HEALTH BENEFITS NEWSLET TER

Transcription

1 HEALTH BENEFITS NEWSLET TER WHAT S IN THIS NEWSLETTER? GET READY! Benefit Overview You must enroll prior to your 90-day anniversary. Elections become effective on your 90-day anniversary. Page 1 GET SET! ClubCorp Benefit Enrollment Site (ESS) We are please to offer you this comprehensive benefit package that includes the following: Three medical High Deductible Health Plan (HDHP) options that include wellness incentives and discounts on plan costs Page 2 Two dental plan options (in most areas) A vision plan Eligibility Life insurance with an option to purchase additional life insurance for you and your family Page 3 Disability coverage that provides income replacement should you not be able to work due to an illness or injury Medical Plan Dependent Care Flexible Spending Account for dependent care expenses Page 4 Health Savings Account is available to all medical plan participants Preparing for Enrollment For additional information, review the benefit plan covering and costs in this newsletter. Full details on all the plans, including eligibility, can be found in the Benefits Guide at Page 9 1

2 HOW TO ENROLL GO! Your benefit elections are only done online through Oracle HCM Employee Self Service (ESS). 1. Contact the ClubCorp Help Desk to secure your Oracle HCM ESS username and temporary password by calling The password is good for 24 hours only. 2. Once you have your ESS username and password, log on to ecwl.fa.us2.oraclecloud.com. 3. Select the orange Benefits icon. 4. From the Benefits page, select Change Benefit Elections. 5. Add your dependent(s) and/or beneficiary(ies) on the Contacts page. Use Date of Hire as the Relationship Start Date and be sure to include the Date of Birth for covered dependents. 6. Once you have entered your Contacts (if any), select Continue (top right hand corner of the screen). 7. On the Authorization page, click Accept to accept the authorization. If you do not accept, you will not be able to enroll. 8. You will be guided through all of the benefits for which you are eligible. 9. Once you have reviewed and completed your enrollment, click Submit. If you do not select Submit, you will not be enrolled in benefits. Please print your Confirmation page for your records. Detailed ESS instructions are on benefits, under Enroll in Benefits (Employee Self Service ESS). BENEFITS ONLINE Accessing your benefits has never gotten easier. The ClubCorp Benefits Center is open for all employees. Visit to access detailed information about your benefits such as: Benefit Summaries Claim Forms Administrative Forms Customer Service Numbers Provider Directories Direct Links to Insurance Carriers and more! Oracle HCM Employee Self Service (ESS) Log In QUESTIONS? Call People Strategy Benefits Monday through Friday 8:00 a.m. to 5:00 p.m. (CT). 2

3 ELIGIBILITY As a regular, full-time Employee Partner, you are required to work thirty (30) hours or more per week on a continuous basis to be eligible to participate in the Medical, Dental, Vision, Life and Disability Plans, as well as the Dependent Care Flexible Spending Account and Health Savings Account. The Plan Administrator reserves the right to review the eligibility status of all participants on a periodic basis, including, but not limited to, verification of dependents status. Your Eligible Dependents Please note that verification of eligibility will be required for newly elected medical coverage before dependents are enrolled. Proof of dependent status must be received within 31 days after the effective date of coverage. Dependents eligible for coverage in the ClubCorp benefit Plans include: Medical and Vision Plans Only Your dependent children up to age 26 (including stepchildren, legally adopted children or children placed with you for adoption, foster children, and any child that you claim as a legal tax dependent) who are United States citizens or legal residents. For Other Plans Your unmarried dependent children up to age 25 who are United States citizens or legal residents and primarily dependent on you for financial support. Your dependent child, regardless of age, provided that he or she is incapable of self-support due to a mental or physical disability, is fully dependent on you for support as indicated on your federal tax return, and is approved by the Medical Plan to continue coverage past age 26. Your legal spouse who is recognized for United States Federal Tax purposes and who is a United States citizen or legal resident. This applies to all plans, unless otherwise indicated in the group policy for dental, vision and supplemental life. When You Can Enroll & When Coverage Becomes Effective? As a new hire you must enroll prior to completion of 90 days of continuous service. Coverage is then effective on your 90-day anniversary. Open Enrollment is your time to make changes to your benefit elections without a qualifying life event. Coverage is effective on January 1 of the following year. For Medical, Dental, Vision, Group Life and Accidental Death & Dismemberment, Supplemental Life, Long Term Disability and Short Term Disability coverage, you have 31 days from the qualifying life event to enroll or change your coverage election and the effective date is the day of the qualifying life event. Qualifying Life Events Include: Change in your legal marital status (marriage, divorce, or legal separation) Change in the number of your dependents (for example, through birth or adoption, or if a child is no longer an eligible dependent) Change in your spouse s employment status (resulting in a loss or gain of coverage) Change in your employment status from full time to part time, or part time to full time, resulting in a loss or gain of coverage Entitlement to Medicare or Medicaid Change in your address or location that affects the plans for which you are enrolled Any change to your benefits must be consistent with the qualifying life event. For example, if a child is born, you may add the newborn but you may not decrease other dependent coverage. Important Information About Medical Plan Coverage for Dependents Proof Required If you enroll your dependent(s) for Medical Plan coverage, proof of dependent status is required for dependent Medical Plan coverage and must be received no later than 31 days after the effective date of coverage in order for Medical Plan coverage to become effective for your dependent(s). Proof of Dependent Status documents may include: Spouse: State issued marriage certificate, joint banking account, mortgage/leasing agreements or tax returns. Dependent Child(ren): State issued birth certificate, QMSCO, adoption/legal ward papers, school enrollment records, medical and disability documentation. For more information and to obtain a Dependent Eligibility Form, please visit 3

4 MEDICAL PLAN OVERVIEW Blue Cross Blue Shield of Texas Deductible (Per Calendar Year) Employee Partner Only Employee Partner + Dependents Out-Of-Pocket Maximum 1 Employee Partner Only Employee Partner + Dependents Non-Network Providers MEDICAL PLAN A MEDICAL PLAN B MEDICAL PLAN C $2,000 $6,000 $6,750 $13,500 $3,000 $8,500 $6,750 $13,500 Not Covered $5,000 $10,000 $6,750 $13,500 Preventive Services 100% (No Deductible) 100% (No Deductible) 100% (No Deductible) In-Network Coinsurance (Amount plan pays after deductible) Telehealth SurgeryPlus ER Services (What You Pay) 70% 70% 70% $10 copay 80% coinsurance Plan Deductible + $250 Copayment, then Plan Coinsurance Applies Retail & Mail Order 2 Pharmacy (Amount you pay after deductible) Generic - Retail (30 day supply) Generic - Mail Order (90 day supply) Preferred Non-Preferred Specialty $20 copay $40 copay 30% coinsurance 50% coinsurance 50% coinsurance $20 copay $40 copay 30% coinsurance 50% coinsurance 50% coinsurance $20 copay $40 copay 30% coinsurance 50% coinsurance 50% coinsurance 1 After out-of-pocket is met, eligible charges are covered at 100% 2 Mandatory for Maintenance Medications To find participating Blue Choice providers for all states, go to and click on Find a Doctor. You can also call Blue Cross and Blue Shield of Texas (BCBSTX) at Medical Bi-Weekly Rates MEDICAL PLAN A MEDICAL PLAN B MEDICAL PLAN C COVERAGE LEVEL Non-Tobacco Tobacco Non-Tobacco Tobacco Non-Tobacco Tobacco Employee Only $ $ $83.00 $ $60.00 $ Employee + Spouse $ $ $ $ $ $ Employee + 2 Children (or Less) $ $ $ $ $ $ Employee + 3 or More Children $ $ $ $ $ $ Employee + Spouse + 2 Children (or Less) $ $ $ $ $ $ Employee + Spouse + 3 or More Children $ $ $ $ $ $ NON-TOBACCO USER DISCOUNT In an effort to encourage overall good health, Employee Partners and their spouses covered under the ClubCorp Medical Plan who are nonsmoker/non-tobacco users can receive discounted medical contributions on their medical plan coverage effective date. During enrollment, you must confirm/select your tobacco user or non-user status as well as the status of your spouse. You must select a Tobacco Usage status even if you are not enrolling in the medical plan. For more information, visit and click on Tobacco User Status and Cessation Program. 4 TOBACCO CESSATION PROGRAM For covered Employee Partners and spouses who are smokers/ tobacco users, ClubCorp offers assistance with the company-sponsored smoking/tobacco cessation program through the American Institute for Preventive Medicine. The smokeless program must be completed within 90 days from the effective date of coverage to receive the discount. To enroll in the Medical Plan smoking/tobacco cessation program, please call the American Institute for Preventive Medicine at x1. Please review the tobacco cessation program instructions in your enrollment packet for more information.

5 BETTER ACCESS TO CARE NEW BENEFITS BEST DOCTORS Best Doctors offers employee partners enrolled in the medical plan access to advice from the world s leading physicians. It s for everything from minor surgery to serious issues like cancer and heart disease. With Best Doctors, you can have an expert physician review your diagnosis and treatment plan, ask basic medical questions, and you can even get help finding a local physician who is right for you. Contact Best Doctors! members.bestdoctors.com Just like the name says, ClubCorp is bringing you New Benefits to help support you and your family. Teladoc As an Employee Partner enrolled on one of the ClubCorp medical plans you and your covered dependents will automatically be enrolled in with our Telehealth plan with a new LOWER copay per visit from $40 to $10 per visit. Telehealth is 24/7 access to U.S. licensed physicians by phone or online video consultation and can obtain a diagnosis and RX if necessary for only a $10 copay. Your visit with the doctor takes place from the comfort of your home or any location. More than just Teladoc with New Benefits, you can also purchase a buy-up plan for $1.50 per pay period, Enhanced Telehealth: Compass, helping you navigate healthcare to get the best care at an affordable cost. Health Advocate provides assistance with medical issues every step of the way. Cariloop connects you with an experienced Healthcare Coach to support you when you are caring for a loved one as it can be overwhelming. Register now at SURGERY PLUS A concierge surgery network with the nation s top surgeons, lower cost and better outcomes. If you are in need of specific non-emergency surgeries, like knee surgery, you have access to a new network of surgery centers designed to provide the best in quality care and outcomes in the industry. See the 2019 Benefits Guide for more information. 5

6 ADDITIONAL PLANS QUESTIONS? DENTAL PLAN Delta Dental DPO plan allows you to go to any dentist while the DHMO requires you select a contract DelaCare USA dentist for both you and your eligible dependents at the time of enrollment in order for services to be covered. Call People Strategy Benefits Monday through Friday 8:00 a.m. to 5:00 p.m. (CT). or go to: for more information Overview DPO DHMO** Deductible (Per Calendar Year) Employee Partner Only Employee Partner + Dependents $50 $150 N/A Preventive Services Covered at 100% $5 per visit Basic Services Filling Simple Extraction Root Canal Major Services Orthodontia Adult Child 20% after Deductible 50% after Deductible Not Covered $0-$75 $0 $95-$355 $355 for a crown $2,100 $1,900 Dental Bi-Weekly Rates DPO DHMO* Employee Partner Only $15.28 $7.90 Employee Partner + Spouse $32.37 $13.56 Employee Partner + Child(ren) $31.74 $13.66 Employee Partner + Family $51.46 $19.68 * States where DHMO Plan is offered: AL, AR, AZ, CA, CO, DC, FL, GA, KS, KY, LA, MD MI, MS, NV, NY, OH, PA, SC (small number of providers), TN, TX, WA, WI, and WV ** You must select and use a DeltaCare USA contracted dentist in order for dental services to be covered VISION PLAN Overview Eye Exam Eyeglass Contact Lenses Lenses Frames In-Network $15 copay $15 copay Up to $125 retail allowance Up to $120 retail allowance Superior Vision Vision Bi-Weekly Rates In-Network Employee Partner Only $2.93 Employee Partner + Spouse $4.36 Employee Partner + Child(ren) $4.66 Employee Partner + Family $7.45 6

7 ADDITIONAL PLANS HEALTH SAVINGS ACCOUNT (HSA) Benefit Wallet TM Eligible HSA Expenses Below is a list of some but not all eligible expenses for your HSA: Acupuncture Chiropractor Diagnostic Services Hospital Bills Psychologist Vaccines and more! A Health Savings Account (HSA) is an account that you can put money into to save for future medical expenses. Your money is deposited into an account with pre-tax dollars and you can use the money in your account for qualified medical expenses. You can save it or spend it you decide when to use your HSA dollars. You can make a contribution to your HSA each year that you are eligible. You, or anyone you elect to contribute on your behalf, can contribute no more than: $3,500 for Employee Partner only coverage $7,000 for family coverage $1,000 catchup contribution for Employee Partners age 55+ DEPENDENT CARE FLEXIBLE SPENDING ACCOUNT (FSA) Tax Saver Plan Dependent Care FSA allows you to set aside up to $5,000 for dependent day care expenses that are necessary for you and your spouse to work or attend school full time. NEED MORE INFORMATION? The benefit of this Plan is that your payroll deductions reduce your taxable income for the year. For more details, visit: 7

8 LIFE AND DISABILITY BASIC LIFE AND AD&D Basic Life and Accidental Death and Dismemberment (AD&D) are a part of ClubCorp s benefits plan and are essential to your and family s future financial security. With our carrier, OneAmerica, the coverage available to you is 1.5x pay, up to a maximum of $50,000. How to calculate the cost for Basic Life & AD&D Take your annual earnings x 1.5 (not to exceed $50,000) Take your coverage amount divided by 1,000 x $0.12 Take the total monthly cost x 50% Multiply your monthly cost x 12 then divide by 26 (up to a max of $1.38 per period for $50,000) = Your coverage amount = Total monthly cost = Your monthly cost = Your biweekly cost VOLUNTARY SUPPLEMENTAL LIFE Full-time Employee Partners may purchase Voluntary Supplemental Life insurance for themselves and their family. This benefit is in addition to your Basic Life benefit. Coverage amounts for Employee Partners are increments of $10,000 up to 7x annual salary with a maximum benefit of $500,000 while Spouses can elect up to $100,000. If you are currently enrolled, you can go up 2 increments up to the maximum while Spouses can go up 2 increments up to the Guaranteed Issue. If you are not currently enrolled, Evidence of Insurability will be required during this enrollment. Premiums are paid through post-tax payroll deductions. You must purchase Voluntary Supplemental Life insurance for yourself to purchase Voluntary Supplemental Life insurance for your Spouse and/or Child(ren). SHORT TERM DISABILITY (STD) (Not available in CA, NY and NY and pre-existing condition applies, see Benefit Guide for more information) After a 14-day waiting period, the STD plan will provide a weekly benefit for up to 13 weeks if you are disabled due to an accident or illness. Go to benefits for the enrollment form. If you reside in CA, NY or NJ, you may have STD benefits available to your through your state disability insurance program. Note: You may enroll in Short Term Disability and choose a weekly benefit in $100 increments up to $500/week, but no more than 60% of your average weekly salary. If you are not a current STD plan participant, you may enroll in the plan at the first increment level of $100/week without evidence of insurability. LONG TERM DISABILITY (LTD) (You must be employed in an eligible position to participate in the LTD plan and pre-existing condition applies, see Benefit Guide for more information) Disability coverage helps protect part of your income if you get hurt or sick and cannot work. After a 90-day waiting period, the LTD plan replaces up to 60% of your weekly pay as long as you are disabled up until you reach age 65. A Salary Continuation benefit of up to 66 2/3% of your weekly pay is available from days after two years of service is available to eligible Employee Partners. Please refer to the benefits guide at benefits for more information for eligible positions. How to calculate your LTD cost Take your monthly salary divided by 100 Take the basis number x $0.38 = Your basis amount = Total monthly cost 8 Take the total monthly cost x 50% Take your monthly cost x 12 then divide by 26 = Your monthly cost = Your biweekly cost

9 PREPARING & ENROLLING To make the enrollment process run smoothly, follow the checklist and verify that you have all that you need to take full advantage of the benefits offered. ONLINE ENROLLMENT Enrollment is online through Oracle HCM Employee Self Service at More details on page 2 DEPENDENT ELIGIBILITY VERIFICATION Verification is required for newly added dependents. If you are enrolling new or additional dependents for Medical coverage during Enrollment, you will be required to provide documentation to verify dependent eligibility. More details on page 3 Go to and click on Eligibility (EP & Dependents) for instructions on verifying your dependents. ID CARDS ID Cards for new enrollees or those who have made changes will be mailed to your current mailing address. Visit to find your insurance carrier to find your ID Card. ELIGIBLE DEPENDENTS (See page 3 for more information) Medical and Vision Plans dependent children up to age 26 legal spouse Other Plans unmarried dependent children up to age 25 legal spouse HOW DO I VERIFY MY DEPENDENTS? Go to and click on Eligibility (EP & Dependents) for instructions and a list of verification documents to use. Proof of dependent status MUST be received within 31 days after the effective date of coverage. CONFIRMATION STATEMENT Be sure to print your Confirmation Statement on ESS. REVIEW PAY CHECKS Please remember to review your first pay check after your benefits become effective to confirm your benefit deductions match our benefit elections. NEED MORE INFORMATION? For more details, visit: 9

10 REQUIRED NOTICES Medical Plan Contribution Discounts During Enrollment, you must confirm/select your tobacco user or non-user status as well as the status of your spouse. You must select a Tobacco Usage status even if you are not enrolling in the medical plan. For more information, visit com/benefits and click on Tobacco User Status and Cessation Program. For covered Employee Partners and Spouses who are smokers/tobacco users, ClubCorp offers assistance with the company-sponsored smoking/tobacco cessation program through the American Institute for Preventive Medicine. You and/or your covered Spouse can participate in the Medical Plan smoking/tobacco cessation program (at no cost to you). You and/or your spouse has 90 days from your benefit effective date to complete the program. Upon receipt of proof of participation in the smoking/tobacco cessation program, you will receive the discounted medical plan contributions. The smoking/tobacco cessation program must be completed within 90 days of your benefit effective date to receive the discount. If it is unreasonably difficult due to a health factor for you to meet the requirement or if it is medically inadvisable for you to attempt to meet the requirements of this program, we are making available a reasonable alternative standard for you to obtain the discounted medical plan contributions the Medical Plan smoking/ tobacco cessation program. If satisfying this reasonable alternative outlined above is medically inadvisable and you can provide a physician s statement indicating so, then please contact the ClubCorp Benefits Department, who will work with you to develop an additional reasonable alternative. Proof of participation in the Medical Plan smoking/tobacco cessation program is a certificate/diploma issued to the participant by the American Institute for Preventive Medicine after a participant has completed the program requirements and final exam (with a passing score). To enroll in the Medical Plan smoking/tobacco cessation program, please call the American Institute for Preventive Medicine at x1. One is considered a non-smoker/non-tobacco user if you (and your covered Spouse): Have not used tobacco products (cigarettes, cigars, chewing tobacco, etc.), for at least 6 months (from the date you certify your tobacco user status), or Enroll in the ClubCorp Medical Plan smoking/tobacco cessation program offered in partnership with the American Institute of Preventive Medicine and provide proof of participation. Upon receipt of proof of successful completion of smoking/tobacco cessation program, you will receive the discounted Medical Plan bi-weekly rates. One is considered a smoker/tobacco user if: You (or your covered Spouse) are currently using any form of tobacco (cigarettes, cigars, chewing tobacco, etc.) in any amount (including occasional social use), or You (or your covered Spouse) have used tobacco based products (cigarettes, cigars, chewing tobacco, etc.) within the last 6 months (from the date you certify your tobacco user status). Any of the above applies if you (or your covered Spouse) do not enroll in and complete the ClubCorp Medical Plan smoking/tobacco cessation program. Definition of smoker: An Employee Partner (or your covered Spouse) who smokes cigarettes, cigars or chews tobacco, etc. Casual or social smoking constitutes smoking by the ClubCorp Medical Plan definition. Right to request documentation: ClubCorp Benefits has the right to request documentation at any time from an Employee Partner or covered Spouse who declares him/herself a smoker enrolled in the approved smoking/tobacco cessation program or from the vendor providing the smoking/tobacco cessation program to the Employee Partner or covered Spouse for the sole purpose of verifying enrollment and participation. Recourse for making a false statement: An Employee Partner who intentionally falsifies his/her or covered Spouse s non-smoking status will be subject to immediate revocation of the non-smoker contribution discount and could face a loss of coverage for intentional falsification of enrollment. For more information, including costs, go to and print the voucher or call People Strategy Benefits at Please read this notice carefully and keep it where you can find it. This notice has information about your current prescription drug coverage with ClubCorp USA, Inc. and about your options under Medicare s prescription drug coverage. This information can help you decide whether or not you want to join a Medicare drug plan. If you are considering joining, you should compare your current coverage, including which drugs are covered at what cost, with the coverage and costs of the plans offering Medicare prescription drug coverage in your area. Information about where you can get help to make decisions about your prescription drug coverage is at the end of this notice. There are two important things you need to know about your current coverage and Medicare s prescription drug coverage: 1. Medicare prescription drug coverage became available in 2006 to everyone with Medicare. You can get this coverage if you join a Medicare Prescription Drug Plan or join a Medicare Advantage Plan (like an HMO or PPO) that offers prescription drug coverage. All Medicare drug plans provide at least a standard level of coverage set by Medicare. Some plans may also offer more coverage for a higher monthly premium. 2. ClubCorp USA, Inc. has determined that the prescription drug coverage offered by the BCBS of Texas plans HDHP 2000 and HDHP 3000 is, on average for all plan participants, expected to pay out as much as standard Medicare prescription drug coverage pays and is therefore considered Creditable Coverage. Because your existing coverage is Creditable Coverage, you can keep this coverage and not pay a higher premium (a penalty) if you later decide to join a Medicare drug plan. When Can You Join A Medicare Drug Plan? You can join a Medicare drug plan when you first become eligible for Medicare during a seven-month initial enrollment period. That period begins three months prior to your 65th birthday, includes the month you turn 65, and continues for the ensuing three months. You may also enroll each year from October 15th through December 7th. However, if you lose your current creditable prescription drug coverage, through no fault of your own, you will also be eligible for a two (2) month Special Enrollment Period (SEP) to join a Medicare drug plan. What Happens To Your Current Coverage If You Decide to Join A Medicare Drug Plan? If you decide to join a Medicare drug plan, your current ClubCorp USA, Inc. coverage will not be affected. For most persons covered under the Plan, the Plan will pay prescription drug benefits first, and Medicare will determine its payments second. For more information about this issue of what program pays first and what program pays second, see the Plan s summary plan description or contact Medicare at the telephone number or web address listed herein. When Will You Pay A Higher Premium (Penalty) To Join A Medicare Drug Plan? You should also know that if you drop or lose your current coverage with ClubCorp USA, Inc. and don t join a Medicare drug plan within 63 continuous days after your current coverage ends, you may pay a higher premium (a penalty) to join a Medicare drug plan later. If you go 63 continuous days or longer without creditable prescription drug coverage, your monthly premium may go up by at least 1% of the Medicare base beneficiary premium per month for every month that you did not have that coverage. For example, if you go nineteen months without creditable coverage, your premium may consistently be at least 19% higher than the Medicare base beneficiary premium. You may have to pay this higher premium (a penalty) as long as you have Medicare prescription drug coverage. In addition, you may have to wait until the following October to join. Important Notice from ClubCorp USA, Inc. About Your Prescription Drug Coverage and Medicare under the BCBS of Texas Plan HDHP 5000 Please read this notice carefully and keep it where you can find it. This notice has information about your current prescription drug coverage with ClubCorp USA, Inc. and about your options under Medicare s prescription drug coverage. This information can help you decide whether or not you want to join a Medicare drug plan. Information about where you can get help to make decisions about your prescription drug coverage is at the end of this notice. Important Notice from ClubCorp USA, Inc. About Your Prescription Drug Coverage and Medicare under the BCBS of Texas plans HDHP 2000 and HDHP There are three important things you need to know about your current coverage and Medicare s prescription drug coverage: 1. Medicare prescription drug coverage became available in 2006 to everyone with Medicare. You can get this coverage if you join a Medicare Prescription

11 Drug Plan or join a Medicare Advantage Plan (like an HMO or PPO) that offers prescription drug coverage. All Medicare drug plans provide at least a standard level of coverage set by Medicare. Some plans may also offer more coverage for a higher monthly premium. 2. ClubCorp USA, Inc. has determined that the prescription drug coverage offered by the BCBS of Texas plan HDHP 5000 is, on average for all plan participants, NOT expected to pay out as much as standard Medicare prescription drug coverage pays. Therefore, your coverage is considered Non-Creditable Coverage. This is important because, most likely, you will get more help with your drug costs if you join a Medicare drug plan, than if you have prescription drug coverage from the ClubCorp USA, Inc. plan. This also is important because it may mean that you may pay a higher premium (a penalty) if you do not join a Medicare drug plan when you first become eligible. 3. You can keep your current coverage from ClubCorp USA, Inc. However, because your coverage is non-creditable, you have decisions to make about Medicare prescription drug coverage that may affect how much you pay for that coverage, depending on if and when you join a drug plan. When you make your decision, you should compare your current coverage, including what drugs are covered, with the coverage and cost of the plans offering Medicare prescription drug coverage in your area. Read this notice carefully - it explains your options. When Can You Join A Medicare Drug Plan? You can join a Medicare drug plan when you first become eligible for Medicare during a seven-month initial enrollment period. That period begins three months prior to your 65th birthday, includes the month you turn 65, and continues for the ensuing three months. You may also enroll each year from October 15th through December 7th. However, if you decide to drop your current coverage with ClubCorp USA, Inc., since it is employer/union sponsored group coverage, you will be eligible for a two (2) month Special Enrollment Period (SEP) to join a Medicare drug plan; however you also may pay a higher premium (a penalty) because you did not have creditable coverage under the ClubCorp USA, Inc. plan. What Happens To Your Current Coverage If You Decide to Join A Medicare Drug Plan? If you decide to join a Medicare drug plan, your current ClubCorp USA, Inc. coverage will not be affected. For most persons covered under the Plan, the Plan will pay prescription drug benefits first, and Medicare will determine its payments second. For more information about this issue of what program pays first and what program pays second, see the Plan s summary plan description or contact Medicare at the telephone number or web address listed herein. When Will You Pay A Higher Premium (Penalty) To Join A Medicare Drug Plan? Since the coverage under ClubCorp USA, Inc. is not creditable, depending on how long you go without creditable prescription drug coverage you may pay a penalty to join a Medicare drug plan. Starting with the end of the last month that you were first eligible to join a Medicare drug plan but didn t join, if you go 63 continuous days or longer without prescription drug coverage that s creditable, your monthly premium may go up by at least 1% of the Medicare base beneficiary premium per month for every month that you did not have that coverage. For example, if you go nineteen months without creditable coverage, your premium may consistently be at least 19% higher than the Medicare base beneficiary premium. You may have to pay this higher premium (penalty) as long as you have Medicare prescription drug coverage. In addition, you may have to wait until the following October to join. For More Information about This Notice or Your Current Prescription Drug Coverage Contact the person listed at the end of these notices for further information. NOTE: You ll get this notice each year. You will also get it before the next period you can join a Medicare drug plan, and if this coverage through ClubCorp USA, Inc. changes. You also may request a copy of this notice at any time. For More Information about Your Options under Medicare Prescription Drug Coverage More detailed information about Medicare plans that offer prescription drug coverage is in the Medicare & You handbook. You ll get a copy of the handbook in the mail every year from Medicare. You may also be contacted directly by Medicare drug plans. For more information about Medicare prescription drug coverage:»» Visit 11»» Call your State Health Insurance Assistance Program (see the inside back cover of your copy of the Medicare & You handbook for their telephone number) for personalized help»» Call MEDICARE ( ). TTY users should call If you have limited income and resources, extra help paying for Medicare prescription drug coverage is available. For information about this extra help, visit Social Security on the web at or call them at (TTY ). Remember: Keep this Medicare Part D notice. If you decide to join one of the Medicare drug plans, you may be required to provide a copy of this notice when you join to show whether or not you have maintained creditable coverage and, therefore, whether or not you are required to pay a higher premium (a penalty). Date: January 1, 2019 Name of Entity/Sender: Contact Position/Office: Address: ClubCorp USA, Inc. People Strategy 3030 LBJ Freeway, Suite #600 Dallas, TX Phone Number: Women s Health and Cancer Rights Act The Women s Health and Cancer Rights Act of 1998 was signed into law on October 21, The Act requires that all group health plans providing medical and surgical benefits with respect to a mastectomy must provide coverage for all of the following:»» Reconstruction of the breast on which a mastectomy has been performed»» Surgery and reconstruction of the other breast to produce a symmetrical appearance»» Prostheses»» Treatment of physical complications of all stages of mastectomy, including lymphedema This coverage will be provided in consultation with the attending physician and the patient, and will be subject to the same annual deductibles and coinsurance provisions which apply for the mastectomy. For deductibles and coinsurance information applicable to the plan in which you enroll, please refer to the summary plan description or contact People Strategy Benefits at HIPAA Privacy and Security The Health Insurance Portability and Accountability Act of 1996 deals with how an employer can enforce eligibility and enrollment for health care benefits, as well as ensuring that protected health information which identifies you is kept private. You have the right to inspect and copy protected health information that is maintained by and for the plan for enrollment, payment, claims and case management. If you feel that protected health information about you is incorrect or incomplete, you may ask your benefits administrator to amend the information. The Notice of Privacy Practices has been recently updated. For a full copy of the Notice of Privacy Practices, describing how protected health information about you may be used and disclosed and how you can get access to the information, contact People Strategy Benefits at HIPAA Special Enrollment Rights 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 later enroll yourself and your dependents in this plan if you or your dependents lose eligibility for that other coverage (or if the employer stops contributing towards your or your dependents other coverage). Loss of eligibility includes but is not limited to:»» Loss of eligibility for coverage as a result of ceasing to meet the plan s eligibility requirements (i.e. legal separation, divorce, cessation of dependent status,

12 death of an employee, termination of employment, reduction in the number of hours of employment);»» Loss of HMO coverage because the person no longer resides or works in the HMO service area and no other coverage option is available through the HMO plan sponsor;»» Elimination of the coverage option a person was enrolled in, and another option is not offered in its place;»» Failing to return from an FMLA leave of absence; and»» Loss of coverage under Medicaid or the Children s Health Insurance Program (CHIP). Unless the event giving rise to your special enrollment right is a loss of coverage under Medicaid or CHIP, you must request enrollment within 31 days after your or your dependent s(s ) other coverage ends (or after the employer that sponsors that coverage stops contributing toward the coverage). If the event giving rise to your special enrollment right is a loss of coverage under Medicaid or the CHIP, you may request enrollment under this plan within 60 days of the date you or your dependent(s) lose such coverage under Medicaid or CHIP. Similarly, if you or your dependent(s) become eligible for a state-granted premium subsidy towards this plan, you may request enrollment under this plan within 60 days after the date Medicaid or CHIP determine that you or the dependent(s) qualify for the subsidy. 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. However, you must request enrollment within 31 days after the marriage, birth, adoption, or placement for adoption. To request special enrollment or obtain more information, contact People Strategy Benefits at Premium Assistance Under Medicaid and the Children s Health Insurance Program (CHIP) If you or your children are eligible for Medicaid or CHIP and you re eligible for health coverage from your employer, your state may have a premium assistance program that can help pay for coverage, using funds from their Medicaid or CHIP programs. If you or your children aren t eligible for Medicaid or CHIP, you won t be eligible for these premium assistance programs but you may be able to buy individual insurance coverage through the Health Insurance Marketplace. For more information, visit If you or your dependents are already enrolled in Medicaid or CHIP and you live in a State listed below, contact your State Medicaid or CHIP office to find out if premium assistance is available. If you or your dependents are NOT currently enrolled in Medicaid or CHIP, and you think you or any of your dependents might be eligible for either of these programs, contact your State Medicaid or CHIP office or dial KIDS NOW or www. insurekidsnow.gov to find out how to apply. If you qualify, ask your state if it has a program that might help you pay the premiums for an employer-sponsored plan. If you or your dependents are eligible for premium assistance under Medicaid or CHIP, as well as eligible under your employer plan, your employer must allow you to enroll in your employer plan if you aren t already enrolled. This is called a special enrollment opportunity, and you must request coverage within 60 days of being determined eligible for premium assistance. If you have questions about enrolling in your employer plan, contact the Department of Labor at or call EBSA (3272). If you live in one of the following states, you may be eligible for assistance paying your employer health plan premiums. The following list of states is current as of August 10, Contact your State for more information on eligibility ALABAMA Medicaid Website: Phone: ALASKA Medicaid The AK Health Insurance Premium Payment Program Website: Phone: CustomerService@MyAKHIPP.com Medicaid Eligibility: ARKANSAS Medicaid Website: Phone: MyARHIPP ( ) COLORADO Health First Colorado (Colorado s Medicaid Program) & Child Health Plan Plus (CHP+) Health First Colorado Website: Health First Colorado Member Contact Center: / State Relay 711 CHP+: Colorado.gov/HCPF/Child-Health-Plan-Plus CHP+ Customer Service: / State Relay 711 FLORIDA Medicaid Website: Phone: GEORGIA Medicaid GEORGIA Medicaid Website: - Click on Health Insurance Premium Payment (HIPP) Phone: INDIANA Medicaid Healthy Indiana Plan for low-income adults Website: Phone: All other Medicaid Website: Phone IOWA Medicaid Website: Phone: KANSAS Medicaid Website: Phone: KENTUCKY Medicaid Website: Phone: LOUISIANA Medicaid Website: Phone: MAINE Medicaid Website: Phone: TTY: Maine relay 711 MASSACHUSETTS Medicaid and CHIP Website: Phone:

13 MINNESOTA Medicaid Website: Phone: MISSOURI Medicaid Website: Phone: MONTANA Medicaid Website: Phone: NEBRASKA Medicaid Website: Phone: (855) Lincoln: (402) Omaha: (402) NEVADA Medicaid Medicaid Website: https//dwss.nv.gov/ Medicaid Phone: NEW HAMPSHIRE Medicaid Website: Phone: NEW JERSEY Medicaid and CHIP Medicaid Website: dmahs/clients/medicaid/ Medicaid Phone: CHIP Website: CHIP Phone: NEW YORK Medicaid Website: Phone: NORTH CAROLINA Medicaid Website: Phone: NORTH DAKOTA Medicaid Website: Phone: OKLAHOMA Medicaid and CHIP Website: Phone: OREGON Medicaid Website: Phone: PENNSYLVANIA Medicaid Website: healthinsurancepremiumpaymenthippprogram/index.htm Phone: RHODE ISLAND Medicaid Website: Phone: SOUTH CAROLINA Medicaid Website: Phone: SOUTH DAKOTA - Medicaid Website: Phone: TEXAS Medicaid Website: Phone: UTAH Medicaid and CHIP Medicaid Website: CHIP Website: Phone: VERMONT Medicaid Website: Phone: VIRGINIA Medicaid and CHIP Medicaid Website: Medicaid Phone: CHIP Website: CHIP Phone: WASHINGTON Medicaid Website: Phone: ext WEST VIRGINIA Medicaid Website: Toll-free phone: MyWVHIPP ( ) WISCONSIN Medicaid and CHIP Website: Phone: WYOMING Medicaid Website: Phone: To see if any other states have added a premium assistance program since August 10, 2017, or for more information on special enrollment rights, contact either: U.S. Department of Labor Employee Benefits Security Administration EBSA (3272) CONTINUATION COVERAGE RIGHTS UNDER COBRA U.S. Department of Health and Human Services Centers for Medicare & Medicaid Services , Menu Option 4, Ext You are receiving this Notice of COBRA healthcare coverage continuation rights because you have recently become covered under one or more group health plans. The plan (or plans) under which you have gained coverage are listed at the end of this Form, and are referred to collectively as the plan except where otherwise indicated. This notice contains important information about your right to COBRA continuation coverage, which is a temporary extension of healthcare coverage under the plan. The right to COBRA continuation coverage was created by a federal law, the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA). COBRA continuation coverage can become available to you and/or to other members of your family who

14 are covered under the plan when you and/or they would otherwise lose the group health coverage. This notice gives only a summary of your COBRA continuation coverage rights. This notice generally explains COBRA continuation coverage, when it may become available to you and your family, and what you need to do to protect the right to receive it. For more information about your rights and obligations under the plan and under federal law, you should either review the plan s Summary Plan Description or contact the Plan Administrator. In some cases the plan document also serves as the Summary Plan Description. You may have other options available to you when you lose group coverage. For example, you may be eligible to buy an individual plan through the Health Insurance Marketplace. By enrolling in coverage through the Marketplace, you may qualify for lower costs on your monthly premiums and lower out-of-pocket costs. Additionally, you may qualify for a 30-day special enrollment period for another group health plan for which you are eligible (such as a spouse s plan), even if that plan generally doesn t accept late enrollees. COBRA Continuation Coverage and Qualifying Events COBRA continuation coverage is a continuation of plan coverage when coverage would otherwise end because of a life event known as a qualifying event. Specific qualifying events are listed later in this notice. COBRA continuation coverage must be offered to each person who is a qualified beneficiary. A qualified beneficiary is someone who will lose coverage under the plan because of a qualifying event. Depending on the type of qualifying event, employees, spouses of employees, and eligible children of employees may be qualified beneficiaries. Certain newborns, newly-adopted children and alternate recipients under qualified medical child support orders may also be qualified beneficiaries. This is discussed in more detail in separate paragraphs below. Under the plan, qualified beneficiaries who elect COBRA continuation coverage must pay for this continuation coverage. If you are a covered employee, you will become a qualified beneficiary if you lose your coverage under the plan because either one of the following qualifying events happens: Your hours of employment are reduced, or Your employment ends for any reason other than your gross misconduct. If you are the spouse of a covered employee, you will become a qualified beneficiary if you lose your coverage under the plan because any of the following qualifying events happens: Your spouse dies; Your spouse s hours of employment are reduced; Your spouse s employment ends for any reason other than his or her gross misconduct; Your spouse becomes enrolled in any part or all of Medicare (under Part A, Part B, Part C, or all); or You become divorced or legally separated from your spouse. Note that if your spouse cancels your coverage in anticipation of a divorce or legal separation and a divorce or legal separation later occurs, then the divorce or legal separation will be considered a qualifying event even though you actually lost coverage earlier. If you notify the Plan Administrator or its designee within 60 days after the divorce or legal separation and can establish that the employee canceled the coverage earlier in anticipation of the divorce or legal separation, then COBRA coverage may be available for a period after the divorce (but not for the period between the date your coverage ended, and the date of divorce or legal separation). But you must provide timely notice of the divorce or legal separation to the Plan Administrator or its designee or you will not be able to obtain COBRA coverage after the divorce or legal separation. See the rules in the box below, under the heading entitled, Notice Requirements, regarding the obligation to provide notice, and the procedures for doing so. Your covered eligible children will become qualified beneficiaries if they lose coverage under the plan because any of the following qualifying events happens: The parent-employee dies; The parent-employee s hours of employment are reduced; The parent-employee s employment ends for any reason other than his or her gross misconduct; The parent-employee becomes enrolled in any part or all of Medicare (Part A, Part B, Part C, or all); The parents become divorced or legally separated; or The child stops being eligible for coverage under the plan as an eligible child. Notice Requirements The plan will offer COBRA continuation coverage to qualified beneficiaries only after the Plan Administrator or its designee has been timely notified that a qualifying event has occurred. When the qualifying event is: the end of employment or reduction of hours of employment, death of the employee, or enrollment of the employee in any part of Medicare (under Part A, Part B, or both), the employer (if the employer is not the Plan Administrator) must notify the Plan Administrator of the qualifying event within 30 days following the date coverage ends. IMPORTANT: For the other qualifying events (divorce or legal separation of the employee and spouse or an eligible child s losing eligibility for coverage as an eligible child), you or someone on your behalf must notify the Plan Administrator or its designee in writing within 60 days after the qualifying event occurs, using the procedures specified below. If these procedures are not followed or if the notice is not provided in writing to the Plan Administrator or its designee during the 60-day notice period, any spouse or eligible child who loses coverage will not be offered the option to elect continuation coverage. NOTICE PROCEDURES: Any notice that you provide must be in writing. Oral notice, including notice by telephone, is not acceptable. You must mail, fax or hand-deliver your notice to the person, department, or firm listed below, at the following address: ClubCorp USA, Inc Attn: ClubCorp Benefits 3030 LBJ Freeway, Suite #600 Dallas, TX If mailed, your notice must be postmarked no later than the last day of the required notice period. Any notice you provide must state: the name of the plan or plans under which you lost or are losing coverage, the name and address of the employee covered under the plan, the name(s) and address(es) of the qualified beneficiary(ies), and the qualifying event and the date it happened. If the qualifying event is a divorce or legal separation, your notice must include a copy of the divorce decree or the legal separation agreement. There are other notice requirements in other contexts. See, for example, the discussion below under the heading entitled, Duration of COBRA Coverage. That explanation describes other situations where notice from you or the qualified beneficiary is required in order to gain the right to COBRA coverage. Once the Plan Administrator or its designee receives timely notice that a qualifying event has occurred, COBRA continuation coverage will be offered to each of the qualified beneficiaries. Each qualified beneficiary will have an independent right to elect COBRA continuation coverage. Covered employees may elect COBRA continuation coverage for their spouses, and parents may elect COBRA continuation coverage on behalf of their children. For each qualified beneficiary who elects COBRA continuation coverage, COBRA continuation coverage will begin on the date that plan coverage would otherwise have been lost. If you or your spouse or eligible children do not elect continuation coverage within the 60-day election period described above, you will lose your right to elect continuation coverage. Duration of COBRA Coverage COBRA continuation coverage is a temporary continuation of coverage. When the qualifying event is the death of the employee, enrollment of the employee in any part or all of Medicare (Part A, Part B, Part C, or all), your divorce or legal separation, or an eligible child losing eligibility as an eligible child, COBRA continuation coverage lasts for up to 36 months. When the qualifying event is the end of employment or reduction of the employee s hours of employment, COBRA continuation coverage lasts for up to 18 months. There are three ways in which the period of COBRA continuation coverage can be extended : 1. Disability extension of 18-month period of continuation coverage. If you or anyone in your family covered under the plan is determined by the Social Security Administration to be disabled as of the date of the qualifying event or at any time during the first 60 days of COBRA continuation coverage and you notify the Plan Administrator or its designee in writing and in a timely fashion, you and your entire family can receive up to an additional 11 months of COBRA continuation coverage, for a total maximum of 29 months. 14

15 You must make sure that the Plan Administrator or its designee is notified in writing of the Social Security Administration s determination within 60 days after (i) of the date of the determination or (ii) the date of the qualifying event or (iii) the date coverage is lost due to the qualifying event, whichever occurs last. But in any event the notice must be provided before the end of the 18-month period of COBRA continuation coverage. The plan requires you to follow the procedures specified in the box above, under the heading entitled Notice Procedures. In addition, your notice must include the name of the disabled qualified beneficiary, the date that the qualified beneficiary became disabled, and the date that the Social Security Administration made its determination. Your notice must also include a copy of the Social Security Administration s determination. If these procedures are not followed or if the notice is not provided in writing to the Plan Administrator or its designee within the required period, then there will be no disability extension of COBRA continuation coverage. 2. Second qualifying event extension of 18-month period of continuation coverage. If your family experiences another qualifying event while receiving COBRA continuation coverage, the spouse and eligible children in your family can get additional months of COBRA continuation coverage, up to a maximum of 36 months (including the initial period of COBRA coverage). This extension is available to the spouse and eligible children if, while they and the covered former employee are purchasing COBRA coverage, the former employee: dies, enrolls in any part or all of Medicare (Part A, Part B, Part C, or all), or gets divorced or legally separated The extension is also available to an eligible child when that child stops being eligible under the plan as an eligible child. In all of these cases, you must make sure that the Plan Administrator or its designee is notified in writing of the second qualifying event within 60 days after (i) the date of the second qualifying event or (ii) the date coverage is lost, whichever occurs last. The plan requires you to follow the procedures specified in the box above, under the heading entitled Notice Procedures. Your notice must also name the second qualifying event and the date it happened. If the second qualifying event is a divorce or legal separation, your notice must include a copy of the divorce decree or legal separation agreement. If these procedures are not followed or if the notice is not provided in writing to the Plan Administrator or its designee within the required 60-day period, then there will be no extension of COBRA continuation coverage due to the second qualifying event. 3. Medicare Extension for Spouse and Eligible Children. If a qualifying event that is a termination of employment or reduction of hours occurs within 18 months after the covered employee becomes entitled to any part or all of Medicare (Part A, Part B, Part C, or all), then the maximum coverage period for the spouse and eligible children is 36 months from the date the employee became entitled to Medicare (Part A, Part B, Part C, or all) - but the covered employee s maximum coverage period will be 18 months. Other Rules and Requirements Same Rights as Active Employees to Add New Dependents. A qualified beneficiary generally has the same rights as similarly situated active employees to add or drop dependents, make enrollment changes during open enrollment, etc. Contact the Plan Administrator for more information. See also the paragraph below titled, Children Born or Placed for Adoption with the Covered Employee During COBRA Period, for information about how certain children acquired by a covered employee purchasing COBRA coverage may actually be treated as qualified beneficiaries themselves. Be sure to promptly notify the Plan Administrator or its designee if you need to make a change to your COBRA coverage. or former employee is a qualified beneficiary, the employee has elected COBRA continuation coverage for himself or herself. The child s COBRA coverage begins when the child is enrolled in the plan, whether through special enrollment or open enrollment, and it lasts for as long as COBRA coverage lasts for other family members of the employee. To be enrolled in the plan, the child must satisfy the otherwise applicable plan eligibility requirements (for example, age requirements). Be sure to promptly notify the Plan Administrator or its designee if you need to make a change to your COBRA coverage. The Plan Administrator or its designee must be notified in writing within 30 days of the date you wish to make such a change. See the rules in the box above, under the heading entitled, Notice Procedures, for an explanation regarding how your notice should be made. Alternate Recipients Under Qualified Medical Child Support Orders. A child of the covered employee or former employee who is receiving benefits under the plan pursuant to a Qualified Medical Child Support Order (QMCSO) received by the Plan Administrator during the employee s period of employment with the employer is entitled the same rights under COBRA as an eligible child of the covered employee, regardless of whether that child would otherwise be considered a dependent. Be sure to promptly notify the Plan Administrator or its designee if you need to make a change to your COBRA coverage. The Plan Administrator or its designee must be notified in writing within 30 days of the date you wish to make such a change. See the rules in the box above, under the heading entitled, Notice Procedures, for an explanation regarding how your notice should be made. If You Have Questions Questions concerning your plan or your COBRA continuation rights should be addressed to the contact or contacts identified below. For more information about your rights under the Employee Retirement Income Security Act (ERISA), including COBRA, the Health Insurance Portability or Accountability Act (HIPAA), Patient Protection and Affordable Care Act (PPACA), and other laws affecting group health plans, contact the nearest Regional or District Office of the U.S. Department of Labor s Employee Benefits Security Administration (EBSA). Addresses and phone numbers of Regional and District EBSA Offices are available through EBSA s Web site at For more information about the Health Insurance Marketplace, visit Keep Your Plan Informed of Address Changes In order to protect your family s rights, you should keep the Plan Administrator or its designee informed of any changes in the addresses of family members. You should also keep a copy, for your records, of any notices you send to the Plan Administrator or its designee. Plan and Plan Contact Information ClubCorp Medical Plan administered by BlueCross BlueShield of Texas DHMO Plan offered by DeltaCare USA, Inc. DPO Dental Plan offered by Delta Dental Insurance Company ClubCorp Vision Plan offered by Superior Vision Services, Inc. For additional information about the plan and COBRA coverage, you may contact the Plan Administrator: ClubCorp USA, Inc. Attn: ClubCorp Benefits 3030 LBJ Freeway, Suite 600 Dallas, TX The Plan Administrator or its designee must be notified in writing within 30 days of the date you wish to make such a change (adding or dropping dependents, for example). See the rules in the box above, under the heading entitled, Notice Procedures, for an explanation regarding how your notice should be made. Children Born to or Placed for Adoption with the Covered Employee During COBRA Period. A child born to, adopted by, or placed for adoption with a covered employee or former employee during a period of continuation coverage is considered to be a qualified beneficiary provided that, if the covered employee 15