TABLE OF CONTENTS DESCRIPTION. Website and Contacts 2. Health Insurance Health Rates & Deduction Calculation 3-5 Health Plans Benefit Comparison 6

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1 TABLE OF CONTENTS DESCRIPTION PAGE Website and Contacts 2 Health Insurance Health Rates & Deduction Calculation 3-5 Health Plans Benefit Comparison 6 Dental Insurance Dental Rates 7 Dental Details 8-10 Vision Insurance Vision Rates 11 Vision Details Base Life Base Life Details Flex & Dependent Care Details Mandatory Notices Blade Benefit Consulting, LLC. All rights reserved.

2 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, view forms & FAQ s, go to For a complete list of Limitations and Exclusions, as well as the ACA Mandated Summary of Coverage and Benefits go to: CONTACTS National Headquarters PO Box 1472 Virginia Beach, VA Ph F President W. Brandon Beavers Cell: Office: Extension 110 brandon@bladebc.com Director of Benefits Amy Thompson Direct: Office: Extension 112 amy@bladebc.com Page 2 Associates in Dermatology

3 ANTHEM 3500/0/3500 HRA RATES Employee Only Bi-Weekly Rates Dependent s Bi-Weekly Rates Associates in Dermatology Page 3

4 ANTHEM 500/20/3500 RATES (BUY-UP PLAN) Employee Only Bi-Weekly Rates Dependent s Bi-Weekly Rates Page 4 Associates in Dermatology

5 HEALTH INSURANCE RATES CALCULATING YOUR PAYROLL DEDUCTION Each person in the family has their own rate. Find each person s age in your family and add them up to determine your total bi-weekly payroll deduction. Please use the calculator below as a guide: Employee Rate: Spouse Rate: Child 1 Rate: Child 2 Rate: Child 3 Rate: = Total Payroll Deduction **All rates shown are bi-weekly. Anthem charges for the first three children. If your deduction is $0 or less, there will be no deduction from payroll. Associates in Dermatology Page 5

6 HEALTH BENEFIT COMPARISON BENEFITS AND FEATURES HRA Account Information AIDERM will contribute $500 to each employee s HRA (Health Reimbursement Arrangement) account when the Anthem 3500/0/3500 is elected. The HRA can be used for expenses such as doctor visits, prescriptions, deductibles, coinsurance, etc. The HRA cannot be used for dental or vision expenses, unless its medically necessary. ***For the Summary of Benefits and Coverage and complete benefit details, including this booklet and enrollment forms, go to Page 7 Associates in Dermatology

7 DENTAL INSURANCE RATES DENTAL RATES Effective December 1, 2015 Bi- Weekly Payroll Deduction Bi-Weekly Employee Only $4.86 Employee + Spouse $17.35 Employee + Child(ren) $25.26 Family $40.25 Associates in Dermatology Page 8

8 DENTAL BENEFIT DETAILS Associates In Dermatology, Inc. Effective: November 01, 2015 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 PPO plan, you can visit any dentist; but you pay less out-of-pocket when you choose a PPO dentist. Out-of-network benefits are limited to our PPO fee schedule. Your Dental Plan Your Network is PPO DentalGuard Preferred Calendar year deductible In-Network Out-of-Network Individual $50 $100 Family limit 3 per family Waived for Preventive None Charges covered for you (co-insurance) In-Network Out-of-Network Preventive Care 100% 90% Basic Care 100% 70% Major Care 60% 40% Orthodontia 50% 50% Annual Maximum Benefit $1000 $1000 Maximum Rollover Yes Rollover Threshold $500 Rollover Amount $250 Rollover In-network Amount $350 Rollover Account Limit $1000 Lifetime Orthodontia Maximum $1000 Dependent Age Limits(Non-Student/Student) 20/26 Page 9 Associates in Dermatology

9 DENTAL BENEFIT DETAILS A Sample of Services Covered by Your Plan: PPO Plan pays (on average) In-network Out-of-network Preventive Care Cleaning (prophylaxis) 100% 90% Frequency: Once Every 6 Months Fluoride Treatments 100% 90% Limits: Under Age 19 Oral Exams 100% 90% Sealants (per tooth) 100% 90% X-rays 100% 90% Basic Care Anesthesia* 100% 70% Fillings 100% 70% Perio Surgery 100% 70% Periodontal Maintenance 100% 70% Frequency: Once Every 6 Months (Enhanced) Repair & Maintenance of Crowns, Bridges & Dentures 100% 70% Root Canal 100% 70% Scaling & Root Planing (per quadrant) 100% 70% Simple Extractions 100% 70% Surgical Extractions 100% 70% Major Care Bridges and Dentures 60% 40% Dental Implants 60% 40% Inlays, Onlays, Veneers** 60% 40% Single Crowns 60% 40% Orthodontia Orthodontia 50% 50% Limits: Child(ren) 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: 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. Find A Dentist: Visit Click on Find A Provider ; You will need to know your plan and dental network, which can be found on the first page of your dental benefit summary. n EXCLUSIONS AND LIMITATIONS Important Information about Guardian s DentalGuard Indemnity and DentalGuard Preferred 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 consultations and for n 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 Associates in Dermatology Page 10

10 VISION RATES VISION INSURANCE RATES Effective December 1, 2015 Bi-Weekly premium deduction from paycheck Bi-Weekly Employee Only $0.85 Employee + Spouse $2.30 Employee + Child(ren) $2.37 Family $4.49 Page 11 Associates in Dermatology

11 VISION BENEFIT DETAILS Associates In Dermatology, Inc. Effective: November 01, 2015 Group Number: Vision Benefit Summary 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. 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, and Pearle. Your Vision Plan Your Network is Copay Exams Copay $ 20 Materials Copay (waived for non-formulary elective contact lenses) $ 20 Sample of Covered Services Full Feature - Designer Davis Vision In-network You pay (after copay if applicable): Out-of-network Eye Exams $0 Amount over $50 Single Vision Lenses $0 Amount over $48 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 $120* Amount over $48 Contact Lenses (Elective and conventional) 85% of amount over $120* Amount over $105 Contact Lenses (Planned replacement and disposable) 85% of amount over $120* Amount over $105 Contact Lenses (Medically Necessary) $0 Amount over $210 Cosmetic Extras Avg % off retail price No discounts Glasses (Additional pair of frames and lenses) Courtesy discount from most providers Laser Correction Surgery Discount Up to 25% off the usual charge or 5% off promotional price Service Frequencies Exams Lenses (for glasses or contact lenses) Frames Network discounts (cosmetic extras, glasses and contact lenses.) Dependent Age Limits (Non-Student/ Student) Benefit includes coverage for glasses or contact lenses, not both. Every calendar year Every calendar year Every two calendar years No discounts No discounts Applies to first purchase & courtesy discount from most providers on subsequent purchases. 20/26 This is only a partial list of vision services. Your certificate of benefits will show exactly what is covered and excluded. Associates in Dermatology Page 12

12 VISION BENEFIT DETAILS With the Davis Vision Designer plans, frames from the Fashion or Designer collections are covered in full in excess of the plan s materials copay, if applicable. Frames from the Premier collection are covered in full in excess of a $25 copay applied in addition to the plan s materials copay, if applicable. Frames from a network provider that are not in the collections are covered up to the plan s retail allowance in excess of the plan s materials copay, if applicable. 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. 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. *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. 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. Find A Vision Provider 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. Visit Click on Find A Provider ; You will need to know your plan and vision network, which can be found on the first page of your vision benefit summary. 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. Page 13 Associates in Dermatology

13 BASE LIFE & AD&D BENEFITS Associates In Dermatology, Inc. Effective: November 01, 2015 Group Number: About Your Benefits: Life Benefit Summary Your family depends on you in many ways and you ve worked hard to ensure their financial security. But if something happened to you, will your family be protected? Will your loved ones be able to stay in their home, pay bills, and prepare for the future. Life insurance provides a financial benefit that your family can depend on. And getting it at work is easier, more convenient and more affordable than doing it on your own. If you have financial dependents- a spouse, children or aging parents, having life insurance is a responsible and a smart decision. Enroll today to secure their future! What Your Benefits Cover: BASIC LIFE Employee Benefit Your employer provides $10,000 Basic Term Life coverage for all full time employees. Accidental Death and Dismemberment 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 you sign up for coverage during the initial enrollment period. Premiums Portability: Allows you to take your coverage with you if you terminate employment. Conversion: Allows you to continue your coverage after your group plan has terminated. Waiver of Premiums: Premium will not need to be paid if you are totally disabled. Your Basic Life coverage includes Accidental Death and Dismemberment coverage equal to one times the employee s life benefits to a maximum of $10,000. Guarantee Issue coverage up to $10,000 per employee Covered by your company if you meet eligibility requirements Yes, with age and other restrictions, including evidence of insurability Yes, with restrictions; see certificate of benefits For employees disabled prior to age 60, with premiums waived until age 65, if conditions are met Benefit Reductions: Benefits are reduced by a certain percentage as an employee ages. 35% at age 65, 60% at age 70, 75% at age 75, 85% at age 80 Subject to coverage limits Associates in Dermatology Page 14

14 VOLUNTARY TERM LIFE BENEFITS 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. LIMITATIONS AND EXCLUSIONS: A SUMMARY OF PLAN LIMITATIONS AND EXCLUSIONS FOR LIFE AND AD&D COVERAGE: 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. 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. 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: Traveling on any type of aircraft while having duties er on that aircraft; by declared or undeclared act of war or armed aggression; while a member of any armed force (May vary by state); while driving a motor vehicle without a current, valid driver s license; by legal intoxication; or by voluntarily using a non-prescription controlled substance. Contract #GP-1-R-ADCL1-00 et al. We won't pay more than 100% of the Insurance amount for all losses due to the same accident, except as stated. The loss must occur within a specific period of time of the accident. Please see contract for specific definition; definition of loss may vary depending on the benefit payable. GP-1-R-LB-90 For AD&D: We pay no benefits for any loss caused: by willful self-injury; sickness, disease or medical treatment; by participating in a civil disorder or committing a felony; Page 15 Associates in Dermatology

15 FLEX PLAN DETAILS Associates in Dermatology helps your paycheck buy more with a Flexible Benefits Plan! Sometimes referred to as a cafeteria plan, flex plan, or a Section 125 Plan a Flexible benefits Plan lets you set aside a certain amount of your paycheck into an account before paying income taxes. During the year you have access to this account for reimbursement of expenses you regularly pay for, such as healthcare and dependent daycare. HERE S HOW IT WORKS Reimbursable expenses can include: P Deductibles P Co-pays P Prescription Drugs P Some Over the-counter Medicine (OTC) (Effective January 1, OTC medications MUST have written physican approval under the Flex plan) P Dental Care P Eyewear & Contact Lenses P Laser Vision Correction P Adult/Child Care Services P And More!! Example: An employee makes $2,000 each pay period and decides to participate in her employer s Flexible Benefits Plan. As a result, her insurance premiums and health and daycare expenses are paid with tax-free dollars, giving her an additional $100 each pay period! Without the Plan Gross Earnings $2,000 FICA, Federal, State Taxes - $500 Insurance Premium - $100 Health/Daycare Expenses - $300 NET EARNINGS $1,100 With the Plan Gross Earnings $2,000 Insurance Premium - $100 Health/Daycare Expenses - $300 Adjust Gross Earnings $1,600 FICA, Federal, State Taxes - $400 NET EARNINGS $1, Carefully read this material and choose which plan(s) you wish to enroll in. Determine how much you expect to spend out of pocket during the plan year. Remember, do not over estimate. Complete the form provided in the enrollment kit. Associates in Dermatology Page 16

16 FLEX PLAN DETAILS COMMONLY ASKED QUESTIONS What is a Flexible Benefits Plan? A benefit provided by your employer that lets you set aside a certain amount of your paycheck into an account before paying income taxes. During the year you can be directly reimbursed from your account for qualified healthcare and daycare expenses. Why should I participate in the Healthcare Reimbursement Account when I already have health insurance? This account is used to pay for expenses not covered by insurance. For example - annual physicals, co-payments, eye exams, glasses, orthodontics, prescription drugs, some non-prescription drugs and hospital care to name a few. If I set aside part of my pay, won t I make less money? Your net take-home pay will increase by the amount of taxes you did not pay. An example of how it may work for you is detailed on the first page of this brochure. Can I change my contributions during the year? Only if you have a change in status such as: marriage, birth, adoption, or a change in your, your spouse s, or your dependent s employment status. What if I currently take the dependent care credit on my annual tax return? If your family income is over $20,000, you will most likely benefit from this plan rather than taking advantage of the current income tax credit. The amount you deposit in your Dependent Care Reimbursement Account reduces the amount, dollar for dollar, that you can claim as a credit on your tax return. How do I get reimbursed for my expenses? Once you have completed the enclosed enrollment form, a debit card will be issued to you. You can also submit paper claims by completing a claim form. If you need a claim form, contact Blade Benefit Consulting at Once you receive the claim form, simply complete it, attach a copy of the healthcare or dependent care bill/receipt, and mail or fax the form and receipts to Blade Benefit Consulting at Within a short time, you will receive your reimbursement by ACH Direct Deposit or mail. When using your debit card, please hold on to all your receipts. You may still need to submit these receipts for claim substantiation. Do I have to wait for the money to be deposited in my account in order to make a claim for reimbursement? The annual amount you have allocated for the Medical Reimbursement Account is available to you at any time throughout the plan year. The amount available from your Dependent Care Reimbursement Account is the amount you have contributed to date. How do I know how much is available in my accounts? Each time you are reimbursed you will receive a statement attached to your ACH Direct Deposit notification or reimbursement check that shows the dollar amount you have set aside as well as the amount you have been paid to date. You may call Blade Benefit Consulting at (757) ext 112 or (866) ext 112. You will also be able to check your balances online. What happens to my accounts if I terminate my employment? You will be able to request reimbursement for healthcare and daycare expenses for services provided prior to your termination, unless COBRA is available under your plan and is elected. What if I don t use all of the money I set aside in my accounts? Carefully review your estimated expenses before making the decision to participate. New IRS regulations allow for up to $500 of any remaining FSA balance to roll over to the next plan year! What if I am not covered under my company s health insurance plan? Good news! You and your family can still participate in the Medical Care or Dependent Care Reimbursement Accounts. How do I benefit by participating? Your biggest advantage is the tax savings. Every dollar you set aside in your account reduces your income taxes, and you can be reimbursed for qualified expenses that you are already paying for! Are there any negatives that I should know about? Yes, because you are not paying any social security tax on that portion of your income that has been redirected, your social security benefits may be slightly reduced. Page 17 Associates in Dermatology

17 FLEX PLAN DETAILS YOUR OPTIONS 1. Medical Expense Reimbursement Account This account reimburses you for medical expenses not covered by insurance. You set aside money, tax-free, through regular payroll deductions. During the year, you can be reimbursed directly from your account for those qualified medical services provided which are not covered by insurance. Common expenses that qualify for reimbursement are-doctor visits, deductibles, co-payments, prescriptions, mental health care, dental services and orthodontics, chiropractor services, eye exams, glasses and contacts. For a more complete listing, contact Blade Benefit Consulting or your Human Resource Department. 2. Dependent Care Reimbursement Account This account reimburses you for daycare expenses for eligible children and adults. Through regular payroll deductions, you set aside part of your income to pay for these expenses on a tax-free basis. To qualify, your dependents must be: A child under the age of 13, or A child, spouse or other dependent who is physically or mentally incapable of self-care and spend at least 8 hours day in your household. Qualified expenses for reimbursement include-adult and child daycare centers, preschool and before/after school care. *Please note: If your family s annual income is over $20,000, this reimbursement option will most likely save you more money than the dependent care tax credit you take on your tax return. You will also receive your tax savings throughout the year, rather than once a year when you file your tax return. DETERMINING YOUR REIMBURSABLE EXPENSE By completing the following information, you can calculate your annual reimbursable expenses. Take into consideration the services to be provided during the upcoming plan year for you and your dependents. Medical Care Expenses Medical (1) Dental (2) Vision (3) Deductibles $ Routine Care $ Exams $ Co-payments $ Fillings/Crowns $ Eye Surgery $ Office Visits $ Orthodontics $ Lenses/Frames $ Prescriptions/OTC $ Others $ Contacts $ Other $ Total $ Solutions $ Total $ Other $ Total $ Dependent Care Expenses Children $ Adults $ Total $ Estimated Annual Expenses Total Medical Expenses (add 1+2+3) Total Dependent Care Expenses Total Expenses $ $ $ Using the information calculated, complete the enclosed form and return it to Blade Benefit Consulting. Associates in Dermatology Page 18

18 FLEX PLAN DETAILS EXAMPLES OF ELIGIBLE HEALTH CARE EXPENSES Acupuncture Alcohol & drug dependency inpatient Ambulance usage Anesthesia Artificial limbs Birth control Braces Braille books and magazines Chiropractic services Christian Science practitioner services Contact lenses and solution Crutches Dental expenses Dentures Dermatology services** Diagnostic fees Doctor fees Eyeglasses, including exam fees Guide dogs Hearing aids and batteries Hospital fees Hypnosis (for treatment of an illness) Insulin In vitro fertilization Laboratory fees Maternity expenses Neurological expenses Nursing home expenses Nursing home expenses Nursing services Obstetric services Opthalmologic treatment Optometry services Organ transplants Orthodontia** Orthopedic services and shoes Osteopathic services OTC medical care items* Pediatric services Physiotherapy Podiatry services Prescription drugs Psychiatric care Psychotherapy Smoking cessation programs Speech therapy Sterilization fees Substance abuse treatment Surgical fees Transportation for treatment Vaccinations and immunizations Vasectomy Vision expenses Wheelchairs X-Rays EXAMPLES OF INELIGIBLE EXPENSES Bath products, cleansers, soap Cosmetic services and supplies Cream, lip balms, lipstick, lotions Dental Bleaching Deodorants and anti-perspirants Feminine hygiene products Foot care products Hair care products Hair removal products Medicine dispensers Shaving and grooming products Stimulants (to stay awake) Sunscreen, sunless tanning * Effective January 1, 2011, OTC medications require a physician s note or prescription. ** Excludes procedures for cosmetic purposes **Starting January 1, 2011, you will no longer be able to use your health care flexible spending account (FSA) to pay for over-the-counter (OTC) medications at a pharmacy, supermarket or other retail store without a prescrip-tion. If you buy the medicine off the shelf you will need to submit an FSA claim form, copy of your receipt and your provider s prescription. Unused Funds When deciding how much to contribute, you should make sure that you carefully estimate enough to cover your eligible health care expenses, but not too much. Effective January 1, 2015 you can roll over up to $500 of your remaining FSA balance to the next plan year! Insulin, prescription medicines and some OTC supplies - such as bandages, crutches, blood sugar test kits and contact solution - will continue to be eligible, if your health care FSA plan allows. Page 19 Associates in Dermatology

19 COBRA NOTICE NOTICE OF RIGHTS TO CONTINUE GROUP BENEFITS You, your covered spouse, and your covered children have the right to continue coverage under Associates in Dermatology group health, dental and vision plans in accordance with the provisions of the Consolidated Omnibus Budge Reconciliation Act (COBRA) and the Health Insurance Portability and Accountability Act of 1996 (HIPPA) for up to 18 months beyond the effective date of one of the following events: 1. Your termination of Employment for any reason other than gross misconduct. 2. A reduction in hours which results in loss of coverage (i.e. full-time to part-time). Note: A child born to, or placed for adoption with, the covered Employee or dependent during a period of continuation coverage is a Qualified Beneficiary, provided Blade Benefit Consulting is notified to add the child to the plan within 30 days following the date of birth or replacement for adoption. If you are totally disabled on or within the first 60 days following the date of your qualifying event, the continuation period for you and your covered family members will be extended from 18 months to 29 months. To qualify for this extension, you must provide the Benefits Department with your Social Security Administration disability award notice within 60 days of the date it was issued. Coverage under this plan will terminate prior to the 18 month period (or 29 months for disabled beneficiaries) if one of the following events occurs: 1. Failure to pay the required premium by the specified due date. 2. Entitlement to Medicare 3. Enrollment in another group plan. However, if your new health plan contains a preexisting condition limitation, you may continue coverage under this plan until the earlier of the following events, provided the appropriate premium is paid: a. The satisfaction of the pre-existing condition limitation per the provision of HIPPA. b. Until the end of the 18 (or 29) month continuation period. 4. Associates in Dermatology terminates the group plan. 5. Coverage has been extended to 29 months due to disability and there has been a final determination that the individual is no longer disabled. Note: Certain qualifying events (such as death, divorce, legal separation and/or Medicare entitlement) that occur during the initial period of continuation coverage may extend a covered dependent s coverage period from 18 months to 36 months, provided the Benefits Department is notified of the qualifying event in a timely manner. Associates in Dermatology Page 20

20 Description of Special Enrollment Rights If you are declining enrollment 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 this 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. Newborns Act Disclosure Group health plans and health insurance 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 the insurance issuer for prescribing a length of stay not in excess of 48 hours (or 96 hours). WHCRA Notice If you have had or are going to have a mastectomy, you may be entitled to certain benefits under the Women s Health and Cancer Rights Act of 1998 (WHCRA). For individuals receiving mastectomy-related benefits, coverage will be provided in a manner determined in consultation with the attending physician and the patient, for: - All stages of reconstruction of the breast on which the mastectomy was performed; - Surgery and reconstruction of the other breast to produce a symmetrical appearance; - Prostheses; and - Treatment of physical complications of the mastectomy, including lymphedemas. These benefits will be provided subject to the same deductibles and coinsurance applicable to other medical and surgical benefits provided under this plan. Therefore, the following deductibles and coinsurance apply: See enclosed benefit summary for details. If you would like more information on WHCRA benefits, call your Plan Administrator extension 112. Page 21 Associates in Dermatology

21 New Health Insurance Marketplace Coverage Options and Your Health Coverage PART A: General Information : What is the Health Insurance Marketplace? Can I Save Money on my Health Insurance Premiums in the Marketplace? Does Employer Health Coverage Affect Eligibility for Premium Savings through the Marketplace? How Can I Get More Information? Blade Benefit Consulting LLC, Form Approved OMB No (expires ) Associates in Dermatology Page 22

22 Have a lovely day!