OPEN ENROLLMENT 2020 · Vision Plan Overview Page 6 ... Club Corp is partnering with WebTPA and the Aetna Signature Administrators network to provide comprehensive medical coverage

OPEN ENROLLMENT 2020October 28 – November 8

Open Enrollment is Coming!Mark your calendars for open enrollment: October 28 - November 8. Review your current benefits, read about the changes coming in 2020, and elect the best benefits for you and your family.

No Changes? Just Print!Your current coverage, on the online Oracle HCM Employee Self Service (ESS) site, will carry over from 2019 to 2020. Please review your current coverage and print a Confirmation Statement for your records. The only exceptions are the Flexible Spending Accounts. You MUST re-enroll in your FSAs each year!

What’s in this Newsletter?• 2020 Changes Page 1 • Medical Plan Overview Page 2• Dental Plan Overview Page 5• Vision Plan Overview Page 6• Flexible Spending Accounts Page 7• Life and Disability Page 8• Dependent Eligibility Page 9• Oracle HCM Employee Self Service (ESS) Page 17

Preparing & EnrollingTo prepare to enroll, we are providing you with the checklist so you have all you need to take full advantage of your elected benefits.

☐ Step 1 - Review Benefit InformationGo to www.clubcorp.com/benefits, where you can review all benefit information to help you make an informed decision:

• All forms• Benefit Summaries• Videos• Benefit Guides• Direct Links to benefit vendors• Bi-weekly rates• Review what is changing for 2020

☐ Step 2 - Need to Make Changes? Online EnrollmentEnrollment is online through Oracle HCM Employee Self Service (ESS) at www.clubcorp.com/benefits. More details on page 17.

• Bene iciary(ies) DesignationIf you are enrolled in Basic and/or Supplemental Life, please review and/or update your beneficiary(ies) designation). More detailson page 17.

☐ Step 3 - Confirmation StatementIf you are enrolling, changing coverage or simply confirming your coverage, print a Confirmation Statement for your records. More detailson page 17.

What’s Changing for 2020!• Changing Medical Plan administrator from Blue Cross Blue Shield of Texas to WebTPA with the Aetna Signature Administrators

(ASA) network. Changing pharmacy benefits manager and adding a new specialty RX provider.• Adding co-pays for physician office visits and other services through the Stewardship benefit level – See pages 2 and 3• Expanding the $0 co-pay list of generic drugs and adding co-pays for other generic and brand-name drugs – See page 2• Changing Medical Plan A, B and C out-of-pocket maximums (OOP) to $7,900 individual/$15,800 family• Adding Out-of-Network coverage with 50% coinsurance and unlimited member liability• Adding $0 co-pay telehealth visits for everyone enrolled in the Medical Plan; the Enhanced Telehealth plan is no longer needed• Adding a new, minimal benefit option for just $5.08 per pay period (or $8.08 per pay period to include your dependents) - see

page 2• Reinstating Health Care Flexible Spending Account and ending the Health Savings Account• Discontinuing Best Doctors and New Benefits December 31, 2019• Including Surgery Plus as a Stewardship provider with a $100 copay and ending the $1,000 incentive program December 31, 2019.

1For more information, go to www.clubcorp.com/benefits or call People Strategy Benefits at 1-800-800-4615.

MEDICAL PLAN

New Medical PlanClub Corp is partnering with WebTPA and the Aetna Signature Administrators network to provide comprehensive medical coverage for you and your covered dependents. WebTPA provides a full suite of services including a toll-free benefits hotline and a self-service portal. Prescription drug coverage will be provided by NBFSA and Vivio Health, coordinated through WebTPA.

Additionally, we have added two new benefit levels—Stewardship and Out-of-Network—to Medical Plans A, B and C to give you more choice and flexibility.

Stewardship Level BenefitsTo receive enhanced Stewardship benefits, you’ll need to follow certain guidelines:

• For $20 primary care office visits (or $50 specialist office visits, if necessary), youcan choose any Aetna Signature Administrators (ASA) network physician. PrimaryCare Physicians (PCPs) include family practice, internal medicine, pediatricians andOB/GYNs. To find an in-network physician, go to http://www.aetna.com/asa. AfterJanuary 1 you can also download the MyA Health mobile app from the App Store(iphone) or Google Play Store (Android) or call 1-877-487-4300.

• For $100 co-pay inpatient or outpatient services, most procedures (including thoseprovided in a physician’s office) must be approved in advance by WebTPA orIntegrated Musculoskeletal Care (IMC) AND performed at an approved facility. Tofind an approved facility, use the MyA Health mobile app or call 1-877-487-4300.

• Prescription generic and brand drugs obtained from an in-network pharmacy will be covered as follows:• Preferred Generic $0 co-pay• Non-Preferred Generic $25 co-pay (or actual cost, if less)• Value Brand $50 co-pay (or actual cost, if less)• Non-Preferred Brand 30% co-insurance after deductible

• Specialty drugs will continue to be subject to your deductible and co-insurance.

Prior Authorization RequiredTo ensure most procedures—including high-cost imaging (MRI, CT/PET scans), physician-administered infusions/injectables and any type of surgery—are covered services, they must be approved in advance by WebTPA or Integrated Musculoskeletal Care (IMC).

Integrated Musculoskeletal Care (IMC)IMC offers a network of highly trained health navigators to provide information about best practices, diagnostic options, and effective treat-ment outcomes to diagnose and treat musculoskeletal conditions. If you have a non-emergency musculoskeletal condition that requires diagnosis or treatment, you will be referred to an IMC health navigator, who will direct you to the most appropriate care pathway. IMC’s Self-Care program resolves over 70% of musculoskeletal disorders without addictive pain medications or invasive procedures such as injections or surgery. IMC will be responsible for pre-authorizing all non-emergency musculoskeletal procedures including MRI/CT, knee injec-tion therapy and surgery. If you do not receive prior authorization from IMC, your procedure will not be covered.

In-Network Level BenefitsYou can still receive covered services at the in-network level, i.e. subject to your deductible and 30 percent co-insurance when you use a provider in the Aetna ASA network. However, procedures such as high-cost imaging (MRI/CT/PET scans, infusions/injectables and all sur-geries must be approved in advance to be covered. Once your expenses reach a certain level (your “out-of-pocket maximum”), the plan pays 100% of covered services for the rest of the plan year.

Out-of-Network Level BenefitsIf you choose a doctor or facility that is not in the Aetna ASA network, you can now receive medically necessary services outside the Aetna network. To ensure a procedure is considered medically necessary, it must be approved in advance. Otherwise, the procedure will not be considered a covered service and you will be responsible for 100% of the cost. Covered services will be subject to deductibles and 50 percent co-insurance with no out-of-pocket maximum, i.e. unlimited liability.


2020 Open Enrollment Newsletter

Introducing MyA Health – Your Go-To Guide for Stewardship BenefitsNeed to find a doctor or facility that provides Stewardship- level benefits? The MyA Health mobile app can help! Just type in your zip code and MyA will show you where to go for the most cost-effective services.

24/7 Call-A-Doc - TelemedicineTime-consuming and expensive visits to the doctor’s office for common, minor illnesses such as colds, allergies, pink eye, bladder infections and skin conditions, are unnecessary when you have 24/7 Call-A-Doc. 24/7 Call-A-Doc physicians can diagnose you by phone and even send a prescription to your local pharmacy, quickly, easily, and conveniently. The Medical Plan—whichever plan option you choose—provides unlimited virtual visits for FREE ($0 co-pay).

Minimal Benefit OptionWe are introducing a new minimal benefit option that provides a very basic set of specified benefits for just $5.08 per pay period (or $8.08 per pay period if you enroll your eligible dependents). This is not a comprehensive medical plan, but it does provide $0 co-pay (FREE) unlimited telemedicine visits with a doctor for minor illnesses and annual preventive care benefit from Network providers including a wellness check-up and specified immunizations. This benefit option also provides coverage for a list of generic prescription drugs for a co-pay of $0 - $25 as well as $10,000 of AD&D coverage. While this benefit option does not cover other prescription drugs or other care or procedures, individuals enrolled in this benefit option also automatically receive a discount purchasing membership that provides access to discounts on brand and specialty drugs, dental and vision care and certain other products. For more information, refer to the Employee Benefit Guide at www.clubcorp.com/benefits.



Medical Plan Overview



Medical Plan A Medical Plan B Medical Plan C Minimal BenefitPlan D

MEDICAL Stewardship In NetworkOut-of-

NetworkStewardship In Network

Out-of-Network

Stewardship In NetworkOut-of-

NetworkN/A

Individual Deductible $0 $2,000 $0 $3,000 $0 $5,000 N/A

Family Deductible $0 $6,000 $0 $8,500 $0 $10,000 N/A

Individual OOP Max $7,900Unlimited Liability

$7,900Unlimited Liability

$7,900Unlimited Liability

N/A

Family OOP Max $15,800 $15,800 $15,800 N/A

Coinsurance N/A 30% 50% N/A 30% 50% N/A 30% 50% N/A

Telemedicine $0 copay N/A N/A $0 copay N/A NA $0 copay NA NA $0 copay

Preventive Care $0 Co-pay50% after

ded$0 Co-pay

50% after ded

$0 Co-pay50% after

ded$0 Co-pay

Primary Care $20 co-pay

50% after ded

$20 co-pay

50% after ded

$20 co-pay

50% after ded

N/A

Specialist $50 co-pay $50 co-pay $50 co-pay N/A

Urgent Care $100 co-pay

30% after ded

$100 copay

30% after ded

$100 copay

30% after ded

N/A

Inpatient* $100 co-pay $100 co-pay $100 co-pay N/A

Outpatient* $100 co-pay $100 co-pay $100 co-pay N/A

Emergency Room (True Emergency)

$250 co-pay $250 co-pay $250 co-pay N/A

Emergency Room (Non-True Emergency)

$250 copay plus 30% after deductible

50% after deductible





N/A

*Prior Authroization Required

PRESCRIPTION DRUGS

Preferred Generic $0 Co-pay

Not Covered

$0 Co-pay

Not Covered

$0 Co-pay

Not Covered

$0 Co-pay

Non-Preferred Generic $25 Co-pay (or actual cost,

if less)$25 Co-pay (or actual cost,


if less)$25 Co-pay (or actual

cost, if less)

Value Brand$50 Co-pay (or actual cost,



if less)Not covered

Non-Preferred Brand 30% after deductible 30% after deductible 30% after deductible Not covered

Specialty 50% after deductible 50% after deductible 50% after deductible Not covered

BI-WEEKLY CONTRIBUTIONS

Non-Tobacco

Tobacco Non-Tobacco Tobacco Non-Tobacco Tobacco

EP Only $116.00 $171.00 $83.00 $158.00 $60.00 $135.00 $5.08

EP + Spouse $311.00 $373.00 $252.00 $327.00 $204.00 $279.00 $8.08

EP + 2 Child(ren) or Less $265.00 $321.00 $188.00 $263.00 $145.00 $220.00 $8.08

EP + 3 Child(ren) or More $280.00 $321.00 $203.00 $278.00 $161.00 $236.00 $8.08

EP + Spouse + 2 Child(ren) or Less

$380.00 $455.00 $303.00 $378.00 $249.00 $324.00 $8.08

EP + Spouse + 3 Child(ren) or More

$405.00 $478.00 $328.00 $403.00 $274.00 $349.00 $8.08

DENTAL

Eligible Employee Partners may participate in the Dental Provider Organization (DPO) or Dental Health Maintenance Organization (DHMO), both of which are offered by Delta Dental.

DPO PlanYou can see any provider to receive care; however, when using a network dentist, your out-of-pocket costs are lower. This is because the network dentists have agreed to charge lower fees and your Plan’s in-network services cover a larger share of the charges. If you choose to use a dentist who doesn’t participate in the network, while the Plan of benefits is the same, your out-of-pocket costs will be higher, and you are subject to charges beyond reasonable & customary.

To find a network DPO dentist, contact Delta Dental at www.deltadentalins.com, Delta Dental DPO option or call 1-800-521-2651.

DeltaCare USA (DHMO) PlanYou will need to select a contracted DeltaCare USA dentist for both yourself and your eligible dependents at the time of enrollment. You must receive treatment from your selected DeltaCare USA contract dentist in order for your dental services or treatment to be covered.

To find a contract DeltaCare USA DHMO dentist, contact Delta Dental at www.deltadentalins.com, DeltaCare USA option or call 1-800-422-4234.

Dental Plan Overview


DPO DHMO

Deductible$50$150

$0

Co-payments Varies

Preventive 0% $0

Basic 20% $0 - $355

Major 50% $355/Crown

Annual Maximum $1,500 NA

OrthodontiaNot Covered

Adult - $2,100Child - $1,900

Max Orthodontia

Bi-Weekly Premium

EP Only $ 16.54 $ 7.90

EP + Spouse $ 35.04 $ 13.56

EP + Child(ren) $ 34.36 $ 13.66

EP + Family $ 55.71 $ 19.68


VISION

You can elect vision coverage for you and your dependents. Superior Vision network professionals provide vision services at discounted rates. When you want vision care, you may choose to see a:

• Superior Vision provider, who contacts Superior Vision for authorization. There are no claims to file. You pay the copayment forthe exam and materials, and the plan pays the rest. Discounts for laser vision correction surgery (LASIK or PRK), special lenses,prescription glasses and sunglasses, contacts are available from certain Superior Vision providers.

• Non-Superior Vision provider. You pay all charges at the time of your appointment. You can then file an itemized receipt withSuperior Vision

Vision Plan Overview


In-Network Out-of-NetworkExamination $15 Exam - Up to $42 - Ophthalmologist

Materials (Lenses and Frames) $15 See Covered Services

Contact Lens Fitting $25 Not Covered

Examination 12 months 12 months (Calendar Year)

Lenses 12 months 12 months (Calendar Year)

Frames 24 months 24 months (Calendar Year)

Contacts 12 months 12 months (Calendar Year)

Single Vision Lenses 100% after copay Up to $26

Bifocal Lenses 100% after copay Up to $34

Trifocal Lenses 100% after copay Up to $50

Frames 100% up to $125 retail allowance Up to $50 retail allowance

Contact Lenses* (Medically Necessary)

100% Up to $210 retail allowance

EP ONLY $2.93

EP + SPOUSE $4.36

EP + CHILD(REN) $4.66

EP + Family $7.45


Flexible Spending Accounts (FSA)The Flexible Spending Accounts (FSAs) allow you to pay for eligible healthcare and dependent care expenses using tax-free dollars — money taken out of your paycheck before income or Social Security taxes have been calculated. Our FSAs are administered by TaxSaver Plan. Call 800-328-4337 or go to www.taxsaverplan.com for more information.

Health Care FSAA Health Care FSA allows you to set aside pre-tax dollars to help pay for certain out-of-pocket healthcare expenses.

• Most medical, dental and vision care expenses that are not covered by your health plan, such as co-pays, co-insurance,deductibles, eyeglasses and doctor-prescribed over-the-counter medications.

• Annual Contribution Limit Maximum contribution is $2,650 per year• You must actively enroll in an FSA each year if you want to participate.

Dependent Care FSAThis plan allows you to set aside pre-tax dollars to help pay for day care services for your eligible dependents. The Dependent Care FSA is not for health care expenses.

• Dependent care expenses (such as day care, after-school programs or elder care programs) so you and your spouse can work orattend school full-time

• A qualifying child under age 13 whom you can claim as a dependent. If the child turned 13 during the year, the child is a qualifyingperson for the part of the year he or she was under age 13. Your disabled spouse who is not physically or mentally able to care forhimself or herself. Any disabled person who is not physically or mentally able to care for himself or herself whom you can claim as adependent or could claim as a dependent.

• Annual Contribution Limits Maximum contribution is $5,000 per year ($2,500 if married and filing separate tax returns)


HEALTH CARE ACCOUNTS2020 Open Enrollment Newsletter

LIFE & DISABILITY

Basic Life and AD&D• Basic Life and Accidental Death and Dismemberment (AD&D) are a part of ClubCorp’s benefits plan and are essential to your

and family’s future financial security. With our carrier, OneAmerica, the coverage available to you is 1.5x pay, up to a maximum of$50,000.

Voluntary Supplemental LifeFull-time Employee Partners may purchase Voluntary Supplemental Life insurance for themselves and their family. This benefit is in addition to your Basic Life benefit.

Coverage amounts for Employee Partners are increments of $10,000 up to 7x annual salary with a maximum benefit of $500,000 while Spouses can elect up to $100,000. If you are currently enrolled, you can go up 2 increments up to the maximum while Spouses can go up 2 increments up to the Guaranteed Issue. If you are not currently enrolled, Evidence of Insurability will be required during this enrollment.

Premiums are paid through post-tax payroll deductions. You must purchase Voluntary Supplemental Life insurance for yourself to purchase Voluntary Supplemental Life insurance for your Spouse and/or Child(ren).

Short Term Disability (STD)(Not available in CA, NY and NY and pre-existing condition applies, see Benefit Guide for more information) After a 14-day waiting period, the STD plan will provide a weekly benefit for up to 13 weeks if you are disabled due to an accident or illness. Go to www.clubcorp.com/ benefits for the enrollment form. If you reside in CA, NY or NJ, you may have STD benefits available to your through your state disability insurance program. Note: You may enroll in Short Term Disability and choose a weekly benefit in $100 increments up to $500/week, but no more than 60% of your average weekly salary.

If you are not a current STD plan participant, you may enroll in the plan at the first increment level of $100/week without evidence of insurability.

Long Term Disability (LTD)(You must be employed in an eligible position to participate in the LTD plan and pre-existing condition applies, see Benefit Guide for more information)

Disability coverage helps protect part of your income if you get hurt or sick and cannot work. After a 90-day waiting period, the LTD plan replaces up to 60% of your weekly pay as long as you are disabled up until you reach age 65. A Salary Continuation benefit of up to 66 2/3% of your weekly pay is available from days 15-90 after two years of service is available to eligible Employee Partners. Please refer to the benefits guide at www.clubcorp.com/ benefits for more information for eligible positions.


How to calculate the cost for Basic Life & AD&D

Take your annual earnings x 1.5 (not to exceed $50,000) = Your coverage amount

Take your coverage amount divided by 1,000 x $0.12 = Total monthly cost

Take the total monthly cost x 50% = Your monthly cost

Multiply your monthly cost x 12 then divide by 26 (up to a max of $1.38 per period for $50,000)

= Your biweekly cost

How to calculate your LTD cost

Take your monthly salary divided by 100 = Your basis amount

Take the basis number x $0.38 = Total monthly cost

Take the total monthly cost x 50% = Your monthly cost

Take your monthly cost x 12 then divide by 26 = Your biweekly cost


ENROLLMENT

Your Eligible Dependents Verification of eligibility will be required for newly elected medical coverage before dependents are enrolled. Proof of dependent status must be by November 27, 2019.

Dependents eligible for coverage in the ClubCorp benefit Plans include: • Medical and Vision Plans Only – Your dependent children up to age 26 (including stepchildren, legally adopted children or children

placed with you for adoption, foster children, and any child that you claim as a legal tax dependent) who are United States citizensor legal residents.

• For Other Plans – Your unmarried dependent children up to age 25 who are United States citizens or legal residents and primarilydependent on you for financial support.

• Your dependent child, regardless of age, provided that he or she is incapable of self-support due to a mental or physical disability,is fully dependent on you for support as indicated on your federal tax return, and is approved by the Medical Plan to continuecoverage past age 26.

• Your legal spouse who is recognized for United States Federal Tax purposes and who is a United States citizen or legal resident.This applies to all plans, unless otherwise indicated in the group policy for dental, vision and supplemental life.

Dependent Verification: November 11 through November 27

How Do I Verify My Dependents?Go to www.clubcorp.com/benefits and click on ‘Eligibility (EP & Dependents)’ for instructions and a list of verification documents to use. Proof of dependent status MUST be received by November 27th.

When You Can Enroll & When Coverage Becomes Effective? • As a new hire you must enroll prior to completion of 90 days of continuous service. Coverage is then effective on your 90-day

anniversary.• Open Enrollment is your time to make changes to your benefit elections without a qualifying life event. Coverage is effective on

January 1 of the following year.• For Medical, Dental, Vision, Group Life and Accidental Death & Dismemberment, Supplemental Life, Long Term Disability and Short

Term Disability coverage, you have 31 days from the qualifying life event to enroll or change your coverage election and the effec-tive date is the day of the qualifying life event.

Qualifying Life Events Include:• Change in your legal marital status (marriage, divorce, or legal separation)• Change in the number of your dependents (for example, through birth or adoption, or if a child is no longer an eligible dependent)• Change in your spouse’s employment status (resulting in a loss or gain of coverage)• Change in your employment status from full time to part time, or part time to full time, resulting in a loss or gain of coverage• Entitlement to Medicare or Medicaid• Change in your address or location that affects the plans for which you are enrolled

Any change to your benefits must be consistent with the qualifying life event. For example, if a child is born, you may add the newborn but you may not decrease other dependent coverage.



Required NoticesMedical Plan Contribution DiscountsDuring Enrollment, you must confirm/select your tobacco user or non-us-er status as well as the status of your spouse. You must select a Tobacco Usage status even if you are not enrolling in the medical plan. For more information, visit www.clubcorp.com/benefits and click on ‘Tobacco User Status and Cessation Program’.

For covered Employee Partners and Spouses who are smokers/tobacco users, ClubCorp offers assistance with the company-sponsored smoking/tobacco cessation program through the American Institute for Preventive Medicine. You and/or your covered Spouse can participate in the Medical Plan smoking/tobacco cessation program (at no cost to you). You and/or your spouse has 90 days from your benefit effective date to complete the program. Upon receipt of proof of participation in the smoking/tobacco ces-sation program, you will receive the discounted medical plan contributions. The smoking/tobacco cessation program must be completed within 90 days of your benefit effective date to receive the discount.

If it is unreasonably difficult due to a health factor for you to meet the requirement or if it is medically inadvisable for you to attempt to meet the requirements of this program, we are making available a reasonable alter-native standard for you to obtain the discounted medical plan contributions – the Medical Plan smoking/tobacco cessation program. If satisfying thisreasonable alternative outlined above is medically inadvisable and you canprovide a physician’s statement indicating so, then please contact the Club-Corp Benefits Department, who will work with you to develop an additionalreasonable alternative.Proof of participation in the Medical Plan smoking/tobacco cessation pro-gram is a certificate/diploma issued to the participant by the American Insti-tute for Preventive Medicine after a participant has completed the programrequirements and final exam (with a passing score).

To enroll in the Medical Plan smoking/tobacco cessation program, please call the American Institute for Preventive Medicine at 1-800-345-2476 x1.One is considered a non-smoker/non-tobacco user if you (and your covered Spouse):Have not used tobacco products (cigarettes, cigars, chewing tobacco, etc.), for at least 6 months (from the date you certify your tobacco user status), orEnroll in the ClubCorp Medical Plan smoking/tobacco cessation program offered in partnership with the American Institute of Preventive Medicine and provide proof of participation. Upon receipt of proof of successful comple-tion of smoking/tobacco cessation program, you will receive the discounted Medical Plan bi-weekly rates.

One is considered a smoker/tobacco user if:You (or your covered Spouse) are currently using any form of tobacco (cig-arettes, cigars, chewing tobacco, etc.) in any amount (including occasional social use), orYou (or your covered Spouse) have used tobacco based products (ciga-rettes, cigars, chewing tobacco, etc.) within the last 6 months (from the date you certify your tobacco user status).Any of the above applies if you (or your covered Spouse) do not enroll in and complete the ClubCorp Medical Plan smoking/tobacco cessation program.

Definition of smoker: An Employee Partner (or your covered Spouse) who smokes cigarettes, cigars or chews tobacco, etc. Casual or social smoking constitutes smoking by the ClubCorp Medical Plan definition.

Right to request documentation: ClubCorp Benefits has the right to request documentation at any time from an Employee Partner or covered Spouse who declares him/herself a smoker enrolled in the approved smoking/to-bacco cessation program or from the vendor providing the smoking/tobacco cessation program to the Employee Partner or covered Spouse for the sole purpose of verifying enrollment and participation.

Recourse for making a false statement: An Employee Partner who inten-tionally falsifies his/her or covered Spouse’s non-smoking status will be subject to immediate revocation of the non-smoker contribution discount and could face a loss of coverage for intentional falsification of enrollment.

For more information, including costs, go to www.clubcorp.com/benefits and print the voucher or call People Strategy Benefits at 1-800-800-4615.

Important Notice from ClubCorp USA, Inc. About Your Prescription Drug Coverage and Medicare under Medical Plan A and Medical Plan BPlease read this notice carefully and keep it where you can find it. This notice has information about your current prescription drug coverage with ClubCorp USA, Inc. and about your options under Medicare’s prescription drug coverage. This information can help you decide whether or not you want to join a Medicare drug plan. If you are considering joining, you should compare your current coverage, including which drugs are covered at what cost, with the coverage and costs of the plans offering Medicare prescription drug coverage in your area. Information about where you can get help to make decisions about your prescription drug coverage is at the end of this notice. There are two important things you need to know about your current cover-age and Medicare’s prescription drug coverage:1. Medicare prescription drug coverage became available in 2006 toeveryone with Medicare. You can get this coverage if you join a MedicarePrescription Drug Plan or join a Medicare Advantage Plan (like an HMO orPPO) that offers prescription drug coverage. All Medicare drug plans provideat least a standard level of coverage set by Medicare. Some plans may alsooffer more coverage for a higher monthly premium.

2. ClubCorp USA, Inc. has determined that the prescription drug coverageoffered by Medical Plan A and Medical Plan B is, on average for all planparticipants, expected to pay out as much as standard Medicare prescrip-tion drug coverage pays and is therefore considered Creditable Coverage.Because your existing coverage is Creditable Coverage, you can keep thiscoverage and not pay a higher premium (a penalty) if you later decide to joina Medicare drug plan.

When Can You Join A Medicare Drug Plan?You can join a Medicare drug plan when you first become eligible for Medicare during a seven-month initial enrollment period. That period begins three months prior to your 65th birthday, includes the month you turn 65, and continues for the ensuing three months. You may also enroll each year from October 15th through December 7th.

However, if you lose your current creditable prescription drug coverage, through no fault of your own, you will also be eligible for a two (2) month Special Enrollment Period (SEP) to join a Medicare drug plan.

What Happens To Your Current Coverage If You Decide to Join A Medi-care Drug Plan?If you decide to join a Medicare drug plan, your current ClubCorp USA, Inc. coverage will not be affected. For most persons covered under the Plan, the Plan will pay prescription drug benefits first, and Medicare will determine its payments second. For more information about this issue of what program pays first and what program pays second, see the Plan’s summary plan description or contact Medicare at the telephone number or web address listed herein.

When Will You Pay A Higher Premium (Penalty) To Join A Medicare Drug Plan?You should also know that if you drop or lose your current coverage with ClubCorp USA, Inc. and don’t join a Medicare drug plan within 63 continuous days after your current coverage ends, you may pay a higher premium (a penalty) to join a Medicare drug plan later.If you go 63 continuous days or longer without creditable prescription drug coverage, your monthly premium may go up by at least 1% of the Medicare





base beneficiary premium per month for every month that you did not have that coverage. For example, if you go nineteen months without creditable coverage, your premium may consistently be at least 19% higher than the Medicare base beneficiary premium. You may have to pay this higher premi-um (a penalty) as long as you have Medicare prescription drug coverage. In addition, you may have to wait until the following October to join.

Important Notice from ClubCorp USA, Inc. About Your Prescription Drug Coverage and Medicare under Medical Plan C and Minimal Benefit OptionPlease read this notice carefully and keep it where you can find it. This notice has information about your current prescription drug coverage with ClubCorp USA, Inc. and about your options under Medicare’s prescription drug coverage. This information can help you decide whether or not you want to join a Medicare drug plan. Information about where you can get help to make decisions about your prescription drug coverage is at the end of this notice.

There are three important things you need to know about your current cov-erage and Medicare’s prescription drug coverage:1. Medicare prescription drug coverage became available in 2006 to everyone with Medicare. You can get this coverage if you join a Medicare Prescription Drug Plan or join a Medicare Advantage Plan (like an HMO or PPO) that offers prescription drug coverage. All Medicare drug plans provide at least a standard level of coverage set by Medicare. Some plans may also offer more coverage for a higher monthly premium.2. ClubCorp USA, Inc. has determined that the prescription drug coverage offered by the WebTPA Medical Plan C is, on average for all plan participants, NOT expected to pay out as much as standard Medicare prescription drug coverage pays. Therefore, your coverage is considered Non-Creditable Coverage. This is important because, most likely, you will get more help with your drug costs if you join a Medicare drug plan, than if you have prescrip-tion drug coverage from the ClubCorp USA, Inc. plan. This also is important because it may mean that you may pay a higher premium (a penalty) if you do not join a Medicare drug plan when you first become eligible.3. You can keep your current coverage from ClubCorp USA, Inc. However, because your coverage is non-creditable, you have decisions to make about Medicare prescription drug coverage that may affect how much you pay for that coverage, depending on if and when you join a drug plan. When you make your decision, you should compare your current coverage, including what drugs are covered, with the coverage and cost of the plans offering Medicare prescription drug coverage in your area. Read this notice carefully - it explains your options.

When Can You Join A Medicare Drug Plan?You can join a Medicare drug plan when you first become eligible for Medicare during a seven-month initial enrollment period. That period begins three months prior to your 65th birthday, includes the month you turn 65, and continues for the ensuing three months. You may also enroll each year from October 15th through December 7th.However, if you decide to drop your current coverage with ClubCorp USA, Inc., since it is employer/union sponsored group coverage, you will be eli-gible for a two (2) month Special Enrollment Period (SEP) to join a Medicare drug plan; however you also may pay a higher premium (a penalty) because you did not have creditable coverage under the ClubCorp USA, Inc. plan.

What Happens To Your Current Coverage If You Decide to Join A Medi-care Drug Plan?If you decide to join a Medicare drug plan, your current ClubCorp USA, Inc. coverage will not be affected. For most persons covered under the Plan, the Plan will pay prescription drug benefits first, and Medicare will determine its payments second. For more information about this issue of what program pays first and what program pays second, see the Plan’s summary plan description or contact Medicare at the telephone number or web address listed herein.

When Will You Pay A Higher Premium (Penalty) To Join A Medicare Drug Plan?Since the coverage under ClubCorp USA, Inc. is not creditable, depending on how long you go without creditable prescription drug coverage you may pay a penalty to join a Medicare drug plan. Starting with the end of the last month that you were first eligible to join a Medicare drug plan but didn’t join, if you go 63 continuous days or longer without prescription drug coverage that’s creditable, your monthly premium may go up by at least 1% of the Medicare base beneficiary premium per month for every month that you did not have that coverage. For example, if you go nineteen months without creditable coverage, your premium may consistently be at least 19% higher than the Medicare base beneficiary premium. You may have to pay this high-er premium (penalty) as long as you have Medicare prescription drug cover-age. In addition, you may have to wait until the following October to join.

For More Information about This Notice or Your Current Prescription Drug Coverage…Contact the person listed at the end of these notices for further information.NOTE: You’ll get this notice each year. You will also get it before the next period you can join a Medicare drug plan, and if this coverage throughClubCorp USA, Inc. changes. You also may request a copy of this notice at any time.

For More Information about Your Options under Medicare Prescription Drug Coverage…More detailed information about Medicare plans that offer prescription drug coverage is in the “Medicare & You” handbook. You’ll get a copy of the handbook in the mail every year from Medicare. You may also be contacted directly by Medicare drug plans.For more information about Medicare prescription drug coverage:»» Visit 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»» 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).Remember: Keep this Medicare Part D notice. If you decide to join one of the Medicare drug plans, you may be required to provide a copy of this notice when you join to show whether or not you have maintained creditable coverage and, therefore, whether or not you are required to pay a higher premium (a penalty).

Date: January 1, 2020Name of Entity/Sender: ClubCorp USA, Inc.Contact—Position/Office: People StrategyAddress: 3030 LBJ Freeway, Suite #600 Dallas, TX 75234Phone Number: 800-800-4615

Women’s Health and Cancer Rights ActThe Women’s Health and Cancer Rights Act of 1998 was signed into law on October 21, 1998. The Act requires that all group health plans providing medical and surgical benefits with respect to a mastectomy must provide coverage for all of the following:»» Reconstruction of the breast on which a mastectomy has been performed»» Surgery and reconstruction of the other breast to produce a symmetrical appearance»» Prostheses»» Treatment of physical complications of all stages of mastectomy, including lymphedema



This coverage will be provided in consultation with the attending physician and the patient, and will be subject to the same annual deductibles and coinsurance provisions which apply for the mastectomy. For deductibles and coinsurance information applicable to the plan in which you enroll, please refer to the summary plan description or contact People Strategy Benefits at 800-800-4615.

HIPAA Privacy and SecurityThe Health Insurance Portability and Accountability Act of 1996 deals with how an employer can enforce eligibility and enrollment for health care bene-fits, as well as ensuring that protected health information which identifies you is kept private. You have the right to inspect and copy protected health infor-mation that is maintained by and for the plan for enrollment, payment, claims and case management. If you feel that protected health information about you is incorrect or incomplete, you may ask your benefits administrator to amend the information. The Notice of Privacy Practices has been recently updated. For a full copy of the Notice of Privacy Practices, describing how protected health information about you may be used and disclosed and how you can get access to the information, contact People Strategy Benefits at 800-800-4615.

HIPAA Special Enrollment RightsIf you are declining enrollment for yourself or your dependents (includ-ing your spouse) because of other health insurance or group health plan coverage, you may be able to later enroll yourself and your dependents in this plan if you or your dependents lose eligibility for that other coverage (or if the employer stops contributing towards your or your dependents’ other coverage).Loss of eligibility includes but is not limited to:»» Loss of eligibility for coverage as a result of ceasing to meet the plan’s eligibility requirements (i.e. legal separation, divorce, cessation of dependent status, death of an employee, termination of employment, reduction in the number of hours of employment);»» Loss of HMO coverage because the person no longer resides or works in the HMO service area and no other coverage option is available through the HMO plan sponsor;»» Elimination of the coverage option a person was enrolled in, and another option is not offered in its place;»» Failing to return from an FMLA leave of absence; and»» Loss of coverage under Medicaid or the Children’s Health Insurance Program (CHIP).Unless the event giving rise to your special enrollment right is a loss of cov-erage under Medicaid or CHIP, you must request enrollment within 31 days after your or your dependent’s(s’) other coverage ends (or after the employ-er that sponsors that coverage stops contributing toward the coverage).

If the event giving rise to your special enrollment right is a loss of coverage under Medicaid or the CHIP, you may request enrollment under this plan within 60 days of the date you or your dependent(s) lose such coverage under Medicaid or CHIP. Similarly, if you or your dependent(s) become eligi-ble for a state-granted premium subsidy towards this plan, you may request enrollment under this plan within 60 days after the date Medicaid or CHIP determine that you or the dependent(s) qualify for the subsidy.

In addition, if you have a new dependent as a result of marriage, birth, adop-tion, or placement for adoption, you may be able to enroll yourself and your dependents. However, you must request enrollment within 31 days after the marriage, birth, adoption, or placement for adoption.To request special enrollment or obtain more information, contact People Strategy Benefits at 800-800-4615.

Premium Assistance Under Medicaid and the Children’s Health Insur-ance 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 Med-icaid 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 Med-icaid 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 cov-erage 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).



CONTINUATION COVERAGE RIGHTS UNDER COBRAYou are receiving this Notice of COBRA healthcare coverage continuation rights because you have recently become covered under one or more group health plans. The plan (or plans) under which you have gained coverage are listed at the end of this Form, and are referred to collectively as “the plan” except where otherwise indicated.

This notice contains important information about your right to COBRA continuation coverage, which is a temporary extension of healthcare coverage under the plan. The right to COBRA continuation coverage was created by a federal law, the Consol¬idated Omnibus Budget Reconciliation Act of 1985 (COBRA). COBRA continuation coverage can become available to you and/or to other members of your family who health coverage. This notice gives only a summary of your COBRA continuation coverage rights. This notice generally explains COBRA continuation coverage, when it may become available to you and your family, and what you need to do to pro-tect the right to receive it. For more information about your rights and obligations under the plan and under federal law, you should either review the plan’s Summary Plan Description or contact the Plan Administrator. In some cases the plan docu¬ment also serves as the Summary Plan Description.

You may have other options available to you when you lose group coverage. For ex¬ample, you may be eligible to buy an individual plan through the Health Insurance Marketplace. By enrolling in coverage through the Marketplace, you may qualify for lower costs on your monthly premiums and lower out-of-pocket costs. Additionally, you may qualify for a 30-day special enrollment period for another group health plan for which you are eligible (such as a spouse’s plan), even if that plan generally doesn’t accept late enrollees.

COBRA Continuation Coverage and “Qualifying Events”COBRA continuation coverage is a continuation of plan coverage when coverage would otherwise end because of a life event known as a “qualifying event.” Specific qualifying events are listed later in this notice. COBRA continuation coverage must be offered to each person who is a “qualified beneficiary.” A qualified beneficiary is someone who will lose coverage under the plan because of a qualifying event. Depending on the type of qualifying event, employees, spouses of employees, and eligible children of employees may be qualified beneficiaries. Certain newborns, newly-adopted children and alternate recipients under qualified medical child support orders may also be qualified beneficiaries. This is discussed in more detail in separate paragraphs below. Under the plan, qualified beneficiaries who elect COBRA continuation coverage must pay for this continuation coverage. If you are a covered employee, you will become a qualified beneficiary if you lose your coverage under the plan because either one of the following qualifying events happens:Your hours of employment are reduced, orYour employment ends for any reason other than your gross misconduct.

If you are the spouse of a covered employee, you will become a qualified beneficia¬ry if you lose your coverage under the plan because any of the following qualifying events happens:Your spouse dies;Your spouse’s hours of employment are reduced;Your spouse’s employment ends for any reason other than his or her gross misconduct;Your spouse becomes enrolled in any part or all of Medicare (under Part A, Part B, Part C, or all); or You become divorced or legally separated from your spouse.

Note that if your spouse cancels your coverage in anticipation of a divorce or legal separation and a divorce or legal separation later occurs, then the divorce or legal separation will be considered a qualifying event even though you actually lost coverage earlier. If you notify the Plan Administrator or its designee within 60 days after the divorce or legal separation and can

establish that the employee canceled the coverage earlier in anticipation of the divorce or legal separation, then COBRA coverage may be available for a period after the divorce (but not for the period between the date your coverage ended, and the date of divorce or legal separa¬tion). But you must provide timely notice of the divorce or legal separation to the Plan Administrator or its designee or you will not be able to obtain COBRA coverage after the divorce or legal separation. See the rules in the box below, under the heading entitled, “Notice Requirements,” regarding the obligation to provide notice, and the procedures for doing so.Your covered eligible children will become qualified beneficiaries if they lose cover¬age under the plan because any of the following qualifying events happens:The parent-employee dies;The parent-employee’s hours of employment are reduced;The parent-employee’s employment ends for any reason other than his or her gross misconduct;The parent-employee becomes enrolled in any part or all of Medicare (Part A, Part B, Part C, or all);The parents become divorced or legally separated; orThe child stops being eligible for coverage under the plan as an “eligible child.”

Notice RequirementsThe plan will offer COBRA continuation coverage to qualified beneficiaries only af¬ter the Plan Administrator or its designee has been timely notified that a qualifying You must make sure that the Plan Administrator or its designee is notified in writing of the Social Security Administration’s determination within 60 days after (i) of the date of the determination or (ii) the date of the qualifying event or (iii) the date coverage is lost due to the qualifying event, whichever occurs last. But in any event the notice must be provided before the end of the 18-month period of COBRA continuation coverage. The plan requires you to follow the procedures specified in the box above, under the heading entitled “Notice Procedures.” In addition, your notice must includethe name of the disabled qualified beneficiary, the date that the qualified beneficiary became disabled, and the date that the Social Security Administration made its determination.

Your notice must also include a copy of the Social Security Administration’s de¬termination. If these procedures are not followed or if the notice is not provided in writing to the Plan Administrator or its designee within the required period, then there will be no disability extension of COBRA continuation coverage. 2. Second qualifying event extension of 18-month period of continuation coverage.If your family experiences another qualifying event while receiving COBRA continuation coverage, the spouse and eligible children in your family can get additional months of COBRA continuation coverage, up to a maximum of 36 months (including the initial period of COBRA coverage). This extension is available to the spouse and eligible children if, while they and the covered former employee are purchasing COBRA coverage, the former employee:dies, enrolls in any part or all of Medicare (Part A, Part B, Part C, or all), or gets divorced or legally separated

The extension is also available to an eligible child when that child stops being eligible under the plan as an eligible child. In all of these cases, you must make sure that the Plan Administrator or its designee is notified in writing of the second qualifying event within 60 days after (i) the date of the second qualifying event or (ii) the date coverage is lost, whichever occurs last. The plan requires you to follow the procedures specified in the box above, under the heading entitled “Notice Procedures.” Your notice must also name the second qualifying event and the date it happened. If the second qualifying event is a divorce or legal separation, your notice must include a copy of the divorce decree or legal separation agreement.



If these procedures are not followed or if the notice is not provided in writing to the Plan Administrator or its designee within the required 60-day period, then there will be no extension of COBRA continuation coverage due to the second qualifying event.3. Medicare Extension for Spouse and Eligible Children.If a qualifying event that is a termination of employment or reduction of hours occurs within 18 months after the covered employee becomes entitled to any part or all of Medicare (Part A, Part B, Part C, or all), then the maximum coverage period for the spouse and eligible children is 36 months from the date the employee became entitled to Medicare (Part A, Part B, Part C, or all) - but the covered employee’s maximum coverage period will be 18 months.

Other Rules and RequirementsSame Rights as Active Employees to Add New Dependents. A qualified beneficia¬ry generally has the same rights as similarly situated active employees to add or drop dependents, make enrollment changes during open enrollment, etc. Con¬tact the Plan Administrator for more information. See also the paragraph below titled, “Children Born or Placed for Adoption with the Covered Employee During COBRA Period,” for information about how certain children acquired by a covered employee purchasing COBRA coverage may actually be treated as qualified beneficiaries themselves. Be sure to promptly notify the Plan Administrator or its designee if you need to make a change to your COBRA coverage.

The Plan Administrator or its designee must be notified in writing within 30 days of the date you wish to make such a change (adding or dropping dependents, for example). See the rules in the box above, under the heading entitled, “Notice Procedures,” for an explanation regarding how your notice should be made.

Children Born to or Placed for Adoption with the Covered Employee During COBRA Period. A child born to, adopted by, or placed for adoption with a covered employee or former employee during a period of continuation coverage is considered to be a qualified beneficiary provided that, if the covered employee or former employee is a qualified beneficiary, the employee has elected COBRA continuation coverage for himself or herself. The child’s COBRA coverage begins when the child is enrolled in the plan, whether through special enrollment or open enrollment, and it lasts for as long as COBRA coverage lasts for other family members of the employee. To be enrolled in the plan, the child must satisfy the otherwise applicable plan eligibility requirements (for example, age require¬ments). Be sure to promptly notify the Plan Administrator or its designee if you need to make a change to your COBRA coverage. The Plan Administrator or its designee must be notified in writing within 30 days of the date you wish to make such a change. See the rules in the box above, under the heading entitled, “No-tice Procedures,” for an explanation regarding how your notice should be made.

Alternate Recipients Under Qualified Medical Child Support Orders. A child of the covered employee or former employee who is receiving benefits under the plan pursuant to a Qualified Medical Child Support Order (QMCSO) received by the Plan Administrator during the employee’s period of employment with the employer is entitled the same rights under COBRA as an eligible child of the cov¬ered employee, regardless of whether that child would otherwise be considered a dependent. Be sure to promptly notify the Plan Administrator or its designee if you need to make a change to your COBRA coverage. The Plan Administrator or its designee must be notified in writing within 30 days of the date you wish to make such a change. See the rules in the box above, under the heading entitled, “Notice Procedures,” for an explanation regarding how your notice should be made.

If You Have QuestionsQuestions concerning your plan or your COBRA continuation rights should be addressed to the contact or contacts identified below. For more information about your rights under the Employee Retirement Income Security Act (ERISA), including COBRA, the Health Insurance Portability

or Accountability Act (HIPAA), Patient Protection and Affordable Care Act (PPACA), and other laws affecting group health plans, contact the nearest Regional or District Office of the U.S. Department of Labor’s Employee Benefits Security Administration (EBSA). Addresses and phone numbers of Regional and District EBSA Offices are available through EBSA’s Web site at www.dol.gov/ebsa. For more information about the Health Insurance Marketplace, visit www.HealthCare.gov.

Keep Your Plan Informed of Address ChangesIn order to protect your family’s rights, you should keep the Plan Administrator or its designee informed of any changes in the addresses of family members. You should also keep a copy, for your records, of any notices you send to the Plan Administrator or its designee.

Plan and Plan Contact Information ClubCorp Medical Plan administered by WebTPA DHMO Plan offered by DeltaCare USA, Inc. DPO Dental Plan offered by Delta Dental Insurance Company ClubCorp Vision Plan offered by Superior Vision Services, Inc.

For additional information about the plan and COBRA coverage, you may contact the Plan Administrator:

ClubCorp USA, Inc.Attn: ClubCorp Benefits

3030 LBJ Freeway, Suite 600 Dallas, TX 75234

972-243-6191Premium 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).

ALABAMA – MedicaidWebsite: http://myalhipp.com/Phone: 1-855-692-5447



ALASKA – MedicaidThe AK Health Insurance Premium Payment ProgramWebsite: http://myakhipp.com/ Phone: 1-866-251-4861Email: [email protected] Medicaid Eligibility: http://dhss.alaska.gov/dpa/Pages/medicaid/default.aspx

ARKANSAS – MedicaidWebsite: http://myarhipp.com/Phone: 1-855-MyARHIPP (855-692-7447)

COLORADO – Health First Colorado (Colorado’s Medicaid Program) & Child Health Plan Plus (CHP+)Health First Colorado Website: https://www.healthfirstcolorado.com/ Health First Colorado Member Contact Center: 1-800-221-3943/ State Relay 711CHP+: Colorado.gov/HCPF/Child-Health-Plan-PlusCHP+ Customer Service: 1-800-359-1991/ State Relay 711To see if any other states have added a premium assistance program since July 31, 2018, or for more information on special enrollment rights, contact either:

FLORIDA – MedicaidWebsite: http://flmedicaidtplrecovery.com/hipp/Phone: 1-877-357-3268GEORGIA – Medicaid Website: http://dch.georgia.gov/medicaid- Click on Health Insurance Premium Payment (HIPP)Phone: 404-656-4507

INDIANA – Medicaid Healthy Indiana Plan for low-income adults 19-64Website: http://www.in.gov/fssa/hip/Phone: 1-877-438-4479All other MedicaidWebsite: http://www.indianamedicaid.comPhone 1-800-403-0864

IOWA – MedicaidWebsite: http://dhs.iowa.gov/hawk-iPhone: 1-800-257-8563 KANSAS – MedicaidWebsite: http://www.kdheks.gov/hcf/Phone: 1-785-296-3512

KENTUCKY – MedicaidWebsite: https://chfs.ky.govPhone: 1-800-635-2570

LOUISIANA – MedicaidWebsite: http://dhh.louisiana.gov/index.cfm/subhome/1/n/331Phone: 1-888-695-2447

MAINE – MedicaidWebsite: http://www.maine.gov/dhhs/ofi/public-assistance/index.htmlPhone: 1-800-442-6003TTY: Maine relay 711

MASSACHUSETTS – Medicaid and CHIPWebsite: http://www.mass.gov/eohhs/gov/departments/masshealth/Phone: 1-800-862-4840

MINNESOTA – MedicaidWebsite: https://mn.gov/dhs/people-we-serve/seniors/health-care/health-care-programs/programs-and-services/other-insurance.jspPhone: 1-800-657-3739

MISSOURI – MedicaidWebsite: http://www.dss.mo.gov/mhd/participants/pages/hipp.htmPhone: 573-751-2005

MONTANA – MedicaidWebsite: http://dphhs.mt.gov/MontanaHealthcarePrograms/HIPPPhone: 1-800-694-3084

NEBRASKA – MedicaidWebsite: http://www.ACCESSNebraska.ne.govPhone: (855) 632-7633Lincoln: (402) 473-7000Omaha: (402) 595-1178

NEVADA – MedicaidMedicaid Website: http://dhcfp.nv.govMedicaid Phone: 1-800-992-0900NEW HAMPSHIRE – MedicaidWebsite: https://www.dhhs.nh.gov/ombp/nhhpp/Phone: 603-271-5218Hotline: NH Medicaid Service Center at 1-888-901-4999

NEW JERSEY – Medicaid and CHIPMedicaid Website: http://www.state.nj.us/humanservices/dmahs/clients/medicaid/Medicaid Phone: 609-631-2392CHIP Website: http://www.njfamilycare.org/index.htmlCHIP Phone: 1-800-701-0710

NEW YORK – MedicaidWebsite: https://www.health.ny.gov/health_care/medicaid/Phone: 1-800-541-2831

NORTH CAROLINA – MedicaidWebsite: https://dma.ncdhhs.gov/ Phone: 919-855-4100

NORTH DAKOTA – MedicaidWebsite: http://www.nd.gov/dhs/services/medicalserv/medicaid/Phone: 1-844-854-4825

OKLAHOMA – Medicaid and CHIPWebsite: http://www.insureoklahoma.orgPhone: 1-888-365-3742

OREGON – MedicaidWebsite: http://healthcare.oregon.gov/Pages/index.aspxhttp://www.oregonhealthcare.gov/index-es.htmlPhone: 1-800-699-9075

PENNSYLVANIA – MedicaidWebsite:http://www.dhs.pa.gov/provider/medicalassistance/healthinsurancepremiumpaymenthippprogram/index.htmPhone: 1-800-692-7462

RHODE ISLAND – MedicaidWebsite: http://www.eohhs.ri.gov/Phone: 855-697-4347



SOUTH CAROLINA – MedicaidWebsite: https://www.scdhhs.govPhone: 1-888-549-0820

SOUTH DAKOTA - MedicaidWebsite: http://dss.sd.govPhone: 1-888-828-0059

TEXAS – MedicaidWebsite: http://gethipptexas.com/Phone: 1-800-440-0493

UTAH – Medicaid and CHIPMedicaid Website: https://medicaid.utah.gov/CHIP Website: http://health.utah.gov/chipPhone: 1-877-543-7669

VERMONT– MedicaidWebsite: http://www.greenmountaincare.org/Phone: 1-800-250-8427

VIRGINIA – Medicaid and CHIPMedicaid Website: http://www.coverva.org/programs_premium_assistance.cfmMedicaid Phone: 1-800-432-5924CHIP Website: http://www.coverva.org/programs_premium_assistance.cfmCHIP Phone: 1-855-242-8282

WASHINGTON – MedicaidWebsite: http://www.hca.wa.gov/free-or-low-cost-health-care/program-administration/premium-payment-programPhone: 1-800-562-3022 ext. 15473

WEST VIRGINIA – MedicaidWebsite: http://mywvhipp.com/Toll-free phone: 1-855-MyWVHIPP (1-855-699-8447)

WISCONSIN – Medicaid and CHIPWebsite: https://www.dhs.wisconsin.gov/publications/p1/p10095.pdfPhone: 1-800-362-3002

WYOMING – MedicaidWebsite: https://wyequalitycare.acs-inc.com/Phone: 307-777-7531

To see if any other states have added a premium assistance program since August 10, 2017, or for more information on special enrollment rights, contact either:

U.S. Department of Labor U.S. Department of Health and Human Services Employee Benefits Security Administration Centers for Medicare & Medicaid Serviceswww.dol.gov/agencies/ebsa www.cms.hhs.gov 1-866-444-EBSA (3272) 1-877-267-2323, Menu Option 4, Ext. 61565

Oracle HCM Employee Self Service (ESS) All Benefit information is online.

Logging on to ESS1. Contact the ClubCorp Help Desk to secure your Oracle HCM ESS username and temporary password by calling 972-888-7777.

The password is good for 24 hours only. 2. Once you have your ESS username and password, log on to ecwl.fa.us2.oraclecloud.com. 3. Select the orange Benefits icon

Review Benefits on ESS1. Contact the ClubCorp Help Desk to secure your Oracle HCM ESS username and temporary password by calling 972-888-7777.

The password is good for 24 hours only. 2. Once you have your ESS username and password, log on to ecwl.fa.us2.oraclecloud.com. 3. Select the orange Benefits icon 4. Select the View current and Future Benefits Icon 5. Your current coverage will appear6. To confirm coverage for 2020, change the Effective Date in the top left corner to 1/1/2020

Enrolling/Updating Benefit Elections on ESSYour benefit elections and/or updates are completed online through ESS.

1. Contact the ClubCorp Help Desk to secure your Oracle HCM ESS username and temporary password by calling 972-888-7777. The password is good for 24 hours only.

2. Once you have your ESS username and password, log on to ecwl.fa.us2.oraclecloud.com. 3. Select the orange Benefits icon 4. From the Benefits page, select “Change Benefit Elections” 5. Add your dependent(s) and/or beneficiary(ies) on the Contacts page 6. Once you have entered your Contacts (if any), select Continue (top right hand corner of the screen) 7. On the Authorization page, click “Accept” to accept the authorization. If you do not accept, you will not be able to enroll. 8. You will be guided through all of the benefits for which you are eligible. 9. Once you have completed your enrollment, click “Submit.” If you do not select Submit, you will not be



Documents

OPEN ENROLLMENT 2020 · Vision Plan Overview Page 6 ... Club Corp is partnering with WebTPA and the Aetna Signature Administrators network to provide comprehensive medical coverage