Benefit Guide

2020

2

Benefit Basics 3

Health Care Coverage 5

Virtual Visits 7

Dental Coverage 8

Vision Coverage 9

Health Savings Account 10

Flexible Spending Account 11

Life and Disability Insurance 12

Employee Assistance Program 15

Medical Supplement Plans: 16 Critical Illness and Accident

401(k) Retirement Savings Plan 17

Benefit Enrollment Instructions 18

Contacts 25

Legal Notices 26

Table of Contents

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Benefit Basics Here at International Market Centers, you have access to a variety of benefits to provide financial wellness for you and your family. Please read this guide to learn more about your benefits, and make sure to enroll by November 15th, 2019.

Eligibility

Most employees are eligible for the benefits described in this guide. You are eligible for benefits if you work at least 30 hours per week. Most of your benefits are effective on the first day of the month following 30 days of employment. Your dependents can also enroll for coverage, including:

Your legal spouse

Your domestic partner

Your children up to age 26.

Your benefits will remain in effect until December 31, 2020. Remember that you may only change coverage if you experience a qualifying life event, as described below.

Qualifying Life Events

Generally, you may only make or change your existing benefit elections during the open enrollment window. However, you may change your benefit elections during the year if you experience an event such as:

Marriage

Divorce or legal separation

Birth of your child

Death of your spouse or dependent child

Adoption of or placement for adoption of your child

Change in employment status of employee, spouse or dependent child

Qualification by the Plan Administrator of a child support order for medical coverage

New entitlement to Medicare or Medicaid

New entitlement to Medicare or Medicaid

Qualification by the Plan Administrator of a child support order for medical coverage

You must notify Human Resources within 30 days of a qualifying life event. Depending on the type of event, you may need to provide proof of the event, such as a marriage license. Human Resources will let you know what documentation you should provide. If you do not contact Human Resources within 30 days of the qualified event, you will have to wait until the next open enrollment window to make changes (unless you experience another qualifying life event).

For more information about your benefits:

Contact Human Resources

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Benefit Who Pays Tax Treatment

Medical Coverage IMC & You You pay Pre-Tax

Dental Coverage IMC & You You pay Pre-Tax

Vision Coverage IMC & You You pay Pre-Tax

Basic Life and Accidental Death & Dismemberment (AD&D) Insurance

IMC Benefit in excess of $50,000 is Taxable

Voluntary Life and Accidental Death & Dismemberment (AD&D) Insurance

You You pay After-tax -- Benefit is Tax-Free

Short Term and Long Term Disability Coverage IMC Benefit to you is Taxable

Flexible Spending Account You You pay Pre-Tax

Critical Illness and Accident You You Pay Pre-Tax

Employee Assistance Plan IMC N/A

401(k) Retirement Savings Plan IMC & You Pre-Tax / Roth

Benefit Basics IMC pays for some of your benefits and you share the cost for others, as shown below:

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Health Savings Account

If you are enrolled for family coverage in the plans using a Health Savings Account (HSA), you must meet the full family deductible before coinsurance would apply. One member of the family could satisfy the family deductible before the plan begins to pay coinsurance. The family’s medical costs may be combined to meet the out-of-pocket maximum.

You decide which medical plan will work best for you and your family based on the monthly cost of coverage, the annual deductible, and the out-of-pocket maximum, and the funding account you will use.

PLEASE NOTE: You will be getting a new combined Medical/Rx ID card for this upcoming plan year. You will have to present the new ID card at the pharmacy come 1/1/2020 as your old ID card will not work.

Health Care Coverage

Your health care coverage includes medical, dental and vision plans. Detailed information about each plan is in this section. If you have questions, please contact Human Resources.

Your Medical Plan

You have two medical plan options:

Premium PPO Plan

Value HSA Plan

In/Out-of-Network Coverage

Each medical plan features in- and out-of-network coverage; individual and family deductibles; coinsurance; and out-of-pocket maximums.

You may use in- or out-of-network providers. You will always pay less if you see a doctor or receive services within the provider network because the plan pays more “in-network.”

Deductible

Some benefits with the Premium PPO plan have copays. For other benefits you must meet an annual deductible before the medical plan begins to cover a portion of your costs.

With the Value HSA you must meet an annual deductible before the medical plan begins to cover a portion of your costs however; your HSA may pay for some of those expenses on your behalf.

Once the deductible is met, the medical plan begins to pay for a percentage of covered expenses (this is called coinsurance).

Note that with the Value HSA, prescriptions are subject to the deductible and out-of-pocket maximum.

Out-of-pocket maximums

Out-of-pocket maximums apply to all of the plans. This is the maximum amount you will pay for health care costs in a calendar year. Once you have reached the out-of-pocket maximum, the plan will fully cover eligible medical expenses for the rest of the benefits plan year (except for any copayments). If you see an out-of-network provider, you may be responsible for out-of-pocket costs that are considered above the “reasonable and customary” fees.

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Plan Provision

Premium PPO Plan Value HSA Plan

In-Network Out-of-Network In-Network Out-of-Network

Company Contribution to HRA/HSA (Individual/Family)

N/A $1,000 / $2,000

Annual Deductible (Individual/Family)

$500/ $1,000

$1,000/ $2,000

$2,000/ $4,000

$4,000/ $8,000

Out-of-Pocket Maximum (Includes Deductible)

$4,500/ $9,000

$9,000/ $18,000

$5,000/ $10,000

$10,000/ $20,000

Lifetime Maximum Unlimited Unlimited

Preventive Care 100% 60%* 100% 60%*

Primary Physician Office Visit

$25 60%* 80%* 60%*

Specialist Office Visit $45 60%* 80%* 60%*

X-Ray and Lab 100% 60%* 80%* 60%*

Inpatient Hospital Services 80%* 60%* 80%* 60%*

Outpatient Hospital Services 80%* 60%* 80%* 60%*

Urgent Care $75 60%* 80%* 60%*

Emergency Room Care 80%* 80%*

Prescription Drug Deductible (Individual/Family)

Joint Medical/Rx Deductible Joint Medical/Rx Deductible

Retail Prescription Drugs (30-day supply)

• Generic

• Brand Preferred

• Brand Non-preferred

$10 Copay $35 Copay $70 Copay

40% to $150

60% 60% 60%

Not Covered

80%* 80%* 80%* 80%*

60% 60% 60%

Not Covered

Mail Order Prescription Drugs (90-day supply)

• Generic

• Brand Preferred

• Brand Non-preferred

2.5x Retail

Not Covered

2.5x Retail

Not Covered

EMPLOYEE BI-WEEKLY CONTRIBUTIONS

2019 2020 2019 2020

Employee $70.48 $73.65 $35.88 $40.03

Employee + Spouse $140.96 $154.30 $71.42 $87.34

Employee + Child(ren) $126.87 $138.87 $67.83 $79.53

Family $219.30 $239.17 $110.68 $130.31

This chart compares the basic provisions of the two medical plan options.

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*After deductible is met. Note: This is a summary only of your coverage. In-network services are based on negotiated charges; out-of-network services are based on reasonable and customary (R&C) charges.

Medical Plans

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When you’re sick and need care quick, a Virtual Visit is a convenient way to start feeling better faster. With a Virtual Visit, you can see and talk to a doctor via mobile device or computer – 24/7, no appointment needed. The doctor can give you a diagnosis and prescription, if needed. With your UnitedHealthcare plan, the most you will pay is $50. Get care in 20 minutes or less! Use a Virtual Visit for these minor medical needs:

To get started with a Virtual Visit, go to uhc.com/virtualvisits.

1. Locate your member ID number on your health plan ID card or look up your number on myuhc.com.

2. Exercise your Choice! You have an option of 2 different provider group networks. You can choose either – your costs are the same regardless of which you choose.

3. Once you choose a Virtual Visit provider group you’ll be directed to their website from

myuhc.com or their app from Health4Me. You also have the option of going directly

to their website or app to access care.

**You can download their app directly from Google Play™ or the Apple® App Store®.

▪ Have your primary care provider name and medical history ready. ▪ Choose a pharmacy that’s open in case you’re given a prescription.

Virtual Visits

• Bladder infection/Urinary tract infection

• Bronchitis

• Cold/Flu

• Fever

• Pinkeye

• Rash

• Sinus Problems

• Sore Throat

• Stomachache

Amwell Health

Doctors on Demand

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EMPLOYEE BI-WEEKLY CONTRIBUTIONS

2019 2020

Employee $6.18 $7.10

Employee + Spouse $12.01 $13.81

Employee + Child(ren) $15.61 $17.95

Family $21.45 $24.66

Provision In-Network Out-Of-Network

Annual deductible (Individual/Family) $50/$150 $50/$150

Annual Maximum per person $3,000 $3,000

Diagnostic and Preventive, to include cleanings, fluoride treatments, sealants and x-rays

100%, no deductible 100%, no deductible

Basic Services to include fillings, periodontics, scaling and root planning, oral surgery

100%** 80%**

Major Services to include crowns, bridges, full and partial dentures

60%** 50%**

Orthodontia (Child only) 50%; $2,000 lifetime maximum 50%; $2,000 lifetime maximum

*Two preventive visits are covered per year. A third is available for some medical conditions including maternity.

**After deductible is met.

IMC provides you with dental benefits through Aetna. Regular dental exams can help you and your dentist detect problems in the early stages when treatment is simpler and costs are lower. Keeping your teeth and gums clean and healthy will help prevent most tooth decay and periodontal disease, and is an important part of maintaining your medical health. This chart shows what the plans pay:

It’s important to have regular dental exams and cleanings so problems are detected before they become painful—and expensive. Keeping your teeth and gums clean and healthy will help prevent most tooth decay and periodontal disease and is an important part of maintaining your medical health.

Dental Plan Your dental plan provides coverage for routine exams and cleanings and pays for a portion of other services, as shown in the chart below.

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*After copay.

EMPLOYEE BI-WEEKLY CONTRIBUTIONS

2019 2020

Employee $2.71 $2.71

Employee + Spouse $5.16 $5.16

Employee + Child(ren) $5.42 $5.42

Family $7.97 $7.97

Benefit In-Network Out-Of-Network

Exam $10 copay Up to $30

Hardware $10 copay See below

Frequency Exam Lenses

• Frames

Every 12 Months Every 12 months Every 24 Months

Frames $140 allowance then a 20% discount on the

amount over the allowance Up to $70

Lenses

• Single vision lenses

• Bifocal lenses

• Trifocal lenses

Covered 100%* Covered 100%* Covered 100%*

Up to $25 Up to $40 Up to $60

Medically necessary contact lenses No Charge Up to $200

Elective contact lenses in lieu of glasses

Up to $155 Up to $124

Vision Plan Your vision plan provides coverage for routine eye exams and pays for all or a portion of the cost of glasses or contact lenses.

Your vision plan is provided through EyeMed. It provides coverage for routine eye exams and pays for all or a portion of the cost of glasses or contact lenses. You can see in- or out-of-network providers; however, you always save money if you see in-network providers.

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Available to those enrolled in the High Deductible Health Plan (Value HSA Plan).

If you elect to enroll in the 2020 High Deductible Health Plan, you will be eligible to contribute pre-tax money into a Health Savings Account (HSA) that can help you save for future medical expenses. This allows you to accumulate money tax-free, year-over-year to save for healthcare expenses, and also reduces your taxable income – so you pay less in taxes. HSAs are only available when they accompany plans with a deductible of $1,400 or greater (Individual), or $2,800 or greater (Family). The minimum deductible level is set annually by the IRS. HSAs are designed to help you save gradually over time so that you are more easily able to meet the higher deductible when you need care. The HSA is not available if you elect the PPO plan option. In order to receive company funding for the HSA you must open an HSA account with Optum before the day your benefits are effective (first day of the month following 30 days). Employer contributions will be available after the 1st payroll date.

Your Contributions In 2020, the IRS contribution limit for Health Savings Accounts is $3,550 if you enroll as a single employee, and $7,100 if you elect to

cover your dependents (Includes both “EE + 1” and “EE + Family” contribution tiers). If you are age 55 or over, you may elect an additional catch-up contribution of $1,000. Please keep in mind that the amount that IMC contributes to your HSA on your behalf

accumulates towards the IRS Maximums. For example, as outlined on Page Six if you enroll in the Value HSA Plan with employee only coverage IMC will contribute $1,000 to your HSA. This means you can only contribute $2,550 to the HSA (Single IRS Max $3,550 – IMC

Single HSA Contribution $1,000 - $2,550)

HSA Plan IRS Limits

IMC HSA Contributions

(Value Plan ONLY)

Single Family Age 55+ Single Family

2020 IRS Maximums $3,550 $7,100 $1,000 $1,000 $2,000

Annual Rollover

Funds deposited into your HSA roll over from year-to-year and keep growing for as long as you choose to keep contributing to your HSA. They are not subject to the “Use-it-or-Lose-it” rule. For this reason, HSAs are solid long-term healthcare savings vehicles. Though there

is an annual contribution limit, there is no annual rollover limit.

Termination of Employment If your employment with International Market Centers ends, your access to your Health Savings Account money will continue. You own

the account, so you take it with you, wherever you go.

Tax Implications Health Savings Accounts provide a triple tax advantage: Your contribution is deposited tax free, it grows tax free, and it stays tax free

when you use it, as long as it is used for qualified medical expenses as defined by the IRS. Additionally, if you enroll in the High Deductible Health Plan and begin using a HSA, make sure to let your tax adviser know about your HSA because there is an additional form to submit

with your annual tax return. Additionally, be sure to keep receipts of all expenses paid from your HSA because the IRS requires you to do so.

Health Savings Accounts and Other Insurance

If you or your dependents are currently covered by Medicare or by another non HDHP health plan (i.e. your spouse’s plan), you will not be allowed to contribute to an HSA for yourself or your dependents.

The minimum amount to begin investing your HSA funds is $2,000.

Health Savings Account

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Account Type And

Eligible Expenses

Annual

Contribution

Limits

Benefit

Day

Funds are

Available

Will I receive

a card?

Will any of

my funds roll

over?

When must I

file claims

incurred

1/1/2020-

12/31/2020?

Health Care FSA

Most medical, dental and vision

care expenses that are not

covered by your health plan

(such as copayments,

coinsurance, deductibles,

eyeglasses and doctor-

prescribed over the counter

medications)

Maximum contribution

is $2,650 per year.

The minimum is $100

Saves on eligible

expenses not

covered by

insurance;

reduces your

taxable income

Frontloaded,

1/1/2020 Yes Yes, $500 4/29/2021

Dependent Care FSA

Dependent care expenses (such

as day care, after school

programs or elder care

programs) so you and your

spouse can work or attend

school full-time

Maximum contribution

is $5,000 per year

($2,500 if married and

filing separate tax

returns)

Reduces your

taxable income

Date of 1st

payroll

No, if you are

also enrolled in

Health FSA.

Yes, if you are

only enrolled in

DCFSA. If you

are enrolled in

the HSA you

will not receive

a card.

No 4/29/2021

Limited Purpose FSA

Dental and vision expenses not

covered by the plan (such as

copayments, coinsurance,

deductibles)

Maximum contribution

is $2,650 per year.

The minimum is $100

Saves on eligible

expenses not

covered by

insurance;

reduces your

taxable income

Frontloaded,

1/1/2020 No Yes, $500 4/29/2021

Flexible Spending Accounts

A Flexible Spending Account (FSA) is a program that helps you pay for health care and dependent care costs using tax free dollars.

Flexible Spending Accounts (FSAs) are designed to save you money on your taxes. They work in a similar way to a savings account. Each pay period, funds are deducted from your pay on a pre-tax basis and are deposited to your Health Care and/or Dependent Care FSA Accounts. You then use your funds to pay for eligible health care, dependent care or commuting expenses. IMPORTANT INFORMATION ABOUT FSAs

Your FSA elections will be in effect from January 1 through December 31. You will have 120 days to submit these claims, allowing you to submit claims through April 30, 2021 for your 2020 election. This is known as the “use it or lose it” rule and it is governed by IRS regulations. Note that FSA elections do not automatically continue from year to year; you must actively enroll each year.

THE ADVANTAGES OF AN FSA

With an FSA, the money you contribute is never taxed—not when you put it in the account, not when you are reimbursed with the funds from the account, and not when you file your income tax return at the end of the year.

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Coverage and Benefits

Short-Term Disability/Salary Continuation

• 60% of weekly wages* up to $750

• 7 day waiting period before benefits begin

Long-Term Disability

• Covers 60% of your monthly salary*, to a monthly $15,000 maximum

• Benefit begins after 90th consecutive day of disability

Account Type Benefit

Employer-provided basic life insurance

• 1X Base Annual Salary*

• Maximum benefit of $150,000

Account Type Benefit

Employer-provided basic life insurance

• 1X Base Annual Salary*

• Maximum benefit of $150,000

Disability Insurance Coverage

Disability insurance provides income replacement should you become disabled and unable to work due to a non-work-related illness or injury. The company provides eligible employees with disability income benefits at no cost as shown below. Coverage is automatic. You do not need to enroll.

Life & Disability What would your family do if your income was lost due to death or disability? Life and disability insurance are important for your financial security.

Life and Disability benefits are provided to you through Mutual of Omaha.

Accidental Death & Dismemberment Insurance

Accidental Death & Dismemberment (AD&D) Insurance provides a benefit in the event of your accidental death or dismemberment. The company provides basic AD&D coverage to all eligible employees at no cost. Coverage is automatic.

Voluntary Life Insurance

IMC offers you the option to purchase additional life insurance for you and your spouse and/or children.

• Team Member Benefit: 5X Annual Salary from

$10,000 to MAX $500,000. Each year during Open

Enrollment you may elect one $10,000 increment

without Evidence of Insurability (EOI).

• Spouse Benefit: 100% of Employee’s Benefit from

$10,000 to MAX $350,000.

• Child Benefit: From $2,500 to MAX $10,000

*Base Annual Salary does not include commissions, overtime pay, bonuses, incentive pay or any other special compensation not received as Covered Monthly Earnings.

Life Insurance

Life insurance is an important part of your financial security, especially if you support a family.

IMC provides basic life insurance to all eligible employees at no cost. Coverage is automatic.

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Voluntary Life and AD&D Insurance

Voluntary Life Insurance

IMC offers you the option to purchase additional life insurance for you and your spouse and/or children. Voluntary Life Insurance is provided to you through Mutual of Omaha.

• Team member and spouse benefits available from $10,000 to $500,000 in $10,000 increments.

• Team member Guarantee Issue Amount is $150,000 & Spouse Guarantee Issue Amount is $30,000.

• Child coverage up to $10,000 (all child coverage is in the Guarantee Issue).

• Every year during Open Enrollment you may elect one increment of $10,000 additional without having to

submit Evidence of Insurability (EOI). However, you may not exceed 5x salary.

Voluntary AD&D Insurance

• Accidental Death & Dismemberment Benefit, spouse benefit limited to 50% of team member election

• Benefit can be triggered by a loss of an appendage, eye sight, or as a result of an injury

• Loss must be caused solely by an accident that occurs while the person is insured, and must occur within 365 days of the accident

• Written notice must be provided to Mutual of Omaha within 31 days after the loss occurs or as soon as possible

Voluntary AD&D Insurance Monthly Premiums

• Employee Coverage: $0.020 per 1,000 (Monthly Rate)

• Family Coverage: $0.041 per 1,000 (Monthly Rate)

For more information, please contact Human Resources

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Benefit Amount

Age 0-29 Age 30-34 Age 35-39 Age 40-44 Age 45-49 Age 50-54 Age 55-59 Age 60-64 Age 65-69 Age 70+

$10,000 $0.23 $0.23 $0.31 $0.48 $0.74 $1.17 $1.89 $2.67 $4.03 $7.95

$20,000 $0.46 $0.46 $0.63 $0.96 $1.48 $2.34 $3.78 $5.34 $8.06 $15.90

$30,000 $0.69 $0.69 $0.94 $1.44 $2.22 $3.52 $5.68 $8.02 $12.09 $23.84

$40,000 $0.92 $0.92 $1.26 $1.92 $2.95 $4.69 $7.57 $10.69 $16.12 $31.79

$50,000 $1.15 $1.15 $1.57 $2.40 $3.69 $5.86 $9.46 $13.36 $20.15 $39.74

$60,000 $1.38 $1.38 $1.88 $2.88 $4.43 $7.03 $11.35 $16.03 $24.18 $47.69

$70,000 $1.62 $1.62 $2.20 $3.36 $5.17 $8.21 $13.25 $18.71 $28.20 $55.63

$80,000 $1.85 $1.85 $2.51 $3.84 $5.91 $9.38 $15.14 $21.38 $32.23 $63.58

$90,000 $2.08 $2.08 $2.82 $4.32 $6.65 $10.55 $17.03 $24.05 $36.26 $71.53

$100,000 $2.31 $2.31 $3.14 $4.80 $7.38 $11.72 $18.92 $26.72 $40.29 $79.48

$110,000 $2.54 $2.54 $3.45 $5.28 $8.12 $12.90 $20.82 $29.40 $44.32 $87.42

$120,000 $2.77 $2.77 $3.77 $5.76 $8.86 $14.07 $22.71 $32.07 $48.35 $95.37

$130,000 $3.00 $3.00 $4.08 $6.24 $9.60 $15.24 $24.60 $34.74 $52.38 $103.32

$140,000 $3.23 $3.23 $4.39 $6.72 $10.34 $16.41 $26.49 $37.41 $56.41 $111.27

$150,000 $3.46 $3.46 $4.71 $7.20 $11.08 $17.58 $28.38 $40.08 $60.44 $119.22

$160,000 $3.69 $3.69 $5.02 $7.68 $11.82 $18.76 $30.28 $42.76 $64.47 $127.16

$170,000 $3.92 $3.92 $5.34 $8.16 $12.55 $19.93 $32.17 $45.43 $68.50 $135.11

$180,000 $4.15 $4.15 $5.65 $8.64 $13.29 $21.10 $34.06 $48.10 $72.53 $143.06

$190,000 $4.38 $4.38 $5.96 $9.12 $14.03 $22.27 $35.95 $50.77 $76.56 $151.01

$200,000 $4.62 $4.62 $6.28 $9.60 $14.77 $23.45 $37.85 $53.45 $80.58 $158.95

$210,000 $4.85 $4.85 $6.59 $10.08 $15.51 $24.62 $39.74 $56.12 $84.61 $166.90

$220,000 $5.08 $5.08 $6.90 $10.56 $16.25 $25.79 $41.63 $58.79 $88.64 $174.85

$230,000 $5.31 $5.31 $7.22 $11.04 $16.98 $26.96 $43.52 $61.46 $92.67 $182.80

$240,000 $5.54 $5.54 $7.53 $11.52 $17.72 $28.14 $45.42 $64.14 $96.70 $190.74

$250,000 $5.77 $5.77 $7.85 $12.00 $18.46 $29.31 $47.31 $66.81 $100.73 $198.69

$260,000 $6.00 $6.00 $8.16 $12.48 $19.20 $30.48 $49.20 $69.48 $104.76 $206.64

$270,000 $6.23 $6.23 $8.47 $12.96 $19.94 $31.65 $51.09 $72.15 $108.79 $214.59

$280,000 $6.46 $6.46 $8.79 $13.44 $20.68 $32.82 $52.98 $74.82 $112.82 $222.54

$290,000 $6.69 $6.69 $9.10 $13.92 $21.42 $34.00 $54.88 $77.50 $116.85 $230.48

$300,000 $6.92 $6.92 $9.42 $14.40 $22.15 $35.17 $56.77 $80.17 $120.88 $238.43

$310,000 $7.15 $7.15 $9.73 $14.88 $22.89 $36.34 $58.66 $82.84 $124.91 $246.38

$320,000 $7.38 $7.38 $10.04 $15.36 $23.63 $37.51 $60.55 $85.51 $128.94 $254.33

$330,000 $7.62 $7.62 $10.36 $15.84 $24.37 $38.69 $62.45 $88.19 $132.96 $262.27

$340,000 $7.85 $7.85 $10.67 $16.32 $25.11 $39.86 $64.34 $90.86 $136.99 $270.22

$350,000 $8.08 $8.08 $10.98 $16.80 $25.85 $41.03 $66.23 $93.53 $141.02 $278.17

$360,000 $8.31 $8.31 $11.30 $17.28 $26.58 $42.20 $68.12 $96.20 $145.05 $286.12

$370,000 $8.54 $8.54 $11.61 $17.76 $27.32 $43.38 $70.02 $98.88 $149.08 $294.06

$380,000 $8.77 $8.77 $11.93 $18.24 $28.06 $44.55 $71.91 $101.55 $153.11 $302.01

$390,000 $9.00 $9.00 $12.24 $18.72 $28.80 $45.72 $73.80 $104.22 $157.14 $309.96

$400,000 $9.23 $9.23 $12.55 $19.20 $29.54 $46.89 $75.69 $106.89 $161.17 $317.91

$410,000 $9.46 $9.46 $12.87 $19.68 $30.28 $48.06 $77.58 $109.56 $165.20 $325.86

$420,000 $9.69 $9.69 $13.18 $20.16 $31.02 $49.24 $79.48 $112.24 $169.23 $333.80

$430,000 $9.92 $9.92 $13.50 $20.64 $31.75 $50.41 $81.37 $114.91 $173.26 $341.75

$440,000 $10.15 $10.15 $13.81 $21.12 $32.49 $51.58 $83.26 $117.58 $177.29 $349.70

$450,000 $10.38 $10.38 $14.12 $21.60 $33.23 $52.75 $85.15 $120.25 $181.32 $357.65

$460,000 $10.62 $10.62 $14.44 $22.08 $33.97 $53.93 $87.05 $122.93 $185.34 $365.59

$470,000 $10.85 $10.85 $14.75 $22.56 $34.71 $55.10 $88.94 $125.60 $189.37 $373.54

Voluntary Life Rates (Bi-Weekly)

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If you find yourself in need of some professional support to deal with personal, work, financial or family issues, your

Employee Assistance Program (EAP) can help. You and your immediate family (spouse or domestic partner, dependent

children, parents and parents-in-law) can use the EAP for help with:

Marriage and family problems

Job-related issues

Stress, anxiety and depression

Parent and child relationships

Legal and financial counseling

Identity theft counseling

Financial planning

Various other related issues

You can trust your EAP professional to assess your needs and handle your concerns in a confidential, respectful manner. If additional services are needed, your EAP will help locate appropriate resources in your area.

Don’t delay if you need help. Visit mutualofomaha.com/eap or call 800-316-2796 for confidential consultation and resource services.

Employee Assistance Program (EAP)

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Medical Supplement Plans

International Market Centers offers you and your family additional benefits to enhance your benefits package.

VOYA Group Voluntary Critical Illness Coverage

Group Voluntary Critical Illness can pay benefits for non-medical, critical illness-related expenses that your medical plan might not cover. The Group Voluntary Critical Illness benefit is in the form of a lump sum payment, which is paid to the employee after a diagnosis is made.

Benefits are paid directly to the employee unless

benefits are assigned to someone else.

Individual, spouse and child(ren) coverage options are

available.

You can take the coverage with you if you leave the

company.

Covered conditions include heart attack, stroke,

invasive cancer, coma, paralysis and more

Coverage does not replace other group medical

benefits. It is designed to supplement your medical

plan coverage.

This coverage includes a wellness benefit that pays

$75 per covered person per year when you get

preventive screenings.

Please refer to Proliant for Bi-weekly Rates.

VOYA Group Voluntary Accident Coverage

Group Voluntary Accident can pay benefits for off-the-job accidents, plus some benefits that correspond with medical care. The coverage can be used on its own or to fill a gap left by other coverage and pays a benefit up to a specified amount for accidental death, dismemberment, dislocation/fracture, initial hospitalization confinement, hospitalization confinement, intensive care, ambulance service, medical expenses, outpatient physician’s treatment and more.

Bi-weekly Rates are as follows:

- Employee only $4.50

- Employee + Spouse $7.41

- Employee + Child(ren) $8.46

- Family $11.37

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For More Information

For additional details about the 401(k) Retirement Savings Plan or to enroll or change your contribution rates or investment elections, please:

Call

800-835-5097

Visit

www.401k.com

401(k) Retirement Savings Plan

The International Market Centers 401(k) Retirement Savings Plan offers an easy way to save for your future through payroll deductions.

Eligibility

You are eligible to participate in the plan as of the first of the month following completion of 30 days of service with the Company.

Employee Contributions

Contributions from your pay are made on a pre-tax basis up to the IRS annual limit of $19,000. If you are 50 years of age or older (or if you will reach age 50 by the end of the year), you may make catch-up contributions in addition to the normal IRS annual limit of $6,000. You are automatically enrolled at 5% pretax upon eligibility; if you wish to opt out of the automatic enrollment, you must update your contributions on 401k.com or by calling Fidelity immediately. You may always increase or decrease your contribution amount by visiting 401k.com

If you are 50 years of age or older, (or if you will reach age 50 by the end of the year), you may make a catch-up contribution in addition to the normal IRS annual limit.

Employer Contributions

The company will match dollar for dollar up to 5% of your contributions; the match is made on a bi-weekly basis. Please note, you must have bi-weekly contributions to receive the match.

Vesting

Vesting refers to your right of ownership to the money in your account. You are immediately vested in all contributions and earnings.

To Enroll and Create Your 401(k) Account

To create an account, please visit www.401k.com, and select ‘REGISTER AS A NEW USER’.

This site will provide additional details about your 401(k) Retirement Savings Plan and provide you with the opportunity to change your contribution rates or investment elections.

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1) To enroll in benefits, please log into Employee Self Service (ESS) at

https://new.readypayonline.com/proliant/Login/login.aspx

Enter your Username and Password, but you will leave the Company field blank.

2) Once logged in, click on Benefits in the toolbar at the top.

3) Another tab or window will open in your browser with the benefits portal, and you will select New Hire under Change Events and click Begin Event.

Benefit Enrollment Instructions

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This will take you through the different screens of the enrollment process. Verify the information on each tab and click Save & Continue to navigate through the screens.

Benefit Enrollment Instructions

21

4) Read the instructions then click Save & Continue to move forward.

Benefit Enrollment Instructions

5) Acknowledge the terms you agree to when using online benefits enrollment by clicking I

Accept and wish to continue

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6) Next, review your personal information currently on file with your employer. If

adjustments are necessary, you should make them in your Employee Self

Service portal.

7) On the following screen, you will add any dependents you may have. If you

do not have dependents, simply click Save & Continue.

Benefit Enrollment Instructions

23

8) Once you’ve made your elections, you will authorize a beneficiary. Any

dependents that were added previously will be presented as options.

However, you can add an additional person by clicking Add Beneficiary if

your beneficiary is not one of your dependents. You also have the option to

select a Primary as well as a Secondary beneficiary. You should enter the

percentage each person will receive. If you only select one beneficiary, enter

100 into the Percentage box.

Benefit Enrollment Instructions

24

9) Next you will establish an Emergency Contact. Again, any dependents added previously

will automatically be offered as options. However, you can add an additional person by

clicking Add Emergency Contact. You are required to provide both a Primary and

Secondary Phone for your Emergency Contact. If the person does not have a Secondary

Phone, you can enter the Primary Phone twice. Be sure you check the box next to the

appropriate person’s name before clicking Save & Continue.

Benefit Enrollment Instructions

25

10) At the end, you will come to a review page, giving you the opportunity to review

your selections before confirming them.

11) Once you confirm, you will receive your Benefits Statement via email or you can

print the Statement from the Confirmation screen.

Benefit Enrollment Instructions

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Plan Provider Phone Numbers Website

Medical United HealthCare 844-636-5295 www.myuhc.com

Health Savings Account (HSA)

Optum Bank 800-791-9361 www.optumbank.com

Dental Aetna 877-238-6200 www.aetna.com

Vision EyeMed 866-939-3633 www.eyemed.com

Flexible Spending Account UHC 844-636-5295 www.myuhc.com

Life and Disability Mutual of Omaha 800-877-5176 www.mutualofomaha.com

Employee Assistance Program

Mutual of Omaha 800-316-2796 www.mutualofomaha.com/eap

Critical Illness/Accident Voya 888-238-4840 www.voya.com

401(k) Retirement Savings Plan

Fidelity 800-835-5097 www.fidelity.com

Advocate 4 Me & 24/7 Nurse Line

UHC 844-636-5295 www.myuhc.com

About This Guide This benefit summary provides selected highlights of International Market Center employee benefits program. It is not a legal document and shall not be construed as a guarantee of benefits nor of continued employment at the Company. All benefit plans are governed by master policies, contracts and plan documents. Any discrepancies between any information provided through this summary and the actual terms of such policies, contracts and plan documents shall be governed by the terms of such policies, contracts and plan documents. International Market Center reserves the right to amend, suspend or terminate any benefit plan, in whole or in part, at any time. The authority to make such changes rests with the Plan Administrator.

Contacts

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Notice of Patient Protection Disclosure

United Healthcare generally allows the designation of a primary care provider. You have the right to designate any primary care provider who participates in our network and who is available to accept you or your family members. For information on how to select a primary care provider, and for a list of the participating primary care providers, contact the Human Resources Department at IMC.

HIPAA Special Enrollment Notice

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 enroll yourself or 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). However, you must request enrollment within 30 days after your or your dependents’ other coverage ends (or after the employer stops contributing toward the other coverage).

In addition, if you have a new dependent as 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 30 days after the marriage, birth, adoption, or placement for adoption.

Special enrollment rights also may exist in the following circumstances:

◼ If you or your dependents experience a loss of eligibility for Medicaid or a state Children’s HealthInsurance Program (CHIP) coverage and you request enrollment within 60 days” or any longer period that applies under the plan after that coverage ends; or

◼ If you or your dependents become eligible for a state premium assistance subsidy through Medicaid or a state CHIP with respect to coverage under this plan and you request enrollment within 60 days after the determination of eligibility for such assistance.

Note: The 60 day period for requesting enrollment applies only in these last two listed circumstances relating to Medicaid and state CHIP. As described above, a 30 day period applies to most special enrollments.

As stated earlier in this notice, a special enrollment opportunity may be available in the future if you or your dependents lose other coverage. This special enrollment opportunity will not be available when other coverage ends, however, unless you provide a written statement now explaining the reason that you are declining coverage for yourself or your dependent(s). Failing to accurately complete and return this form for each person for whom you are declining coverage may eliminate this special enrollment opportunity for the person(s) for whom a statement is not completed, even if other coverage is currently in effect and is later lost. In addition, unless you indicate in the statement that you are declining coverage because other coverage is in effect, you may not have this special enrollment opportunity for the person(s) covered by the statement. (See the paragraphs above, however, regarding enrollment in the event of marriage, birth, adoption, placement for adoption, loss of eligibility for Medicaid or a state CHIP, and gaining eligibility for a state premium assistance subsidy through Medicaid or a state CHIP.)

To request special enrollment or obtain more information, contact the Human Resources Department.

Legal Notices

28

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 www.healthcare.gov.

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 1-877-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 www.askebsa.dol.gov or call 1-866-444-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 July 31, 2019. Contact your State for more information on eligibility –

ALABAMA – Medicaid FLORIDA – Medicaid

Website: http://myalhipp.com/

Phone: 1-855-692-5447

Website: http://flmedicaidtplrecovery.com/hipp/

Phone: 1-877-357-3268

ALASKA – Medicaid GEORGIA – Medicaid

The AK Health Insurance Premium Payment Program

Website: http://myakhipp.com/

Phone: 1-866-251-4861

Email: CustomerService@MyAKHIPP.com

Medicaid Eligibility: http://dhss.alaska.gov/dpa/Pages/medicaid/default.aspx

Website: https://medicaid.georgia.gov/health-insurance-premium-payment-program-hipp

Phone: 678-564-1162 ext 2131

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29

ARKANSAS – Medicaid INDIANA – Medicaid

Website: http://myarhipp.com/

Phone: 1-855-MyARHIPP (855-692-7447)

Healthy Indiana Plan for low-income adults 19-64

Website: http://www.in.gov/fssa/hip/

Phone: 1-877-438-4479

All other Medicaid

Website: http://www.indianamedicaid.com

Phone 1-800-403-0864

COLORADO – Health First Colorado (Colorado’s Medicaid Program) &

Child Health Plan Plus (CHP+)

IOWA – Medicaid

Health First Colorado Website: https://www.healthfirstcolorado.com/

Health First Colorado Member Contact Center:

1-800-221-3943/ State Relay 711

CHP+: https://www.colorado.gov/pacific/hcpf/child-health-plan-plus

CHP+ Customer Service: 1-800-359-1991/ State Relay 711

Website:

http://dhs.iowa.gov/Hawki

Phone: 1-800-257-8563

KANSAS – Medicaid NEW HAMPSHIRE – Medicaid

Website: http://www.kdheks.gov/hcf/

Phone: 1-785-296-3512

Website: https://www.dhhs.nh.gov/oii/hipp.htm

Phone: 603-271-5218

Toll free number for the HIPP program: 1-800-852-3345, ext 5218

KENTUCKY – Medicaid NEW JERSEY – Medicaid and CHIP

Website: https://chfs.ky.gov

Phone: 1-800-635-2570

Medicaid Website:

http://www.state.nj.us/humanservices/

dmahs/clients/medicaid/

Medicaid Phone: 609-631-2392

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CHIP Website: http://www.njfamilycare.org/index.html

CHIP Phone: 1-800-701-0710

LOUISIANA – Medicaid NEW YORK – Medicaid

Website: http://dhh.louisiana.gov/index.cfm/subhome/1/n/331

Phone: 1-888-695-2447

Website: https://www.health.ny.gov/health_care/medicaid/

Phone: 1-800-541-2831

MAINE – Medicaid NORTH CAROLINA – Medicaid

Website: http://www.maine.gov/dhhs/ofi/public-assistance/index.html

Phone: 1-800-442-6003

TTY: Maine relay 711

Website: https://medicaid.ncdhhs.gov/

Phone: 919-855-4100

MASSACHUSETTS – Medicaid and CHIP NORTH DAKOTA – Medicaid

Website: http://www.mass.gov/eohhs/gov/departments/masshealth/

Phone: 1-800-862-4840

Website: http://www.nd.gov/dhs/services/medicalserv/medicaid/

Phone: 1-844-854-4825

MINNESOTA – Medicaid OKLAHOMA – Medicaid and CHIP

Website:

https://mn.gov/dhs/people-we-serve/seniors/health-care/health-care-programs/programs-and-services/other-insurance.jsp

Phone: 1-800-657-3739

Website: http://www.insureoklahoma.org

Phone: 1-888-365-3742

MISSOURI – Medicaid OREGON – Medicaid

Website: http://www.dss.mo.gov/mhd/participants/pages/hipp.htm

Phone: 573-751-2005

Website: http://healthcare.oregon.gov/Pages/index.aspx

http://www.oregonhealthcare.gov/index-es.html

Phone: 1-800-699-9075

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MONTANA – Medicaid PENNSYLVANIA – Medicaid

Website: http://dphhs.mt.gov/MontanaHealthcarePrograms/HIPP

Phone: 1-800-694-3084

Website: http://www.dhs.pa.gov/provider/medicalassistance/healthinsurancepremiumpaymenthippprogram/index.htm

Phone: 1-800-692-7462

NEBRASKA – Medicaid RHODE ISLAND – Medicaid and CHIP

Website: http://www.ACCESSNebraska.ne.gov

Phone: (855) 632-7633

Lincoln: (402) 473-7000

Omaha: (402) 595-1178

Website: http://www.eohhs.ri.gov/

Phone: 855-697-4347, or 401-462-0311 (Direct RIte Share Line)

NEVADA – Medicaid SOUTH CAROLINA – Medicaid

Medicaid Website: https://dhcfp.nv.gov

Medicaid Phone: 1-800-992-0900

Website: https://www.scdhhs.gov

Phone: 1-888-549-0820

SOUTH DAKOTA - Medicaid WASHINGTON – Medicaid

Website: http://dss.sd.gov

Phone: 1-888-828-0059

Website: https://www.hca.wa.gov/

Phone: 1-800-562-3022 ext. 15473

TEXAS – Medicaid WEST VIRGINIA – Medicaid

Website: http://gethipptexas.com/

Phone: 1-800-440-0493

Website: http://mywvhipp.com/

Toll-free phone: 1-855-MyWVHIPP (1-855-699-8447)

UTAH – Medicaid and CHIP WISCONSIN – Medicaid and CHIP

Medicaid Website: https://medicaid.utah.gov/

CHIP Website: http://health.utah.gov/chip

Phone: 1-877-543-7669

Website:

https://www.dhs.wisconsin.gov/publications/p1/p10095.pdf

Phone: 1-800-362-3002

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To see if any other states have added a premium assistance program since July 31, 2019, or for more information on special enrollment rights, contact either:

U.S. Department of Labor U.S. Department of Health and Human Services

Employee Benefits Security Administration Centers for Medicare & Medicaid Services

www.dol.gov/agencies/ebsa www.cms.hhs.gov

1-866-444-EBSA (3272) 1-877-267-2323, Menu Option 4, Ext. 61565

Women’s Health and Cancer Rights Act Notice

If you have had or are going to have a mastectomy, you may be entitled to certain benefits under the Women’s Health and Cancer Rights Act of 1998 (WHCRA). For individuals receiving mastectomy-related benefits, coverage will be provided in a manner determined in consultation with the attending physician and the patient, for:

• All stages of reconstruction of the breast on which the mastectomy was performed;

• Surgery and reconstruction of the other breast to produce a symmetrical appearance;

• Prostheses; and

• Treatment of physical complications of the mastectomy, including lymphedema.

These benefits will be provided subject to the same deductibles and coinsurance applicable to other medical and surgical benefits provided under this plan. If you would like more information on WHCRA benefits, call the Human Resources Department.

Paperwork Reduction Act Statement

According to the Paperwork Reduction Act of 1995 (Pub. L. 104-13) (PRA), no persons are required to respond to a collection of information unless such collection displays a valid Office of Management and

VERMONT– Medicaid WYOMING – Medicaid

Website: http://www.greenmountaincare.org/

Phone: 1-800-250-8427

Website: https://wyequalitycare.acs-inc.com/

Phone: 307-777-7531

VIRGINIA – Medicaid and CHIP

Medicaid Website: http://www.coverva.org/programs_premium_assistance.cfm

Medicaid Phone: 1-800-432-5924

CHIP Website: http://www.coverva.org/programs_premium_assistance.cfm

CHIP Phone: 1-855-242-8282

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Budget (OMB) control number. The Department notes that a Federal agency cannot conduct or sponsor a collection of information unless it is approved by OMB under the PRA, and displays a currently valid OMB control number, and the public is not required to respond to a collection of information unless it displays a currently valid OMB control number. See 44 U.S.C. 3507. Also, notwithstanding any other provisions of law, no person shall be subject to penalty for failing to comply with a collection of information if the collection of information does not display a currently valid OMB control number. See 44 U.S.C. 3512.

The public reporting burden for this collection of information is estimated to average approximately seven minutes per respondent. Interested parties are encouraged to send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the U.S. Department of Labor, Employee Benefits Security Administration, Office of Policy and Research, Attention: PRA Clearance Officer, 200 Constitution Avenue, N.W., Room N-5718, Washington, DC 20210 or email ebsa.opr@dol.gov and reference the OMB Control Number 1210-0137.

General Notice of COBRA Continuation Coverage Rights

Introduction

You’re getting this notice because you recently gained coverage under a group health plan (the Plan). This notice has important information about your right to COBRA continuation coverage, which is a temporary extension of coverage under the Plan. This notice explains COBRA continuation coverage, when it may become available to you and your family, and what you need to do to protect your right to get it. When you become eligible for COBRA, you may also become eligible for other coverage options that may cost less than COBRA continuation coverage.

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 other members of your family when group health coverage would otherwise end. For more information about your rights and obligations under the Plan and under federal law, you should review the Plan’s Summary Plan Description or contact the Plan Administrator.

You may have other options available to you when you lose group health 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.

What is COBRA continuation coverage?

COBRA continuation coverage is a continuation of Plan coverage when it would otherwise end because of a life event. This is also called a “qualifying event.” Specific qualifying events are listed later in this notice. After a qualifying event, COBRA continuation coverage must be offered to each person who is a “qualified beneficiary.” You, your spouse, and your dependent children could become qualified beneficiaries if coverage under the Plan is lost because of the qualifying event. Under the Plan, qualified beneficiaries who elect COBRA continuation coverage must pay for COBRA continuation coverage.

Legal Notices

34

If you’re an employee, you’ll become a qualified beneficiary if you lose your coverage under the Plan because of the following qualifying events:

• Your hours of employment are reduced, or

• Your employment ends for any reason other than your gross misconduct.

If you’re the spouse of an employee, you’ll become a qualified beneficiary if you lose your coverage under the Plan because of the following qualifying events:

• 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 entitled to Medicare benefits (under Part A, Part B, or both); or

• You become divorced or legally separated from your spouse.

Your dependent children will become qualified beneficiaries if they lose coverage under the Plan because of the following qualifying events:

• 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 entitled to Medicare benefits (Part A, Part B, or both);

• The parents become divorced or legally separated; or

• The child stops being eligible for coverage under the Plan as a “dependent child.”

When is COBRA continuation coverage available?

The Plan will offer COBRA continuation coverage to qualified beneficiaries only after the Plan Administrator has been notified that a qualifying event has occurred. The employer must notify the Plan Administrator of the following qualifying events:

• The end of employment or reduction of hours of employment;

• Death of the employee;

• The employee’s becoming entitled to Medicare benefits (under Part A, Part B, or both).

Legal Notices

35

For all other qualifying events (divorce or legal separation of the employee and spouse or a dependent child’s losing eligibility for coverage as a dependent child), you must notify the Plan Administrator within 60 days after the qualifying event occurs. You must provide this notice to: IMC Human Resources.

How is COBRA continuation coverage provided?

Once the Plan Administrator receives 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 on behalf of their spouses, and parents may elect COBRA continuation coverage on behalf of their children.

COBRA continuation coverage is a temporary continuation of coverage that generally lasts for 18 months due to employment termination or reduction of hours of work. Certain qualifying events, or a second qualifying event during the initial period of coverage, may permit a beneficiary to receive a maximum of 36 months of coverage.

There are also ways in which this 18-month period of COBRA continuation coverage can be extended:

Disability extension of 18-month period of COBRA continuation coverage

If you or anyone in your family covered under the Plan is determined by Social Security to be disabled and you notify the Plan Administrator in a timely fashion, you and your entire family may be entitled to get up to an additional 11 months of COBRA continuation coverage, for a maximum of 29 months. The disability would have to have started at some time before the 60th day of COBRA continuation coverage and must last at least until the end of the 18-month period of COBRA continuation coverage.

Second qualifying event extension of 18-month period of continuation coverage

If your family experiences another qualifying event during the 18 months of COBRA continuation coverage, the spouse and dependent children in your family can get up to 18 additional months of COBRA continuation coverage, for a maximum of 36 months, if the Plan is properly notified about the second qualifying event. This extension may be available to the spouse and any dependent children getting COBRA continuation coverage if the employee or former employee dies; becomes entitled to Medicare benefits (under Part A, Part B, or both); gets divorced or legally separated; or if the dependent child stops being eligible under the Plan as a dependent child. This extension is only available if the second qualifying event would have caused the spouse or dependent child to lose coverage under the Plan had the first qualifying event not occurred.

Are there other coverage options besides COBRA Continuation Coverage?

Yes. Instead of enrolling in COBRA continuation coverage, there may be other coverage options for you and your family through the Health Insurance Marketplace, Medicaid, or other group health plan coverage options (such as a spouse’s plan) through what is called a “special enrollment period.” Some of these options may cost less than COBRA continuation coverage. You can learn more about many of these options at www.healthcare.gov.

If you have questions

Questions concerning your Plan or your COBRA continuation coverage rights should be addressed to the contact or contacts identified below. For more information about your rights under the Employee

Legal Notices

36

Retirement Income Security Act (ERISA), including COBRA, the Patient Protection and Affordable Care Act, 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) in your area or visit www.dol.gov/ebsa. (Addresses and phone numbers of Regional and District EBSA Offices are available through EBSA’s website.) For more information about the Marketplace, visit www.HealthCare.gov.

Keep your Plan informed of address changes

To protect your family’s rights, let the Plan Administrator know about 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.

Plan contact information: Human Resources

Notice of Availability United Healthcare Notice of Privacy Practices

United Healthcare (the “Plan”) provides health benefits to eligible employees of International Market Centers (the “Company”) and their eligible dependents as described in the summary plan description(s) for the Plan.

The Plan creates, receives, uses, maintains and discloses health information about participating employees and dependents in the course of providing these health benefits. The Plan is required by law to provide notice to participants of the Plan’s duties and privacy practices with respect to covered individuals’ protected health information, and has done so by providing to Plan participants a Notice of Privacy Practices, which describes the ways that the Plan uses and discloses protected health information. To receive a copy of the Plan’s Notice of Privacy Practices you should contact Human Resources who has been designated as the Plan’s contact person for all issues regarding the Plan’s privacy practices and covered individuals’ privacy rights.

CMS Medicare Part D Credible Coverage Disclosure Notice

Important Notice from International Market Centers About Your Prescription Drug Coverage and Medicare

Please read this notice carefully and keep it where you can find it. This notice has information about your current prescription drug coverage with United Healthcare 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.

Legal Notices

37

2. United Healthcare has determined that the prescription drug coverage offered by International Market Centers 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 and each year from October 15th to 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 United Heatlhcare coverage will be affected. If you do decide to join a Medicare drug plan and drop your current United Healthcare coverage, be aware that you and your dependents will not be able to get this coverage back.

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 United Healthcare 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.

For More Information About This Notice Or Your Current Prescription Drug Coverage…

Contact the person listed below 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 United Healthcare 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 www.medicare.gov

• 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

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• Call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048.

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 www.socialsecurity.gov, or call them at 1-800-772-1213 (TTY 1-800-325-0778).

Date: 10/15/2019

Name of Entity/Sender: International Market Centers

Contact--Position/Office: Human Resources

Remember: Keep this Creditable Coverage 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).

Legal Notices