Benefits Wise Plan Year

Benefits Wise 2018-2019 Plan Year April 1, 2018 through March 31, 2019

Welcome to Your 2018-2019 ICUBA Benefits Guide! ICUBA and The Florida Institute of Technology offer a comprehensive range of benefits to promote health and financial WellBeing for you and your family. This booklet provides a summary of your benefits. Official plan and insurance documents govern your rights and benefits under each plan. For more details about your benefits, including covered expenses, exclusions, and limitations, please refer to the summary plan descriptions, plan document, or certificate of coverage. If any discrepancy exists between this brochure and the official documents, the official documents will prevail. Please review this brochure carefully so you can choose the coverage that s right for you! It s time to make your benefit decisions for 2018-2019! Highlights for April 1, 2018! New $4,000/$8,000 Deductible PPO Plan Our new Medical Plan provides premium cost savings for healthy families with children! This plan offers the same great value based benefits as ICUBA s Preferred PPO Plan at a lower cost. However, this plan is designed as ICUBA s first silver plan equivalent with a higher deductible, out-of-pocket maximum and higher employee cost share. Free Generic Statin Prescription Drugs If you meet certain criteria as outlined by the Affordable Care Act (ACA), you may be eligible for Free Generic Statin prescription drugs. Talk to your doctor or call the ICUBAcares Pharmacist Advocate Program to find out more! In-Network Outpatient Hospital Labs In-Network Outpatient Hospital Labs are no longer subject to deductible. In the 2018-2019 Plan Year these laboratory tests (which were recommended through Quest Diagnostics) can be performed during a visit to an in-network outpatient hospital/office in places like Moffitt Cancer Center or the Mayo Clinic. Employees will only be responsible for the coinsurance. Advanced Imaging The Advanced Imaging benefit has been brought up to today s standard of care. Members are no longer subject to the full deductible when you need advanced imaging like an MRI or CT scan. In the 2018-2019 Plan Year you are only responsible for the allowable charges up to $500. Please note: Prior Authorization is still required for all advanced imaging. Amazon Gift Card winners every 14-days for City Challenges in Rally (with tracking device) Are you tired of entering Rally sweepstakes and forfeiting your coins to the black hole of luck? ICUBA found a solution and is giving away $50 Amazon Gift Cards every 14 days. When you complete a cross city challenge milestone, not only will you earn coins as you sync your tracking device, but you will be entered EVERY. SINGLE. TIME. a milestone is reached! Teladoc Rave Reviews for $5! Have You Tried It Yet? Talk to a Doctor anytime! Teladoc gives you 24/7/365 access to a U.S. based board certified doctor through the convenience of a phone or video chat consultations. It s an affordable alternative to costly urgent care and ER visits when you need care now. You can find additional information about Teladoc on page 7. Blue Distinction Total Care (BDTC) Need to see a doctor? Choose a family physician, internal medicine physician or pediatrician with the BDTC designation, previously known as Blue Physician Recognition and your copayment will be $0. This is an enhanced benefit for members of the ICUBA health plan through Blue Cross and Blue Shield of Florida, Inc. Find more information about BDTC on page 7. Dental and Vision Minimal increases for Humana Dental and no increase for the EyeMed Vision plan. 2 Your Benefits Wise Plan Year

Who s Eligible As long as you are a full-time employee of Florida Institute of Technology, hours will vary by school and class, you and your dependents are eligible for the benefits described in this booklet. As a newly hired employee, coverage for your elected benefits will be effective on the first day of the month following or coinciding with the date of hire. Dependent Eligibility You may enroll your eligible dependents for coverage once you are eligible. Your eligible dependents include: Your legally recognized spouse and your legal child dependent(s) including: natural child, legally adopted child, stepchild, child required to be covered pursuant to a Qualified Medical Child Support Order, child with proof of legal guardianship who resides with you, or a foster child. It is your responsibility to provide Human Resources with proof of your dependents eligibility. Status Change/Qualifying Events Once your benefit elections become effective, they remain in effect until the end of the plan year (March 31). You may only change coverage due to a qualifying event. You must notify HR and complete your enrollment changes within 30 days of the event occurring. The following list highlights these qualifying events, but is not limited to: Change in marital status (marriage, death of spouse, divorce, legal separation); Change in number of dependents (birth, death, adoption, eligibility status, child support order); Change in employment status for you or your spouse (commencement, termination, leave of absence, full-time to part-time or vice versa); Special enrollment rights under HIPAA; or You, your spouse or child gains or loses Medicare or Medicaid coverage. For further information on eligible qualifying events, please refer to the Summary Plan Description or contact your Human Resource Department. Key Things To Know Health Care Reimbursement Account (HRA) When you enroll in an ICUBA medical plan, The Florida Institute of Technology contributes funds to a HRA for you at the end of each month. The HRA contributions will be available on your ICUBA MasterCard for eligible health care expenses for ICUBA medical plan participants and covered dependents such as deductibles, copays, dental and vision care, and other eligible expenses not paid for by your plan. The funds in your account earn interest on a quarterly basis. Unused funds roll over tax-free from year to year, allowing you to save for future health care expenses. Employees with 36 continuous months of employer contributions become vested in their HRA. This means the funds are yours to keep for life to use for eligible expenses, although fees apply if you stop working for an ICUBA employer. Health Care Flexible Spending Account (FSA) Health Care Flexible Spending Accounts (FSAs), such as our Health Care Spending Account (HCSA) and Dependent Care Spending Account (DCSA), allow you to pay for certain eligible health and/or dependent care expenses using pre-tax dollars. IRS rules allow you to contribute to your account(s) through payroll deduction on a pre-tax basis before federal income tax and Social Security taxes are deducted reducing your taxable income. FSA dollars can be used for all qualified, taxable dependents. Florida Institute of Technology honors a grace period for the HCSA/DCSA s. You will have additional time to incur and submit claims so that you don t forfeit your funds. For the current plan year ending March 31, 2019, you can continue to incur eligible expenses until June 15, 2019, but will need to be sure to submit your request for reimbursement before June 30, 2019. Unused dollars at the end of the grace period will be forfeited. Using Your ICUBA Benefits MasterCard When you enroll in an ICUBA medical plan you will receive an ICUBA MasterCard to pay for eligible health care expenses such as, deductibles, copays, dental and vision care, and other eligible expenses not paid for by your plan. View your ICUBA Benefits MasterCard account information online! Your Benefits Wise Plan Year 3

ICUBA Medical Plan Option - Preferred Provider Organization (PPO) Benefits Summary Preferred PPO In-Network Out-of-Network EMPLOYEE PAYS Deductible (Individual/Family) $2,000/$4,000 $3,500/$9,750 Coinsurance 20% 40% Out-of-Pocket Maximum (Individual/Family) Includes all medical copays, deductibles & coinsurance $3,500/$7,000 $7,000/$14,000 Physician Office Visits 20% 40% after deductible Blue Distinction Total Care (Family Practice, Internal Medicine, Pediatrics) $0 Not Applicable Specialist Office Visits 20% 40% after deductible Convenient Care Clinics Independent Clinical Labs (free standing facilities & office visits) $10 Copay 0%* 40% after deductible Preventive Care 0% Not covered Teladoc Visit $5 Copay Not covered Urgent Care Center Emergency Room Services Ambulance $30 Copay 0% after $300 Copay (waived if admitted) $250 Copay Hospital Inpatient 20% after deductible 40% after deductible Monthly Employee Premium Amount FIT HRA Contribution FIT Cost Employee Premium Employee $120.00 $506.00 $96.00 Employee & Spouse $240.00 $960.75 $320.25 Employee & Child(ren) $260.00 $813.00 $271.00 Family $260.00 $1,265.25 $421.75 Note: Please refer to rate calculator on page 11 in order to reach your per pay rate! *Quest Diagnostics Lab is the In-Network lab for BlueCross BlueShield of Florida. 4 Your Benefits Wise Plan Year

ICUBA Medical Plan Option - Premier Copay Plan Benefits Summary Premier Copay Plan In-Network Out-of-Network EMPLOYEE PAYS Deductible (Individual/Family) $2,000/$4,000 $3,500/$9,750 Coinsurance 20% 40% Out-of-Pocket Maximum (Individual/Family) Includes all medical copays, deductibles & coinsurance $3,500/$7,000 $7,000/$14,000 Physician Office Visits $25 Copay 40% after deductible Blue Distinction Total Care (Family Practice, Internal Medicine, Pediatrics) $0 Not Applicable Specialist Office Visits $50 Copay 40% after deductible Convenient Care Clinics Independent Clinical Labs (free standing facilities & office visits) $10 Copay 0%* 40% after deductible Preventive Care 0% Not covered Teladoc Visit $5 Copay Not covered Urgent Care Center Emergency Room Services Ambulance $50 Copay 0% after $300 Copay (waived if admitted) $250 Copay Hospital Inpatient 20% after deductible 40% after deductible Monthly Employee Premium Amount FIT HRA Contribution FIT Cost Employee Premium Employee $120.00 $442.00 $190.00 Employee & Spouse $240.00 $940.28 $403.72 Employee & Child(ren) $260.00 $796.40 $341.60 Family $260.00 $1,239.49 $531.51 Note: Please refer to rate calculator on page 11 in order to reach your per pay rate! *Quest Diagnostics Lab is the In-Network lab for BlueCross BlueShield of Florida. Your Benefits Wise Plan Year 5

ICUBA Medical Plan Option - $4,000/$8,000 Deductible Plan Benefits Summary $4,000/$8,000 Deductible Plan In-Network Out-of-Network EMPLOYEE PAYS Deductible (Individual/Family) $4,000/$8,000 $8,000/$16,000 Coinsurance 30% 50% Out-of-Pocket Maximum (Individual/Family) Includes all medical copays, deductibles & coinsurance $5,350/$10,700 $10,700/$21,400 Physician Office Visits $35 Copay 50% after deductible Blue Distinction Total Care (Family Practice, Internal Medicine, Pediatrics) $0 Not applicable Specialist Office Visits $70 Copay 50% after deductible Convenient Care Clinics Independent Clinical Labs (free standing facilities & office visits) $10 Copay 0%* 50% after deductible Preventive Care $0 Not covered Teladoc Visit $5 Copay Not covered Urgent Care Center Emergency Room Services Ambulance $70 Copay $500 Copay (waived if admitted) $250 Copay Hospital Inpatient 30% after deductible 50% after deductible Monthly Employee Premium Amount FIT HRA Contribution FIT Cost Employee Premium Employee $120.00 $501.00 $96.00 Employee & Spouse $240.00 $955.50 $318.50 Employee & Child(ren) $260.00 $680.25 $226.75 Family $260.00 $1,139.25 $379.75 Note: Please refer to rate calculator on page 11 in order to reach your per pay rate! *Quest Diagnostics Lab is the In-Network lab for Florida Blue. 6 Your Benefits Wise Plan Year

Blue Distinction Total Care Primary Care Providers Doctors with the Blue Distinction Total Care (BDTC) recognition are dedicated to improving the quality of care for their patients. By selecting one of the BDTC physicians, your copay is $0 for family practice, internal medicine, and/or pediatrics. These physicians specialize in care for people with chronic conditions, like diabetes, asthma, COPD and heart problems, to ensure each person receives preventive screenings and follow-up care. BDTC designation does not necessarily mean they provide a higher standard of care than other doctors. It means these doctors take part in a quality improvement program recognized by BCBS of Florida. Use the online Doctor and Hospital finder to locate doctors with BDTC designations. Simply log in to your member account through the single sign-on section at ICUBAbenefits.org. (If applicable: Dependents can visit the BCBS website directly at www.myhealthtoolkitfl.com.) Take advantage of the detailed information available in the Doctor and Hospital Finder to decide which doctor is right for you! Teladoc Teladoc gives you 24/7/365 access to U.S. board-certified doctors through the convenience of phone or video consults. It s an affordable alternative to costly urgent care and ER visits when you need care now. Talk to a doctor any time for a low $5 copay. Please note: Restrictions apply as it relates to number of consults during the year and severity of condition for consultation. With your consent, Teladoc is happy to provide information about your Teladoc consult to your primary care physician. For first time registration with Teladoc there is a single sign-on feature through BCBS MyHealthToolkit or you may visit www.teladoc.com directly. If you experience any difficulties, call 1-800-Teladoc, and a customer service representative will be more than happy to walk you through getting your account setup. BlueRewards Powered by Rally Health How would you like to be happy, get in shape, eat better, be stress-free, quit smoking, lose weight and be rewarded for it? Now you can! Each employee and spouse in the medical plan will be eligible to participate in this exciting new WellBeing incentive. Rally is our digital health engagement experience that will help you be more active in improving your health. You will have access to our WellBeing portal powered by Rally Health by visiting http://icubabenefits.org and utilizing the single sign-on feature for BCBS MyHealthToolkit. The site features an innovative health survey, personalized activity recommendations, individual goals, and supportive online communities. You can link wearable activity tracking devices to your Rally account to make it easy to track your steps, check your progress, and compete against others in challenges. As you work toward your WellBeing goals, you ll earn coins and dollars that can be cashed in through Rally Coin Marketplace and a variety of electronic gift cards. (As applicable, spouses should visit BCBS website directly at www.myhealthtoolkitfl.com.) Also, did you know The Florida Institute of Technology has an active Wellbeing Committee on campus that plans ways for faculty and staff to reach their wellness goals? Visit the Human Resources office for more information on how to get involved and get healthy! Your Benefits Wise Plan Year 7

ICUBA Prescription Plan Benefits Summary Prescription Drug Plan Retail 30 Retail 90 Mail Preferred Generics (NSU) $0 $0 N/A Preferred Generic $5 $10 $10 Non Preferred Generics $10 $20 $20 Preferred Brands $40 $80 $80 Non-Preferred Brands $75 $150 $150 Preferred Specialty $75* N/A N/A Non Preferred Specialty $75 N/A N/A * Preferred Specialty medications are eligible for copay card usage. Out-of-Pocket Maximum In-Network Rx copays will be applied toward an individual maximum out-of-pocket of $2,000/single and $4,000/family. Once you reach your out-of-pocket maximum, your prescriptions will be paid for at 100% by the plan and no cost to you ($0 copay). If you have a question about your pharmacy benefit, call the OptumRx Customer Care Center, 24 hours a day, 7 days a week. The toll-free number can be found on the back of your Optum ID card. ICUBA Vision Benefit Options from EyeMed Benefits Summary ICUBA offers a voluntary vision Base Plan through EyeMed. The Base Plan allows you and your covered family members one routine exam per calendar year, plus lenses once a calendar year, and new frames every 24 months. To view the entire provider network, please visit the EyeMed website at www.eyemed.com or contact the Service Center at (866) 800-5457. Please review the complete summary of benefits for full coverage details. Base Plan Exam (Once every 12 months) Frames Single Vision Lenses (Once every 12 months) Contacts (Once every 12 months) In Network Out-of Network Reimbursement $5 copay up to $35 $0 copay; $100 allowance; 20% off balance over $100; (Once every 24 mos.) up to $50 $15 copay up to $20 $0 copay; $100 allowance; plus balance over $100 up to $80 Monthly Employee Premium Amount Employee Pays Employee $3.91 Employee & Family $10.02 8 Your Benefits Wise Plan Year

ICUBA Dental Benefit Options from Humana Benefits Summary The dental coverage is offered so you and your family can receive the important dental care you need for good health. You can choose from three different fully insured dental plans that best fit your needs. Humana offers a Dental Health Maintenance Organization (DHMO) and Preferred Provider Organization (PPO) plans. High Option PPO Preventive Plus DHMO Prepaid 250CS Plan Year Maximum $2,000 $1,000 Unlimited Providers In & Out-of Network Providers In & Out-of Network Providers Network Providers/ Assignment Providers Deductible $50 Individual/ $150 Family $50 Individual/ $150 Family Not Applicable In-Network Out-of Network Plan Pays In & Out-of Network Patient Pays Assigned Network Provider Benefit/Service EMPLOYEE PAYS Preventive Services 0% 20% 0% You pay a pre-set copay Basic Services Major Services Orthodontia (Adult and/or Child) Orthodontia Lifetime Maximum for each member 20% after ded. 50% after ded. 50% 50% after ded. 70% after ded. 20% after ded. You pay a pre-set copay Discount available for In-Network only* Discount available for In-Network only* $2,000 Not Covered You pay a pre-set copay You pay a pre-set copay No Maximum, Member pays pre-set copay Monthly Employee Premium Amount Higher Option PPO Preventive Plus DHMO 250CS Employee Only $39.77 $19.48 $11.72 Employee + 1 $79.21 $45.28 $23.50 Employee & Family $133.21 $74.96 $36.50 * Discount is subject to provider discretion and does not count toward the deductible or maximum out-of-pocket. Note: The missing tooth exclusion has been removed from the High Option PPO Dental Plan effective 04/01/17 Your Benefits Wise Plan Year 9

Income Protection Short Term Disability All benefit eligible employees are provided Short Term Disability coverage at no cost. You will receive 66 2/3% of weekly earnings, to a maximum benefit of $2,000 per week. The elimination period of this coverage is 14 calendar days for disability due to an injury or sickness. Short Term Disability is provided for 11 weeks before an employee converts to Long Term Disability. Long Term Disability All benefit eligible employees are provided salary continuance insurance. There are two options to choose from: Option A: Base Level - This plan provides a benefit of 60% of weekly earnings, to a maximum of $2,000 per month, and is provided by FIT at no cost to all benefit eligible employees. Option B: Buy-Up Level - This plan provides a benefit of 66 2/3% of weekly earnings, to a maximum of $14,000 per month. You and FIT share the cost of this coverage. Benefit cost is based on your age and salary level. Life Insurance and AD&D Plan Florida Institute of Technology provides group life insurance at no cost to all active full-time, benefit eligible employees. Employees receive one times their annual earnings. All amounts are rounded to the next higher multiple of $1,000, if not already an exact multiple thereof. Age reductions may apply. Employee Voluntary Supplemental Life Insurance and AD&D Plan You may purchase this coverage in $10,000 benefit units up to 5 times your annual salary not to exceed $500,000. Evidence of Insurability is required for amounts above $150,000 and must be approved by Symetra. All amounts are rounded to the next higher multiple of $10,000, if not already an exact multiple thereof. Age reductions may apply. Dependent Voluntary Life Insurance In order to purchase life insurance for your spouse and/or child, you must purchase Supplemental Life coverage for yourself. The spouse value can be purchased up to 50% of employee amount in increments of $5,000, not to exceed $250,000. Evidence of Insurability is required for amounts above $50,000 and requires approval by Symetra. Child life insurance can be purchased in increments of $2,000 up to $10,000 if less than 50% of the employee coverage amount. Age reductions may apply. 10 Your Benefits Wise Plan Year

Additional Voluntary Benefits LegalShield This pre-paid legal services provides protection, peace of mind and security for you and your family while saving you time and money. You can purchase this coverage with after-tax dollars. LegalShield is available at 407-657-1940 or online at www.prepaidlegal.com. Please contact Human Resources if you are interested. AFLAC Florida Institute of Technology offers three separate plans with Aflac. These are portable individual policies that you pay for with after-tax dollars. Policy options include: Personal Cancer, Personal Accident, Hospital Indemnity. Aflac is available at 1-800-992-3522 or online at www.aflac.com. Please contact Human Resources if you are interested. Nationwide Pet Insurance Nationwide Pet Insurance is available to the employees at Florida Institute of Technology. There are multiple plans to choose from including: Major Medical, Injury, Emergency, Feline Plans, Wellness and more. There are no pre-authorizations or hoops to jump through. Please contact Human Resources if you are interested! Paycheck Calculator Do you want to know what your benefits will cost each paycheck? Use this handy paycheck calculator tool to help determine the exact amount. You can repeat this process for each monthly benefit cost shown in this brochure! Equation [monthly amount] x 12 months = [paychecks per year] = total cost per paycheck 20 Pay Employees x 12 months = 20 paychecks per year = total cost per paycheck (benefit amount) 26 Pay Employees x 12 months = 26 paychecks per year = total cost per paycheck (benefit amount) Your Benefits Wise Plan Year 11

Remember to visit our website http://icubabenefits.org! This user friendly site is your one stop shop for all things benefits! Visit our single sign-on section located below the scrolling banner and gain access to ICUBA s Brand Partners including BCBS MyHealthToolkit and Rally, OptumRx Prescription Portal, Resources for Living and Aetna Navigator and of course, the ICUBA MasterCard! MESSAGE: This summary of benefits does not create a contract between the University and any employee. Details of these plans can be found in official plan documents that govern the plans. In the event of a discrepancy between the plan documents and this document, the plan documents govern. While care has been taken to ensure the accuracy of this information, the plan documents and University policies will govern in all cases. Although it is Florida Institute of Technology s intention to continue the plans, the University reserves the right to modify, amend or terminate the plans at any time. All rates are based on current percentage of participation and are subject to change. Revised 4/1/18.