CSS INDUSTRIES, INC. HEALTH AND WELFARE BENEFITS EXEMPT/NONEXEMPT FREQUENTLY ASKED QUESTIONS Revised July 2017

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1 CSS INDUSTRIES, INC. HEALTH AND WELFARE BENEFITS EXEMPT/NONEXEMPT FREQUENTLY ASKED QUESTIONS Revised July 2017 The following document was put together to help answer common questions about the CSS Industries, Inc. (Company) health and welfare benefits. We have done our best to ensure accuracy and constancy between this Q&A, other employee communications and the Summary of Benefits and Coverage (SBC). However, if there are inconsistencies or errors, the Company reserves the right, in its sole and absolute discretion, to modify or change any responses herein. Any changes described in this document are effective September 1, TABLE OF CONTENTS BENEFITS ENROLLMENT... 2 GETTING HELP... 2 MEDICAL BENEFITS... 3 Medical Insurance Carriers... 3 Medical Plan Choices... 3 Deductibles and Co-pays... 4 Co-Insurance... 5 Spousal Coverage... 5 Dependent Children Coverage... 6 General Medical... 7 WELLNESS PROGRAM... 8 General... 8 Biometrics... 9 Tobacco... 9 PRESCRIPTION BENEFITS General Prescription Mandatory Mail Order/Maintenance Drugs Mandatory Prior Authorization Step Therapy OUT-OF-POCKET MAXIMUM HSA S, FSA S AND DCA S Health Savings Account (HSA) versus Flexible Spending Account (FSA) Health Savings Account (HSA) Flexible Spending Account (FSA) Dependent Care Account (DCA) Plan Administration Plan Administration FSA and DCA Only OTHER HEALTH AND WELFARE BENEFITS Dental Vision Other VENDOR CONTACTS Page 1 of 21

2 BENEFITS ENROLLMENT Q. When can I enroll in benefits? A. There are 2 opportunities to enroll in benefits (1) as a newly eligible employee and (2) the annual open enrollment period. The Company s benefits year runs from September 1 to August 31. The annual open enrollment process is held in the July/August timeframe for employees to make benefit changes. Q. How do I enroll in benefits? A. The Company utilizes a 3 rd party Univers to manage its enrollment process. Enrollment specifics are outlined in a Benefits Enrollment Guide. Benefit Counselors are available through Univers to assist you in understanding your benefit election choices. Q. When can I make changes? A. Outside of the annual open enrollment process, changes are not allowed unless there is a qualifying life event as defined by the IRS. Examples of qualifying life events include, but are not limited to, marriage/divorce, birth/adoption of a child, and a spouse gaining or losing coverage at his/her job. Q. Where can I find the documents and forms referenced in this document (e.g., SBCs)? A. Most benefit documents and forms are available on the HR Intranet. Q. What if I have very detailed or individual specific questions? A. You can contact Benefits Advocacy Services or the relevant insurance provider for assistance. See the Vendor Contacts for phone numbers and websites. Q. Do I get new insurance cards each year? A. In general, new cards are only issued if you newly enroll or change plans. If you need to see a provider before you have received your card, please contact the insurance carrier or Benefits Advocacy Services for assistance. GETTING HELP Q. How do I get help with health & welfare benefit questions (outside of Univers)? A. There are 3 primary resources to assist you: Contact Benefit Advocacy Services. A 3 rd party resource the Company provides to assist you. Contact the insurance carrier. The insurance carrier websites contain lots of useful information (including the ability to search for in-network providers). Refer to the HR Intranet for most documents and forms referenced in this document. See Vendor Contacts for phone numbers, websites and mobile apps. Q. When should I contact Human Resources? A. Human Resources can assist you with: Questions about benefits eligibility (including spouses and dependents). Obtaining a Benefits Enrollment Guide. Help finding documents and forms on the HR Intranet. Making mid-year changes related to qualifying events. All other types of questions should be directed to Benefits Advocacy Service or the insurance carrier. Q. What is Benefits Advocacy Services? A. Benefits Advocacy Services is a 3 rd party resource available to you for help with all your benefit questions. The group is made up of highly-qualified individuals who average more than 18 years of benefits industry experience. They are a persistent, professionally experienced group focused on helping you! They are dedicated to resolving your benefit challenges and ensuring you have a voice and helping hand. Page 2 of 21

3 Q. What kinds of things can Benefits Advocacy Service help with? A. Benefits Advocacy Services can assist you with questions related to plan design, providers and benefits eligibility. They can also help you understand Explanation of Benefits (EOBS) and help you resolve issues. Q. Is my personal information confidential with Benefits Advocacy Services? A. Benefits Advocacy Services is committed to the highest standards of confidentiality. Your calls and dates are guarded so that no one can access your information without permission. As an independent party, Benefits Advocacy Services even restricts employer access. Q. How is Benefits Advocacy Services different from Univers? A. Univers is our vendor for enrollment services only and is only available when newly enrolling or during open enrollment. Benefits Advocacy Services is available to you year round. Medical Insurance Carriers MEDICAL BENEFITS Q. What insurance carriers does the Company use? A. The Company utilizes both Independence Blue Cross (IBC) and Geisinger. Your carrier depends upon your work location, where you live and the type of plan being offered. In general, employees who work in Moosic and Berwick and live in Pennsylvania will have Geisinger as their insurance carrier for the Gold & Silver plans, but Blue Cross for the Bronze plan. Most other employees will have Independence Blue Cross regardless of the plan. Q. Do I have a choice between carriers? A. No. The company determines what carriers to use, typically driven by the discounts the carrier provides and available options. Medical Plan Choices Q. What are my plan choices? A. Exempt and non-exempt employees have several plan choices shown below with a very high level comparison of the major differences. For full details, please refer to the Summary of Benefits and Coverage (SBC) for each plan. Bronze Plan Silver Plan Gold Plan Monthly Premiums Lowest Medium Highest Co-pays at time of service N/A* Highest Lowest Deductibles Highest Medium Lowest Co-Insurance Yes Yes No Out-of-Network Benefits Yes No Yes *With an HDHP, there are no co-pays as you pay ALL expenses (except for preventative care) until the deductible is satisfied and then you pay co-insurance. Q. What are the monthly premiums? A. Please refer to the Employee Insurance Rate Sheets available on the HR Intranet. Page 3 of 21

4 Q. What are the actual names of the Plans? A. The plan names are determined by the carrier. Carrier Bronze Plan Silver Plan Gold Plan Independence Blue Cross (IBC) High Deductible Health Plan (HDHP) Closed Panel Plan (CPP) Preferred Provider Organization (PPO) Geisinger NA Solutions Direct Plan Preferred Provider Organization (PPO) Q. Why is there no Bronze Plan under Geisinger? A. IBC provided a better option for the Company. The Bronze Plan under IBC is available even if your other options are through Geisinger. Q. Are the plan designs the same for both IBC and Geisinger? A. The plans are the same or similar for the vast majority of services. Q. Where can I find a summary of the plan designs? A. Please refer to the Summary of Benefits and Coverage (SBC) to find out the details about covered services, deductibles, co-pays and co-insurance. Deductibles and Co-pays Q. Do all the plans have deductibles and co-pays? A. Refer to the Summary of Benefits and Coverage (SBC) to see which plans have deductibles and co-pays. Q. What is the difference between a deductible and co-pay? A. A deductible is an upfront cost that you pay before your insurance plan begins to cover services. A co-pay is a fee you pay for a service every time you use that service. Q. What services are subject to the deductible? A. For the HDHP, all services are subject to the deductible except for preventive care, which is covered at 100% no deductible. For the other plans, a general rule of thumb is that everything that doesn t have a co-pay is subject to the deductible. Thus, the deductible applies to out-patient surgical procedures, durable medical equipment and other services that do not have a co-pay. Although inpatient hospitalizations have a co-pay, they are also subject to the deductible. Most, but not all, services that have a co-pay are not subject to the deductible that includes doctor office visits (primary care and specialist) and emergency room visits. Q. Where can I get a list of services that are subject to the deductible? A. Refer to the Summary of Benefits and Coverage (SBC), contact the insurance carrier or Benefits Advocacy Services for assistance. Q. Is the inpatient co-pay in addition to the annual deductible? A. Yes. If you are admitted to the hospital, you will have to pay the inpatient co-pay AND satisfy the annual deductible and co-insurance (if applicable). Q. If I am admitted to the hospital, do I have to pay the inpatient co-pay up-front? A. No. You will be billed for the inpatient co-pay. Q. Do I have to pay a co-pay for diagnostic services? A. No. The deductible applies. Page 4 of 21

5 Q. Do I have to pay separately for blood work if it is part of an office visit? A. There are many factors that affect your cost for blood work, including how your doctor s office codes the visit. You can discuss the cost with your doctor or office staff prior to scheduling your blood work. Q. Is the deductible per person? A. Yes. There is also a family deductible limit of two times the individual deductible. Q. What does family deductible mean? A. Each individual pays no more than the individual deductible. The family deductible is satisfied when the total dollars applied reaches the family deductible amount even if no individual has reached the individual deductible. Co-Insurance Q. Do all plans have co-insurance? A. Refer to the Summary of Benefits and Coverage (SBC) to see which plans have co-insurance. Q. What is co-insurance/how does it work? A. Co-insurance is additional employee cost sharing after deductibles and inpatient co-pays, if applicable, are met. Co-insurance doesn t start until you first satisfy your deductible. Once your deductible is satisfied, you pay a portion of the remaining balance until you reach the out-of-pocket maximum. Q. How do I know how much co-insurance I am responsible for? A. Refer to the Summary of Benefits and Coverage (SBC) to see the percentage of co-insurance for your plan. Some insurance carriers provide tools for estimating the cost of a procedure so that you can approximate your coinsure liabilities. Please contact your insurance carrier for details. Q. Do I have to pay the co-insurance at the time of service? A. No. Services where payment is expected at the time of service are the co-pays shown on your insurance card. If you enroll in the HDHP plan, you will not pay the co-insurance at the time of your visit. Your doctor will send the claim to the insurance company to determine your cost share, and you will be billed by the doctor s office after the service. Q. How can I find out which services are subject to co-insurance? A. Refer to the Summary of Benefits and Coverage (SBC), contact the insurance carrier or Benefits Advocacy Services for assistance. Spousal Coverage Q. Can I cover my spouse under the Company s plan? A. If your spouse is employed and is eligible for coverage through his/her employer, he/she is not allowed to participate in the Company s plan. If your spouse doesn t work or does work but isn t eligible for coverage, he/she may be enrolled in the Company plan. Q. Why doesn t the Company cover spouses who have coverage with their own employer? A. The cost to the Company to cover spouses who could get coverage through their own employer is an unnecessary burden to the Company which contributes to the overall cost of insurance for our employees. Q. How will you know if my spouse has other coverage or not? A. Anyone who wishes to enroll a spouse in a Company plan must complete a spousal affidavit. The spousal affidavit requires you to provide details on your spouse s employment status and benefits eligibility. You will also need to provide the Company with written confirmation from your spouse s employer of his/her ineligibility for medical coverage. The Company will also conduct periodic audits on spousal enrollments. Employees involved in the audit will be required to provide current proof of a spouse s employment status and benefits ineligibility. Page 5 of 21

6 Q. What is the penalty for lying on a spousal affidavit? A. Intentionally providing false information may result in disciplinary action up to and including termination of employment for falsification of records. In addition, you will be subject to potential loss of eligibility for you and all family members and you may be required to pay for any claims incurred under false pretense. Q. If during the year my spouse loses eligibility for medical coverage through his/her employer due to layoff or termination, can I add him/her to the Company plan? A. Yes. The loss of coverage is considered a qualifying event. You will need to complete a spousal affidavit and a medical election form within 30 days of the event to add your spouse. Q. What happens if my spouse becomes eligible for coverage through his/her employer? A. You must notify Human Resources within 30 days if your spouse becomes eligible for his/her employer s coverage. You will be required to drop your spouse from the Company s plan. Q. My spouse s employer coverage isn t very good. Is there an exception for spouses who have poor plans? A. No. The rules apply regardless of the level of coverage for which your spouse is eligible. Q. What if my spouse is a contract worker through an employment or temporary agency that offers coverage? A. The same rules apply. If your spouse has medical coverage available through his/her employer even if their employer is an employment or temporary agency your spouse is not eligible for the Company plan. Q. What if my spouse is self-employed and has only an individual plan? Can he/she drop that plan and be on the Company s plan? A. Yes. Individual plans are not employer plans. Q. What if my self-employed spouse has a group policy for his/her employees? A. A group policy is an employer plan and he/she would not be eligible for the Company plan. Q. Can I still enroll my spouse in the dental and vision plans if they have other coverage available? A. Yes. Dental and vision plans are excluded. Q. Do I have to re-certify my spouse s eligibility status on an annual basis? A. No. You must certify your spouse s eligibility status anytime you add your spouse to the plan or your spouse changes employers. The Company will also conduct periodic audits on spousal enrollments. Employees involved in the audit will be required to provide current proof of a spouse s employment status and benefits ineligibility. Dependent Children Coverage Q. Can I enroll my dependent children? A. Children up to the age of 26 can participate in the plan. Q. Do I have to notify the Company when my child reaches 26? A. Your child will automatically be dropped from coverage the end of the month in which they turn 26, at which time they will be eligible for COBRA. Q. Is there any way my child can remain covered beyond age 26? A. Yes. Your child will be offered COBRA coverage when he/she reaches 26. Q. My child is disabled. Are disabled children eligible for coverage beyond the age of 26? A. Yes. However, certification may be required, is determined by the insurance carrier, and is dependent on the medical information provided by your child s doctor. Your child remains eligible as long as he/she continues to be certified as disabled and you remain eligible for coverage. Q. What if my child ceases to be disabled and I forget to notify the Company? A. Your child will still lose coverage the end of the month he/she ceases to be eligible for coverage. If you do not notify Human Resources within 30 days your dependent will lose eligibility for continuation of coverage under COBRA. Page 6 of 21

7 General Medical Q. How do I find out if a specific doctor or hospital is in-network? A. Contact the insurance carrier (their websites have search features) or Benefits Advocacy Services. Q. I have IBC, why is there a PPO on the card when I am enrolled in the Silver (CPP) plan or Bronze (HDHP) plan?? A. The PPO symbol on the lower right hand corner of your card indicates your network. The network is the Blue Cross National Blue Card PPO network regardless of the plan. Q. How do I get a new/replacement insurance card? A. Please contact the insurance carrier or Benefits Advocacy Services for assistance. Q. Do the insurance carriers have their own wellness programs? A. Both IBC and Geisinger have wellness programs that you can participate in. Contact the carrier for more information. These wellness programs are independent from the CSS Wellness Program. Q. How can I find out what is covered under each plan? A. Refer to the Summary of Benefits and Coverage (SBC), contact the insurance carrier or Benefits Advocacy Services for assistance. Q. How can I find out what I owe for medical services I received? A. The insurance carriers provide Explanation of Benefits (EOBs) that explain the charges and your responsibility. If you do not receive one, please contact the insurance carrier. EOBs are also available on-line through the insurance carrier website. Q. Do I need a referral to see a specialist? A. No. Q. What is preventive care and is it free? A. Preventive screening services are based on age and standards set by medical associations. They include things such as childhood immunizations, routine Pap smears, routine mammograms and routine colon screenings. In most cases, if the preventive care is non-diagnostic, the services will be free. However, if the preventive screening leads to a diagnosis and/or other issues are discovered during the preventive screening, the provider may classify the visit differently and you may be subject to co-pays, deductibles and co-insurance charges. Q. If I have a plan that does not have out-of-network coverage and need emergency medical care when I am out of town, what happens? A. In an emergency you should go to the nearest emergency room. In an emergency, out-of-network providers are treated as in-network providers. Charges from out-of-network providers for non-emergencies are not covered. Q. If I am still working full time and collecting Social Security Insurance (SSI) do I have to use Medicare or do I still have an option to use the Company health insurance? A. You can enroll in the Company plan as long as you are eligible. Medicare eligibility or enrollment does not affect your eligibility for the Company plan. Page 7 of 21

8 WELLNESS PROGRAM General Q. What is the Wellness Program? A. There are two components in the Wellness Program General Wellness and Tobacco Free. You can participate in one or both programs. Employees and spouses (if covered by the Medical Plan) who do not complete the activities will pay a monthly medical premium surcharge. Q. How much is the surcharge if I don t participate? A. Refer to the current Wellness Program Summary for surcharge amounts. Q. What are the requirements for the Wellness Program? A. Please refer to the Wellness Program Summary for full details. Q. What if my spouse chooses not to participate in the Wellness Program? A. Employees and covered spouses are treated separately when determining credit for activities. Thus, if an employee completes the General Wellness Program but the covered spouse does not (or vice versa), only one surcharge will apply. If neither completes the General Wellness Program, the surcharge will apply to both. The Tobacco Free Program is handled the same way. Q. Who is the Wellness Program vendor? A. The vendor is Healthyroads. Q. Why do I have to complete a Health Assessment annually? A. Health Assessments are an excellent tool to measure your overall view of wellness. It is repeated every year to measure progress. Q. If my employment terminates and I elect Cobra do I still need to complete the Wellness Program? A. No. Your eligibility to participate ends if you terminate. The surcharges do not apply to COBRA. Q. What happens if I go out on leave during the year? A. You must still complete the Wellness Program activities to avoid paying the surcharge. Q. Can I complete the activities if I am on layoff status? A. Laid off employees who had coverage prior to layoff are eligible to participate in the program year round. Regardless if coverage is picked up upon recall or at open enrollment, all the activities must be completed by the deadline, to avoid paying the surcharge. Q. What is metabolic syndrome? A. Metabolic syndrome is a cluster of conditions increased blood pressure, high blood sugar, excess body fat around the waist, and abnormal cholesterol or triglyceride levels that occur together, increasing your risk of heart disease, stroke and diabetes. Having just one of these conditions doesn t mean you have metabolic syndrome. However, any of these conditions increase your risk of serious disease. Having more than one of these might increase your risk even more. Page 8 of 21

9 Biometrics Q. Is blood work required this year? A. Please refer to the Wellness Program Summary to determine what is required each year. When blood work is required, we will generally hold on-site screening events at larger locations. Blood work is typically done using a finger stick method. Employees who work at locations that do not have an on-site event can go to a local Quest site for the testing. Q. How much does the screening cost? A. The on-site screening is a free to employees and spouses. Q. Can I go to a local Quest site for the testing? A. Yes. You should call ahead to see if the site requires an appointment. There is no cost to you for testing at a Quest site. Q. What if I want to go to my own doctor for the screening? A. You can certainly go to your own doctor for the screening. You will be responsible for co-pays, deductibles and co-insurance, if applicable. You will need to download the Health Screening Form from Healthyroads. Your health care provider will need to complete and return the form to Healthyroads. Q. Who has access to my biometric screening results? A. Quest and Healthyroads are responsible for the management and security of all biometric screening data that is collected from each event. Biometrics screening results can only be accessed by the necessary personnel directly responsible for the coordination and implementation of the screening initiative. Q. Will my doctor receive a copy of my biometric screening results? A. No. Healthyroads does not share the biometric results with anyone other than you. Tobacco Q. Why are we focused on tobacco users? A. Statistics show that tobacco users incur more medical claims and higher medical costs than those who are tobacco free. Q. What is the definition of tobacco free? A. To be considered tobacco free, you must not have used any form of tobacco/nicotine products in the 6 months prior to completing the Tobacco Attestation. Tobacco products include those that are smoked (e.g., cigarettes, cigars, pipes, e-cigarettes), applied to the gums (e.g. dipping, chewing tobacco or snuff) and/or inhaled. Q. Won t some people lie on the Tobacco Attestation to avoid the surcharge? A. The Tobacco Attestation is considered a Company document and falsification of Company documents is not acceptable. If it is determined someone has lied, they could face penalties and/or disciplinary action up to and including termination along with the requirement to pay any back surcharges. In addition, CSS conducts random tobacco testing of employees and covered spouses who identify as tobacco free. Q. Who is subject to tobacco/nicotine testing? A. Employees and covered spouses who identified as tobacco/nicotine free on the most recent Tobacco Attestation are subject to testing. Our Wellness vendor will provide a Tobacco-Attestation report with names of each employee/spouse and their attestation status to the Company to use for this purpose. Page 9 of 21

10 Q. Will the test also pick up drug use? A. No. Q. When and how will the testing be done? A. The Company will conduct the testing throughout the year. The Company is using third parties to conduct the tests. Mostly a urine sample will be required. Q. Where will the tests be conducted? A. Whenever possible, the testing will be conducted on-site. When on-site testing is not a viable option, employees will need to go to a local testing facility. In most cases, this will be a Quest lab which the Company currently uses for its new hire drug tests. Q. How much notice will I receive prior to taking the test? A. If you are selected for on-site testing, you will be notified the day of the test. If you are selected for off-site testing, you will be provided one week to get the test completed. Q. If I am required to do off-site testing, will I be paid for the time it takes to get the test completed? A. No. The tests must be done on your own time. Q. Who pays for the test? A. The Company will pay for the test. Q. What is the minimum amount of tobacco use that will disqualify me from passing? A. The testing levels to pass are set high enough by the vendor to exclude those subjected to second hand smoke and those using tobacco cessation products. Keep in mind that the definition of tobacco free is someone who has not used tobacco/nicotine for at least 6 months. Q. What if I live with a smoker? A. The testing levels to pass are set high enough by the vendor to exclude those subjected to second hand smoke and those using tobacco cessation products. Q. What if I am taking a tobacco cessation product? A. The testing levels to pass are set high enough by the vendor to exclude those subjected to second hand smoke and those using tobacco cessation products. Q. Are you testing for Nicotine or Cotinine? A. Testing for tobacco in the human body is actually done by testing for nicotine and cotinine. Cotinine is what the body uses to help metabolize nicotine and is found in urine, blood, saliva and hair. Q. Is there any reason the test would show a false positive? A. According to the vendors, false positives are highly unlikely. Q. What if I do not agree with the test results? A. You should work with the Medical Review Officer (MRO) from the testing vendor to discuss the reason(s) you do not agree with the test results. The MRO will review your concerns and release the appropriate results to CSS. CSS will accept the MRO s reported results as final. Q. How do I know if I passed the test? A. CSS will only notify those who fail a test. Page 10 of 21

11 Q. What if I fail my test? A. You will be required to immediately pay the surcharge from the previous year s program. You will also face possible disciplinary action up to and including termination for falsification of Company records. Q. What if I was tobacco free when I completed the attestation, but I am using tobacco now? A. Employees and covered spouses are required to notify the Company if their tobacco free status changes during the plan year. The employee will then start paying the surcharge. Q. What if I confess that I have been using tobacco prior to taking the test? A. We will consider your admission as a positive test and you will be subject to the same surcharges as others who fail the test. Q. What if I refuse to take the test? A. We will consider your refusal as a positive test and you will be subject to the same surcharges as others who fail the test. Q. Will the Company be testing new hires for tobacco usage along with the initial drug test? A. The Company is evaluating this option. Currently only employees and covered spouses who identified as tobacco free on the most recent Tobacco Attestation are subject to testing. Q. What if a newly hired employee chooses the Company s insurance and uses tobacco? A. Newly hired employees and covered spouses are subject to the same requirements as others. Q. When is the next time I will be able to re-certify my tobacco user status? A. Employees and covered spouses have an opportunity to complete the Tobacco Attestation once per plan year. Q. Does my insurance cover tobacco cessation products? A. Most tobacco/nicotine cessation products are available for free for the first 168 day supply per calendar year. After that the applicable co-pay will apply. Q. Can I get reimbursed for over the counter tobacco cessation products through the FSA or HSA? A. Over the counter drugs, including tobacco cessation products, are only covered under FSA if you have a doctor s prescription. Please discuss with your doctor. Page 11 of 21

12 PRESCRIPTION BENEFITS General Prescription Q. Who is our prescription provider? A. CVS/caremark (regardless of your medical insurance carrier). Q. Do I have to use a CVS pharmacy? A. No. There are many other participating pharmacies. Q. How do I find participating pharmacies? A. Contact the provider (search features are available on their website) or Benefits Advocacy Services. Q. What if I choose to fill a prescription at a non-participating pharmacy? A. There are no out-of-network benefits. You will have to pay the full price of a prescription at a non-participating pharmacy. Q. How do I change my prescription from a non-participating retail pharmacy to a CVS participating retail pharmacy? A. Go to a CVS/caremark participating retail pharmacy and tell the pharmacist where your prescription is currently on file. The pharmacist can request the transfer for you. Q. What is the difference between generic, preferred and non-preferred drugs? A. Generic is a drug sold or prescribed under the nonproprietary name of its active ingredients rather than under a brand or trade name. The preferred drugs are covered under a health plan at a discounted rate. A "non-preferred brand name" is a brand name drug that is not in the preferred list and has a higher co-pay. Q. Are generic drugs mandatory? A. Yes. Q. Are all generics preferred? A. No. However, most generics are preferred. Q. How will I know whether my drug is generic, preferred or non-preferred? A. Contact the provider. The preferred drug list is quite extensive. Q. What drugs have no co-pays? A. There are 5 generic drug categories where the Company pays the full cost for you. Generic drugs are free to you if used to treat one of the following diagnoses: High Blood Pressure, Asthma, Diabetes, Clinical Depression and High Cholesterol. Also, under the Affordable Care Act, many types of birth control are free. Q. How do I order the free generic drugs? A. The free generics are typically maintenance drugs and therefore subject to mandatory mail order. Q. If generics are free, why do I have to use mail order? A. The drugs are free to you but not to the Company. Drugs that are obtained in larger quantities through one supplier are cheaper than those purchased at a retail pharmacy. Q. Why do some drugs have a higher co-pay? A. Specialty drugs have higher co-pays and are only available through CVS/specialty. Specialty drugs are biological drugs that are extremely expensive or drugs with short shelf lives. The co-pays are higher due to the special handling required and cost. The Specialty drug co-pay for the Gold & Silver plans is $100. For the HDHP, there is a $500 co-pay after the deductible is met. Page 12 of 21

13 Q. What are the options to order refills? A. Refills are available in person at a participating pharmacy along with mail, website or phone. You can also opt for automatic refills for select drugs via the website or through a customer service representative. The selections can be updated at any time. Q. How many prescription cards will I receive? A. There will be one card issued for single coverage and two cards issued to anyone covering more than one person. For additional prescription cards please call the provider. Mandatory Mail Order/Maintenance Drugs Q. What is a maintenance drug? A. Maintenance drugs are prescription drugs that treat an on-going condition such as arthritis and are used for diseases when the duration of use can be reasonably expected to exceed one year. Drugs prescribed for short-term or one-time issues, such as antibiotics for a sinus infection, are not considered maintenance drugs. Q. What is the mail order requirement? A. Any drug considered to be a maintenance drug must be ordered through mail order. Q. How do I get my prescription filled through mail order? A. There are a few ways to get your maintenance prescription filled: Submit original written prescriptions via mail using the CVS/caremark Mail Service Order Form. Take the mail order form to your physician, who can fax it with a prescription. Please note that faxed prescriptions must be submitted by physicians, not members. Take a 90-day supply prescription directly to a CVS pharmacy. You will receive the same pricing as you would through mail order. Q. Where can I obtain the mail order form? A. It is available on the provider s website. Q. Why can I get a mail order prescription filled at a pharmacy; I thought it had be filled via mail order? A. When you take a 90-day supply prescription directly to a CVS pharmacy, it is treated as mail order. This is because CVS is also our pharmacy vendor. Q. Do I need to use a Mail Services Order Form if I take my prescription to a CVS pharmacy? A. No. Q. Why is mail order less expensive for me? A. CVS/caremark and other pharmacy benefit managers purchase drugs in extremely large quantities. This allows them to get much lower prices than retail pharmacies, which means that the Company also pays less for mail order drugs. This is how the Company can offer employees up to 90-day supply at two times the retail co-pay. You save the cost of one month. Q. Can I sign up for auto refills for my mail order? A. Yes. You can also opt for automatic refills for select drugs via phone or the provider s website. The selections can be updated at any time. Q. How should I ask my doctor to write my prescription in order to receive the maximum benefit from mail order? A. Remind your doctor to write a 90-day supply plus refills for maintenance medications that are to be purchased through mail order. If you need to begin taking the medication right away then you should request two prescriptions: a 30-day supply to take to the pharmacy for an immediate fill and a 90-day supply to be refilled on an on-going basis through mail order. Page 13 of 21

14 Q. When can I order refills? A. You can order refills when you have used 75% of your on-hand supply. Q. What if my doctor will only write me a prescription for a 30-day or less supply? Do I still have to get it through mail order? A. The mail order service only applies to maintenance drugs which are drugs taken on a recurring basis. The mail order service will allow up to two retail fills at a pharmacy for new prescription before mail order is required. Q. How much will my mail order prescriptions cost? A. You will pay two times the per fill co-pay for up to a 90-day supply. Thus, it s actually cheaper for you to get the prescription filled via mail order. Remember, the co-pay is per fill regardless of how many days supply one fill contains. Q. What if the cost of my drug is less than the co-pay? A. You will pay the lesser of the co-pay or the cost of the drug. Q. How do I pay for mail order drugs? A. You have several payment options check, money order, credit/debit card and e-check. If you choose e-check, credit or debit, this method of payment will be automatically used for all future orders. You may receive an authorization call for orders over $250. Q. Do I have to pay for my mail order before they will ship it to me? A. No. Your order will include a bill if you did not provide payment at the time you place your order. Q. How long does it take to get my prescriptions using the mail order service? A. The turnaround time for new mail orders is usually 7-10 days from when CVS/caremark receives it. Q. I have drugs that must be refrigerated. Do they have to come through mail order? A. Drugs are stored and shipped per the manufacturer s directions. The CVS/caremark Mail Service Pharmacy monitors weather conditions daily to ensure appropriate temperature-sensitive packaging is used when applicable. Q. How do I check the status of my order? A. Contact the provider. Q. Will CVS/caremark call a participant s doctor to get a new mail order prescription? Can a doctor call in or fax in prescriptions? A. The CVS/caremark Mail Service Pharmacy will work with the doctor s office to obtain a new prescription for a member when requested. Doctors can call or fax in new prescriptions as well. Q. Do I have to sign for my mail order or will it be left at my house? What if I have a PO Box? A. No. You do not have to sign for mail order. Unless your prescription requires special handling it will be sent via the US Postal Service. Prescriptions that require special handling are sent via a carrier such as FedEx. You do not have to sign for these prescriptions but they cannot be delivered to a PO Box. The carrier will require a street address. Mandatory Prior Authorization Q. What is Prior Authorization? A. Prior Authorization is a program designed especially for people who take prescription drugs regularly to treat ongoing medical conditions such as arthritis. In Prior Authorization, medications are grouped into two categories: Front-Line Medications: These are the medications recommended for you to take first, usually generic medications, which have been proven safe and effective. Back-Up Medications: These are brand-name medications, like those you see advertised on TV. They re recommended for you to take only if a front-line medication doesn t work for you. They are more expensive. Page 14 of 21

15 Q. How will I know if my doctor prescribes a medication that requires Prior Authorization? A. You should tell your doctor that you have mandatory prior authorization he or she should know what that means and prescribe an appropriate front-line medication. However, if your doctor prescribes a back-up medication first, the pharmacist will contact your doctor to ask if it is okay to substitute with a front-line clinically effective medication used to treat the same condition or will call CVS/caremark s Prior Authorization department to request an override. An override will not be approved unless your doctor provides medical substantiation to CVS/caremark of the need for you to have the back-up medication. Q. Can my doctor override Prior Authorization? A. No. If your doctor prescribes a medication that requires Prior Authorization, the pharmacist will contact the doctor. Prior Authorization will only be over-ridden if your doctor can document a medical reason of the need for you to receive a back-up medication without trying a front-line medication first. This is handled between the pharmacist, your doctor and CVS/caremark. Step Therapy Q. What is generic step therapy? A. Many lower-cost medicines provide great health benefits and save you money. In fact, you may be paying too much to treat your health condition. That is why CVS/caremark wants to help you and your doctor choose a lower-cost medicine as the first step in treating your condition. This is called Step Therapy. Through this Step Therapy program, the Company and CVS/caremark are working together to make your prescription medicines more affordable. The CVS/caremark Step Therapy Program is designed for people like you who take medicine to treat ongoing health conditions such as arthritis. Using lower-cost options, like generic medicines, as the first step in treating your condition can help save you money. Page 15 of 21

16 Q. What is an out-of-pocket maximum? OUT-OF-POCKET MAXIMUM A. The Affordable Care Act puts limits on the amount of out-of-pocket expenses you can have in a plan year for medical and pharmacy combined. These limits do not apply to the premiums you pay monthly. The limits apply to the dollars you have to pay in a plan year for things like deductibles, co-pays or co-insurance. Q. How much is the out-of-pocket maximum? A. The caps on out-of-pocket maximums are established by the IRS. Caps on the different plans are broken down between medical and pharmacy as follows: Gold Plans In- Network Silver Plans In-Network Bronze Plans In-Network Individual Family Individual Family Individual Family Medical $4,600 $9,200 $4,600 $9,200 $6,550 $13,100 Pharmacy $2,000 $4,000 $2,000 $4,000 Combined with medical Total $6,600 $13,200 $6,600 $13,200 $6,550 $13,100 *Out-of-Network Maximums vary; see SCB's for individual plan details. HSA S, FSA S AND DCA S Health Savings Account (HSA) versus Flexible Spending Account (FSA) Q. What are Health Savings Accounts (HSAs) and Flexible Spending Accounts (FSAs)? A. Both HSAs and FSAs are tax-advantage accounts that allow people to save money to pay for qualified medical expenses. You can only contribute to an HSA if you are enrolled in a High Deductible Health Plan (HDHP). Q. What are the key differences? A. Component HSA FSA Tied to Medical Must be enrolled in an HDHP to make Not tied to a medical plan contributions Contribution limits Capped See current IRS limits Capped See current IRS limits Changing contribution amounts Can change your contribution amount throughout the year Can only change at open enrollment or with a qualifying event Rollover Unused balance roll over Unused balances are forfeited Portable Yes you can take it with you when you No unused balances are forfeited leave employment Effect on taxes HSAs are triple tax advantaged - contributions are pretax, distributions are Contributions are pretax and distributions are untaxed. untaxed, and interest and investments are not taxed. Covered Expenses Follows IRS regulations on qualified Follows IRS regulations on qualified Can money be withdrawn for other reasons expenses ( After age 65, money can be withdrawn without penalty, but if it is not used for qualified medical expenses income taxes will be owed. If money is withdrawn for other purposes prior to age 65, it is taxed and there is an additional tax penalty applied. expenses ( No Page 16 of 21

17 Q. What types of expenses are eligible for reimbursement? A. HSAs and FSAs follow IRS regulations. In general, medical, dental and vision expenses that are not covered by insurance are eligible. This includes your co-pays for medical and drugs, amounts applied to deductibles, amounts not covered because they exceed plan limits or not covered by a medical, dental or vision plan, orthodontics and some over the counter items. A full list of eligible expenses is available at ww.irs.gov. Premiums are NOT eligible expenses. Q. Can I be reimbursed for my insurance premium? A. No. Premiums are NOT eligible expenses. Q. Can I participate in both the HSA and medical FSA? A. No. The company does not offer this option. Health Savings Account (HSA) Q. How do I get reimbursed? Benefit Resource offers multiple ways to use your HSA funds, including using your Beniversal debit card at the time of service or when paying a bill, online transfers from your HSA account to your personal checking or savings account, and online bill payment so your provider can be paid directly. Q. Are there rules around how quickly you must submit expenses for reimbursement? No, there is not a requirement to reimburse yourself within a certain time, however you cannot reimburse yourself for expenses that were incurred prior to your HSA being established. For example, you cannot reimburse yourself for expenses from last year once you open the HSA this year. Q. Can I combine HSA accounts from different employers (like 401ks)? Yes. Contact Benefit Resources for instructions Q. What happens to the money in my HSA if I change plans in the future and am no longer in a HDHP? A. You can continue to use the funds exclusively for qualified medical expenses as defined by the IRS however you can no longer contribute to your HSA. Q. If I leave employment, how do I get access to my HSA? A. Your HSA is your individual account and you will continue to access your account if your employment with CSS ends. Flexible Spending Account (FSA) Q. How do I get reimbursed? A. You will receive a Beniveral card which is debit card. You can use this card like any other debit card but only to pay for eligible medical expenses. Q. Can I get a new debit card if I lose mine? A. Yes, however BRI will deduct a replacement fee of $10 from your account balance. Page 17 of 21

18 Dependent Care Account (DCA) Q. What is a Dependent Care Account (DCA)? A. Dependent Care Accounts is an FSA used to reimburse expenses related to day care and dependent care using pretax dollars. Q. Can I be reimbursed from my Dependent Care Account for babysitting expenses? A. Only expenses which allow you to work or look for work are eligible. If you are married they must enable your spouse to work, look for work or attend school full time to be eligible for reimbursement. Care cannot be provided by someone who is your minor child or dependent for income tax purposes (e.g., an older child). Please remember all dependent care providers must also be reported on your tax returns. Q. If I no longer need child care due to my spouse having a change in or loss of employment, can I cancel my dependent care FSA? A. A change in employment may be a qualifying event for a dependent care account. You may be able to change your election for future deductions. Payroll deductions already withheld cannot be returned to you except through claim reimbursement, but you may be able to stop future deductions. Please contact the vendor for more information on qualifying events for dependent care accounts. Plan Administration Q. What are the contribution limits? A. Please refer to current IRS limits. Q. Are contributions taken out of every check? A. Yes, deductions will be taken out of every pay check up to the IRS limits. Q. Who is the administrator of these accounts? A. Benefit Resource, Inc. (BRI) Q. Who do I contact if I have a question about what expenses are eligible for reimbursement? A. Contact the provider or Benefits Advocacy Services. Q. It seems like BRI wants documentation for everything. Why? A. Regulations require that all medical expenses be substantiated. Any expenses that do not have a fixed cost to you will require substantiation. This includes most dental expenses since your cost is a percentage after a deductible. BRI will need your Explanation of Benefits (EOBs) that show what you are responsible for paying. This is also true for medical and vision expenses that are for expenses other than co-pays. Plan Administration FSA and DCA Only Q. When must I have all of my money spent for my current FSA or DCA? A. August 31 of the current year. Q. Can I still submit a receipt for reimbursement after August 31 for the FSA or DCA? A. There is a 60-day run out period to submit expenses incurred on or before August 31 of the current year. That gives you until October 30 of the current year to turn in eligible expenses incurred on or before August 31 of the current year. All run out claims MUST BE RECEIVED by October 30 of the current year to be eligible for reimbursement. Page 18 of 21

19 Q. What if I do not provide substantial proof for claims when requested? A. When the plan year is reconciled and closed in December if you have unsubstantiated claims for the prior plan year, IRS regulations require the Company to make the plan whole by taking taxable deductions in the amount of these unsubstantiated claims from your next calendar year s compensation. We will notify you in advance with the amount and date that the Company will take this taxable deduction in January. Q. What happens to my money if I don t spend it all? A. If actual expenses during the Plan Year are less than the amount you elect for that purpose, the Federal regulations requires that you forfeit the unused portion. This is sometimes referred to as the use it or lose it rule. Page 19 of 21

20 OTHER HEALTH AND WELFARE BENEFITS Dental Q. Who is our dental insurance carrier? A. Delta Dental of Pennsylvania. Q. What are my plan options? A. There are two plans, a basic plan and an enhanced plan. The primary difference is the level of coverage after each plan s deductible has been met. The basic plan does not cover major services, dentures or orthodontics. These services are covered under the enhanced plan. Q. How can I find out what is covered under the plan? A. Refer to the plan highlights, available on the HR Intranet or contact the insurance carrier. Q. How can I find in-network providers? A. Contact the insurance carrier or Benefits Advocacy Services for assistance. Vision Q. Is vision covered by my medical insurance? A. There are some vision benefits through Geisinger. There are no vision benefits through IBC. Q. Can I purchase additional vision coverage? A. Yes. You can purchase vision coverage through EyeMed. Q. What are my plan options? A. There is only one plan option and it is fully employee paid. Q. How can I find out what is covered under the plan? A. Refer to the EyeMed plan summary sheet on the HR Intranet. Other Q. Are there other Health & Welfare benefits available? A. Yes. The Company automatically enrolls new hires into a few company paid benefits including Disability, Basic Life Insurance and Accidental Death & Dismemberment. The Company also makes several other voluntary (employee paid) benefits available including Supplemental and Dependent Life and AD&D Insurance, Critical Illness Insurance, Accident Insurance and Whole Life Insurance. The providers vary. Information on these programs is provided in your Benefit Enrollment Guide and is also available on the HR Intranet. Page 20 of 21