To create a support ticket, go to Help Desk: , option 0

Transcription

1 WEBSITE AND CONTACTS To view this booklet as well as claim forms and provider lookups, go to We have also created a new ticket system, allowing you to create a support ticket on our website. This system can be used for things like claims problems, provider directories, address changes, etc. Once the ticket is created, you will automatically be assigned a ticket number and login credentials to view the status of your ticket 24 hours a day. This system is SSL secured and allows for documents to be scanned and uploaded. To create a support ticket, go to Help Desk: , option 0 CONTACTS National Headquarters PO Box 1472 Virginia Beach, VA Ph F President W. Brandon Beavers Office: Extension 110 brandon@bladebc.com Director of Benefits Amy Thompson Direct: Office: Extension 112 amy@bladebc.com For a complete list of Limitations and Exclusions, as well as the ACA Mandated Summary of Coverage and Benefits go to: Page Blade Benefit Consulting LLC True Life Destinations Employee Benefits

2 HEALTH BENEFIT RATES HEALTH INSURANCE RATES Effective November 1, 2016 Weekly Rates Optima Equity Vantage 5000/100 Optima Vantage 1000/20/80 Optima Vantage 25/70 Employee $30.36 $53.79 $57.80 Employee + Spouse $57.78 $96.83 $ Employee + Child $96.60 $ $ Employee + Children $ $ $ Family $ $ $ Page Blade Benefit Consulting LLC Sorrentino Mariani & Company Employee Benefits

3 HEALTH BENEFIT COMPARISON BENEFITS AND FEATURES Sorrentino Mariani & Company Inc. Benefits Comparison 11/1/2016 High Deductible Health Plan Mid Plan High Plan Optima Optima Optima BENEFITS AND FEATURES Equity Vantage Vantage Vantage Annual deductibles (indiv/family) 5000/ /20/80% 25/70 In-network $5,000 / $10,000 $1,000 / $2,000 None Out-of-network N/A N/A N/A Coinsurance (plan pays) In-network Covered at 100% (AD) Covered at 80 % (AD) Covered at 70% (ND) Out-of-network N/A N/A N/A Out of pocket maximum (indiv/family) In-network $6,550 / $13,100 $3,500 / $7,000 $3,000 / $6,000 Out-of-network N/A N/A N/A Physician Services Primary Care Visit Covered at 100% (AD) $20 Copay $25 Copay Specialist Visit Covered at 100% (AD) $40 Copay $50 Copay Hospital Services Inpatient hospitalization Covered at 100% (AD) Covered at 80% (AD) Covered at 70% (ND) Outpatient Surgery Covered at 100% (AD) Covered at 80% (AD) Covered at 70% (ND) Emergency/Urgent Care Svcs. Emergency care (true emergency) Covered at 100% (AD) Covered at 80% (AD) Covered at 70% (ND) Urgent care centers (non-er level of Covered at 100% (AD) $40 Copay $50 Copay care) Prescription Coverage Retail Pharmacy 90-day Mail Order Preventive Vision (AD) = After Deductible (ND) = No Deductible $10/40/60/20% (After medical deductible), $250 per script max $30/120/180 (After medical deductible), $250 per script max 1 exam every 12 months: no cost $10/40/60/20% ; $250 Rx Max per script (AD $150) $25/100/180 or 20% ; $750 Rx Max (AD $150) 1 exam every 12 months: no cost $10/40/60/20% ; $250 Rx Max per script (AD $150) $25/100/180 or 20% ; $750 Rx Max (AD $150) 1 exam every 12 months: no cost Sorrentino Mariani & Company Employee Benefits 2016 Blade Benefit Consulting LLC Page 3

4 OPTIMA VANTAGE 5000/100 BENEFIT DETAILS Summary of Benefits Equity Vantage 5000/100% This document is not a contract or policy with Optima Health. It is a high-level summary of benefits and services available through the Plan. Some services may have limits associated with them or may require prior authorization. Annual Deductible In-Network Individual $5,000 Family $10,000 Coinsurance Out-of-Pocket Maximum 0% AD Individual $6,550 Family $13,100 Physician Office Visits PCP Office Visit Covered at 100% AD Specialist Office Visit Covered at 100% AD Preventive Care Visits Covered at 100% Outpatient Surgery Outpatient Therapy Services Outpatient Rehabilitation Services* Outpatient Diagnostic Procedures (Diagnostic Procedures, X-ray, Ultrasound) Outpatient Advanced Imaging/Testing (Sleep Studies, MRI, MRA, CT, CTA, and PET) Inpatient Care Emergency Department Urgent Care Center Outpatient Services Inpatient Hospital Services Emergency Services Covered at 100% AD Covered at 100% AD Covered at 100% AD Covered at 100% AD Covered at 100% AD Covered at 100% AD Covered at 100% AD Covered at 100% AD Behavioral Health and Substance Abuse Services Inpatient Services Covered at 100% AD Outpatient Visits Covered at 100% AD Employee Assistance Program Covered at 100% Diabetic Supplies & Infusion Sets Maternity Care Other Services Covered at 100% AD Covered at 100% AD AD After Deductible. *Occupational and Physical Therapy have a combined 30-visit limit per person per calendar year. Speech Therapy and Rehabilitative Outpatient Therapy each have 30-visit limits per person per calendar year. Sorrentino Mariani & Company Employee Benefits 2016 Blade Benefit Consulting LLC Page 4

5 OPTIMA VANTAGE 5000/100 BENEFIT DETAILS Summary of Benefits Equity Vantage 5000/100% Deductible Selected Generic (Tier 1) Pharmacy Medical deductible applies $10 Copayment AD retail prescriptions / $30 Copayment AD mail order prescriptions Selected Brand and Other Generic (Tier 2) $40 Copayment AD retail prescriptions / $120 Copayment AD mail order prescriptions Non-Selected Brand (Tier 3) Greater of $60 Copayment AD retail prescription and $180 Copayment AD mail order prescription or 20% Coinsurance AD up to a $250 maximum retail Copayment per 31-day supply, $750 maximum mail order Copayment per 90-day supply. Specialty drugs (Tier 4) 20% Coinsurance AD up to a $250 maximum retail Copayment per 31-day supply 90-day mail order supply available. If brand drugs are used when a generic is available, you must pay the difference in cost plus the Copayment. What does that mean? Below are a few term that will help you understand how your benefits work: Copayments are fixed dollar amounts (for example, $15) you pay for covered healthcare, usually when you receive the service. Coinsurance is your share of the costs of a covered service, calculated as a percent of the allowable charge for the service. For example, if the Plan's allowable charge for an overnight hospital stay is $1,000, your Coinsurance payment of 20% would be $200. This may change if you haven't met your Deductible. The amount the Plan pays for covered services is based on the allowable charge. If an out-of-network provider charges more than the allowable charge, you may have to pay the difference. For example, if an out-of-network hospital charges $1,500 for an overnight stay and the allowable charge is $1,000, you may have to pay the $500 difference. (This is called balance billing.) This Plan may encourage you to use participating providers by charging you lower Deductibles, Copayments and Coinsurance amounts. Health Reform For more information on Health Reform, covered preventive services, or essential health benefits, please visit optimahealth.com/healthreform. Uniform Summaries of Benefits and Coverage (USBC) may also be found there. If you are an existing member, you may locate your Plan-specific documents or your USBC on optimahealth.com/members once you log on. You may also request a printed copy of these documents by calling the Member Services number located on the back of your member ID card. All Optima Health plans have benefit exclusions and limitations and terms under which the policy may be continued in force or discontinued. For costs and complete details of coverage, please call your broker or Optima Health, or log on to Optimahealth.com. Optima Health is the trade name of Optima Health Plan, Optima Health Insurance Company, Optima Health Group, Inc., and Sentara Health Plans, Inc. Page Blade Benefit Consulting LLC Sorrentino Mariani & Company Employee Benefits

6 OPTIMA VANTAGE 1000/20/80 BENEFIT DETAILS Summary of Benefits Vantage 1000/20/80% This document is not a contract or policy with Optima Health. It is a high-level summary of benefits and services available through the Plan. Some services may have limits associated with them or may require prior authorization. Annual Deductible In-Network Individual $1,000 Family $2,000 Coinsurance Out-of-Pocket Maximum 20% AD Individual $3,500 Family $7,000 Physician Office Visits PCP Office Visit $20 Copayment Per visit Specialist Office Visit $40 Copayment Per visit Preventive Care Visits Covered at 100% Outpatient Surgery Outpatient Therapy Services Outpatient Rehabilitation Services* Outpatient Diagnostic Procedures (Diagnostic Procedures, X-ray, Ultrasound) Outpatient Advanced Imaging/Testing (Sleep Studies, MRI, MRA, CT, CTA, and PET) Inpatient Care Emergency Department Urgent Care Center Outpatient Services Inpatient Hospital Services Emergency Services 20% Coinsurance AD 20% Coinsurance AD 20% Coinsurance AD 20% Coinsurance AD 20% Coinsurance AD 20% Coinsurance AD 20% Coinsurance AD $40 Copayment Per visit Behavioral Health and Substance Abuse Services Inpatient Services 20% Coinsurance AD Outpatient Visits $20 Copayment Per visit Employee Assistance Program Covered at 100% Diabetic Supplies & Infusion Sets Maternity Care Other Services 20% Coinsurance AD $450 Copayment Global AD After Deductible. *Occupational and Physical Therapy have a combined 30-visit limit per person per calendar year. Speech Therapy and Rehabilitative Outpatient Therapy each have 30-visit limits per person per calendar year. Sorrentino Mariani & Company Employee Benefits 2016 Blade Benefit Consulting LLC Page 6

7 OPTIMA VANTAGE 1000/20/80 BENEFIT DETAILS Summary of Benefits Vantage 1000/20/80% Deductible Selected Generic (Tier 1) Pharmacy $75 per person $10 Copayment AD retail prescriptions / $25 Copayment AD mail order prescriptions Selected Brand and Other Generic (Tier 2) $40 Copayment AD retail prescriptions / $100 Copayment AD mail order prescriptions Non-Selected Brand (Tier 3) Greater of $60 Copayment AD retail prescription and $180 Copayment AD mail order prescription or 20% Coinsurance AD up to a $250 maximum retail Copayment per 31-day supply, $750 maximum mail order Copayment per 90-day supply. Specialty drugs (Tier 4) 20% Coinsurance AD up to a $250 maximum retail Copayment per 31-day supply 90-day mail order supply available. If brand drugs are used when a generic is available, you must pay the difference in cost plus the Copayment. What does that mean? Below are a few term that will help you understand how your benefits work: Copayments are fixed dollar amounts (for example, $15) you pay for covered healthcare, usually when you receive the service. Coinsurance is your share of the costs of a covered service, calculated as a percent of the allowable charge for the service. For example, if the Plan's allowable charge for an overnight hospital stay is $1,000, your Coinsurance payment of 20% would be $200. This may change if you haven't met your Deductible. The amount the Plan pays for covered services is based on the allowable charge. If an out-of-network provider charges more than the allowable charge, you may have to pay the difference. For example, if an out-of-network hospital charges $1,500 for an overnight stay and the allowable charge is $1,000, you may have to pay the $500 difference. (This is called balance billing.) This Plan may encourage you to use participating providers by charging you lower Deductibles, Copayments and Coinsurance amounts. Health Reform For more information on Health Reform, covered preventive services, or essential health benefits, please visit optimahealth.com/healthreform. Uniform Summaries of Benefits and Coverage (USBC) may also be found there. If you are an existing member, you may locate your Plan-specific documents or your USBC on optimahealth.com/members once you log on. You may also request a printed copy of these documents by calling the Member Services number located on the back of your member ID card. All Optima Health plans have benefit exclusions and limitations and terms under which the policy may be continued in force or discontinued. For costs and complete details of coverage, please call your broker or Optima Health, or log on to Optimahealth.com. Optima Health is the trade name of Optima Health Plan, Optima Health Insurance Company, Optima Health Group, Inc., and Sentara Health Plans, Inc. Page Blade Benefit Consulting LLC Sorrentino Mariani & Company Employee Benefits

8 OPTIMA VANTAGE 25/70 BENEFIT DETAILS Summary of Benefits Vantage 25/70% This document is not a contract or policy with Optima Health. It is a high-level summary of benefits and services available through the Plan. Some services may have limits associated with them or may require prior authorization. Individual Family Annual Deductible Coinsurance Out-of-Pocket Maximum In-Network none none Individual $3,000 Family $6,000 Physician Office Visits PCP Office Visit $25 Copayment Per visit Specialist Office Visit $50 Copayment Per visit Preventive Care Visits Covered at 100% Outpatient Surgery Outpatient Therapy Services Outpatient Rehabilitation Services* Outpatient Diagnostic Procedures (Diagnostic Procedures, X-ray, Ultrasound) Outpatient Advanced Imaging/Testing (Sleep Studies, MRI, MRA, CT, CTA, and PET) Inpatient Care Emergency Department Urgent Care Center Outpatient Services Inpatient Hospital Services Emergency Services 30% 30% Coinsurance 30% Coinsurance 30% Coinsurance 30% Coinsurance 30% Coinsurance 30% Coinsurance 30% Coinsurance $50 Copayment Per visit Behavioral Health and Substance Abuse Services Inpatient Services 30% Coinsurance Outpatient Visits $25 Copayment Per visit Employee Assistance Program Covered at 100% Diabetic Supplies & Infusion Sets Maternity Care Other Services 20% Coinsurance $500 Copayment Global AD After Deductible. *Occupational and Physical Therapy have a combined 30-visit limit per person per calendar year. Speech Therapy and Rehabilitative Outpatient Therapy each have 30-visit limits per person per calendar year. Sorrentino Mariani & Company Employee Benefits 2016 Blade Benefit Consulting LLC Page 8

9 OPTIMA VANTAGE 25/70 BENEFIT DETAILS Summary of Benefits Vantage 25/70% Deductible Selected Generic (Tier 1) Pharmacy $150 per person $10 Copayment AD retail prescriptions / $25 Copayment AD mail order prescriptions Selected Brand and Other Generic (Tier 2) $40 Copayment AD retail prescriptions / $100 Copayment AD mail order prescriptions Non-Selected Brand (Tier 3) Greater of $60 Copayment AD retail prescription and $180 Copayment AD mail order prescription or 20% Coinsurance AD up to a $250 maximum retail Copayment per 31-day supply, $750 maximum mail order Copayment per 90-day supply. Specialty drugs (Tier 4) 20% Coinsurance AD up to a $250 maximum retail Copayment per 31-day supply 90-day mail order supply available. If brand drugs are used when a generic is available, you must pay the difference in cost plus the Copayment. What does that mean? Below are a few term that will help you understand how your benefits work: Copayments are fixed dollar amounts (for example, $15) you pay for covered healthcare, usually when you receive the service. Coinsurance is your share of the costs of a covered service, calculated as a percent of the allowable charge for the service. For example, if the Plan's allowable charge for an overnight hospital stay is $1,000, your Coinsurance payment of 20% would be $200. This may change if you haven't met your Deductible. The amount the Plan pays for covered services is based on the allowable charge. If an out-of-network provider charges more than the allowable charge, you may have to pay the difference. For example, if an out-of-network hospital charges $1,500 for an overnight stay and the allowable charge is $1,000, you may have to pay the $500 difference. (This is called balance billing.) This Plan may encourage you to use participating providers by charging you lower Deductibles, Copayments and Coinsurance amounts. Health Reform For more information on Health Reform, covered preventive services, or essential health benefits, please visit optimahealth.com/healthreform. Uniform Summaries of Benefits and Coverage (USBC) may also be found there. If you are an existing member, you may locate your Plan-specific documents or your USBC on optimahealth.com/members once you log on. You may also request a printed copy of these documents by calling the Member Services number located on the back of your member ID card. All Optima Health plans have benefit exclusions and limitations and terms under which the policy may be continued in force or discontinued. For costs and complete details of coverage, please call your broker or Optima Health, or log on to Optimahealth.com. Optima Health is the trade name of Optima Health Plan, Optima Health Insurance Company, Optima Health Group, Inc., and Sentara Health Plans, Inc. Page Blade Benefit Consulting LLC Sorrentino Mariani & Company Employee Benefits

10 DENTAL BENEFIT DETAILS SORRENTINO MARIANI & CO Group Number: Dental Benefit Summary About Your Benefits: A visit to your dentist can help you keep a great smile and prevent many health issues. But dental care can be costly and you can be faced with unforeseen expenses. Did you know, a crown can cost as much as $1,400 1? Guardian dental insurance will help you pay for it. With access to one of the largest network of dental providers in the country, who agreed to charge negotiated fees for their services of up to 30% less than average charges in the same community, you will benefit from lower out-of-pocket costs, quality care from screened and reviewed dentist, no claim forms to file, and excellent customer service. Enroll today and smile next time you see your dentist! 1 With your Guardian Choice plan, employees select either a Network Access Plan (NAP) or a Value Plan and can change their election annually. Premium rates are the same for both plans. The Value Plan offers members who choose to see a Guardian participating dentist the most savings and Out-of-Network benefits are limited to our PPO fee schedule. Your Dental Plan PPO Your Network is DentalGuard Preferred Your Weekly premium $6.51 You and spouse/domestic partner $13.22 You and child(ren) $16.71 You, spouse/domestic partner and child(ren) $24.98 Calendar year deductible Value Plan NAP Plan In / Out-Net In / Out-Net Individual $50 $50 Family limit 3 per family Waived for Preventive Preventive Charges covered for you (co-insurance) Value Plan NAP Plan In / Out-Net In / Out-Net Preventive Care 100% 100% Basic Care 100% 80% Major Care 60% 50% Orthodontia Not Covered Annual Maximum Benefit $3000 Preventive Services Exempt from Maximum Yes Maximum Rollover Yes Rollover Threshold $1000 Rollover Amount $500 Rollover In-network Amount $750 Rollover Account Limit $1500 Lifetime Orthodontia Maximum Not Applicable Dependent Age Limits 26 Page Blade Benefit Consulting LLC Sorrentino Mariani & Company Employee Benefits

11 DENTAL BENEFIT DETAILS A Sample of Services Covered by Your Plan: PPO Plan pays (on average) Value Plan NAP Plan In / Out-Net In / Out-Net Preventive Care Cleaning (prophylaxis) 100% 100% Frequency: Once Every 6 Months Fluoride Treatments 100% 100% Limits: Under Age 14 Oral Exams 100% 100% Sealants (per tooth) 100% 100% X-rays 100% 100% Basic Care Fillings 100% 80% Perio Surgery 100% 80% Periodontal Maintenance 100% 80% Frequency: Once Every 3 Months (Enhanced) Root Canal 100% 80% Scaling & Root Planing (per quadrant) 100% 80% Simple Extractions 100% 80% Major Care Anesthesia* 60% 50% Bridges and Dentures 60% 50% Inlays, Onlays, Veneers** 60% 50% Repair & Maintenance of Crowns, Bridges & Dentures 60% 50% Single Crowns 60% 50% Surgical Extractions 60% 50% This is only a partial list of dental services. Your certificate of benefits will show exactly what is covered and excluded. **For PPO and or Indemnity members, Crowns, Inlays, Onlays and Labial Veneers are covered only when needed because of decay or injury or other pathology when the tooth cannot be restored with amalgam or composite filing material. When Orthodontia coverage is for "Child(ren)" only, the orthodontic appliance must be placed prior to the age limit set by your plan; If full-time status is required by your plan in order to remain insured after a certain age; then orthodontic maintenance may continue as long as full-time student status is maintained. If Orthodontia coverage is for "Adults and Child(ren)" this limitation does not apply. The total number of cleanings and periodontal maintenance procedures are combined in a 12 month period. *General Anesthesia restrictions apply. For PPO and or Indemnity members, Fillings restrictions may apply to composite fillings. This handout is for illustrative purposes only and is an approximation. If any discrepancies between this handout and your paycheck stub exist, your paycheck stub prevails. Manage Your Benefits: Need Assistance? Go to to access secure information about your Guardian benefits including access to an image of your ID Card. Your on-line account will be set up within 30 days after your plan effective date.. Find A Dentist: Visit Click on Find A Provider ; You will need to know your plan, which can be found on the first page of your dental benefit summary. EXCLUSIONS AND LIMITATIONS n Important Information about Guardian s DentalGuard Indemnity and DentalGuard Preferred Network PPO plans: This policy provides dental insurance only. Coverage is limited to those charges that are necessary to prevent, diagnose or treat dental disease, defect, or injury. Deductibles apply. The plan does not pay for: oral hygiene services (except as covered under preventive services), orthodontia (unless expressly provided for), cosmetic or experimental treatments (unless they are expressly provided for), any treatments to the extent benefits are payable by any other payor or for which no charge is made, prosthetic devices unless certain conditions are met, and services ancillary to surgical treatment. The plan limits benefits for diagnostic n Call the Guardian Helpline (888) , weekdays, 8:00 AM to 8:30 PM, EST. Refer to your member ID (social security number) and your plan number: Please call the Guardian Helpline if you need to use your benefits within 30 days of plan effective date. Please note, self-serve options over the phone or online at Guardian Anytime are not available until the case is fully implemented, please wait to speak to a live agent when calling the Guardian Helpline. consultations and for preventive, restorative, endodontic, periodontic, and prosthodontic services. The services, exclusions and limitations listed above do not constitute a contract and are a summary only. The Guardian plan documents are the final arbiter of coverage. Contract # GP-1-DG2000 et al. PPO and or Indemnity Special Limitation: Teeth lost or missing before a covered person becomes insured by this plan. A covered person may have one or more congenitally missing teeth or have lost one or more teeth before he became insured by this plan. We won t pay for a prosthetic device which replaces such teeth unless the device also replaces one or more natural teeth lost or extracted after the covered person became insured by this plan. R3-DG2000 Sorrentino Mariani & Company Employee Benefits 2016 Blade Benefit Consulting LLC Page 11

12 DENTAL BENEFIT DETAILS Guardian Choice Additional Details You have the flexibility to choose the plan that can best meet your needs. Both plans can meet your needs; the difference is how out-of-network benefits are reimbursed. Here s how this benefit works: Premiums are the same for either plan Option to switch plans each year at annual enrollment time Save an average of 30% over what dentists usually charge by using network providers Plan Description: Value Plan Benefits are paid at the same coinsurance percentages in-network and out-of-network. When you seek in-network care, you receive our PPO savings and you ll have less out of pocket costs Network Access Plan Benefits are paid at the same coinsurance percentages in-network and out-of-network. You retain complete freedom of choice to see any dentist in or out-of-network. In-network: Out-of-network: Co-insurance: Benefits are based on a negotiated contracted fee schedule (an average discount of 30%). No additional fees to the dentist! Benefits are based on the discounted fee Benefits are based on usual, customary and schedules agreed upon by our network reasonable (UCR) charges that dentists in dentists. your area charge for each procedure. Any amount that is charged over the fee schedule is the responsibility of the patient. Preventive services are covered 100%. Co-insurance for other services is higher than the Network Access Plan. Preventive services are covered 100%. Co-insurance for other services is lower than the Value Plan. To find a dentist, visit or download our Guardian Anytime mobile app. For Overview of your Dental Benefits, please see About Your Benefit Section of this Enrollment Booklet. Guardian's Dental Insurance is underwritten and issued by The Guardian Life Insurance Company of America or its subsidiaries, New York, NY. Products are not available in all states. Policy limitations and exclusions apply. Optional riders and/or features may incur additional costs. Plan documents are the final arbiter of coverage." Policy Form #GP-1-DG2000, et al. Page Blade Benefit Consulting LLC Sorrentino Mariani & Company Employee Benefits

13 VISION RATES SORRENTINO MARIANI & CO Vision Benefit Summary Group Number: About Your Benefits: Eye care is a vital component of a healthy lifestyle. With vision insurance, having regular exams and purchasing contacts or glasses is simple and affordable. The coverage is inexpensive, yet the benefits can be significant! Guardian provides rich, flexible plans that allow you to safeguard your health while saving you money. Review your plan options and see why vision insurance may be a great benefit for you. Option 1: Significant out-of-pocket savings available with your Full Feature plan by visiting one of Davis Vision's network locations including retail centers such as Wal-Mart, JCPenney, Sears, Target, Sam s Club, Pearle, and Visionworks. Option 2: Visit any network doctor in your Access Plan and you'll receive discounts on exams, glasses, contact and laser vision surgery. (Benefits provided with the election of Dental coverage, unless a Vision plan is selected.) Your Vision Plan Option 1: Full Feature - Designer Option 2: Discount Access Your Network is Davis Vision Davis Vision Your Weekly premium $ 1.65 No Charge You and spouse/domestic partner $ 2.77 No Charge You and child(ren) $ 2.83 No Charge You, spouse/domestic partner and child(ren) $ 4.47 No Charge Copay Exams Copay $ 10 Not Applicable Materials Copay (waived for non-formulary elective contact lenses) $ 25 Not Applicable Sample of Covered Services You pay (after copay if applicable): In-network Out-of-network Eye Exams $0 Amount over $50 Sample of Coverage Services are Not Single Vision Lenses $0 Amount over $48 Applicable for Discount Access Lined Bifocal Lenses $0 Amount over $67 Lined Trifocal Lenses $0 Amount over $86 Lenticular Lenses $0 Amount over $126 Frames 80% of amount over Amount over $48 $130*² Contact Lenses (Elective and conventional) 85% of amount over Amount over $105 $130* Contact Lenses (Planned replacement and 85% of amount over Amount over $105 disposable) $130* Contact Lenses (Medically Necessary) $0 Amount over $210 Cosmetic Extras Avg % off retail No discounts price Glasses (Additional pair of frames and lenses) Courtesy discount No discounts from most providers Laser Correction Surgery Discount Up to 25% off the usual charge or 5% off promotional price No discounts Page Blade Benefit Consulting LLC Sorrentino Mariani & Company Employee Benefits

14 VISION BENEFIT DETAILS Your Vision Plan Option 1: Full Feature - Designer Option 2: Discount Access Service Frequencies Exams Every calendar year Limitless - 15% off doctor's usual charge Lenses (for glasses or contact lenses) Every calendar year Not Applicable Frames Every two calendar years Not Applicable Network discounts (cosmetic extras, glasses and contact lenses.) Applies to first purchase & courtesy discount from most providers on subsequent purchases. Applies to first purchase & courtesy discount from most providers on subsequent purchases. Dependent Age Limits 26 Age limit matches Dental Plan Visit and click on Find a Provider This is only a partial list of vision services. Your certificate of benefits will show exactly what is covered and excluded. Davis Benefit includes coverage for glasses or contact lenses, not both. Contact lenses from Davis Vision's Collection are available at most private practice locations with Full Feature and Materials Only plans. Contacts from the collection are covered in full including fitting and evaluation, in excess of the plan's materials copay. Elective contacts that are not part of the Collection are covered up to the plan's elective contact lens allowance and the materials copay is waived. *Due to lower prices available at Wal-mart and Sam's Club locations, discounts do not apply. Members will pay 100% of the amount over their allowance. For Davis Vision, complete eyeglasses must be purchased at one time from one provider. For example, if a member purchases only lenses, he or she cannot purchase frames later in the same benefit period. The member is not eligible for new vision materials until the next benefit period. Only charges for an initial purchase can be used toward the material allowance. Any unused balance remaining after the initial purchase cannot be banked for future use. 2 Extra $50 at Visionworks stores This handout is for illustrative purposes only and is an approximation. If any discrepancies between this handout and your paycheck stub exist, your paycheck stub prevails. Manage Your Benefits: Go to to access secure information about your Guardian benefits including access to an image of your ID Card. Your on-line account will be set up within 30 days after your plan effective date. Need Assistance? Call the Guardian Helpline (888) , weekdays, 8:00 AM to 8:30 PM, EST. Refer to your member ID (social security number) and your plan number: Please call the Guardian Helpline if you need to use your benefits within 30 days of plan effective date. Please note, self-serve options over the phone or online at Guardian Anytime are not available until the case is fully implemented, please wait to speak to a live agent when calling the Guardian Helpline. EXCLUSIONS AND LIMITATIONS Important Information: This policy provides vision care limited benefits health insurance only. It does not provide basic hospital, basic medical or major medical insurance as defined by the New York State Insurance Department. Coverage is limited to those charges that are necessary for a routine vision examination. Co-pays apply. The plan does not pay for: orthoptics or vision training and any associated supplemental testing; medical or surgical treatment of the eye; and eye examination or corrective eyewear required by an employer as a condition of employment; replacement of lenses and frames that are furnished under this plan, which are lost or broken (except at normal intervals when services are otherwise available or a warranty exists). The plan limits benefits for blended lenses, oversized lenses, photochromic lenses, tinted lenses, progressive multifocal lenses, coated or laminated lenses, a frame that exceeds plan allowance, cosmetic lenses; U-V protected lenses and optional cosmetic processes. The services, exclusions and limitations listed above do not constitute a contract and are a summary only. The Guardian plan documents are the final arbiter of coverage. Contract #GP-1-DAVIS-05-VIS et al. Laser Correction Surgery: Up to 25% off for vision laser surgery. Laser surgery is not an insured benefit. The surgery is available at a discounted fee. The covered person must pay the entire discounted fee. In addition, the laser surgery discount may not be available in all states. Sorrentino Mariani & Company Employee Benefits 2016 Blade Benefit Consulting LLC Page 14

15 ACCIDENT PLAN BENEFIT DETAILS SORRENTINO MARIANI & CO Group Number: Accident Benefit Summary About Your Benefits: Accidents happen every day. Did you know almost 39 Million emergency room visits a year are due to an injury?¹ If you were injured from an accident, chances are you will have expenses that you were not anticipating-will you be prepared? Accident Insurance can help you deal with those expenses. Benefit payments can help you with your medical deductibles and co-pays, and cover household expenses like groceries, mortgage payments and childcare, which can begin to pile up if you have to take some time off from work. You are guaranteed coverage, so please enroll today! 1 Injury Facts, 2011 Edition, National Safety Council. What Your Benefits Cover: ACCIDENT COVERAGE - DETAILS Your Weekly premium $3.18 You and Spouse $4.91 You and Child(ren) $5.02 You, Spouse and Child(ren) $6.75 Accident Coverage Type On and Off Job Portability - Allows you to take your Accident coverage with you if you terminate Included employment. Ported Accident plan terminates at age 70. ACCIDENTAL DEATH AND DISMEMBERMENT Employee $10,000 Benefit Amount(s) Spouse $5,000 Child $5,000 Quadriplegia, Loss of speech & hearing (both ears), Catastrophic Loss Loss of Cognitive function: 100% of AD&D Hemiplegia & Paraplegia: 50% of AD&D Common Carrier 200% of AD&D benefit Common Disaster 200% of Spouse AD&D benefit Dismemberment - Hand, Foot, Sight Single: 50% of AD&D benefit Multiple: 100% of AD&D benefit Dismemberment - Thumb/Index Finger Same Hand, Four Fingers Same Hand, All 25% of AD&D benefit Toes Same Foot Seatbelts and Airbags Seatbelts: $10,000 & Airbags: $15,000 Reasonable Accommodation to Home or Vehicle $2,500 Child(ren) Age Limits Children age birth to 26 years FEATURES Accident Emergency Room Treatment $150 Accident Follow-Up Visit - Doctor $25 up to 6 treatments Air Ambulance $500 Ambulance $100 Appliance - Wheelchair, leg or back brace, crutches, walker, walking boot that $100 extends above the ankle or brace for the neck. Blood/Plasma/Platelets $300 Page Blade Benefit Consulting LLC Sorrentino Mariani & Company Employee Benefits

16 ACCIDENT PLAN BENEFIT DETAILS FEATURES (Cont.) 9 sq inches to 18 sq inches: $0/$2,000 Burns (2nd Degree/3rd Degree) 18 sq inches to 35 sq inches: $1,000/$4,000 Over 35 sq inches: $3,000/$12,000 Burn - Skin Graft 50% of burn benefit Child Organized Sport - Benefit is paid if the covered accident occurred while your 20% increase to child benefits covered child is participating in an organized sport that is governed by an organization and requires formal registration to participate. Coma $7,500 Concussions $50 Dislocations Schedule up to $3,600 Diagnostic Exam (Major) $100 Emergency Dental Work $200/Crown, $50/Extraction Epidural pain management $100, 2 times per accident Eye Injury $200 Family Care $20/day up to 30 days Fracture Schedule up to $4,500 Hospital Admission $750 Hospital Confinement $175/day - up to 1 year Hospital ICU Admission $1,500 Hospital ICU Confinement $350/day - up to 15 days Initial Physician's office/urgent Care Facility Treatment $50 Joint Replacement (hip/knee/shoulder) $1,500/$750/$750 Knee Cartilage $500 Laceration Schedule up to $300 Lodging - The hospital must be more than 50 miles from the insured's residence. $100/day, up to 30 days for companion hotel stay Occupational or Physical Therapy $25/day up to 10 days Prosthetic Device/Artificial Limb 1: $500 2 or more: $1,000 Rehabilitation Unit Confinement $150/day up to 15 days Ruptured Disc With Surgical Repair $500 Surgery Schedule up to $1,000 Hernia: $125 Surgery - Exploratory or Arthroscopic $150 Tendon/Ligament/Rotator Cuff 1: $250 2 or more: $500 Transportation - Benefit is paid if you have to travel more than 50 miles one way to $400, 3 times per accident receive special treatment at a hospital or facility due to a covered accident. X - Ray $20 UNDERSTANDING YOUR BENEFITS: Common Carrier Benefit is paid if an insured's death occurs due to an accident while riding as a fare-paying passanger in a public conveyance. If this is paid, we do not pay the Accidental Death benefit. Common Disaster Benefit is paid if both you & your spouse die in a covered accident or separate covered accidents within the same 24 hour period. Reasonable Accomodation Benefit is payable if a modification is required to an insured's place of residence or vehicle due to an Accidental Dismemberment or Catastrophic loss. This handout is for illustrative purposes only and is an approximation. If any discrepancies between this handout and your paycheck stub exist, your paycheck stub prevails. Sorrentino Mariani & Company Employee Benefits 2016 Blade Benefit Consulting LLC Page 16

17 DISABILITY PLAN BENEFIT DETAILS Group Number: About Your Benefits: You probably have insurance for your car or home, but what about the source of income that pays for it? You rely on your paycheck for so many things, but what if you were suddenly unable to work due to an accident or illness? How will you put food on the table, pay your mortgage or heat your home? Disability insurance can help replace lost income and make a difficult time a little easier. Protect your most valuable asset, your paycheck-enroll today!. What Your Benefits Cover: Coverage amount Maximum payment period: Maximum length of time you can receive disability benefits. Short-Term Disability 60% of salary to maximum $750/week 13 weeks Long-Term Disability 60% of salary to maximum $3000/month Social Security Normal Retirement Age Accident benefits begin: The length of time you must be disabled before benefits begin. Illness benefits begin: The length of time you must be disabled before benefits begin. Day 1 Day 91 Day 8 Day 91 Evidence of Insurability: A health statement requiring you to answer a few medical history questions. Guarantee Issue: The guarantee means you are not required to answer health questions to qualify for coverage up to and including the specified amount, when applicant signs up for coverage during the initial enrollment period. Minimum work hours/week: Minimum number of hours you must regularly work each week to be eligible for coverage. Health Statement may be required We Guarantee Issue $750 in coverage Planholder Determines Health Statement may be required We Guarantee Issue $3000 in coverage Planholder Determines Pre-existing conditions: A pre-existing condition includes any condition/symptom for which you, in the specified time period prior to coverage in this plan, consulted with a physician, received treatment, or took prescribed drugs. 3 months look back; 12 months after 2 week limitation 12 months look back; 12 months after exclusion Premium waived if disabled: Premium will not need to be paid when you are receiving benefits. Survivor benefit: Additional benefit payable to your family if you die while disabled. Yes No Yes 3 months UNDERSTANDING YOUR BENEFITS DISABILITY (Some information may vary by state) l Disability (long-term): For first two years of disability, you will receive benefit payments while you are unable to work in your own occupation. After two years, you will continue to receive benefits if you cannot work in any occupation based on training, experience and education. Benefit information illustrated within this material reflects the plan covered by Guardian as of 10/14/2016 l Earnings definition: Your covered salary excludes bonuses and commissions. l Special limitations: Provides a 24-month benefit limit for mental health and substance abuse. 23 l Work incentive: Plan benefit will not be reduced for a specified amount of months so that you have part-time earnings while you remain disabled, unless the combined benefit and earnings exceed 100% of your previous earnings. Page Blade Benefit Consulting LLC Sorrentino Mariani & Company Employee Benefits

18 DISABILITY PLAN BENEFIT DETAILS Disability Cost Illustration: To determine the most appropriate level of coverage, you should consider your current basic monthly expenses. To help you assess your needs, you can also go to Guardian Anytime and use our Disability Insurance Explorer Tool. Short-Term Disability Plan Weekly Cost Illustration: Policy amounts shown based on sample salary amounts only. < Your premium rate $0.465 $0.498 $0.631 $0.564 $0.564 $0.631 $0.764 $0.996 $1.361 Election Cost Per Age Bracket < $15,000 Annual Salary $173 Weekly Benefit $1.86 $1.99 $2.52 $2.25 $2.25 $2.52 $3.05 $3.98 $5.43 $20,000 Annual Salary $231 Weekly Benefit $2.48 $2.66 $3.36 $3.01 $3.01 $3.36 $4.07 $5.31 $7.26 $25,000 Annual Salary $288 Weekly Benefit $3.09 $3.31 $4.19 $3.75 $3.75 $4.19 $5.08 $6.62 $9.05 $30,000 Annual Salary $346 Weekly Benefit $3.71 $3.98 $5.04 $4.50 $4.50 $5.04 $6.10 $7.95 $10.87 $35,000 Annual Salary $404 Weekly Benefit $4.34 $4.64 $5.88 $5.26 $5.26 $5.88 $7.12 $9.29 $12.69 $40,000 Annual Salary $462 Weekly Benefit $4.96 $5.31 $6.73 $6.01 $6.01 $6.73 $8.15 $10.62 $14.51 $45,000 Annual Salary $519 Weekly Benefit $5.57 $5.97 $7.56 $6.76 $6.76 $7.56 $9.15 $11.93 $16.30 $50,000 Annual Salary $577 Weekly Benefit $6.19 $6.63 $8.40 $7.51 $7.51 $8.40 $10.17 $13.26 $18.12 $55,000 Annual Salary $635 Weekly Benefit $6.81 $7.30 $9.25 $8.27 $8.27 $9.25 $11.20 $14.60 $19.94 $60,000 Annual Salary $692 Weekly Benefit $7.43 $7.95 $10.08 $9.01 $9.01 $10.08 $12.20 $15.91 $21.73 $65,000 Annual Salary $750 Weekly Benefit $8.05 $8.62 $10.92 $9.76 $9.76 $10.92 $13.22 $17.24 $23.56 $70,000 Annual Salary $750 Weekly Benefit $8.05 $8.62 $10.92 $9.76 $9.76 $10.92 $13.22 $17.24 $23.56 $75,000 Annual Salary $750 Weekly Benefit $8.05 $8.62 $10.92 $9.76 $9.76 $10.92 $13.22 $17.24 $23.56 $80,000 Annual Salary $750 Weekly Benefit $8.05 $8.62 $10.92 $9.76 $9.76 $10.92 $13.22 $17.24 $23.56 $85,000 Annual Salary $750 Weekly Benefit $8.05 $8.62 $10.92 $9.76 $9.76 $10.92 $13.22 $17.24 $23.56 $90,000 Annual Salary $750 Weekly Benefit $8.05 $8.62 $10.92 $9.76 $9.76 $10.92 $13.22 $17.24 $23.56 $95,000 Annual Salary $750 Weekly Benefit $8.05 $8.62 $10.92 $9.76 $9.76 $10.92 $13.22 $17.24 $23.56 $100,000 Annual Salary $750 Weekly Benefit $8.05 $8.62 $10.92 $9.76 $9.76 $10.92 $13.22 $17.24 $23.56 Sorrentino Mariani & Company Employee Benefits 2016 Blade Benefit Consulting LLC Page 18

19 DISABILITY PLAN BENEFIT DETAILS < $105,000 Annual Salary $750 Weekly Benefit $8.05 $8.62 $10.92 $9.76 $9.76 $10.92 $13.22 $17.24 $23.56 $110,000 Annual Salary $750 Weekly Benefit $8.05 $8.62 $10.92 $9.76 $9.76 $10.92 $13.22 $17.24 $23.56 $115,000 Annual Salary $750 Weekly Benefit $8.05 $8.62 $10.92 $9.76 $9.76 $10.92 $13.22 $17.24 $23.56 $120,000 Annual Salary $750 Weekly Benefit $8.05 $8.62 $10.92 $9.76 $9.76 $10.92 $13.22 $17.24 $23.56 Long-Term Disability Plan Weekly Cost Illustration: Policy amounts shown based on sample salary amounts only. < Your premium rate $0.287 $0.313 $0.461 $0.705 $1.018 $1.540 $2.062 $2.488 $1.905 Election Cost Per Age Bracket < $15,000 Annual Salary $750 Monthly Benefit $0.83 $0.90 $1.33 $2.03 $2.94 $4.44 $5.95 $7.18 $5.50 $20,000 Annual Salary $1,000 Monthly Benefit $1.10 $1.20 $1.77 $2.71 $3.92 $5.92 $7.93 $9.57 $7.33 $25,000 Annual Salary $1,250 Monthly Benefit $1.38 $1.51 $2.22 $3.39 $4.89 $7.40 $9.91 $11.96 $9.16 $30,000 Annual Salary $1,500 Monthly Benefit $1.66 $1.81 $2.66 $4.07 $5.87 $8.89 $11.90 $14.35 $10.99 $35,000 Annual Salary $1,750 Monthly Benefit $1.93 $2.11 $3.10 $4.75 $6.85 $10.37 $13.88 $16.75 $12.82 $40,000 Annual Salary $2,000 Monthly Benefit $2.21 $2.41 $3.55 $5.42 $7.83 $11.85 $15.86 $19.14 $14.65 $45,000 Annual Salary $2,250 Monthly Benefit $2.48 $2.71 $3.99 $6.10 $8.81 $13.33 $17.84 $21.53 $16.49 $50,000 Annual Salary $2,500 Monthly Benefit $2.76 $3.01 $4.43 $6.78 $9.79 $14.81 $19.83 $23.93 $18.32 $55,000 Annual Salary $2,750 Monthly Benefit $3.04 $3.31 $4.88 $7.46 $10.77 $16.29 $21.81 $26.31 $20.15 $60,000 Annual Salary $3,000 Monthly Benefit $3.31 $3.61 $5.32 $8.14 $11.75 $17.77 $23.79 $28.71 $21.98 $65,000 Annual Salary $3,000 Monthly Benefit $3.31 $3.61 $5.32 $8.14 $11.75 $17.77 $23.79 $28.71 $21.98 $70,000 Annual Salary $3,000 Monthly Benefit $3.31 $3.61 $5.32 $8.14 $11.75 $17.77 $23.79 $28.71 $21.98 $75,000 Annual Salary $3,000 Monthly Benefit $3.31 $3.61 $5.32 $8.14 $11.75 $17.77 $23.79 $28.71 $21.98 $80,000 Annual Salary $3,000 Monthly Benefit $3.31 $3.61 $5.32 $8.14 $11.75 $17.77 $23.79 $28.71 $21.98 Page Blade Benefit Consulting LLC Sorrentino Mariani & Company Employee Benefits

20 DISABILITY PLAN BENEFIT DETAILS < $85,000 Annual Salary $3,000 Monthly Benefit $3.31 $3.61 $5.32 $8.14 $11.75 $17.77 $23.79 $28.71 $21.98 $90,000 Annual Salary $3,000 Monthly Benefit $3.31 $3.61 $5.32 $8.14 $11.75 $17.77 $23.79 $28.71 $21.98 $95,000 Annual Salary $3,000 Monthly Benefit $3.31 $3.61 $5.32 $8.14 $11.75 $17.77 $23.79 $28.71 $21.98 $100,000 Annual Salary $3,000 Monthly Benefit $3.31 $3.61 $5.32 $8.14 $11.75 $17.77 $23.79 $28.71 $21.98 $105,000 Annual Salary $3,000 Monthly Benefit $3.31 $3.61 $5.32 $8.14 $11.75 $17.77 $23.79 $28.71 $21.98 $110,000 Annual Salary $3,000 Monthly Benefit $3.31 $3.61 $5.32 $8.14 $11.75 $17.77 $23.79 $28.71 $21.98 $115,000 Annual Salary $3,000 Monthly Benefit $3.31 $3.61 $5.32 $8.14 $11.75 $17.77 $23.79 $28.71 $21.98 $120,000 Annual Salary $3,000 Monthly Benefit $3.31 $3.61 $5.32 $8.14 $11.75 $17.77 $23.79 $28.71 $21.98 Manage Your Benefits: Go to to access secure information about your Guardian benefits. Your on-line account will be set up within 30 days after your plan effective date. Need Assistance? Call the Guardian Helpline (888) , weekdays, 8:00 AM to 8:30 PM, EST. Refer to your member ID (social security number) and your plan number: A SUMMARY OF DISABILITY PLAN LIMITATIONS AND EXCLUSIONS n n n n n n Evidence of Insurability is required on all late enrollees. This coverage will not be effective until approved by a Guardian underwriter. This proposal is hedged subject to satisfactory financial evaluation. Please refer to certificate of coverage for full plan description. You must be working full-time on the effective date of your coverage; otherwise, your coverage becomes effective after you have completed a specific waiting period. Employees must be legally working in the United States in order to be eligible for coverage. Underwriting must approve coverage for employees on temporary assignment: (a) exceeding one year; or (b) in an area under travel warning by the US Department of State. Subject to state specific variations. For Long-Term Disability coverage, we pay no benefits for a disability caused or contributed to by a pre-existing condition unless the disability starts after you have been insured under this plan for a specified period of time. We limit the duration of payments for long term disabilities caused by mental or emotional conditions, or alcohol or drug abuse. For Short-Term Disability coverage, benefits for a disability caused or contributed to by a pre-existing condition are limited, unless the disability starts after you have been insured under this plan for a specified period of time. We do not pay short term disability benefits for any job-related or on-the-job injury, or conditions for which Workers' Compensation benefits are payable. We do not pay benefits for charges relating to a covered person: taking part in any war or act of war (including service in the armed forces) committing a n n n felony or taking part in any riot or other civil disorder or intentionally injuring themselves or attempting suicide while sane or insane. We do not pay benefits for charges relating to legal intoxication, including but not limited to the operation of a motor vehicle, and for the voluntary use of any poison, chemical, prescription or non-prescription drug or controlled substance unless it has been prescribed by a doctor and is used as prescribed. We limit the duration of payments for long term disabilities caused by mental or emotional conditions, or alcohol or drug abuse. We do not pay benefits during any period in which a covered person is confined to a correctional facility, an employee is not under the care of a doctor, an employee is receiving treatment outside of the US or Canada, and the employee s loss of earnings is not solely due to disability. This policy provides disability income insurance only. It does not provide "basic hospital", "basic medical", or "medical" insurance as defined by the New York State Insurance Department. If this plan is transferred from another insurance carrier, the time an insured is covered under that plan will count toward satisfying Guardian's pre-existing condition limitation period. State variations may apply. When applicable, this coverage will integrate with NJ TDB, NY DBL, CA SDI, RI TDI, Hawaii TDI and Puerto Rico DBA. Contract #.s GP-1-STD et al; GP-1-STD2K-1.0 et al; GP-1-STD et al; GP-1-STD et al. Contract #.s GP-1-LTD94-A,B,C-1.0 et al.; GP-1-LTD2K-1.0 et al; GP-1-LTD et al; GP-1-LTD et al. This handout is for illustrative purposes only and is an approximation. If any discrepancies between this handout and your paycheck stub exist, your paycheck stub prevails. Sorrentino Mariani & Company Employee Benefits 2016 Blade Benefit Consulting LLC Page 20