be the same as those you would ordinarily pay if you applied for an individual policy at that time. If the employee dies during the 31-day period, benefits will be payable even if you have not applied for conversion. For Portability and/or Conversion assistance, contact Unum at

32 Optional Life Insurance - Unum Employee Optional Life In the event of your death, the Optional Life Plan provides an additional benefit to your beneficiary. The benefit is paid with, and in the same manner as, the Company-provided Basic Life Plan. Levels of Coverage Optional Life is available in amounts equal to one, two, three, four, or five times your annual base pay, rounded up to the next $1,000. The maximum amount of coverage for Optional Life cannot exceed $2 million. Dependent Life Insurance In the event your spouse or dependent child(ren) dies, the Dependent Life Plan pays a benefit to you, as the beneficiary. Levels of Coverage Dependent Life for your spouse (or same gender partner) or your child(ren) is available at two coverage levels: Spouse Benefit Amount: Level 1: $10,000 Level 2: $20,000 Child Benefit Amount: Level 1: $5,000 Level 2: $10,000 Evidence of Insurability New hires can elect Optional Life coverage up to 3x to a maximum of $600,000. Spouse coverage up to $20,000 and Child coverage with no evidence of insurability if enrolling within 30 days of becoming eligible. During Glatfelter s Annual Enrollment Period employees are eligible to increase coverage by one level up to a maximum coverage amount of 3x annual base pay or $600,000. If you newly elect or increase your coverage by more than one level, or you choose an amount that brings your coverage over 3x annual base pay or $600,000, you will be required to provide evidence of insurability. During the annual enrollment period, evidence of insurability is required for employees who elect spousal coverage for the first time or increase the coverage from $10,000 to $20,000. Child coverage never requires evidence of insurability and can be elected at any time. If evidence of insurability is required, coverage will become effective once Unum approves the application, subject to the active at work requirement and non-confinement requirement. Active at Work requirement: If on the day an employee s coverage would otherwise take effect, he or she is not actively at work, coverage will not take effective until they return to work. Non-confinement requirement for Dependents: If on the day a dependent s coverage would otherwise take effect, he or she is medically confined at home or elsewhere, coverage will not take effect until they are released. Portability Plan If your coverage under the Optional Life or Dependent Life plans ends for a reason other than disability, failure to pay premiums, or termination of the group contract, you may apply to continue your coverage under the Portability Plan. Certain conditions apply. Conversion Option During the 31 days following a termination of coverage, you may convert Optional Life and Dependent Life plans to individual whole life policies available from the insurance company, without having to furnish evidence of insurability. The policy will be effective at the end of the 31-day period, and the premiums will be the same as those you would ordinarily pay if you applied for an individual policy at that time. If the employee or dependent dies during the 31-day period, benefits will be payable even if you have not applied for conversion. For Portability and/or Conversion assistance, contact Unum at

33 Disability - Unum Short-Term Disability Plan Highlights Company-provided benefit to full-time salaried and nonunion employees. Provides a percentage of your income if you miss work due to extended sickness or injury. Coverage equal to 66-2/3 percent or 100 percent of your base monthly earnings depending on years of service. (If you are a non-union hourly Fremont employee, your benefits are 60 percent of your base monthly earnings with no relationship to years of service). Benefits are provided for up to 26 weeks. Company-provided benefits are taxable income to you. How the Plan Works When you are off work due to an extended non-occupational accidental injury, sickness or pregnancy, short-term disability pays a benefit up to 26 weeks, after you ve met the 30-day eligibility waiting period. STD benefits begin on the first day for hospital confinement of 24 hours or more, accident and outpatient surgery. STD benefits for a sickness begin after a 7-day waiting period for most employees (after a 3-day waiting period for Fremont employees). For STD, the definition of disabled means you have been certified as unable to perform the material and substantial duties of your regular occupation and not working in any gainful occupation. Maximum STD Benefit Period Benefits under the STD plan will continue until the date you are no longer disabled, the date your employment with Glatfelter terminates, or 26 weeks, whichever comes first. Levels of Coverage Company-provided short-term disability plan pays a percentage of your base monthly earnings based on years of service and follows the 30-day eligibility waiting period. Long-Term Disability Plan Highlights Company-provided benefit to full-time salaried and nonunion employees. Provides a percentage of your income if an extended illness or injury persists beyond 26 weeks. Pays a benefit of up to 50 percent of your pre-disability monthly earnings. Minimum benefit of $100 per month and maximum benefit of $15,000 per month. Company-provided benefits are taxable income to you. How the Plan Works The first 26 weeks of continuous total disability are considered your benefit waiting period. If your disability continues beyond 26 weeks, you are eligible to apply for long-term disability benefits. You may receive up to 50 percent of your pre-disability monthly earnings, up to $15,000. For purposes of this Plan, disability is defined as follows: For the first 24 months of LTD payments, due to sickness or injury, you are unable to perform the material and substantial duties of your regular occupation, you have a 20 percent or more loss in your indexed monthly earnings, and you are under the regular care and attendance of a physician; After 24 months of LTD payments, you will continue to collect benefits if you are unable, due to the same sickness or injury, to perform the duties of any occupation for which you are reasonably fitted by education, training or experience, and you have a 40 percent or more loss in your indexed monthly earnings. (continued on next page) 31

34 Disability - Unum continued Levels of Coverage Company-provided long-term disability pays up to 50 percent of your pre-disability monthly earnings after you have been disabled for 26 weeks due to a non-work related illness or injury. The minimum LTD benefit is $100 per month. The maximum LTD benefit is $15,000 per month. LTD benefits are offset by any other income you are eligible to receive, such as Social Security, state disability, Railroad Retirement Act benefits, benefits from any other group LTD plan, income you receive from working while receiving LTD benefits, no fault accident wage replacement benefits, a retirement plan, or any other forms of income. Your total income from all sources may not exceed 50 percent of your Glatfelter pre-disability monthly earnings. If any of your other income is received as a lump sum, that amount will be prorated into a monthly amount and deducted from your LTD benefit. Limited Benefit Periods Benefits for disabilities due to mental illness, drugs and/or alcoholism are limited to 24 monthly payments over a lifetime. How to File a Disability Claim Contact Unum, the Claim Administrator at to establish your claim. You should file as soon as you believe your disability will last more than 7 days for salaried employees, and after 3 days for Fremont employees. In some cases, such as surgery, your disability may be covered on the first day. Your physician will be required to provide medical certification of your disability. Termination of Coverage Coverage under the disability plans ends for you on the earliest of: the date the policy or the Plan is canceled; the date you are no longer eligible; the date benefits end for failure to comply with the terms and conditions of the Policy; the date your eligible group is no longer covered; or the date on which you cease to be an active full-time employee in an eligible class, including temporary layoff, leave of absence, including, but not limited to, leave for military service, work stoppage (including strike or lockout) or retirement. Plan Information This summary of the disability plans describes the essential features of the plans, which are administered by Unum (as a third party administrator for the STD benefits and as an insurer for the LTD benefits). Final determination of all benefits will be made in accordance with the Plan document. STD benefits are self-funded and are paid from the Company s general assets. This coverage is not insured by Unum The LTD benefits are fully insured by Unum. Claim Administrator The Benefits Center P.O. Box Columbia, SC

35 Employee Assistance Program (EAP) - WellSpan The employee assistance program offers complete confidentiality to employees and their families. The decision to use the EAP is completely up to you (unless it is a mandatory referral), and your contact is strictly confidential, unless life or safety is threatened, or disclosure is required by law. Glatfelter has no direct involvement with the program, and does not know which employees are in the program or any information about individual situations. Licensed providers are available to help you clarify the problem, identify options and develop a plan of action. Shortterm counseling sessions through the EAP by experienced counselors in your local community are provided free of charge. Short-term counseling will help you deal with issues such as stress, family problems, substance abuse, depression, marital or relationship issues, anxiety and other personal issues. Your EAP counselor will meet with you in person to evaluate your situation. You are eligible for up to five visits under the EAP program. Short-term care through the EAP program is free of charge. Short-term care refers to face-to-face counseling with an EAP professional. If it is recommended after the short-term counseling sessions that you need specialized treatment or a higher level of care, your EAP counselor will refer you to an appropriate resource in the community. In most cases, this continued care will be provided under the provisions of the medical plan (see Medical section for details). If you are an employee of the Ohio Operations, or reside outside of South Central PA, call to get a referral to a WellSpan EAP provider in your area. If you are an employee of the Pennsylvania Operations, and reside within South Central PA, go to for a list of providers in your area. Otherwise, you may call for assistance. If applicable, notify the representative that you were referred to by your supervisor. If you or a family member is experiencing emotional distress or suicidal thoughts, you may also contact a crisis intervention hotline toll-free at If at any time you are dissatisfied with the EAP counselor, a new one will be assigned to you upon your request. 33

36 Glossary of Terms This glossary has many commonly used terms, but it isn t a full list. These terms are not contract terms, which can be found in your insurance policy or certificate. Bold text indicates a term defined in this Glossary. ALLOWED AMOUNT: Maximum amount on which payment is based for covered health care services. This may be called eligible expense, payment allowance or negotiated rate. If your provider charges more than the allowed amount, you may have to pay the difference. (See Balance Billing.) APPEAL: A request for your health insurer or plan to review a decision or a grievance again. Balance Billing: When a provider bills you for the difference between the provider s charge and the allowed amount. For example, if the provider s charge is $100 and the allowed amount is $70, the provider may bill you for the remaining $30. A preferred provider may not balance bill you. Co-insurance: Your share of the costs of a covered health care service, calculated as a percent (for example, 20%) of the allowed amount for the service. You pay co-insurance plus any deductibles you owe. For example, if the health insurance or plan s allowed amount for an office visit is $100 and you ve met your deductible, your co-insurance payment of 20% would be $20. The health insurance or plan pays the rest of the allowed amount. (Jane pays 20%, her plan pays 80%.) Complications of Pregnancy: Conditions due to pregnancy, labor and delivery that require medical care to prevent serious harm to the health of the mother or the fetus. Morning sickness and a non-emergency caesarean section aren t complications of pregnancy. Copayment: A fixed amount (for example, $15) you pay for a covered health care service, usually when you receive the service. The amount can vary by the type of covered health care service. 34 Deductible: The amount you owe for health care services your health insurance or plan covers before your health insurance or plan begins to pay. For example, if your deductible is $1000, your plan won t pay anything until you ve met your $1000 deductible for covered health care services subject to the deductible. The deductible may not apply to all services. (Jane pays 100%, her plan pays 0%.) Durable Medical Equipment (DME): Equipment and supplies ordered by a health care provider for everyday or extended use. Coverage for DME may include: oxygen equipment, wheelchairs, crutches or blood testing strips for diabetics. Emergency Medical Condition: An illness, injury, symptom or condition so serious that a reasonable person would seek care right away to avoid severe harm. Emergency Medical Transportation Ambulance services for an emergency medical condition. Emergency Room Care: Emergency services received in an emergency room. Emergency Services: Evaluation of an emergency medical condition and treatment to keep the condition from getting worse. Excluded Services: Health care services that your health insurance or plan doesn t pay for or cover. Grievance: A complaint that you communicate to your health insurer or plan. Habilitation Services: Health care services that help a person keep, learn or improve skills and functioning for daily living. Examples include therapy for a child who isn t walking or talking at the expected age. These services may include physical and occupational therapy, speech-language pathology and other services for people with disabilities in a variety of inpatient and/or outpatient settings. (continued on next page)

37 Glossary of Terms continued Health Insurance: A contract that requires your health insurer to pay some or all of your health care costs in exchange for a premium. Home Health Care: Health care services a person receives at home. Hospice Services: Services to provide comfort and support for persons in the last stages of a terminal illness and their families. Hospitalization: Care in a hospital that requires admission as an inpatient and usually requires an overnight stay. An overnight stay for observation could be outpatient care. Hospital Outpatient Care: Care in a hospital that usually doesn t require an overnight stay. In-network Co-insurance: The percent (for example, 20%) you pay of the allowed amount for covered health care services to providers who contract with your health insurance or plan. In-network co-insurance usually costs you less than out-of-network co-insurance. In-network Copayment: A fixed amount (for example, $15) you pay for covered health care services to providers who contract with your health insurance or plan. Innetwork copayments usually are less than out-of-network copayments. Medically Necessary: Health care services or supplies needed to prevent, diagnose or treat an illness, injury, disease or its symptoms and that meet accepted standards of medicine. Network: The facilities, providers and suppliers your health insurer or plan has contracted with to provide health care services. Non-Preferred Provider: A provider who doesn t have a contract with your health insurer or plan to provide services to you. You ll pay more to see a non-preferred provider. Check your policy to see if you can go to all providers who have contracted with your health insurance or plan, or if your health insurance or plan has a tiered network and you must pay extra to see some providers. Out-of-network Co-insurance: The percent (for example, 40%) you pay of the allowed amount for covered health care services to providers who do not contract with your health insurance or plan. Out-of-network co-insurance usually costs you more than in-network co-insurance. Out-of-network Copayment: A fixed amount (for example, $30) you pay for covered health care services from providers who do not contract with your health insurance or plan. Out-of-network copayments usually are more than in-network copayments. Out-of-Pocket Limit: The most you pay during policy period (usually a year) before your health insurance or plan begins to pay 100% of the allowed amount. This limit never includes your premium, balance-billed charges or health care your health insurance or plan doesn t cover. The out-of-pocket limits include copayments, deductibles and co-insurance. Physician Services: Health care services a licensed medical physician (M.D. Medical Doctor or D.O. Doctor of Osteopathic Medicine) provides or coordinates. Plan: A benefit your employer, union or other group sponsor provides to you to pay for your health care services. Preauthorization: A decision by your health insurer or plan that a health care service, treatment plan, prescription drug or durable medical equipment is medically necessary. Sometimes called prior authorization, prior approval or precertification. Your health insurance or plan may require preauthorization for certain services before you receive them, except in an emergency. Preauthorization isn t a promise your health insurance or plan will cover the cost. (continued on next page) 35

38 Glossary of Terms continued Preferred Provider: A provider who has a contract with your health insurer or plan to provide services to you at a discount. Check your policy to see if you can see all preferred providers or if your health insurance or plan has a tiered network and you must pay extra to see some providers. Your health insurance or plan may have preferred providers who are also participating providers. Participating providers also contract with your health insurer or plan, but the discount may not be as great, and you may have to pay more. Premium: The amount that must be paid for your health insurance or plan. You and or your employer usually pay it yearly. Prescription Drug Coverage: Health insurance or plan that helps pay for prescription drugs and medications. Prescription Drugs: Drugs and medications that by law require a prescription. Primary Care Physician: A physician (M.D. Medical Doctor or D.O. Doctor of Osteopathic Medicine) who directly provides or coordinates a range of health care services for a patient. Primary Care Provider: A physician (M.D. Medical Doctor or D.O. Doctor of Osteopathic Medicine), nurse practitioner, clinical nurse specialist or physician assistant, as allowed under state law, who provides, coordinates or helps a patient access a range of health care services. Provider: A physician (M.D. Medical Doctor or D.O. Doctor of Osteopathic Medicine), health care professional or health care facility licensed, certified or accredited as required by state law. Reconstructive Surgery: Surgery and follow-up treatment needed to correct or improve a part of the body because of birth defects, accidents, injuries or medical conditions. Rehabilitation Services: Health care services that help a person keep, get back or improve skills and functioning for daily living that have been lost or impaired because a person was sick, hurt or disabled. These services may include physical and occupational therapy, speech-language pathology and psychiatric rehabilitation services in a variety of inpatient and/ or outpatient settings. Skilled Nursing Care: Services from licensed nurses in your own home or in a nursing home. Skilled care services are from technicians and therapists in your own home or in a nursing home. Specialist: A physician specialist focuses on a specific area of medicine or a group of patients to diagnose, manage, prevent or treat certain types of symptoms and conditions. A non-physician specialist is a provider who has more training in a specific area of health care. UCR (Usual, Customary and Reasonable): The amount paid for a medical service in a geographic area based on what providers in the area usually charge for the same or similar medical service. The UCR amount sometimes is used to determine the allowed amount. Urgent Care: Care for an illness, injury or condition serious enough that a reasonable person would seek care right away, but not so severe as to require emergency room care. 36

39 COBRA Under the Consolidated Omnibus Budget Reconciliation Act (COBRA) of 1985, COBRA qualified beneficiaries (QBs) generally are eligible for group coverage during a maximum of 18 months for qualifying events due to employment termination or reduction of hours of work. Certain qualifying events, or a second qualifying event during the initial period of coverage, may permit a beneficiary to receive a maximum of 36 months of coverage. COBRA coverage is not extended for those terminated for gross misconduct. Upon termination, or other COBRA qualifying event, the former employee and any other QBs will receive COBRA enrollment information. Qualifying events for employees include voluntary/involuntary termination of employment, and the reduction in the number of hours of employment. Qualifying events for spouses or dependent children include those events above, plus, the covered employee becoming entitled to Medicare; divorce or legal separation of the covered employee; death of the covered employee; and the loss of dependent status under the plan rules. If a QB chooses to continue group benefits under COBRA, they must complete an enrollment form and return it to the Plan Administrator with the appropriate premium due. Upon receipt of premium payment and enrollment form, the coverage will be reinstated. Thereafter, premiums are due on the 1st of the month. If premium payments are not received in a timely manner, Federal law stipulates that your coverage will be cancelled after a 30-day grace period. If you have any questions about COBRA or the Plan, please contact the Plan Administrator. Please note, if the terms of the Plan and any response you receive from the Plan Administrator s representatives conflict, the Plan document will control. Notices Health Insurance Portability and Accountability Act (HIPAA) The Health Insurance Portability and Accountability Act of 1996 and its implementing regulations ( HIPAA ) require, among other things, that group health plans protect the privacy of certain individually identifiable health information ( Protected Health Information ) about their members. Glatfelter s Notice of Privacy Practices describes a Covered Individual s HIPAA privacy rights and can be on the Corporate website, CoreSource, as the claims administrator of the Plan, will use and disclose Covered Individuals Protected Health Information only as permitted by its Administrative and Network Service Agreement with Glatfelter, and as permitted by applicable state and federal laws and regulations, including HIPAA. If a Covered Individual has a complaint, question, or concern, or requires a copy of Glatfelter s Notice of Privacy Practices, they should contact Glatfelter Benefits Service Center at Newborns and Mothers Health Protection Act Group health plans and health 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 issuer for prescribing a length of stay not in excess of 48 hours (or 96 hours if applicable). Notice Regarding Special Enrollment If you are waiving enrollment in the Medical plan for yourself or your dependents (including your spouse) because of other health insurance coverage, you may in the future be able to enroll yourself or your dependents in the Medical plan, provided that you request enrollment within 30 days after your other coverage ends. 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 provided that you request enrollment within 30 days after the marriage, birth, adoption, or placement for adoption. 37

40 Notices continued Special Enrollment Rights CHIPRA Children s Health Insurance Plan Effective April 1, 2009 you and your dependents who are eligible for coverage, but who have not enrolled, have the right to elect coverage during the plan year under two circumstances: You or your dependent s state Medicaid or CHIP (Children s Health Insurance Program) coverage terminated because you ceased to be eligible; You become eligible for a CHIP premium assistant subsidy under state Medicaid or CHIP (Children s Health Insurance Program); You must request special enrollment within 60 days of the loss of coverage and/or within 60 days of when eligibility is determined for the premium subsidy. Qualified Medical Child Support Order QMCSO is a medical child support order issued under State law that creates or recognizes the existence of an alternate recipient s right to receive benefits for which a participant or beneficiary is eligible under a group health plan. An alternate recipient is any child of a participant (including a child adopted by or placed for adoption with a participant in a group health plan) who is recognized under a medical child support order as having a right to enrollment under a group health plan with respect to such participant. Upon receipt, the administrator of a group health plan is required to determine, within a reasonable period of time, whether a medical child support order is qualified, and to administer benefits in accordance with the applicable terms of each order that is qualified. In the event you are served with a notice to provide medical coverage for a dependent child as the result of a legal determination, you may obtain information from your employer on the rules for seeking to enact such coverage. These rules are provided at no cost to you and may be requested from your employer at any time. Women s Health and Cancer Rights Act of 1998 This medical plan provides benefits for mastectomy-related services including all stages of reconstruction and surgery to achieve symmetry between the breasts, prostheses and complications resulting from a mastectomy, including lymphedema. Please contact your plan administrator for more information. Women s Preventive Health Benefits As you may know, the Affordable Care Act (ACA, or Health Care Reform law) includes changes that are being phased in over a number of years. The latest set of changes includes additional benefits for certain Women s Preventive Health Services. When plans renew or are effective on or after August 1, 2012, all of the following women s health services will be considered preventive (some were already covered). These services generally will be covered at no cost share, when provided in network: Well-woman visits (annually and now including prenatal visits); Screening for gestational diabetes; Human papillomavirus (HPV) DNA testing; Counseling for sexually transmitted infections; Counseling and screening for human immunodeficiency virus (HIV); Screening and counseling for interpersonal and domestic violence; Breastfeeding support, supplies and counseling; Generic formulary contraceptives are covered without member cost-share (for example, no copayment). Certain religious organizations or religious employers may be exempt from offering contraceptive services. (continued on next page) 38

41 Notices continued Notice of Required Coverage Following Mastectomies In compliance with the Women s Health and Cancer Rights Act of 1998, the plan provides the following benefits to all participants who elect breast reconstruction in connection with a mastectomy, to the extent that the benefits otherwise meet the requirements for coverage under the plan: reconstruction of the breast on which the mastectomy has been performed; surgery and reconstruction of the other breast to produce a symmetrical appearance; and coverage for prostheses and physical complications of all stages of the mastectomy, including lymphedemas. The benefits shall be provided in a manner determined in consultation with the attending physician and the patient. Plan terms such as deductibles or co-insurance apply to these benefits. Genetic Nondiscrimination The Genetic Nondiscrimination Act of 2008 (GINA) prohibits employers and other entities covered by GINA Title II from requesting, or requiring, genetic information of an individual or family member of the individual, except as specifically allowed by this law. To comply with this law, the Company asks Employees not to provide any genetic information when providing or responding to a request for medical information. Genetic information, as defined by GINA, includes an individual s family medical history, the results of an individual s or family member s genetic tests, the fact that an individual or an individual s family member sought or received genetic services, and genetic information of a fetus carried by an individual or an individual s family member or an embryo lawfully held by an individual or family member receiving assistive reproductive services. Mental Health Parity and Addiction Equity Act of 2008 This act expands the mental health parity requirements in the Employee Retirement Income Security Act, the Internal Revenue Code and the Public Health Services Act by imposing new mandates on group health plans that provide both medical and surgical benefits and mental health or substance abuse disorder benefits. Among the new requirements, such plans (or the health insurance coverage offered in connection with such plans) must ensure that: the financial requirements applicable to mental health or substance abuse disorder benefits are no more restrictive than the predominant financial requirements applied to substantially all medical and surgical benefits covered by the plan (or coverage), and there are no separate cost sharing requirements that are applicable only with respect to mental health or substance abuse disorder benefits. 39

42 2016 Benefit Options & Costs FOR PENNSYLVANIA SALARIED monthly Medical Monthly Per Pay Cost Plan Name Employee Only Employee + 1 Family CDHP-Basic with Wellness Completion $ $ $ without Wellness Completion $ $ $ CDHP-Premier with Wellness Completion $ $ $ without Wellness Completion $ $ $ Preferred Provider Organization (PPO) with Wellness Completion $ $ $ without Wellness Completion $ $ $ Primary Care Plan (PCP) with Wellness Completion $ $ $ without Wellness Completion $ $ $ Opt Out Incentive* You Receive $1,800 annually (taxed and prorated per paycheck) If applicable, a tobacco surcharge will increase your health plan cost by $180 annually ($15.00 monthly) Dental Monthly Per Pay Cost Plan Name Employee Only Employee + 1 Family Delta Dental PPO Plus Premier You Pay $9.17 $15.97 $23.47 vision Monthly Per Pay Cost Plan Name Employee Only Employee + 1 Family 40 NVA $15 Copay You Pay $5.90 $9.73 $15.35 VSP Choice $15 Copay You Pay $5.35 $11.14 $17.93 flexible spending account (FSA) Health Care FSA Your Annual Contribution $240 minimum / $2,550 maximum Dependent Care FSA Your Annual Contribution $240 minimum / $5,000 maximum health savings account (HSA) If enrolled in the Consumer Driven Health Plan Individual Maximum Annual Contribution $2,450 Family Maximum Annual Contribution $4,950 (net of company contribution) optional term life** Monthly Rates Age rate per $1,000 AGE RATE per $1,000 Employee coverage is available at one to five times your annual base pay rounded to the next $1,000 and not to exceed $2 million. optional dependent term life** Monthly Rates Under 35 $ $ $ $ $ $ $ and over $ $0.208 spouse coverage OPTIONS RATE CHILD(ren) coverage Options rate $10,000 $1.777 $5,000 $0.371 $20,000 $3.556 $10,000 $0.740 * Glatfelter employees married to other Glatfelter employees are ineligible for the Opt Out Incentive. ** During open enrollment, if you newly elect or increase your coverage by more than one level, or you choose an amount that brings your coverage over 3x annual base pay or $600,000, you will be required to provide evidence of insurability. Above are the cost of the benefit options available to you for In addition to these optional benefits, you also have other Companyprovided benefits automatically provided at no cost to you. These other benefits, such as basic life and disability, are not shown here because they don t require a decision by you at this time. For details about all your benefits, see your Health and Welfare Summary Plan Description on the corporate website, click on Careers then Global Total Rewards, then click on Benefits Enrollment, then click on US Benefit Plan Documents. Or, you may go directly to

43 2016 Benefit Options & Costs FOR PENNSYLVANIA SALARIED bi-weekly Medical Bi-Weekly Per Pay Cost Plan Name Employee Only Employee + 1 Family CDHP-Basic with Wellness Completion $56.77 $ $ without Wellness Completion $56.77 $ $ CDHP-Premier with Wellness Completion $69.39 $ $ without Wellness Completion $69.39 $ $ Preferred Provider Organization (PPO) with Wellness Completion $ $ $ without Wellness Completion $ $ $ Primary Care Plan (PCP) with Wellness Completion $76.84 $ $ without Wellness Completion $88.38 $ $ Opt Out Incentive* You Receive $1,800 annually (taxed and prorated per paycheck) If applicable, a tobacco surcharge will increase your health plan cost by $180 annually ($6.92 bi-weekly) Dental Bi-Weekly Per Pay Cost Plan Name Employee Only Employee + 1 Family Delta Dental PPO Plus Premier You Pay $4.23 $7.37 $10.83 vision Bi-Weekly Per Pay Cost Plan Name Employee Only Employee + 1 Family NVA $15 Copay You Pay $2.72 $4.49 $7.08 VSP Choice $15 Copay You Pay $2.47 $5.14 $8.28 flexible spending account (FSA) Health Care FSA Your Annual Contribution $240 minimum / $2,550 maximum Dependent Care FSA Your Annual Contribution $240 minimum / $5,000 maximum health savings account (HSA) If enrolled in the Consumer Driven Plan Individual Maximum Annual Contribution $2,450 Family Maximum Annual Contribution $4,950 (net of company contribution) optional term life** Monthly Rates Age rate per $1,000 AGE RATE per $1,000 Employee coverage is available at one to five times your annual base pay rounded to the next $1,000 and not to exceed $2 million. optional dependent term life** Monthly Rates Under 35 $ $ $ $ $ $ $ and over $ $0.208 spouse coverage OPTIONS RATE CHILD(ren) coverage Options rate $10,000 $1.777 $5,000 $0.371 $20,000 $3.556 $10,000 $0.740 * Glatfelter employees married to other Glatfelter employees are ineligible for the Opt Out Incentive. ** During open enrollment, if you newly elect or increase your coverage by more than one level, or you choose an amount that brings your coverage over 3x annual base pay or $600,000, you will be required to provide evidence of insurability. Above are the cost of the benefit options available to you for In addition to these optional benefits, you also have other Companyprovided benefits automatically provided at no cost to you. These other benefits, such as basic life and disability, are not shown here because they don t require a decision by you at this time. For details about all your benefits, see your Health and Welfare Summary Plan Description on the corporate website, click on Careers then Global Total Rewards, then click on Benefits Enrollment, then click on US Benefit Plan Documents. Or, you may go directly to 41

44 2016 Benefit Options & Costs FOR ohio salaried monthly Medical Monthly Per Pay Cost Plan Name Employee Only Employee + 1 Family CDHP-Basic with Wellness Completion $ $ $ without Wellness Completion $ $ $ CDHP-Premier with Wellness Completion $ $ $ without Wellness Completion $ $ $ Preferred Provider Organization (PPO) with Wellness Completion $ $ $ without Wellness Completion $ $ $ Glatfelter Family Medical Center with Wellness Completion $ $ $ (only available to those who live/work in Chillicothe, OH) without Wellness Completion $ $ $ Opt Out Incentive* You Receive $1,800 annually (taxed and prorated per paycheck) If applicable, a tobacco surcharge will increase your health plan cost by $180 annually ($15.00 monthly) Dental Monthly Per Pay Cost Plan Name Employee Only Employee + 1 Family Delta Dental PPO Plus Premier You Pay $9.17 $15.97 $23.47 vision Monthly Per Pay Cost Plan Name Employee Only Employee + 1 Family 42 NVA $15 Copay You Pay $5.90 $9.73 $15.35 VSP Choice $15 Copay You Pay $5.35 $11.14 $17.93 flexible spending account (FSA) Health Care FSA Your Annual Contribution $240 minimum / $2,550 maximum Dependent Care FSA Your Annual Contribution $240 minimum / $5,000 maximum health savings account (HSA) If enrolled in the Consumer Driven Plan Individual Maximum Annual Contribution $2,450 Family Maximum Annual Contribution $4,950 (net of company contribution) optional term life** Monthly Rates Age rate per $1,000 AGE RATE per $1,000 Employee coverage is available at one to five times your annual base pay rounded to the next $1,000 and not to exceed $2 million. optional dependent term life** Monthly Rates Under 35 $ $ $ $ $ $ $ and over $ $0.208 spouse coverage OPTIONS RATE CHILD(ren) coverage Options rate $10,000 $1.777 $5,000 $0.371 $20,000 $3.556 $10,000 $0.740 * Glatfelter employees married to other Glatfelter employees are ineligible for the Opt Out Incentive. ** During open enrollment, if you newly elect or increase your coverage by more than one level, or you choose an amount that brings your coverage over 3x annual base pay or $600,000, you will be required to provide evidence of insurability. Above are the cost of the benefit options available to you for In addition to these optional benefits, you also have other Companyprovided benefits automatically provided at no cost to you. These other benefits, such as basic life and disability, are not shown here because they don t require a decision by you at this time. For details about all your benefits, see your Health and Welfare Summary Plan Description on the corporate website, click on Careers then Global Total Rewards, then click on Benefits Enrollment, then click on US Benefit Plan Documents. Or, you may go directly to

45 2016 Benefit Options & Costs FOR ohio SALARIED bi-weekly Medical Bi-Weekly Per Pay Cost Plan Name Employee Only Employee + 1 Family CDHP-Basic with Wellness Completion $56.77 $ $ without Wellness Completion $56.77 $ $ CDHP-Premier with Wellness Completion $69.39 $ $ without Wellness Completion $69.39 $ $ Preferred Provider Organization (PPO) with Wellness Completion $ $ $ without Wellness Completion $ $ $ Glatfelter Family Medical Center with Wellness Completion $78.38 $ $ without Wellness Completion $89.92 $ $ Opt Out Incentive* You Receive $1,800 annually (taxed and prorated per paycheck) If applicable, a tobacco surcharge will increase your health plan cost by $180 annually ($6.92 bi-weekly) Dental Bi-Weekly Per Pay Cost Plan Name Employee Only Employee + 1 Family Delta Dental PPO Plus Premier You Pay $4.23 $7.37 $10.83 vision Bi-Weekly Per Pay Cost Plan Name Employee Only Employee + 1 Family NVA $15 Copay You Pay $2.72 $4.49 $7.08 VSP Choice $15 Copay You Pay $2.47 $5.14 $8.28 flexible spending account (FSA) Health Care FSA Your Annual Contribution $240 minimum / $2,550 maximum Dependent Care FSA Your Annual Contribution $240 minimum / $5,000 maximum health savings account (HSA) If enrolled in the Consumer Driven Plan Individual Maximum Annual Contribution $2,450 Family Maximum Annual Contribution $4,950 (net of company contribution) optional term life** Monthly Rates Age rate per $1,000 AGE RATE per $1,000 Employee coverage is available at one to five times your annual base pay rounded to the next $1,000 and not to exceed $2 million. optional dependent term life** Monthly Rates Under 35 $ $ $ $ $ $ $ and over $ $0.208 spouse coverage OPTIONS RATE CHILD(ren) coverage Options rate $10,000 $1.777 $5,000 $0.371 $20,000 $3.556 $10,000 $0.740 * Glatfelter employees married to other Glatfelter employees are ineligible for the Opt Out Incentive. ** During open enrollment, if you newly elect or increase your coverage by more than one level, or you choose an amount that brings your coverage over 3x annual base pay or $600,000, you will be required to provide evidence of insurability. Above are the cost of the benefit options available to you for In addition to these optional benefits, you also have other Companyprovided benefits automatically provided at no cost to you. These other benefits, such as basic life and disability, are not shown here because they don t require a decision by you at this time. For details about all your benefits, see your Health and Welfare Summary Plan Description on the corporate website, click on Careers then Global Total Rewards, then click on Benefits Enrollment, then click on US Benefit Plan Documents. Or, you may go directly to 43

46 2016 Benefit Options & Costs FOR FREMONT salaried MONTHLY Medical Monthly Per Pay Cost Plan Name Employee Only Employee + 1 Family CDHP-Basic with Wellness Completion $ $ $ without Wellness Completion $ $ $ CDHP-Premier with Wellness Completion $ $ $ without Wellness Completion $ $ $ Preferred Provider Organization (PPO) with Wellness Completion $ $ $ without Wellness Completion $ $ $ Opt Out Incentive* You Receive $1,800 annually (taxed and prorated per paycheck) If applicable, a tobacco surcharge will increase your health plan cost by $180 annually ($15.00 monthly) Dental Monthly Per Pay Cost Plan Name Employee Only Employee + 1 Family Delta Dental PPO Plus Premier You Pay $9.17 $15.97 $23.47 vision Monthly Per Pay Cost Plan Name Employee Only Employee + 1 Family NVA $15 Copay You Pay $5.90 $9.73 $15.35 VSP Choice $15 Copay You Pay $5.35 $11.14 $17.93 flexible spending account (FSA) Health Care FSA Your Annual Contribution $240 minimum / $2,550 maximum Dependent Care FSA Your Annual Contribution $240 minimum / $5,000 maximum health savings account (HSA) If enrolled in the Consumer Driven Health Plan Individual Maximum Annual Contribution $2,450 Family Maximum Annual Contribution $4,950 (net of company contribution) optional term life** Monthly Rates Age rate per $1,000 AGE RATE per $1,000 Employee coverage is available at one to five times your annual base pay rounded to the next $1,000 and not to exceed $2 million. optional dependent term life** Monthly Rates Under 35 $ $ $ $ $ $ $ and over $ $0.208 spouse coverage OPTIONS RATE CHILD(ren) coverage Options rate $10,000 $1.777 $5,000 $0.371 $20,000 $3.556 $10,000 $0.740 * Glatfelter employees married to other Glatfelter employees are ineligible for the Opt Out Incentive. ** During open enrollment, if you newly elect or increase your coverage by more than one level, or you choose an amount that brings your coverage over 3x annual base pay or $600,000, you will be required to provide evidence of insurability. Above are the cost of the benefit options available to you for In addition to these optional benefits, you also have other Companyprovided benefits automatically provided at no cost to you. These other benefits, such as basic life and disability, are not shown here because they don t require a decision by you at this time. For details about all your benefits, see your Health and Welfare Summary Plan Description on the corporate website, click on Careers then Global Total Rewards, then click on Benefits Enrollment, then click on US Benefit Plan Documents. Or, you may go directly to 44

47 2016 Benefit Options & Costs FOR FREMONT NON-UNION HOURLY weekly Medical Weekly Per Pay Cost Plan Name Employee Only Employee + 1 Family CDHP-Basic with Wellness Completion $28.39 $56.77 $ without Wellness Completion $28.39 $56.77 $ CDHP-Premier with Wellness Completion $34.70 $69.39 $ without Wellness Completion $34.70 $69.39 $ Preferred Provider Organization (PPO) with Wellness Completion $50.85 $ $ without Wellness Completion $56.61 $ $ Opt Out Incentive* You Receive $1,800 annually (taxed and prorated per paycheck) If applicable, a tobacco surcharge will increase your health plan cost by $180 annually ($3.46 weekly) Dental Weekly Per Pay Cost Plan Name Employee Only Employee + 1 Family Delta Dental PPO Plus Premier You Pay $2.12 $3.69 $5.42 vision Weekly Per Pay Cost Plan Name Employee Only Employee + 1 Family NVA $15 Copay You Pay $1.36 $2.25 $3.54 VSP Choice $15 Copay You Pay $1.23 $2.57 $4.14 flexible spending account (FSA) Health Care FSA Your Annual Contribution $240 minimum / $2,550 maximum Dependent Care FSA Your Annual Contribution $240 minimum / $5,000 maximum health savings account (HSA) If enrolled in the Consumer Driven Plan Individual Maximum Annual Contribution $2,450 Family Maximum Annual Contribution $4,950 (net of company contribution) optional term life** Monthly Rates Age rate per $1,000 AGE RATE per $1,000 Employee coverage is available at one to five times your annual base pay rounded to the next $1,000 and not to exceed $2 million. optional dependent term life** Monthly Rates Under 35 $ $ $ $ $ $ $ and over $ $0.208 spouse coverage OPTIONS RATE CHILD(ren) coverage Options rate $10,000 $1.777 $5,000 $0.371 $20,000 $3.556 $10,000 $0.740 * Glatfelter employees married to other Glatfelter employees are ineligible for the Opt Out Incentive. ** During open enrollment, if you newly elect or increase your coverage by more than one level, or you choose an amount that brings your coverage over 3x annual base pay or $600,000, you will be required to provide evidence of insurability. Above are the cost of the benefit options available to you for In addition to these optional benefits, you also have other Companyprovided benefits automatically provided at no cost to you. These other benefits, such as basic life and disability, are not shown here because they don t require a decision by you at this time. For details about all your benefits, see your Health and Welfare Summary Plan Description on the corporate website, click on Careers then Global Total Rewards, then click on Benefits Enrollment, then click on US Benefit Plan Documents. Or, you may go directly to 45

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52 200 International Circle s Suite 4500 s Hunt Valley, Maryland Tel: s Fax: s