· Table of Contents Choosing & Using Your Benefits Your To Do List 2 Online Enrollment Instructions 3 Benefit Highlights & What’s New 9 Who is Eligible 11 Making Changes 13 Choosi

2019 Employee Benefits Health. Finance. Work-Life Wellness.

Table of Contents

Choosing & Using Your Benefits

Your To Do List 2 Online Enrollment Instructions 3 Benefit Highlights & What’s New 9 Who is Eligible 11 Making Changes 13 Choosing Your Care 15 Save the ER for Emergencies 17 Financial Benefits

Flex Spending Account 31 Protecting Your Income

…for Loved Ones – Life Insurance 37 …for You – Disability Insurance 39 Additional Benefits 41

Work/Life Balance Benefits

Employee Assistance Program 41 Wellness Incentive 41

Health Benefits

Medical, Rx & Critical Illness 24 Accident Insurance 25 Dental 33 Vision 35

Resources

Damar Wellness Incentive Form 43 Damar Spousal Questionnaire 44 Annual Notices 49

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Your To Do List The following checklist will walk you through all steps required to enroll in your benefits for the plan year October 22, 2018 to November 2, 2018.

Educate Yourself to Make the Best Decision

□ Review your health care costsfrom last year and estimate yourpersonal and family health careneeds for this year.

□ Learn your 2019 benefit options:1. Read this Benefit Guide2. Attend one of Damar’s Open

Enrollment meetingscheduled for:• Tuesday October 16th,

11:00 a.m. – 12:00 p.m.• Tuesday, October 16th,

3:00 – 4:00 p.m.• Thursday October 18th,

11:00 a.m. – 12:00 p.m.• Thursday October 18th,

3:00 – 4:00 p.m.

□ Make the following decisions:1. Who will you cover this year?2. What plans will you elect?3. Will you contribute to a Flex

Spending Account (FSA); if sohow much?

4. Will you make changes toyour retirement contribution?

Enroll in Your Benefits

Current Employees: Complete during Open Enrollment: October 22nd – November 2nd, 2018.

New Hires: Complete any time during your first 30 days of employment.

□ Make sure you have your (andyour qualified dependents’)birthdate(s), address(es) and SocialSecurity Number(s) on hand.

□ Go to the Paycor BenefitsEnrollment Screen to begin theenrollment process. (See OnlineEnrollment Instructions on thefollowing page.)

□ Review your existing coverageand/or select new coverage.

□ Confirm your personal andqualified dependents’ info.

□ Update beneficiaries (if applicable).

□ Complete all necessary formsand/or additional setup steps:1. Spousal Questionnaire2. FSA Enrollment Forms (if

applicable)3. Provide Proof of Dependent

Eligibility to HR

□ Print and save a copy of yourenrollment for your records.

Remember these Last Steps AFTER Enrollment is Complete

□ You can make changes to yourelections only during yourenrollment period. Make sure youhave chosen appropriately as youwill not be able to make changesuntil next year’s Open EnrollmentOR unless you experience aqualifying event (see the MakingChanges section in this guide).

□ A couple weeks after enrollment,look for new insurance cards inthe mail.

□ Once the plan year begins, reviewyour paycheck. If you noticeerrors in your payroll deductions,notify HR immediately!

□ Provide your new insurancecard(s) to your health careproviders after the start of theplan year.

□ Review the Choosing Your Caresection of this guide to make sureyou are using your health plan toits fullest potential.

PREPARE ENROLL LAUNCH

2

Online Enrollment InstructionsDuring a benefit elections enrollment, you are given the opportunity to update your dependents, beneficiaries and benefit elections offered through Damar. When navigating through each benefit enrollment screen, you will need to read the instructions on each screen carefully.

To access an enrollment event, you may do the following: 1. Sign in through www.paycor.com; then hover over Me and select, “Profile Summary”.2. Open the Company menu on the left and select “Benefit Elections”.3. Your current enrolled, waived, and past benefit elections will be displayed here.4. If there is an enrollment in progress, click the link at the top of the screen.5. This will open your enrollment event. Proceed through each of the screens.

The benefits enrollment process also collects any changes that you may need to make to your personal (general), dependent and beneficiary information. Any changes made in these screens will be updated upon the closing of an enrollment event. Any changes made to benefit enrollments will be effective when the benefit plan(s) go into effect.

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http://www.paycor.com/

Personal Information Verify your personal information.

Click to return to the previous page (without saving changes), when ready to continue or to save changes so you can complete the enrollment later. To navigate within the enrollment event, click on any of the blue tabs to the left of your screen.

NOTE: If you have personal information that needs to be updated before the end of the enrollment event period, you should make sure to alert Human Resources of those changes.

Dependents Verify/update any dependent information.

Dependents can be added by clicking Add Dependent. Dependents entered on this page can be enrolled in benefits later during this enrollment event. If you are planning on adding a dependent to any benefit plans, you must add them on this page first.

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Reminder: Dependent documentation MUST be provided to Human Resources by November 2nd at 5 pm to ensure coverage. This includes the Spousal Questionnaire and proof of eligibility (i.e., birth certificate, proof of full-time student status, Social Security card, marriage certificate) for all enrolled dependents.

Click to return to the previous page (without saving changes). when ready to continue or to save changes so you can complete the enrollment later.

Beneficiaries Verify/update any beneficiary information.

Beneficiaries can be added by clicking Add Beneficiary. Beneficiaries entered on this page can be attached to benefits later during this enrollment event. If you are planning on assigning beneficiaries to any benefit plans, you must add them on this page first.

Click to return to the previous page (without saving changes). when ready to continue or to save changes to complete the open enrollment later. To navigate within the open enrollment, click on any of the blue tabs to the left of the open enrollment screen.

5

Benefit Plans Indicate your elections for the benefit plans included in this enrollment event.

If you have a choice between various benefit plans, all the plans in that type will appear on the same page. In this example, there are two medical plans available: A Basic and a High Deductible. Information about the plan provider can be found within the gray boxes to the right of the plan. Select the coverage level/volume within the plan in which you wish to enroll.

If the plan allows dependents to be enrolled (such as with most medical plans), any dependents provided earlier on the Dependents page or that already existed in the system are now available for you to enroll. Select the checkbox next to the dependents you want to enroll.

Click to return to the previous page (without saving changes). when ready to continue or to save changes so you can complete the enrollment later.

6

Summary Review your changes and elections; then, click the Print Summary button to print this screen for your records.

Once you are finished verifying/updating your information, click from the last page of the enrollment event to save and submit your elections/changes. Important Reminder: Your enrollment is not complete until you Save/Submit.

Click to return to the other enrollment screens. You can return to this page at any time by going to Me>Profile Summary>Company>Benefit Elections. You can restart the enrollment event process any time before the

enrollment period closes. However, you MUST click the button to submit your election choices to your Human Resources administrator for approval.

If you reopen your enrollment but fail to Save/Submit, you have not completed your enrollment.

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Email Notification (approval)

Once your enrollment elections/changes have been approved by Human Resources, you will receive an email notifying you of the approval. Follow the link included with the email to return your enrollment confirmation page.

Email Notification (Action Required): If further action is required before Human Resources can approve your elections/changes, you may receive an “Action Required” email that includes specific instructions from Human Resources. Please follow the link included with the email to return to the first page of the enrollment event.

Once all changes have been made, click Save/Submit.

To complete enrollment, all changes must be made, and all required documentation must be received and submitted by November 2nd at 5 p.m.

8

Benefit Highlights & What’s New At Damar, we work hard to offer you a competitive and comprehensive benefits package as part of your total rewards. Our hope is that these benefits will help you and your family fully realize your health, finance and work-life balance goals.

See below for a quick glance at your benefit options. Pre-tax benefits are not subject to Social Security withholding, federal, most state and local income taxes. This helps save you money!

Benefit Carrier Company Contribution Tax Treatment Medical/Prescription Coverage Anthem You & Damar

share the cost Pre-Tax

Dental Coverage Delta Dental You pay 100% Pre-Tax

Vision Coverage VSP You pay 100% Pre-Tax

Basic Term Life and AD&D Sun Life Damar pays 100% Not Applicable

Short Term Disability Sun Life You pay 100% Post-Tax

Long Term Disability Sun Life

Damar pays 100% of the cost for the Base plan

You pay 100% of the cost for the Buy-up plan

Post-Tax

Optional Life Insurance and AD&D Sun Life You pay 100% Post-Tax

Medical Flexible Spending Account Discovery Benefits You pay 100% Pre-Tax

Dependent Care Flexible Spending Account Discovery Benefits You pay 100% Pre-Tax

Critical Illness & Accident Boston Mutual You Pay 100% Post-Tax

If you enroll during Open Enrollment, the benefits discussed in this guide will be effective starting January 1, 2019.

If you are newly hired or you newly qualify for our benefits you have 30 days from date of hire/eligibility to enroll, and your benefits will go into effect on the first of the month following your date of hire/eligibility.

At-A-Glance

Coverage Begins

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For most benefits, your coverage will end on the last day of the month in which:

• Your regular work schedule is reduced to under 30 hours per week;• Your employment with Damar ends due to resignation, termination

or death; or• You stop paying your premiums.

For your dependent(s), coverage ends: • When your coverage ends or• The last day of the month the dependent child(ren) turns 26 for

Medical; 19, (up to age 24 if full-time student) for Dental and Vision;19 (up to age 26) for Voluntary Dependent Life.

Please note the following regarding our benefits package commencing January 1, 2019:

• No changes to your Benefit plans• Rates are the same as previous year• New Vendor for the Flexible Spending plans – Discovery Benefits replaces Nyhart• Now offering Critical Illness Insurance• Now offering Improved Accident Insurance

Coverage Ends

New This Year

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Want to enroll in

your spouse’s plan

instead of ours?

Who is Eligible Before you decide what plans you want to elect, it helps to know who qualifies to receive our benefits. First, let’s look at some definitions of who is eligible for what.

Definitions Benefits Available…

Medical Rx Dental Vision Life Disability

Employee (EE)

As an employee of Damar, you can enroll in our employee benefits if: • You are actively a full-time

employee and/or• You are regularly scheduled to

work 30 hours a week ormore.

Spouse (SP)

Spouses eligible to enroll include: • Legal Spouse (either opposite-

sex or same-sex, legallymarried in one of the 50states, the District ofColumbia, a US territory or aforeign country)

X Child(ren) (CH)

Dependent Children are eligible to enroll if they are under age 26 for Medical (age 19 or 24 if full-time student for Vision & Dental; Voluntary Life age 19, 26 if full-time student) and are one of the following (for you and/or your SP/DP): • Biological child• Adopted or placed for

adoption• Step-children• Under legal guardianship• Any of the above at ANY age

who is legally dependent onyou due to a physical ormental disability

X

That’s a-ok! Just be aware that his or her employer may have a restriction or extra charge if you’re able to get coverage elsewhere. We offer you qualified coverage, so you might be excluded or charged extra.

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Now that you know who in your family is eligible, it’s time to determine what tier (or level) you will elect. Your options are below:

Working Spouse Rule

Is your spouse currently employed? Does his or her employer offer health coverage? If yes, your spouse is not allowed to enroll in Damar’s medical benefit.

This rule is meant to encourage all individuals to take the benefits offered by their own employer. However, if your spouse is unemployed, does not have other coverage or is covered by Medicare/Medicaid, this rule does not apply. To prove your spouse’s eligibility, you will need to complete the Spousal Questionnaire included in your Enrollment Packet (or see HR).

EE Only Elect this if you wish

to cover only yourself.

EE + SP This tier covers you and your spouse.

BUT…see Working Spouse Rule below.

EE + CH This tier covers you and

your dependent child(ren). No spousal coverage!

Family This tier covers you, your spouse

AND child(ren). See Working Spouse Rule below.

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Wondering what’s required when you experience a qualifying life event?

You will need to let Human Resources know in writing within 30 days of the event to make any changes necessary. Also, you will need to provide the required documentation. This includes:

• Proof of dependent relationship(marriage certificate, birth certificate,etc.)

• Any enrollment forms that may berequired

• Spousal Questionnaire

Making Changes Open Enrollment season is a vital time of year for you and your employer. Because of IRS regulations, it is typically the only time during the year in which you can make changes to your benefit choices, such as adding or dropping coverage, adding or dropping dependents or enrolling in benefits for the first time.

Missing this vital deadline can mean losing coverage and/or being unable to change benefit elections until you experience a Qualifying Life Event.

Qualifying Life Events are defined by the IRS. Examples include but are not limited to:

Change in Marital Status • Marriage• Divorce• Legal separation

Change in Number of Dependents • Birth• Adoption• Assumption of legal guardianship• Death• Child/spouse no longer eligible

Change in Employment Status Resulting in gain/loss of coverage for you OR your spouse • Transition from part time to full time

(or vice versa)• Resignation or termination• New hire• Spouse’s employer terminates health

plan

Court Ordered Coverage Required coverage of a child by you OR your spouse • Qualified Medical Child Support Order

(QMCSO)

Documentation Required

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If you do not enroll during Open Enrollment (or your new hire enrollment period) … • You will not have Damar coverage for the remainder of the plan year unless you experience a qualifying life event.• You will not be enrolled in the Flex Spending Account Plan(s) for 2019. Participation and pre-tax contributions

require enrollment every year.

What is Damar legally required to do? Legally, employers are not required to do anything for employees who have missed the Open Enrollment deadline. In fact, the terms of Damar’s benefit plans prohibit them from making exceptions for those employees who do not make benefit elections within a certain time period. BE PREPARED. The open enrollment process relies on you, the employee, to take action.

How does Damar Help Employees with Open Enrollment? To ensure employees can make the most out of the Open Enrollment period and the benefits Damar provides, we implement the following strategies:

Opportunities for Education

Damar offers education to you prior and during the Open Enrollment period to help alleviate some of the confusion you may face. Utilize the tools in this guide AND mark your calendars for our Open Enrollment Meeting for an in-person walk through of your benefits:

• October 16, 2018 or October 18, 2018• Times: 11:00 a.m. to 12:00 p.m. and 3:00 to 4:00 p.m.

Have Specific Questions about Open Enrollment?

If you have enrollment/benefit questions that are NOT answered by this guide or other resources provided, please do not hesitate to reach out to Human Resources. TODAY! We would rather have the conversation with you before it’s too late. Missing your enrollment period severely limits and might even restrict our ability to help.

if I

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Choosing Your Care: Bang for Your Buck! We’ve all been there. Everything is going according to plan until life happens, and you or a family member is accosted by an unexpected illness or injury. In the panic and worry that follows, the only thing that comes to mind is doing whatever it takes to feel better—and fast! That panic can lead to a rush to get care without making an informed decision.

Educate yourself now when there is no urgent need! Making the wrong choice can result in delayed medical attention and may cost hundreds, if not thousands, of extra dollars. If you’re faced with a sudden illness or injury, ask yourself:

What kind of care do I need? • Routine? (visit to doctor’s office)• Urgent? (care that can’t wait but

isn’t life-threatening)• Emergency? (life-threatening

need that requires immediatecare)

How much money am I willing to spend to get that care? If you have a life-threatening need, go to the ER. But if it’s not life-threatening, would you rather find care that will cost less?

How convenient must my care be? Maybe the ER is easier to find. Maybe you’re used to a certain doctor. But if it’s not an emergency, are you willing to go an extra mile to save substantial amounts of money?

After you’ve thought this through, decide which provider’s “door” you want to use:

If you’re not experiencing a life-threatening emergency, consider calling Anthem’s FREE 24-hour Nurse Line! You will speak directly to a registered nurse who can help answer your medical-related questions. The call is toll-free, confidential and the service is available anytime. Call 1.888.279.5449.

REMEMBER: While some options may be more cost-effective, they are not a substitute for emergency care. If it’s an emergency, go to the ER!

Summaries above are generalizations; costs & convenience may vary.

Cut off your arm?

Equipped to handle life-threatening

injuries, illnesses and other medical

conditions

TYPE OF CARE: Emergency COST: $$$$$$$$$$$$ CONVENIENCE: Easy to find; long waits

EMERGENCY ROOM URGENT CARE DOCTOR’S OFFICE ANTHEM LIVE HEALTH ONLINE

Broke your toe?

Equipped to handle urgent

injuries, illnesses and other medical

conditions

TYPE OF CARE: Urgent COST: $$$$$$$ CONVENIENCE: Requires looking for facility

Sinus infection?

Equipped to handle routine

issues that can be treated at home

until appointment

TYPE OF CARE: Routine COST: $$$$ CONVENIENCE: Familiar; requires wait for availability

Common cold?

Equipped to handle routine issues but does

not require leaving the home

to receive care

TYPE OF CARE: Routine COST: $$$$ CONVENIENCE: Skype or FaceTime IN-HOME OPTION

Not sure

where to go?

15

Working with a doctor who has requested lab work or X-rays or some outpatient procedure? Usually your doctor will recommend a place. Did you know that you do NOT have to go where your doctor refers you?

Why not shop for health care procedures the way you do for a new TV or a new car? Doing some research to find out the cost and quality of care for the same procedure at various locations can be a HUGE money saver!

Not sure what type of illnesses and injuries are classified as emergencies, urgent needs and/or routine care? This is not an all-inclusive “key,” but it should help give you an idea. Again, if you have any question, assume it’s an emergency. If it’s not life-threatening, try calling the Nurse Line for further guidance (XXX-XXX-XXXX).

EMERGENCIES • Compound fractures• Deep knife or gunshot wounds• Moderate to severe burns• Poisoning or suspected poisoning• Seizures or loss of consciousness• Serious head, neck or back injuries• Severe abdominal pain• Severe chest pain or difficulty

breathing• Signs of a heart attack or stroke• Suicidal or homicidal feelings• Uncontrollable bleeding

URGENT NEEDS • Controlled bleeding or cuts that

require stitches• Ear infections• High fever or the flu• Minor broken bones (e.g. toes,

fingers)• Severe sore throat or cough• Sprains or strains• Skin rashes and infections• Urinary tract infections• Vomiting, diarrhea or dehydration

ROUTINE NEEDS • Minor cuts and sprains• Most fevers (<102º)• Headache• Sore throat• Upper respiratory infection• Common back and neck

pain

Did you know that some health care providers are not In-Network providers?

To get the most bang for your buck when seeking unexpected or planned care, you want to make sure you go to an in-network provider! While these providers aren’t always as easy to identify as the color-coded images below, it’s fairly easy to determine. You can find a list of in-network providers by going to your medical, dental and/or vision carrier’s website, by calling the number on the back of your insurance card.

You can also call and ask your doctor! The benefits of seeking in-network care (instead of out-of-network) include less cost for service, no chance for billing you the balance of what your insurer does not pay and no chance of having to fill out additional claims paperwork. Less money and less stress? It’s the way to go!

Shop for Planned Care

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Save the ER for Emergencies A Message from Anthem

Going to the emergency room (ER) or calling 9-1-1 is always the way to go when it’s an emergency. And we’ve got you covered for those situations.

If you need care but it’s not an emergency, try these other options. You can avoid a long wait and the higher costs that come with a non-emergency ER visit.

Call your doctor. Your doctor may be the right place to start. After all, your doctor knows your story. You can make an appointment or speak to an on-call doctor.

Visit a retail health clinic. Consider this when you have a rash, minor burns, cough, sore throat, minor allergic reactions, bumps, cuts, and scrapes, or when you need shots. Hours of operation vary.

Head to urgent care. This may be the right choice when you have back and joint pain, cough/cold, sinus or ear pain, sprains and strains, or even need x-rays. Flexible hours, including nights and weekends.

Check in at LiveHealth Online. Visit with a doctor 24/7 online when you have a common health condition. Sign up at livehealthonline.com or on the mobile app.

We know there are situations when the ER is the only option, so we’re including exceptions: members under the age of 14, ER visits directed by your doctor, ER visits between 8:00 p.m. Saturday and 8:00 a.m. Monday, or when the closest urgent care is more than 15 miles from your home.

Your plan isn’t changing, but on January 1, 2019, you may be responsible for ER costs when it’s not an emergency.

Want to know more? Go to anthem.com/urgentcare to search for care options near you or call our 24/7 Nurseline on the back of your member ID card.

Questions? We are here to help, so give us a call at the Member Services number on your ID card. You can also visit our blog at or log in to anthem.com for a closer look at your benefits.

Anthem Blue Cross and Blue Shield is the trade name of Anthem Insurance Companies, Inc. Independent licensee of the Blue Cross and Blue Shield Association. ANTHEM is a registered trademark of Anthem Insurance Companies, Inc.

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34

17

What should you do when you need care right away, but it’s not an emergency?

The emergency room (ER) might be your fi rst choice, but you also have options that cost less and are quicker than the ER. Learn more about these choices and how to fi nd care.

First call your primary care doctor

This is the doctor you see for most of your care. When you call your doctor, he or she will tell you if you should make an appointment with the doctor, go to the ER or choose another place to get care. Your doctor may even be able to give you advice on the phone or see you later in the day or on the weekend.

But when you can’t see your doctor or if your doctor’s offi ce is closed, choose an option below. It often takes less time than the ER and costs about the same as a doctor visit. Plus, most are open weeknights and weekends.

Choose an option that could save time and money

Retail health clinic — A clinic staffed by health care experts who give basic health care services to walk-in patients. It’s usually in a major pharmacy or retail store.

Walk-in doctor’s offi ce — A doctor’s offi ce that doesn’t require you to be an existing patient or have an appointment. Can handle routine care and common illnesses.

Urgent care center — A center with doctors who treat conditionsthat should be looked at right away but aren’t as severe as emergencies. Can often do X-rays, lab tests and stitches.

LiveHealth Online — This online tool lets you video chat with a board-certifi ed doctor who can answer questions and diagnose many common problems, including sore throats, infections and the fl u. You can use your computer’s webcam, a smartphone or a tablet without an appointment or waiting. Enroll at livehealthonline.com or on the LiveHealth Online iOS or Android app.

Pick a care facility and call before you go

Ask:

What are your hours?

Tell them what has happened (for example, “I have a cut”).Then ask, “Do you have services that I need?”

What age range do you treat?

Are you a provider who is part of my health plan network?

Do you accept my health insurance?

What you pay for a visit

Care facility CostER

Retail health clinic

Walk-in doctor’s offi ce

Urgent care center

LiveHealth Online

When to use the ER

Always call 911 or go to the ER if you think you could put your health at serious risk by delaying care.

Be prepared now?

Where to get care when you need it now

See the other side for examples of when to go to the ER and when to consider other options. 235433CAMENABC Rev. 09/14

30% coinsurance

$20 copay

$30 coinsurance

50% coinsurance

$49 or less

Learn more at anthem.com/ca for:

Urgent care that’s not an emergency — Go toanthem.com/ca/f ndurgentcarei . You can even take aquiz to learn how to save time and money.

Places to get care other than the ER — Go toanthem.com/ca and select Find Urgent Care. ChooseSearch for Urgent Care and enter the information tof nd a facility near you.i

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Deciding where to go

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Retail health clinic Physician assistant or nurse practitioner • • • • • • • • •

Walk-in doctor’s offi ce Family practice doctor • • • • • • • • • • • • •

Urgent care center

Internal medicine, family practice, pediatric and ER doctors

• • • • • • • • • • • • • • • • •LiveHealth Online Board-certifi ed

doctor • • • • • • • •When to go to the ER Some examples of ER medical emergencies are:

Any life-threatening or disabling condition Severe shortness of breath Cut or wound that won’t stop bleeding

Sudden or unexplained loss of consciousnessHigh fever with stiff neck, mental confusion or diffi culty breathing

Major injuries

Chest pain; numbness in the face, arm or leg; diffi culty speaking

Coughing up or vomiting blood Possible broken bones

Options have different services and costs. Call and ask before you go. Remember you have choices. If it’s not an emergency, call your doctor fi rst or the 24/7 NurseLine. The phone number is on your ID card. The nurse on the phone can help you decide what to do next.

If you are an HMO member, you should call your primary care doctor’s offi ce or medical group to fi nd out your choices for urgent care.

When you need care, the ER doesn’t always have to be your fi rst choice

Here are the top 10 reasons why members go to the ER when it’s usually not necessary:*

1. Minor headache 6. Dizziness

2. Urinary tract infection 7. Migraine

3. Flu 8. Bronchitis

4. Common cold 9. Lower-back pain

5. Nausea with vomiting 10. Minor head injury

* Internal claims analysis.

If you get care from a provider that is NOT part of your health plan network, you may have signif cantly higher out-of-pocket costs. i

LiveHealth Online is the trade name of Health Management Corporation, a separate company providing telehealth services on behalf of Anthem Blue Cross.

Anthem Blue Cross is the trade name of Blue Cross of California. Anthem Blue Cross and Anthem Blue Cross Life and Health Insurance Company are independent licensees of the Blue Cross Association. ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. The Blue Cross name and symbol are registered marks of the Blue Cross Association.

Remember, if it’s serious, sudden or severe, go to the ER. If it’s minor, mild or moderate, try an urgent care center, retail health clinic, or walk-in doctor’s off ce to save time and money. i Be ready for whatever comes your way. Learn more at anthem.com/ca/f ndurgentcarei .

$20 copay

$30 coinsurance

50% coinsurance

$49 or less

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LiveHealth Online Quick and easy access to a doctor 24/7

LiveHealth Online Psychology An easy, convenient way to see a therapist or psychologist in just a few days

If you’re feeling stressed, worried, or having a tough time, you can

talk to a licensed psychologist or therapist through video using

LiveHealth Online Psychology. It’s easy to use, private and, in most

cases, you can see a therapist within four days or less.3 All you

have to do is sign up at livehealthonline.com or download the app

to get started. The cost is similar to what you’d pay for an office

therapy visit.

Make your first appointment — when it’s easy for you

}} Use the app or go to livehealthonline.com and log in. Select

LiveHealth Online Psychology and choose the therapist

you’d like to see.

}} Or, call LiveHealth Online at 1-844-784-8409 from 7 a.m.

to 11 p.m.

}} You’ll get an email confirming your appointment.

Have you ever been at work and didn’t feel well? Maybe you had a fever or a sore throat but you didn’t have time to leave and see your doctor or go to urgent care. Now, with LiveHealth Online, you can see a board-certified doctor in minutes.

57980ANMENABS VPOD 12/15

Just use your smartphone, tablet or computer with a webcam. It’s so convenient, almost 90% of people who’ve used it feel they saved two hours or more and would use it again in the future.1 Plus, online visits using LiveHealth Online are already part of your Anthem Blue Cross and Blue Shield benef ts.i To start using LiveHealth Online, all you need to do is sign up at livehealthonline.com or download the app.

Sign up for free today and get:

1. 24/7 access to doctors. They can assess your condition,provide treatment options and even send a prescription tothe pharmacy of your choice, if needed.2 It’s a great way toget care when your doctor isn’t available.

2. Medical care when you need it. For things like the f u, alcold, sinus infection, pink eye, rashes, fever and more.

3. Convenience. Since there are no appointments or longwaits. In fact, most people are connected to a doctor inabout 10 minutes or less.

Doctors using LiveHealth Online typically charge $49 or less per visit, depending on your health plan.

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LiveHealth Online: what you need to know

What kind of doctors can you see on LiveHealth Online?

Doctors on LiveHealth Online are:

}} Board certified with an average of 15 years of practicing medicine

}} Mainly primary care physicians

}} Specially trained for online visits

When can you use LiveHealth Online?

LiveHealth Online is a great option for care when your own doctor isn’t available and more convenient than a trip to the urgent care. With LiveHealth Online, you can receive medical care for things like:

}} Cold and flu symptoms, such as a cough, fever and headaches

}} Allergies

}} Sinus infections and more

How do I pay for an online visit using LiveHealth Online?

LiveHealth Online accepts Visa, MasterCard and Discover cards as payment for an online doctor visit. Keep in mind that charges for prescriptions aren’t included in the cost of your doctor visit.

LiveHealth Online Psychology

What conditions can be treated when you have a visit with a psychologist or therapist?

You can get help for these types of conditions:

}} Stress

}} Anxiety

}} Depression

}} Family or relationship issues

}} Grief

}} Panic attacks

}} Stress from coping with a sickness

How much does a therapist visit cost?

The cost should be similar to what you’d pay for an office therapy visit, depending on your benefits, copay or coinsurance. You’ll see what you owe before you start a visit and any cost is charged to your credit card. The cost is the same no matter when you have the visit — whether it’s a weekday, the weekend, evening or a holiday.

How do I decide which therapist to see?

After you log in at livehealthonline.com or with the app, select LiveHealth Online Psychology. Next, you can read profiles of therapists and psychologists. Once you select the one you would like to see, schedule a visit online or by phone. At the end of the first visit, you can set up future visits with the same therapist if both of you feel it’s needed. You always have the choice of the therapist you want to see.

What else do I need to know about LiveHealth Online Psychology?

}} You must be at least 18 years old to see a therapist online and have your own LiveHealth Online account.

}} Psychologists and therapists using LiveHealth Online do not prescribe medications.

}} Visits usually last about 45 minutes.

Get started today

It’s quick and easy to sign up for LiveHealth Online. Just go to livehealthonline.com or download the mobile app at Google PlayTM or the App StoreSM.

LiveHealth Online is the trade name of Health Management Corporation, a separate company providing telehealth services on behalf of Anthem Blue Cross and Blue Shield.

Online counseling is not appropriate for all kinds of problems. If you are in crisis or have suicidal thoughts, it’s important that you seek help immediately. Please call 1-800-784-2433 (National Suicide Prevention Lifeline) or 911 and ask for help. If your issue is an emergency, call 911 or go to your nearest emergency room. LiveHealth Online does not offer emergency services.

1 LiveHealth Online user feedback survey, May 2015. 2 Prescription availability is def ned by physician judgment and state regulations. LiveHealth Online is available in most states and is expected to grow more in the near future. i Please visit the map at livehealthonline.com for more details. 3 Appointments subject to availability of a therapist.

Anthem Blue Cross and Blue Shield is the trade name of: In Colorado: Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc. In Connecticut: Anthem Health Plans, Inc. In Indiana: Anthem Insurance Companies, Inc. In Kentucky: Anthem Health Plans of Kentucky, Inc. In Maine: Anthem Health Plans of Maine, Inc. In Missouri (excluding 30 counties in the Kansas City area): RightCHOICE® Managed Care, Inc. (RIT), Healthy Alliance® Life Insurance Company (HALIC), and HMO Missouri, Inc. RIT and certain aff liates administer non-HMO benef ts underwritten by HALIC and HMO benef ts underwritten by HMO Missouri, Inc. RIT and certain aff liates only provide administrative services for self-iiiifunded plans and do not underwrite benef ts. In Nevada: Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc., dba HMO Nevada. In Newi Hampshire: Anthem Health Plans of New Hampshire, Inc.; HMO plans administered by Anthem Health Plans of New Hampshire, Inc. and underwritten by Matthew Thornton Health Plan, Inc. In Ohio: Community Insurance Company. In Virginia: Anthem Health Plans of Virginia, Inc. trades as Anthem Blue Cross and Blue Shield in Virginia, and its service area is all of Virginia except for the City of Fairfax, the Town of Vienna, and the area east of State Route 123. In Wisconsin: Blue Cross Blue Shield of Wisconsin (BCBSWi), which underwrites or administers the PPO and indemnity policies; Compcare Health Services Insurance Corporation (Compcare), which underwrites or administers the HMO policies; and Compcare and BCBSWi collectively, which underwrite or administer the POS policies. Independent licensees of the Blue Cross and Blue Shield Association. ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association.

21

They can also:}} Help you find providers and specialists in your area.

}} Give you referrals to LiveHealth Online, a tool that allows you to have live video chats with board-certified doctors using a smartphone, tablet or computer and webcam.*

}} Enroll you and your dependents in valuable health management programs for certain health conditions.

}} Remind you about scheduling important screenings and exams, including dental and vision checkups.

}} Provide guidance during natural catastrophes and health outbreaks.

}} Offer links to health-related educational videos or audio topics.

Get round-the-clock peace of mind

*Prescription availability is defined by physician judgment and state regulations. LiveHealth Online is available in most states and is expected to expand to more in the near future. Visit the home page of livehealthonline.com to view the service map by state.

24/7 NurseLine has you covered anytime, anywhere

Got health questions? Answers are at your f ngertips. i

Add 800-337-4770 to your contacts today!

Anthem Blue Cross and Blue Shield is the trade name of Anthem Insurance Companies, Inc. Independent licensee of the Blue Cross and Blue Shield Association. ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association.

MINSH1301A VPOD Rev. 10/15

Whether it’s 3 a.m. or a lazy Sunday afternoon with the family, health issues can crop up at the most inconvenient times and places.

What if you had a nurse in your back pocket — someone knowledgeable you could talk to any time of the day or night, 365 days a year?

That’s why Anthem Blue Cross and Blue Shield (Anthem) offers 24/7 NurseLine, a resource you call when life throws you a curve ball.

While 24/7 NurseLine may be your f rst line of defense for the unexpected,i it’s also part of Anthem’s whole-health approach. The registered nurses can help you with your baby’s fever, give you allergy relief tips and advise you where to go for care.

24/7 NurseLine can connect you to Anthem’s other health and wellness programs, so you have access to the best resources for the best health results.

LiveHealth Online is the trade name of Health Management Corporation, a separate company, providing telehealth services on behalf of Anthem Blue Cross and Blue Shield.

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} A toll-free number so you can talk to a nurse coach 24/7 about your pregnancy. A nurse may also call you from time to time to see how you’re doing.

} The Mayo Clinic Guide to a Healthy Pregnancy book that shows changes you can expect for you and your baby during the next nine months.

} A screening to check your health risk for depression or early delivery.

} Other useful tools to help you, your doctor and your Future Moms nurse keep track of your pregnancy and help you make healthier choices.

} Free phone calls with pharmacists, nutritionists and other specialists, if needed.

} A booklet with tips to help keep you and your new baby safe and well.

} Other helpful information on labor and delivery, including options and how to prepare.

Visit with a lactation consultant online

Nine months. Many questions.

It’s easy to join

Once your baby is born, get lactation support with LiveHealth Online.

Future Moms can help — any time, any day

Ever wish you had a go-to source for all of your questions about pregnancy? Now, you do. Future Moms is a program that can answer your questions, help you make good choices and follow your health care provider’s plan of care. And it can help you have a safe delivery and a healthy child.

Sign up as soon as you know you’re pregnant. Just call us toll free at 800-828-5891. One of our registered nurses will help you get started. You’ll get:

Using Future Moms with Breastfeeding Support on LiveHealth Online, you can make appointments for free video visits with a certif edi lactation consultant, counselor or registered dietitian at no extra cost to you! These professionals can provide personalized support to help you with breastfeeding techniques, learn about milk production, baby hunger cues, foods to avoid, nutrition while breastfeeding and more.

Sign up for Future Moms by calling us toll free at 800-828-5891. There’s no extra cost to you.

Sign up now for livehealthonline.com or use the free mobile app and enter your health plan information. Once you’ve created an account, select Future Moms with Breastfeeding Support to view the available lactation consultants, counselors and registered dietitians. Appointments are available 7 days a week and evenings, too. Schedule your appointment at any time by logging in to LiveHealth Online.

Anthem Blue Cross and Blue Shield is the trade name of: In Colorado: Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc. In Connecticut: Anthem Health Plans, Inc. In Indiana: Anthem Insurance Companies, Inc. In Kentucky: Anthem Health Plans of Kentucky, Inc. In Maine: Anthem Health Plans of Maine, Inc. In Missouri (excluding 30 counties in the Kansas City area): RightCHOICE® Managed Care, Inc. (RIT), Healthy Alliance® Life Insurance Company (HALIC), and HMO Missouri, Inc. RIT and certain aff liates administer non-HMO benef tsii underwritten by HALIC and HMO benef ts underwritten by HMO Missouri, Inc. RIT and certain aff liates only provide administrative services for self-funded plans and do not underwrite benef ts. In Nevada: Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado,iii Inc., dba HMO Nevada. In New Hampshire: Anthem Health Plans of New Hampshire, Inc.; HMO plans are administered by Anthem Health Plans of New Hampshire, Inc. and underwritten by Matthew Thornton Health Plan, Inc. In Ohio: Community Insurance Company. In Virginia: Anthem Health Plans of Virginia, Inc. trades as Anthem Blue Cross and Blue Shield in Virginia, and its service area is all of Virginia except for the City of Fairfax, the Town of Vienna, and the area east of State Route 123. In Wisconsin: Blue Cross Blue Shield of Wisconsin (BCBSWi), underwrites or administers PPO and indemnity policies and underwrites the out of network benef ts in POS policies offered by Compcare Health Services Insurance Corporation (Compcare) or Wisconsin Collaborative Insurance Corporation (WCIC). Compcare underwrites or administers HMO or POS policies; WCIC underwrites or administers WelliPriority HMO or POS policies. Independent licensees of the Blue Cross and Blue Shield Association. ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association.

62150ANMENANS VPOD Rev. 8/16 23

Medical, Rx and Critical Illness Damar provides two plan options to you through Anthem. Details of the plans are as follows. These descriptions are only a summary. For full details, please refer to your plan documents. If discrepancies exist, plan documents prevail.

New for this year, Damar also offers a voluntary Critical Illness plan to help supplement your Medical plan. See page 25 for more information on this valuable coverage.

Standard Plan Premium Plan

Network In-Network Out-of-Network3 In-Network Out-of-Network3 Annual Deductible

Single $4,500 $9,000 $1,500 $3,000

Family1 $9,000 $18,000 $3,000 $6,000

Out-of-Pocket Maximum2 Single $6,600 $13,200 $5,000 $10,000

Family1 $13,200 $26,400 $10,000 $20,000

Other Costs Coinsurance Rate (You pay) 20% 50% 20% 50%

Account Attached to Plan4 FSA (Medical) FSA (Medical) Can Employee Contribute? Yes Yes

Max Total Contribution Allowed Per Year- Medical $2,500 $2,500

Account Funds Rollover Yes, up to $500 for the Medical FSA Yes, up to $500 for the Medical FSA

1. Family here is defined as Employee+Spouse, Employee+Child(ren) or Family. These employees also have what is called an“embedded individual deductible,” meaning if a single person in the family meets the individual deductible, insurance will kickin for that individual prior to the family deductible being met.

2. Out-of-pocket maximum includes the deductible and copays.3. Amounts ABOVE Reasonable and Customary charges are NOT applied to the deductible or out-of-pocket maximum.4. Read more about these accounts in the corresponding sections of this guide.

THOUGHT NUGGET: IN-NETWORK & OUT-OF-NETWORK TIERS

Here’s the good news: You can go to any provider you want to! The bad news? If you go to one that is not in the plan’s network, you will be paying more money for those services. Obviously, it’s better to find an in-network provider, and you can do so by going to www.anthem.com.

The tiers for each of our plans are broken down into two networks: Standard Plan Premium Plan

In-Network: Anthem Blue Access

Out-of-Network: More Expensive

In-Network: Anthem Blue Access

Out-of-Network: More Expensive

The Quick Glance

24

New: Critical Illness Insurance & Improved: Accident InsuranceAre you prepared to spin the wheel of misfortune? Statistics say—eventually—spin you will!

What happens if you, your spouse or your child has an accident or receives a diagnosis of a critical illness? Are you ready to take on the extra expense?

Would cash to help pay out-of-pocket costs in the case of a qualified accident or illness be a good benefit to have?

These policies supplement your medical and disability benefits. Read details below!

YOUR QUESTIONS OUR ANSWERS Critical Illness Accident

Carrier Boston Mutual Boston Mutual

How much coverage can I purchase?

Policy based on age and tobacco status. $5,000 - $50,000

Benefits include: Urgent Care/Physician/ER visits, hospital confinement, dislocation/

fractures & so much more!

What’s in it for me?

Cash benefit paid directly to you, regardless what medical insurance pays for a diagnosis

of cancer, heart attack, stroke and more!

Cash benefit paid directly to you, regardless what medical insurance pays

Who can be covered? 1 Employee, Spouse, Children to plan limits Employee only, Employee/Spouse,

Employee/Children & Family coverage available

Anything special? No medical questions to enroll this year

(Pre-existing condition limitations and 12-month cancer free limitation apply)

No medical questions to enroll Includes a Hospital Confinement benefit for sickness

Can I keep this coverage if I change jobs or retire? Yes! Yes!

Must hold policy for 30 days.

1. Critical Illness: Employee Policy Series WS-C1 4/12: 18 – 70+ years; Dependent, unmarried children 0-25 years.Spouse 18 – 69 yearsAccident WPS-ACC 07/15: Employee & Spouse 18+ years; Dependent, unmarried children 0-25 years.

THOUGHT NUGGET:

Did you know??? You can collect $50 per insured adult for having a covered routine health screening on both the Critical Illness AND the Accident plan…even if your medical insurance pays 100%!!

How do you get more information/enroll? Attend one of the Open Enrollment meetings on the 16th or 18th!!

Can’t attend? The Gregory & Appel call center will be open from October18th to October 25th Type the URL below into your computer browser to schedule an appointment

https://www.timetrade.com/book/G6Z1K

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https://www.timetrade.com/book/G6Z1K

The chart below diagrams your cost sharing responsibilities by the type of service you receive. Note that you have better coverage seeking in-network services than out-of-network services.

MEDICAL SERVICES Standard Plan Premium Plan

Network In-Network Out-of-Network In-Network Out-of-Network Office Visits

Routine Preventive Care 0% Deductible Waived Based on Location 0% Deductible

Waived 0% Deductible

Waived

Primary Care Physician $30 Copay 50% After Deductible $20 Copay 50% After Deductible

Specialist $50 Copay 50% After Deductible $30 Copay 50% After Deductible

Behavioral/Mental Health Therapy $30 Copay 50% After Deductible $20 Copay 50% After Deductible

More Serious Visits

Urgent Care Services $75 Copay 50% After Deductible $50 Copay 50% After Deductible

Emergency Room Services

$500 Copay per visit then 20% Paid as In-Network $500 Copay per visit

then 20% Paid as In-Network

Ambulance 20% After Deductible Paid as In-Network 20% After Deductible Paid as In-Network

Outpatient Care

Physician Fees1 20% After Deductible 50% After Deductible 20% After Deductible 50% After Deductible

Diagnostic Labs & X-rays (non-preventive) 20% After Deductible 50% After Deductible 20% After Deductible 50% After Deductible

MRI/CT/PET Scans 20% After Deductible 50% After Deductible 20% After Deductible 50% After Deductible

Outpatient Surgeries or Services1 20% After Deductible 50% After Deductible 20% After Deductible 50% After Deductible

Inpatient Care

Physician Fees1 20% After Deductible 50% After Deductible 20% After Deductible 50% After Deductible

Inpatient Hospitalizations1 20% After Deductible 50% After Deductible 20% After Deductible 50% After Deductible

Mental Health/ Substance Abuse Hospitalizations

20% After Deductible 50% After Deductible 20% After Deductible 50% After Deductible

Other Services

Home Health Care 20% After Deductible 50% After Deductible 20% After Deductible 50% After Deductible

Hospice 20% After Deductible 20% After Deductible 20% After Deductible 20% After Deductible

Durable Medical Equipment 20% After Deductible 50% After Deductible 20% After Deductible 50% After Deductible

Pregnancy Benefits Based on Location Based on Location Based on Location Based on Location

Chiropractic Services Based on Location Based on Location Based on Location Based on Location

Physical/Occupational Therapy Based on Location Based on Location Based on Location Based on Location

1. If you are having a complex procedure, there are often multiple charges to your bill: Physician Fee, Facility Fee,Anesthesiologist Fee, etc. Each fee will be processed according to its corresponding category.

Medical Services

26


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

Retail 30 Day Supply 30 Day Supply

Generic $10 Copay 50% Coinsurance; $40 minimum $10 Copay 50% Coinsurance;

$40 minimum

Preferred Brand $40 Copay 50% Coinsurance; $40 minimum $40 Copay 50% Coinsurance;

$40 minimum

Non-Preferred Brand $60 Copay + 25% of the balance

50% Coinsurance; $40 minimum

$60 Copay + 25% of the balance


Specialty 25% Coinsurance; $200 Maximum


25% Coinsurance; $200 Maximum


Mail Order 90 Day Supply 90 Day Supply

Generic $20 Copay Not Covered $20 Copay Not Covered

Preferred Brand $80 Copay Not Covered $80 Copay Not Covered

Non-Preferred Brand $120 Copay + 25% of the balance Not Covered $120 Copay + 25% of

the balance Not Covered

Specialty Not Covered Not Covered Not Covered Not Covered

Home Delivery Choice – More convenience. Better health. Bigger savings. Through the Anthem medical plans, employees can have maintenance medication delivered automatically to a home address! Maintenance drugs are those drugs that treat long-term chronic health conditions such as high blood pressure, diabetes, or high cholesterol. Missing even one dose of these types of drugs can mean serious health problems, which in turn can lead to higher health costs.

With Home Delivery Choice, participants decide where they get these types of drugs. You can get up to two fills of your medicine at your local pharmacy. After that, you must decide if you’d like to keep using that pharmacy or start using Anthem’s preferred Home Delivery Pharmacy, managed by Express Scripts. You will get free standard shipping and refill reminders. Participants can even set up automatic refills. To enroll:

• Go to www.anthem.com• Select Manage Prescriptions on the home page• Login

Anthem’s Essential Formulary Drug List Anthem’s Essential Formulary Drug List is a closed formulary/drug list, which means there may be times a current prescription may not be covered. The Essential Drug List excludes medications that cost more, so it’s easier to find the most cost-effective choices instead: those lower-cost generic alternatives or over-the-counter (OTC) drugs. If a participant’s current prescription drug happens to be one of the few drugs not covered, the participant should talk to the doctor and see if he/she can recommend another option. The doctor can always call and talk with Anthem to discuss.

Prescriptions

27

“Premium” is the fancy word for what you pay out of your paycheck to purchase Damar’s health care plan. To determine what your biweekly cost will be, find the number in the chart below that applies to you.

Your Yearly Salary


Bi-weekly Premium Bi-weekly Premium

$0 - $29,999

Employee Only $27.10 $176.06

Employee + Spouse $69.23 $402.93

Employee + Child(ren) $50.51 $302.09

Employee + Family $90.43 $517.08

$30,000 - $49,999





$50,000 - $69,999





$70,000+





Per-Pay Premiums

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eciohC yrevileD emoHMore convenience. Better health. Bigger savings.

65483MUMENABS_HDChoice VPOD 02/17

What is Home Delivery Choice?

Home Delivery Choice lets you decide how you want to get your maintenance medicines — at your local pharmacy or delivered to your door. You get free standard shipping and ref ll reminders. And you can even set up automatic ref lls. ii

Maintenance medicines are drugs that treat long-term, chronic health conditions such as:

Indigestion

High blood pressure

High cholesterol

Diabetes

Missing even one dose of these types of drugs can mean serious health problems and may lead to higher health care costs. That’s why Home Delivery Choice is a great way to make sure you get your ref lls when you need them. i

*Express Scripts is a separate company that helps manage our prescription drug benef ts. i

Let us know your choice You can stick with your local pharmacy or move to the home delivery pharmacy. It’s completely your choice! Either way, you just need to let us know. Here’s how:

Use the My Decision Center tool on the Express Scripts* website. First, go to anthem.com, select ManagePrescriptions on the home page and log in. On yourpharmacy page, select Switch to Home Delivery. UnderManage Your Prescriptions on the Express Scriptswebsite, choose My Decision Center. Then, choosehome delivery to have your prescriptions shippeddirectly to your door or retail pharmacy to continuef lling prescriptions at your pharmacy with no penalty.i

Call us at 1-877-536-4320, Monday through Friday,8:30 a.m. to 6 p.m. ET (5:30 a.m. to 3 p.m. PT).If you have hearing or speech diff culties, calli1-800-221-6915 (TTY/TDD).

29

1 Iyengar RI, Henderson RR, Visaria J, Frazee SG. Dispensing Channel and Medication Adherence: Evidence Across Three Therapy Classes. American Journal of Managed Care (October 2013). Patients taking high blood cholesterol medications were 19% more adherent when receiving them through home delivery pharmacies. 2 Express Scripts internal data, 2010-2014. 3 If you’re signed up for a copay assistance program or use manufacturer coupons to help pay for your prescriptions, you’ll need to submit detailed claim information and your receipt to the assistance or coupon programs to get paid back. Express Scripts cannot bill Anthem and third parties for prescriptions you f ll through home delivery. i

Anthem Blue Cross and Blue Shield is the trade name of: In Colorado: Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc. Copies of Colorado network access plans are available on request from member services or can be obtained by going to anthem.com/co/networkaccess. In Connecticut: Anthem Health Plans, Inc. In Indiana: Anthem Insurance Companies, Inc. In Kentucky: Anthem Health Plans of Kentucky, Inc. In Maine: Anthem Health Plans of Maine, Inc. In Missouri (excluding 30 counties in the Kansas City area): RightCHOICE® Managed Care, Inc. (RIT), Healthy Alliance® Life Insurance Company (HALIC), and HMO Missouri, Inc. RIT and certain aff liates administer non-HMO benef ts underwritten by HALIC and HMO benef ts underwritten by HMO Missouri, Inc. RIT and certain aff liates only provide administrative servicesiiii for self-funded plans and do not underwrite benef ts. In Nevada: Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc., dba HMO Nevada. In New Hampshire: Anthem Health Plans of New Hampshire, Inc.; HMO plans are administered by Anthemi Health Plans of New Hampshire, Inc. and underwritten by Matthew Thornton Health Plan, Inc. In Ohio: Community Insurance Company. In Virginia: Anthem Health Plans of Virginia, Inc. trades as Anthem Blue Cross and Blue Shield in Virginia, and its service area is all of Virginia except for the City of Fairfax, the Town of Vienna, and the area east of State Route 123. In Wisconsin: Blue Cross Blue Shield of Wisconsin (BCBSWi), underwrites or administers PPO and indemnity policies and underwrites the out of network benef ts in POS policies offered by Compcare Health Services Insurancei Corporation (Compcare) or Wisconsin Collaborative Insurance Corporation (WCIC). Compcare underwrites or administers HMO or POS policies; WCIC underwrites or administers Well Priority HMO or POS policies. Independent licensees of the Blue Cross and Blue Shield Association. ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association.

Why Home Delivery Choice?

Switching from a retail pharmacy to the home delivery pharmacy is easy and won’t cost you anything. It can save you time and money — and help keep you healthy. With the home delivery pharmacy, you get:

Lower costs. Depending on your plan, you may be able tosave on drug copays. The cost of a 90-day supply of manydrugs is lower than the cost of three 30-day ref lls.i

Convenience. Save yourself trips to the drugstore — andskip the lines. With home delivery, your medicine arrives atyour door with free standard shipping. First-time ordersarrive within two weeks from the time the pharmacy gets theorder. After that, ref lls take just 3 to 5 days.i

Automatic ref llsi . No need to worry about ref lling on time.iIf you sign up for automatic ref lls, your medicine can beisent to you automatically before your next ref ll date. Getistarted on anthem.com. On the home page, chooseManage Your Prescriptions, then log in. On the pharmacypage, choose Additional Pharmacy Services. On theExpress Scripts site, select Manage Automatic Ref llsi fromthe Manage Prescriptions menu.

Help following your doctor’s orders. When you get yourmedicine sent to your home, you’re less likely to miss a doseand more likely to take it the way your doctor prescribed.1

This can mean fewer visits to the doctor or hospital — and ahealthier you.

Safety. You can be sure you’re getting the right medicinewith the home delivery pharmacy. It has a higher accuracyrate compared to retail pharmacies.2

Ease of payment. You can pay by check, eCheck, moneyorder, f exible spending or health savings accountl(FSA/HSA) card, major credit card or debit card.3 You alsocan use an extended payment plan to spread it out overthree payments.

How does Home Delivery Choice work?

When you f ll a maintenance medicine at a retail pharmacy: i

1. We’ll contact you by phone and mail to tell you aboutHome Delivery Choice and its benef ts, including howimuch you’ll save using it. We’ll ask you to pick your retailpharmacy or home delivery for future ref lls.i

2. If you’re ready to make the change to home delivery, wecan get you started right away.

3. If you’re not ready to choose, you can use a retailpharmacy for up to two ref lls. After the last f ll allowed,iiyou’ll have to pay 100% of the cost of your maintenancemedicine until you make a f nal decision.i

Whether you switch to the home delivery pharmacy or keep using your retail pharmacy, you’ll pay just your normal copay/coinsurance amount and get up to a 90-day supply.

Questions? We’re here to help You can f nd lots of information about your pharmacyi benef ts online. Just go to i anthem.com, choose Manage Your Prescriptions and log in. That will take you to your personal pharmacy page.

If you still have questions, you can always call the Member Services number on your member ID card.

30

Flexible Spending Accounts (FSAs) Do you like a good deal? Why not consider a Flex Spending Account (FSA)? Let’s look at how an FSA can help keep money in your bank!

The different types of FSAs are detailed below. Each one can help you save up to 30% of each dollar spent. Here’s how that works:

1. You elect how much money you would like to contribute to your FSA.2. That money is deducted throughout the year from your paycheck, tax free.3. The short version: You don’t pay federal, state or FICA taxes on this income! See the

case study on the following page for more details!

Flex Spending Account Options from Discovery Benefits

Medical FSA Dependent Care FSA

Am I eligible? If you contribute to an HSA, no. Otherwise, yes. Yes

What can I use it to pay for?

IRS-approved prescriptions, dental, vision & medical;

See https://www.irs.gov/pub/irs-pdf/p502.pdf for a list of approved

expenses.

Day care expenses for the following that allow you or your spouse to go to work or school full time: • Dependent child under age 13• Physically or mentally disabled

dependent of any age who spends 8+hours per day in your home

When can I use it? Immediately (even before accruing payroll deposits)

Immediately (even before accruing payroll deposits)

Can I roll over funds? Yes, you may roll over $500 each year to be used within the next calendar year No. These funds are use-it-or-lose it!

What is the minimum annual contribution? $130 $130

What is the maximum annual contribution? $2,500 $5,000 (or $2,500 if married and filing

separately)

What time period will the 2019 account cover?

You can incur claims from 1/1/19 – 12/31/19

You can incur claims from 1/1/19 – 12/31/19

When is the “run-out period” (aka. the deadline to submit claims incurred in the above period)?

March 31, 2020 March 31, 2020

2019

31

https://www.irs.gov/pub/irs-pdf/p502.pdf

https://www.irs.gov/pub/irs-pdf/p502.pdf

Eric and Brianna’s combined gross income is $30,000. They have two children and file their income taxes jointly. Since Eric needs some major orthodontic work this year, they decide to put $2,000 into a Medical FSA. Also, for their two kiddos, they plan to put $3,000 in a Dependent Care FSA for day care expenses. Check out how this is going to put more money in their pockets!

Without FSAs With FSAsGross annual income $30,000 $30,000 Total FSA contributions -$0 -$5,000 Adjusted gross income $30,000 $25,000 Estimated taxes

Federal -$2,550* -$1,776* State -$900** -$750** FICA -$2,295 -$1,913

After-tax earnings $24,255 $20,561 Eligible out-of-pocket expenses Medical & Dependent Care Expenses

-$5,000 (no tax advantage) -$0 (covered by FSA)

Remaining spendable income $19,255 $20,561 Spendable income increase $1,306!!!

* Assumes standard deductions and four exemptions** Varies, assume 3 percentFOR ILLUSTRATIVE PURPOSES ONLY. CONSULT A TAX ADVISOR WITHQUESTIONS.

THOUGHT NUGGET: RESTRICTIONS ON FLEX SPENDING ACCOUNTS

If you choose to open any type of these accounts, there are a few things you CANNOT do. You will want to be mindful of these restrictions when planning how you want to proceed.

Keep in mind: • You cannot change the amount coming out of your paycheck mid-year unless you

experience a qualifying event (see Making Changes section of this guide).• You cannot transfer money from one FSA to another FSA—for example, if you are going to

have too much money left in your Dependent Care FSA but not enough in your MedicalFSA, you can’t use the Dependent Care FSA funds for Medical needs.

• You cannot use Medical FSA money for over-the-counter medicines unless you have aprescription from your physician.

• If you elect to participate in an HRA, you cannot use FSA money until the HRA is depleted.

Additional restrictions for the Dependent Care FSA only include: • You cannot use this money to pay an in-home babysitter whom you claim as a dependent.• You cannot use this money to cover expenses for your domestic partner or your domestic

partner’s dependent.

Ready to Open an FSA?

You will need to complete the FSA enrollment paperwork to set up your account with Discovery Benefits. Even if you signed up last year, you must re-enroll!

When submitting expenses for payment, you can use the following methods:

• Debit card• Direct deposit (requires

special enrollment form)• Manually reimburse yourself

HOWEVER – the IRS requires proof that you are spending appropriately. So get itemized receipts from your care providers and KEEP THEM!

Discovery Benefits will require you to provide this proof to allow you to continue getting money out of your account.

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Dental Have you been taking care of your pearly whites? You should! It’s been proven that people with clean teeth often have better health, including a reduced risk for stroke and heart disease. You take care of them? They take care of you! Damar aims to help promote your hygiene health by offering dental insurance through Delta Dental.

Dental Plan Option from Delta DentalPPO Dentist Premier Dentist Out-of-Network

Deductible Individual $50 $50 $50 Family $100 $100 $100

Annual Plan Payment Maximum

Individual $1000 Preventive Services Deductible does not apply

Services Covered Exams, cleanings, fluoride, sealants, space maintainers, x-rays, brush biopsy

Coverage Rate 100% 80% 80% Basic Services Deductible applies

Services Covered Fillings & crown repair, simple extractions, Endodontics (root canals), oral surgery, Periodontics (to treat gum disease)

Coverage Rate 80% 60% 60% Major Restorative Services Deductible applies

Services Covered Crowns, inlays/onlays, dentures, bridgework, implants Coverage Rate 50% 50% 50%

Orthodontia Individuals Covered Eligible children up to age 19 Lifetime Payment Maximum $1,500 per individual Coverage Rate 50% 50% 50%

Special Services Might Be Included:

If you are someone who qualifies under one of the following conditions, you may be eligible for additional cleanings and periodontal services than the limitations mentioned in the box to the left. See your plan document for details. • Pregnancy• Diabetes• Diagnosed Periodontal Disease• Suppressed Immune System• Kidney Failure/Dialysis

Some Procedures Might Be Excluded/Limited:

Please note that cosmetic procedures are NOT covered under this dental plan. Additionally, the following procedures are limited by a specific number of visits/age group: • Oral Exams/Cleanings: 2 per year• Full Mouth X-rays: once every 3 years• Bitewing X-rays (adult): 2 per year;

(child to age 19): 2 per year• Panoramic X-rays: once every 5 years• Fluoride (child to age 19): 2 per year

Details

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Wondering how much it costs to purchase this dental coverage?

Costs to Purchase

Tier of CoverageEmployee Only $10.70

Employee + Spouse $19.75

Employee + Child(ren) $26.29

Family $42.08

THOUGHT NUGGETS: IN-NETWORK DENTISTS ARE THE BEST!

Have a family dentist that you love and don’t want to leave? We get it! The good news is, generally, most dental plans allow you to choose which dentist you go see. The bad news is, if the dentist you see is not in-network, it’s going to cost you more money.

To find out if your dentist is in-network, go to www.deltadentalin.com.

BALANCE BILLING IS THE WORST!

“Balance billing” (a term you may hear thrown around) is the way we describe what can happen if you go to an out-of-network dentist. Your dental insurance carrier has a predetermined idea of what pricing is considered “reasonable and customary” for all possible procedures. The insurance carrier is so sure about this predetermined pricing that they will not pay anything MORE than that dollar figure to your dentist for each corresponding procedure. That means, if your dentist usually charges more, he or she may end up feeling shorted for services provided.

Here’s the bummer news: If your dentist is considered out-of-network, then he or she can pass on the difference between the dentist’s charge and the carrier’s “reasonable and customary” amount on to YOU. This way, the dentist is paid in full, but you might feel overcharged. So think hard about if you want to keep seeing an out-of-network dentist!

Per-Pay Premiums

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http://www.deltadentalin.com/

Vision Did you know that the health of your body can sometimes affect the health of your eyes? Eye doctors do certain tests that can help with early detection of certain illnesses—like diabetes. That’s why it’s important for EVERYONE to get a regular eye exam, whether they need glasses or not! By providing vision insurance through VSP, Damar wants to help.

Now for a rundown of the benefits…

Vision Plan Option from VSPIn-Network Out-of-Network Frequency

Exam $5 copay Up to $35 Once every 12 months

Frames $150 allowance; 20% discount above $150 Up to $45 Once every 24 months

Lenses Single $25 copay Up to $25

Once every 12 months Bifocal $25 copay Up to $40 Trifocal $25 copay Up to $55 Lenticular $25 copay Up to $80

Contact Lenses (in lieu of glasses) Contact Lens Fitting & Evaluation Fee (at exam) Up to $60 Up to $105

Once every 12 months Medically Necessary $0 copay; paid in full Up to $210 Elective $0 copay; $120 allowance Up to $105

Additional Benefits

Corrective Eye Surgery (LASIK) Average 15% off the regular price or 5% off the promotional price; discounts only available from contracted facilities

Glasses and Sunglasses

- Extra $20 to spend on featured frame brands. Go towww.vsp.com/specialoffers for details.

- 30% savings on additional glasses and sunglasses, including lensenhancements, from the same VSP provider on the same day as your WellVision Exam. Or get 20% from any VSP provider within 12 months of yourlast Well Vision Exam.

Lens Options See plan document for full list

THOUGHT NUGGET: IN-NETWORK VS. OUT-OF-NETWORK

As you might have guessed, it’s more cost effective to go to an in-network eye doctor over an out-of-network one. To find an in-network eye doctor, complete the following:

• Go to www.vsp.com• Select “Find A Doctor” and follow the instructions

If you go out-of-network, you will notice the details below show an “up to” amount. This is because you must pay the full cost of the service out of pocket, and then the insurance plan will reimburse you “up to” the defined amount. Look at your plan details for information on how to file for reimbursement.

Details

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http://www.vsp.com/specialoffers

http://www.vsp.com/

Coverage through Medical Plan If you enroll in one of our Medical plans, you might notice that you do have some coverage for your eyes through that plan. HOWEVER, this coverage is limited to specific accidents or injuries and is not meant to be an all-encompassing vision plan. If you plan to visit an eye doctor, and you know that you need access to contacts and/or glasses, you will want to consider purchasing this additional coverage. Wondering how much it costs to purchase our vision plan?

Costs to Purchase

Tier of Coverage Employee Only $3.61

Employee + Spouse $5.76

Employee + Child(ren) $5.86

Family $9.50

Don’t “See” a Vision Insurance Card? This time, it’s not a trick of your eye. VSP does not distribute a member specific ID card. If you go to your eye doctor and provide your name, your SSN and VSP’s name, your doctor should be able to look you up in the system. Still wish you had a card to carry with you? You can download a generic card with the basic information you will need from VSP’s website at www.vsp.com.

Per-Pay Premiums

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http://www.vsp.com/

Protecting Your Income For Your Loved Ones – Life Insurance Think about it. You insure your car. You insure your home/apartment. You even insure certain expensive valuables like diamonds in case they are lost or stolen. But what about your life? Not that we like to talk about it, but what if YOU are tragically lost or stolen from those who love and depend upon you? Would your loved ones still have enough income if you’re not here? Life insurance is one way to secure your dependent’s financial security, and Damar offers you multiple options! YOUR QUESTIONS OUR ANSWERS

Basic Life Insurance Options from Sun Life

Am I eligible for this benefit? Yes, if you are scheduled to work 30 hours or more per week

How much would the benefit pay? It will pay 1x your Base annual salary with a minimum of $20,000 and a maximum of $300,000

Does this benefit include AD&D Coverage? Yes

How much does it cost to purchase? That’s the best part: NOTHING! This benefit is provided by Damar at no charge to you

Can I bring this policy with me or convert it to an individual policy if I leave?

You may apply for Conversion Privilege within 31 days of leaving employment

THOUGHT NUGGET: WHAT IS AD&D ANYWAY?1

AD&D stands for Accidental Death and Dismemberment. While the experience itself would be as unpleasant as it sounds, having insurance that comes to your financial aid if it does happen can be invaluable. An AD&D policy provides a list of potential accidents and various amounts the policy will pay for each incident. Loss of arm, leg, toe, finger, eye, vision, hearing…these and more are usually covered, assuming they happen by accident.

AD&D coverage is often tied to a Life Insurance policy, but it isn’t always included. Make sure to refer to the charts in this section to see if AD&D is included and/or if it has an extra charge.

THOUGHT NUGGET: CHOOSE YOUR BENEFICIARY!

Your beneficiary is the individual(s) who receive(s) the payment when life insurance is claimed. Consequently, you can see how important it is to elect one when you enroll! If you don’t, the benefit money could get locked up in your Estate and the court systems. Note that you can change your beneficiary at any time.

You can elect more than one beneficiary, assigning different percentages of the payout OR a type:

• Primary Beneficiary – receives the payment first if still living when the benefit is claimed.

• Contingent Beneficiary – receives the payment if your primary beneficiary is no longer living when the benefit is claimed.

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Depending on your and your family’s needs, the Basic Life Insurance policy may not be enough. Accordingly, Damar provides you with the option to purchase additional voluntary life insurance, described as follows.

YOUR QUESTIONS OUR ANSWERS – Voluntary Life Insurance Options from Sun Life

For You For Your Spouse For Your Child(ren)

Am I eligible for this benefit?

Yes, if you are scheduled to work 30 hours or more per week and

are enrolled in the Basic Life plan

Yes; you must have elected Voluntary Life on yourself

Yes; you must have elected Voluntary Life

on yourself

How much coverage can I elect?

1x, 2x, 3x, 4x or 5x your Base annual salary up to a maximum

of $500,000

Increments of $5,000, up to a maximum of $250,000

Option 1: $5,000 Option 2: $10,000 Option 3: $20,000

How much coverage is guaranteed to issue without EOI? (See below)2

In your first year of eligibility, you can elect up to $200,000

In your first year of eligibility, you can elect up to $50,000

In your first year of eligibility, all amounts

are guaranteed to issue

Does the payout benefit reduce over time?

Benefit reduces to 67% when you reach age 70 and to 50%

when you reach age 75

Benefit reduces to 67% when you reach age 70 and to

50% when you reach age 75

Benefit terminates at age 19; to age 26 if a

full-time student

Any other information I should know about these options?

You must elect coverage for yourself to elect coverage for

spouse/child

Spouse’s coverage not to exceed 100% of the amount

you elect for yourself

Child(ren)’s coverage not to exceed 100% of the amount you elect

for yourself Does this benefit include AD&D Coverage? No No No

Can I bring this policy with me or convert it to an individual policy if I leave?

Yes

How Much Voluntary Life Insurance Costs… You are responsible to pay the full cost to purchase this benefit. To determine an estimate of what your monthly cost will be, use the table and equations below: Monthly Cost per $1,000 of coverage for Voluntary Life and AD&D (Employee/Spouse):

Age Range Life Rate

AD&D Rate

(Optional)

Age Range

Life Rate

AD&D Rate

(Optional)

<20 $.030 $0.26 50-54 $.458 $0.26 20-29 $.054 $0.26 55-59 $.876 $0.26 30-34 $.084 $0.26 60-64 $1.289 $0.26 35-39 $.108 $0.26 65-69 $2.070 $0.26 40-44 $.167 $0.26 70-74 $3.275 $0.26 45-49 $.253 $0.26 75+ $3.275 $0.26

Monthly Cost per $1,000 of coverage for Voluntary Life and AD&D (Child):

Age Range Life AD&D (Optional)

All ages $.20 $.026

THOUGHT NUGGET: WHAT IS EOI ANYWAY?2

Evidence of Insurability (EOI) is something Sun Life may ask for if you meet one of the following conditions: 1. This is your first year eligible for

the benefit, and you are electing an amount of coverage that is OVER a set amount (called Guaranteed Issue).

2. You elected coverage in a previous year, and you are INCREASING the coverage you originally elected.

3. You neglected to elect coverage when it first became available to you, and you now want to elect ANY amount of coverage (even if under the Guaranteed Issue).

EOI usually involves a substantial set of questions and/or a blood test to evaluate your current state of health.

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Protecting Your Income For You – Disability Insurance Think you won’t need disability insurance someday? Statistics say that one in four twenty-year-olds will be disabled before they reach retirement, and 95 percent of accidents are not work related. Pregnancy, back and neck pain, cancer, heart disease, mental illness…all can lead to various lengths of being unable to work. A great way to protect your paycheck should something happen is to invest in disability insurance. Here are some details of what’s available to you:

YOUR QUESTIONS OUR ANSWERS Short Term Disability (STD) Options from Sun Life

Who is eligible for this benefit? Employees scheduled to work 30 or more hours per week

What percent of my paycheck will be covered?

60% of basic weekly earnings for the Basic LTD provided by Damar 66 2/3% if you purchase the Optional Buy-up LTD

What is the maximum amount I’ll be paid weekly? $1,000

How long do I have to wait until my benefits kick in? 8th day accident/ 8th day illness

What is the longest period the weekly benefit will be paid?

13 or 26 weeks

Does this benefit pay if I’m also claiming Worker’s Comp?

No – you cannot claim Worker’s Comp and STD benefits at the same time.

How Much Short Term Disability Costs… Since STD protects your earnings and most people’s earnings are different, it makes sense that the cost to purchase this protection varies from person to person. While the following looks complicated, it’s not. Use the chart below to determine your rate and the equation below to determine how much you will pay per month.

Your Age <30 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74

STD (13 weeks) $0.459 $0.459 $0.459 $0.683 $1.008 $1.512 $2.061 $2.464 $2.464 $2.464

STD (26 weeks) $0.538 $0.538 $0.538 $0.795 $1.165 $1.781 $2.430 $2.699 $2.699 $2.699

Voluntary Short Term Disability Sample Calculation: Example: John Smith wants to elect STD for 13 weeks duration. He is 35 years old and earns $30,000 per year.

First John must determine how much he earns per week: $30,000/52 (weeks per year) = $577 x 60% = $346

Here’s how to determine how much STD would cost John per month: ($.459 x $346)/10 = $15.88 per month

Here’s how to determine how much STD would cost John per pay: ($15.88 x 12)/26 = $7.33 per pay period

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There may be a list of exclusions, pre-existing conditions and/or limitations that come with your Short Term and/or Long Term Disability plans. Please review your plan certificate for full details.

Damar also offers Long Term Disability. See the chart below for the details

YOUR QUESTIONS OUR ANSWERS Long Term Disability (LTD) Options from Sun Life

Who is eligible for this benefit? Available to employees scheduled to work 30 hours or more per week who have completed one year of employment by January 1, 2019

What percent of my paycheck will be covered?

60% for the basic LTD provided by Damar 66 2/3% if you purchase the Optional Buy-up LTD 66 2/3%

What is the maximum amount I’ll be paid monthly?

$1,000 for the basic LTD $10,000 for the Optional Buy-up LTD

How long do I have to wait until my benefits kick in? 180 days for basic LTD; 3 months for Buy Up LTD coverage

What is the longest period the monthly benefit will be paid? Until Social Security Normal Retirement Age

Is there a pre-existing condition? Yes. You cannot receive benefits for a disability… (1) For which you receive treatment within 3 months prior to the policy’s effective date OR (2) That

occurs within the first 12 months of coverage.

Will tax be deducted from my monthly benefit?

Tax will be deducted from the basic LTD but will not be deducted from the Buy Up LTD

How does my PTO and accrued sick leave tie into this wait?

Since there is a longer waiting period before the LTD benefits begin, there should be no overlap with your PTO or sick time.

Does this benefit pay if I’m also claiming Worker’s Comp? No – you cannot claim Worker’s Comp and LTD benefits at the same time.

How Much Long Term Disability Costs… Your employer provides a base amount of LTD coverage at no cost to you. If you would like to purchase additional Buy Up coverage, you may use the equation below to determine how much you will pay per month. Since LTD protects your earnings and most people’s earnings are different, it makes sense that the cost to purchase this protection varies from person to person.

Your Age <30 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 LTD Buy Up $.862 $.862 $.862 $.862 $.963 $.963 $.963 $1.363 $1.363 $1.363

Long Term Disability Sample Calculation: Example: John Smith wants to elect LTD Buy-up. He is 35 years old and earns $30,000 per year.

First John must determine how much he earns per month: $30,000/12 (months per year) = $2,500

Here’s how to determine how much LTD Buy-up Option would cost John per month: ($.862 x $2,500)/$100 = $21.55 per month

Here’s how to determine how much LTD would cost John per pay: ($21.55 x 12)/26 = $9.95 per pay period

Please Note

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Additional Benefits Damar employees also have access to these other benefit offerings:

• The Employee Assistance Program (EAP) is a counseling and referral service designed to assist employees and their families in overcoming personal problems. EAP counselors are trained to deal with a wide variety of employee problems and can offer professional support and direction toward resolving the problems. EAP trained counselors maintain confidentiality in providing services to the employee or employee’s family. This benefit is provided through the St. Vincent Stress Center at no cost to the employee. Simply contact EAP at 317.338.4900 or toll free at 1.800.544.9412.

• Damar 401(k) Retirement Plan: Employees are eligible to contribute into the Damar 401(k) plan immediately upon hire. In addition to employees having the option to make personal contributions to a retirement account, Damar makes discretionary contributions for employees who have completed one year of employment as of January 1st or July 1st. To qualify for Damar contributions, the employee must be 21 years of age and have worked a minimum of 1000 hours in the plan year (7/1 through 6/30) to receive the annual contribution from Damar.

• Wellness Incentive: Damar offers a wellness incentive to any employee and/or spouse enrolled

in one of the Damar medical plans. To receive this incentive, the employee or covered spouse must visit the primary care physician for an annual wellness exam. The wellness exam requires lab work be completed and results confirmed at the time of the doctor visit. Both the doctor visit and lab work must be completed during the plan year (January 1 – December 31, 2019). Employees who are enrolled in a Damar medical plan can receive $100 for themselves and $100 for their enrolled spouse. A Wellness Incentive Form is included at the end of this guide.

REMINDERS: FORMS TO BE COMPLETED

1. If enrolling a spouse, please complete the Spousal Questionnaire. This form MUST be

submitted to Human Resources prior to your enrollment deadline date to enroll a spouse in any Damar benefit plans.

2. If enrolling any dependents, the employee must provide proof of eligibility (i.e., a marriage certificate, birth certificate, and/or proof of full-time student status for children over age 19. All documentation must be received and enrollment elections completed prior to your enrollment deadline date to ensure dependents are enrolled in benefit plans.

3. The Evidence of Insurability form is required for Voluntary Life Insurance enrollments if: • The employee didn’t elect Voluntary Life Insurance benefits during the initial eligibility

period (i.e., upon hire) OR • The amount requested is over the Guaranteed Issue amount

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Behind this Page, You Will Find…

Important Forms and Annual Federal Notices…

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DAMAR WELLNESS INCENTIVE FORM

PLEASE PRINT

Name of person who is receiving this wellness exam and screening: __________________________________________________________

Is this the: Employee Spouse _________________________ Date you signed this page: _________

Employee signature: ________________________________________________ Employee Date of Birth: _______________________________

My signature above means I understand that I am voluntarily receiving a wellness exam and screening and voluntarily giving this completed form to HR Services in Damar’s Human Resources department. Also, by signing this form, I am giving permission for Damar Services to verify the information below by phone call to my physician. Please make sure your physician’s office retains a copy of this form for their records.

TO BE COMPLETED BY IN NETWORK MEDICAL PROVIDER:

Damar Services will pay a wellness incentive to the person named above for seeing an in network medical provider and having certain wellness screenings as noted below. Please confirm which of these screenings have been performed. By checking “Yes” you are confirming the labs have been done and the results have been received.

PLEASE CHECK THE APPROPRIATE BOX(S) BELOW:

1. Yes No Blood pressure screening

2. Yes No Diabetes screening

3. Yes No Cholesterol screening

4. Yes No Tobacco use screening

5. Yes No Waist measurement

6. Yes No Do you agree to counsel or provide treatment as appropriate based on screening results?

Name of In Network Medical Provider: ________ Address of In Network Medical Provider: Phone Number of In Network Medical Provider: ________ Signature of In Network Medical Provider: Date EMPLOYEE OR SPOUSE: Return this completed form to Human Resources. Information is subject to verification before your wellness incentive is paid.

Date form received: ________________ Is form complete and information verified? Yes No

If yes, date to accounting for payment: _________ If no, date returned to employee for completion: _____________ 43

DAMAR SPOUSAL QUESTIONNAIRE FOR MEDICAL, DENTAL & VISION COVERAGE

PLEASE PRINT

Name of Damar Employee: _________________________________________________ SSN: _____________________________________________

Name of Spouse: _______________________________________________________________________________________________________________

IF SPOUSE IS NOT EMPLOYED: My spouse is: Unemployed Retired Self-Employed

*Does not have access to group medical, dental and/or vision coverage

IF SPOUSE IS EMPLOYED: The below needs to be completed by the Employer of the Spouse.

Damar Services requires spouses of covered employees to join their employer’s group plans were such availability to coverage exists. In instances where a group plan is available to the spouse through his/her employer, the spouse is not eligible to enroll in Damar’s plans. Please complete the section below in order for your employee to be eligible for enrollment in Damar’s plans.

SPOUSE’S EMPLOYER: Please check the appropriate box(es) below:

1. Yes No Is your employee currently enrolled or will he/she be enrolled in your employer-sponsored group medical, dental and/or vision? If so, which one(s)?

Medical Dental Vision

2. Yes No Does your employee have access to employer-sponsored medical, dental and/or vision through your company? If so, which one(s)?

Medical Dental Vision

3. Yes No Do you, the employer of the spouse, subsidize at least 50% of the total monthly cost for the single medical coverage?

4. If offered, does the employer sponsored plan provide the following types of coverage? (Please check all that apply) Medical Preventative Care Yes No Major Medical Yes No Prescription Drug Yes No Dental Yes No Vision Yes No

Please complete the following: Name of Employer: _____________________________________________________________________________________________________________ Employer Representative Name: _______________________________________________________________________________________________ Employer Representative Title: _________________________________________________________________________________________________ Phone Number: ____________________________________ Email Address: ____________________________________________________________ Signature of Employer Representative: ________________________________________ Date: _______________________________________ _ This Form is required to be submitted within the benefits enrollment period. Failure to return this form, including all necessary documentation, will result in no spousal coverage for the plan year.

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Participating Labs in The Anthem Blue Access PPO Network

MID AMERICA CLINICALLABORA TORIES LLCReference Laboratory

Lab In-Network

2.0 miles away 1011 Main St Ste 240, Speedway, IN 46224 Telephone: 877-803-1010

INDIANA UNIVERSITY HEALTHReference Laboratory

Lab In-Network

10.4 miles away 1375 N Green St, Brownsburg, IN 46112 Telephone: 317-852-2251

PCL ALVERNOReference Laboratory

Lab In-Network

12.6 miles away 965 Emerson Pkwy Ste J, Greenwood, IN 46143 Telephone: 317-887-5675

PREMIERTOX 2 0 INCReference Laboratory

Lab In-Network

Call for nearest locationTelephone: 877-412-8330

ESKENAZI HEAL THReference Laboratory

Lab In-Network

4.3 miles away 720 Eskenazi Ave, Indianapolis, IN 46202 Telephone: 317-880-0000


Lab In-Network

10.5 miles away 1402 E County Line Rd, Indianapolis, IN 46227 Telephone: 877-803-1010


Lab In-Network

13.6 miles away 151 Pennsylvania Pkwy, Indianapolis, IN 46280 Telephone: 317-817-1100

AMERIPATH CINCINNATIINCReference Laboratory

Lab In-Network



Lab In-Network

4.3 miles away 705 Riley Hospital Dr, Indianapolis, IN 46202 Telephone: 317-944-5000


Lab In-Network

10.5 miles away 1402 E County Line Rd, Indianapolis, IN 46227 Telephone: 877-803-1010


Lab In-Network

14.0 miles away 9660 E Washington St, Indianapolis, IN 46229 Telephone: 317-890-5400

ACL ASSOCIA TED CLINICAL LABORA TORIESReference Laboratory

Lab In-Network



Lab In-Network

4.6 miles away 550 University Blvd, Indianapolis, IN 46202 Telephone: 317-944-5000

SOUTH BEND MEDICALFOUNDATIONReference Laboratory

Lab In-Network

10.7 miles away 8050 Township Line Rd, Indianapolis, IN 46260 Telephone: 317-872-3673


Lab In-Network

14.2 miles away 8205 E 56Th St Ste 110, Indianapolis, IN 46216 Telephone: 317-803-1010

ACL ASSOCIA TED CLINICAL LABORA TORIESReference Laboratory

Lab In-Network


INDIANA UNIVERSITY HEALTH WEST HOSPITALReference Laboratory

Lab In-Network

4.9 miles away 1111 Ronald Reagan Pkwy, Avon, IN 46123 Telephone: 317-217-3000


Lab In-Network

10.7 miles away 8071 Township Line Rd Ste115, Indianapolis, IN 46260 Telephone: 877-803-1010


Lab In-Network

14.4 miles away 10122 E 10Th St Ste 200, Indianapolis, IN 46229 Telephone: 877-803-1010

CUTANEOUS AND MAXILLOFACIAL PATHOLOGYLABORA TORY PCReference Laboratory

Lab In-Network


While we make efforts to ensure that our lists of doctors are up to date and accurate, doctors do leave our networks from time to time, and these listings do change. There may be higher fees associated with visitinga doctor who is not in our network or for obtaining a service that is not covered by your plan. You may be responsible for those costs. To avoid higher fees we recommend that you confirm your doctor is in networkand that the desired service is covered when scheduling your appointment.

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Lab In-Network

5.0 miles away 3630 Guion Rd, Indianapolis, IN 46222 Telephone: 877-803-1010


Lab In-Network

11.1 miles away 8301 Harcourt Rd Ste 139, Indianapolis, IN 46260 Telephone: 877-803-1010

ST VINCENT NEIGHBORHOOD HOSPITAL

Lab In-Network

14.6 miles away 8602 Allisonville Rd, Indianapolis, IN 46250 Telephone: 317-703-1970

AMBRY GENETICS CORPORATIONReference Laboratory

Lab In-Network



Lab In-Network

5.1 miles away 3850 Shore Dr Ste 101, Indianapolis, IN 46254 Telephone: 877-803-1010


Lab In-Network

11.2 miles away 8424 Naab Rd Ste 1C, Indianapolis, IN 46260 Telephone: 877-803-1010

PATHOLOGY LABORA TORIES INCReference Laboratory

Lab In-Network

14.9 miles away 11495 N Pennsylvania St Ste270, Carmel, IN 46032 Telephone: 317-588-3605

BIO REFERENCE LABORATORIES INCReference Laboratory

Lab In-Network


LABCORPReference Laboratory

Lab In-Network

5.1 miles away 6620 Parkdale Pl Ste P, Indianapolis, IN 46254 Telephone: 888-522-2677


Lab In-Network

11.3 miles away 1001 Hadley Rd Ste 170, Mooresville, IN 46158 Telephone: 317-834-5146


Lab In-Network

15.0 miles away 7914 N Shadeland Ave Ste150, Indianapolis, IN 46250 Telephone: 888-522-2677

BIO REFERENCE LABORATORIES INCReference Laboratory

Lab In-Network



Lab In-Network

5.1 miles away 9613 E Us Highway 36, Avon, IN 46123 Telephone: 317-613-5300


Lab In-Network

11.4 miles away 3147 W Smith Valley Rd, Greenwood, IN 46142 Telephone: 317-851-2885

INDIANA UNIVERSITY HEALTH NORTH HOSPITALReference Laboratory

Lab In-Network

15.1 miles away 11700 N Meridian St, Carmel, IN 46032 Telephone: 317-688-2000


Lab In-Network



Lab In-Network

5.2 miles away 6850 Parkdale Pl, Indianapolis, IN 46254 Telephone: 317-329-7222


Lab In-Network

11.4 miles away 2020 W 86Th St Ste 106, Indianapolis, IN 46260 Telephone: 888-522-2677


Lab In-Network

15.2 miles away 8075 N Shadeland Ave, Indianapolis, IN 46250 Telephone: 877-803-1010

AIM LABORA TORIES LLCReference Laboratory

Lab In-Network


INDIANA STATE DEPT OFHEALTH LABORA TORYReference Laboratory

Lab In-Network

5.2 miles away 550 W 16Th St Ste B, Indianapolis, IN 46202 Telephone: 317-921-5500


Lab In-Network

11.4 miles away 2001 W 86Th St, Indianapolis, IN 46260 Telephone: 317-803-0405


Lab In-Network

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46


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48

Health Insurance Exchange Notice For Employers Who Offer a Health Plan to Some or All Employees

New Health Insurance Marketplace Coverage Options and Your Health Coverage PART A: General Information When key parts of the health care law took effect in 2014, there was a new way to buy health insurance: The Health Insurance Marketplace. To assist you as you evaluate options for you and your family, this notice provides some basic information about the new Marketplace and employment-based health coverage offered by your employer.

What is the Health Insurance Marketplace?

The Marketplace is designed to help you find health insurance that meets your needs and fits your budget. The Marketplace offers "one-stop shopping" to find and compare private health insurance options. You may also be eligible for a new kind of tax credit that lowers your monthly premium right away. Open enrollment for health insurance coverage through the Marketplace begins in October 2018 for coverage starting as early as January 1, 2019.

Can I Save Money on my Health Insurance Premiums in the Marketplace?

You may qualify to save money and lower your monthly premium, but only if your employer does not offer coverage, or offers coverage that doesn't meet certain standards. The savings on your premium that you're eligible for depends on your household income.

Does Employer Health Coverage Affect Eligibility for Premium Savings through the Marketplace?

Yes. If you have an offer of health coverage from your employer that meets certain standards, you will not be eligible for a tax credit through the Marketplace and may wish to enroll in your employer's health plan. However, you may be eligible for a tax credit that lowers your monthly premium, or a reduction in certain cost-sharing if your employer does not offer coverage to you at all or does not offer coverage that meets certain standards. If the cost of a plan from your employer that would cover you (and not any other members of your family) is more than 9.5% of your household income for the year, or if the coverage your employer provides does not meet the "minimum value" standard set by the Affordable Care Act, you may be eligible for a tax credit.1

Note: If you purchase a health plan through the Marketplace instead of accepting health coverage offered by your employer, then you may lose the employer contribution (if any) to the employer-offered coverage. Also, this employer contribution -as well as your employee contribution to employer-offered coverage- is often excluded from income for Federal and State income tax purposes. Your payments for coverage through the Marketplace are made on an after-tax basis.

How Can I Get More Information? For more information about your coverage offered by your employer, please check your summary plan description or contact:

Ellen Guido 6067 Decatur Blvd Indianapolis, Indiana 46241 (317) [email protected]

The Marketplace can help you evaluate your coverage options, including your eligibility for coverage through the Marketplace and its cost. Please visit HealthCare.gov for more information, including an online application for health insurance coverage and contact information for a Health Insurance Marketplace in your area.

1 An employer-sponsored health plan meets the "minimum value standard" if the plan's share of the total allowed benefit costs covered by the plan is no less than 60 percent of such costs.

49

http://www.healthcare.gov/

PART B: Information About Health Coverage Offered by Your Employer This section contains information about any health coverage offered by your employer. If you decide to complete an application for coverage in the Marketplace, you will be asked to provide this information. This information is numbered to correspond to the Marketplace application.

Here is some basic information about health coverage offered by this employer:

• As your employer, we offer a health plan to: All employees. Employees scheduled to work 30 or more hours per week or otherwise eligible under ACA

• With respect to dependents: We do offer coverage. Eligible dependents are: legal spouse (if no access to coverage through his/her ownemployer, or the employer does not subsidize at least 50% of single premium for Medical Insurance), natural child(ren),stepchild(ren), legally adopted or foster child(ren) under age 26.

If checked, this coverage meets the minimum value standard, and the cost of this coverage to you is intended to be affordable, based on employee wages.

Note: Even if your employer intends your coverage to be affordable, you may still be eligible for a premium discount through the Marketplace. The Marketplace will use your household income, along with other factors, to determine whether you may be eligible for a premium discount. If, for example, your wages vary from week to week (perhaps you are an hourly employee or you work on a commission basis), if you are newly employed mid-year, or if you have other income losses, you may still qualify for a premium discount.

3. Employer nameDamar

4. Employer Identification Number (EIN)35-1168048

5. Employer address6067 Decatur Blvd

6. Employer phone number(317) 856-5201

7. CityIndianapolis

8. StateIndiana

9. ZIP code46241

10. Who can we contact about employee health coverage at this job?Ellen Guido

11. Phone number(317) 856-5201

12. Email [email protected]

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Notice of Special Enrollment Rights If you are declining enrollment for yourself or your dependents (including your spouse) because of other health insurance or group health plan coverage, you may be able to 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 toward 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).

If you have a new dependent as a result of marriage, birth, adoption, or placement for adoption, you may be able to enroll yourself and your dependents. However, you must request enrollment within 30 days after the marriage, birth, adoption, or placement for adoption.

If you or your dependent(s) lose coverage under a state Children’s Health Insurance Program (CHIP) or Medicaid, you may be able to enroll yourself and your dependents. However, you must request enrollment within 60 days after the loss of CHIP or Medicaid coverage.

If you or your dependent(s) become eligible to receive premium assistance under a state CHIP or Medicaid, you may be able to enroll yourself and your dependents. However, you must request enrollment within 60 days of the determination of eligibility for premium assistance from state CHIP or Medicaid.

To request special enrollment or obtain more information, contact Ellen Guido at 6067 Decatur Blvd, Indianapolis, Indiana 46241, (317) 856-5201, [email protected].

Women's Health and Cancer Rights Act (WHCRA) Notices Enrollment 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. Therefore, the following deductibles and coinsurance apply: $1500 deductible (in-network) and 20% coinsurance (in-network) and $3000 deductible (out-of-network) and 50% coinsurance (out-of-network). If you would like more information on WHCRA benefits, call your plan administrator at (317) 856-5201.

Annual Notice Do you know that your plan, as required by the Women’s Health and Cancer Rights Act of 1998, provides benefits for mastectomy-related services including all stages of reconstruction and surgery to achieve symmetry between the breasts, prostheses, and complications resulting from a mastectomy, including lymphedema? Call your plan administrator at (317) 856-5201 for more information.

51

Mental Health Parity and Addiction Equity Act (MHPAEA) Disclosure The Mental Health Parity and Addiction Equity Act of 2008 generally requires group health plans and health insurance issuers to ensure that financial requirements (such as co-pays and deductibles) and treatment limitations (such as annual visit limits) applicable to mental health or substance use disorder benefits are no more restrictive than the predominant requirements or limitations applied to substantially all medical/surgical benefits. For information regarding the criteria for medical necessity determinations made under the Damar Services with respect to mental health or substance use disorder benefits, please contact your plan administrator at (317) 856-5201.

Employer’s Children’s Health Insurance Program (CHIP) Notice 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, 2018. 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: [email protected] Medicaid Eligibility: http://dhss.alaska.gov/dpa/Pages/medicaid/default.aspx

Website: http://dch.georgia.gov/medicaid - Click on Health Insurance Premium Payment (HIPP) Phone: 404-656-4507

52


http://www.insurekidsnow.gov/

http://www.askebsa.dol.gov/

http://myalhipp.com/

http://flmedicaidtplrecovery.com/hipp/

http://myakhipp.com/

mailto:[email protected]

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

http://dch.georgia.gov/medicaid

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 711CHP+: Colorado.gov/HCPF/Child-Health-Plan-PlusCHP+ Customer Service: 1-800-359-1991/State Relay 711

Website: http://dhs.iowa.gov/hawk-i Phone: 1-800-257-8563

KANSAS – Medicaid NEW HAMPSHIRE – Medicaid Website: http://www.kdheks.gov/hcf/ Phone: 1-785-296-3512

Website: http://www.dhhs.nh.gov/ombp/nhhpp/ Phone: 603-271-5218 Hotline: NH Medicaid Service Center at 1-888-901-4999

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 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://dma.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: http://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

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

53

http://myarhipp.com/

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

http://www.indianamedicaid.com/

https://www.healthfirstcolorado.com/

http://dhs.iowa.gov/hawk-i

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

http://www.dhhs.nh.gov/ombp/nhhpp/

https://chfs.ky.gov/

http://www.state.nj.us/humanservices/dmahs/clients/medicaid/

http://www.state.nj.us/humanservices/dmahs/clients/medicaid/

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

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

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

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

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

https://dma.ncdhhs.gov/

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

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

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



http://www.insureoklahoma.org/

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

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

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

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

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

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

NEBRASKA – Medicaid RHODE ISLAND – Medicaid 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

NEVADA – Medicaid SOUTH CAROLINA – Medicaid Medicaid Website: http://dhcfp.nv.gov/ Medicaid Phone: 1-800-992-0900

Website: http://www.scdhhs.gov Phone: 1-888-549-0820

SOUTH DAKOTA - Medicaid WASHINGTON – Medicaid Website: http://dss.sd.gov Phone: 1-888-828-0059

Website: http://www.hca.wa.gov/free-or-low-cost-health-care/program-administration/premium-payment-program 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

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

To 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:

U.S. Department of Labor Employee Benefits Security Administration

www.dol.gov/agencies/ebsa 1-866-444-EBSA (3272)

U.S. Department of Health and Human Services Centers for Medicare & Medicaid Services

www.cms.hhs.gov 1-877-267-2323, Menu Option 4, Ext. 61565

54

http://www.accessnebraska.ne.gov/

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

http://dhcfp.nv.gov/

http://www.scdhhs.gov/

http://dss.sd.gov/

http://www.hca.wa.gov/free-or-low-cost-health-care/program-administration/premium-payment-program

http://www.hca.wa.gov/free-or-low-cost-health-care/program-administration/premium-payment-program

http://gethipptexas.com/

http://mywvhipp.com/

https://medicaid.utah.gov/

http://health.utah.gov/chip

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

http://www.greenmountaincare.org/

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

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




https://www.dol.gov/agencies/ebsa

http://www.cms.hhs.gov/

Michelle's Law Notice Note: Pursuant to Michelle’s Law, you are being provided with the following notice because the Damar group health plan provides dependent coverage beyond age 26 and bases eligibility for such dependent coverage on student status. Please review the following information with respect to your dependent child's rights under the plan in the event student status is lost.

When a dependent child loses student status for purposes of Damar group health plan coverage as a result of a medically necessary leave of absence from a post-secondary educational institution, the Damar group health plan will continue to provide coverage during the leave of absence for up to one year, or until coverage would otherwise terminate under the Damar group health plan, whichever is earlier.

In order to be eligible to continue coverage as a dependent during such leave of absence:

• The Damar group health plan must receive written certification by a treating physician of the dependent child whichstates that the child is suffering from a serious illness or injury and that the leave of absence (or other change ofenrollment) is medically necessary

To obtain additional information, please contact:

Ellen Guido 6067 Decatur Blvd, Indianapolis, Indiana 46241 (317) [email protected]

Newborns' and Mothers' Health Protection Act Notice Group health plans and health insurance issuers generally may not, under Federal law, restrict benefits for any hospital length of stay in connection with childbirth for the mother or newborn child to less than 48 hours following a vaginal delivery, or less than 96 hours following a cesarean section. However, Federal law generally does not prohibit the mother’s or newborn’s attending provider, after consulting with the mother, from discharging the mother or her newborn earlier than 48 hours (or 96 hours as applicable). In any case, plans and issuers may not, under Federal law, require that a provider obtain authorization from the plan or the insurance issuer for prescribing a length of stay not in excess of 48 hours (or 96 hours).

Genetic Information Nondiscrimination Act (GINA) Disclosures Genetic Information Nondiscrimination Act of 2008

The Genetic Information Nondiscrimination Act of 2008 (“GINA”) protects employees against discrimination based on their genetic information. Unless otherwise permitted, your Employer may not request or require any genetic information from you or your family members.

The Genetic Information Nondiscrimination Act of 2008 (GINA) prohibits employers and other entities covered by GINA Title II from requesting or requiring genetic information of an individual or family member of the individual, except as specifically allowed by this law. To comply with this law, we are asking that you not provide any genetic information when responding to this request for medical information. “Genetic information,” as defined by GINA, includes an individual’s family medical history, the results of an individual’s or family member’s genetic tests, the fact that an individual or an individual’s family member sought or received genetic services, and genetic information of a fetus carried by an individual or an individual’s family member or an embryo lawfully held by an individual or family member receiving assistive reproductive services.

55

Medicare Part D Creditable Coverage Notice Important Notice from Damar 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 Damar 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 coverageif you join a Medicare Prescription Drug Plan or join a Medicare Advantage Plan (like an HMO or PPO) that offersprescription 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. Damar has determined that the prescription drug coverage offered by the Damar Services is, on average for all planparticipants, expected to pay out as much as standard Medicare prescription drug coverage pays and is thereforeconsidered Creditable Coverage. Because your existing coverage is Creditable Coverage, you can keep this coverageand 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 Damar coverage will not be affected. Plan participants can keep their prescription drug coverage under the group health plan if they select Medicare Part D prescription drug coverage. If they select Medicare Part D prescription drug coverage, the group health plan prescription drug coverage will coordinate with the Medicare Part D prescription drug coverage.

If you do decide to join a Medicare drug plan and drop your current Damar coverage, be aware that you and your dependents will 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 Damar 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 call Ellen Guido at (317) 856-5201. 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 Damar changes. You also may request a copy of this notice at any time.

56

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 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).

Date: 10/08/2018

Name of Entity/Sender: Damar

Contact--Position/Office: Ellen Guido, Benefits Manager

Address: 6067 Decatur Blvd Indianapolis, Indiana 46241

Phone Number: (317) 856-5201

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http://www.medicare.gov/

http://www.socialsecurity.gov/

General Notice of COBRA Rights (For use by single-employer group health plans)

Continuation Coverage Rights Under COBRA

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.

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

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• 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).

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:

Ellen Guido Benefits Manager 6067 Decatur Blvd Indianapolis, Indiana 46241 (317) [email protected]

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)

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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 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 Damar Services Ellen Guido 6067 Decatur Blvd Indianapolis, Indiana 46241 (317) [email protected]

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General FMLA Notice EMPLOYEE RIGHTS

UNDER THE FAMILY AND MEDICAL LEAVE ACT

The United States Department of Labor Wage and Hour Division Leave Entitlements Eligible employees who work for a covered employer can take up to 12 weeks of unpaid, job-protected leave in a 12-month period for the following reasons:

• The birth of a child or placement of a child for adoption or foster care;• To bond with a child (leave must be taken within 1 year of the child’s birth or placement);• To care for the employee’s spouse, child, or parent who has a qualifying serious health condition;• For the employee’s own qualifying serious health condition that makes the employee unable to perform the employee’s job; • For qualifying exigencies related to the foreign deployment of a military member who is the employee’s spouse, child,

or parent.

An eligible employee who is a covered servicemember’s spouse, child, parent, or next of kin may also take up to 26 weeks of FMLA leave in a single 12-month period to care for the servicemember with a serious injury or illness.

An employee does not need to use leave in one block. When it is medically necessary or otherwise permitted, employees may take leave intermittently or on a reduced schedule.

Employees may choose, or an employer may require, use of accrued paid leave while taking FMLA leave. If an employee substitutes accrued paid leave for FMLA leave, the employee must comply with the employer’s normal paid leave policies.

Benefits & Protections While employees are on FMLA leave, employers must continue health insurance coverage as if the employees were not on leave.

Upon return from FMLA leave, most employees must be restored to the same job or one nearly identical to it with equivalent pay, benefits, and other employment terms and conditions.

An employer may not interfere with an individual’s FMLA rights or retaliate against someone for using or trying to use FMLA leave, opposing any practice made unlawful by the FMLA, or being involved in any proceeding under or related to the FMLA.

Eligibility Requirements An employee who works for a covered employer must meet three criteria in order to be eligible for FMLA leave. The employee must:

• Have worked for the employer for at least 12 months;• Have at least 1,250 hours of service in the 12 months before taking leave;* and• Work at a location where the employer has at least 50 employees within 75 miles of the employee’s worksite.

*Special “hours of service” requirements apply to airline flight crew employees.

Requesting Leave Generally, employees must give 30-days’ advance notice of the need for FMLA leave. If it is not possible to give 30-days’ notice, an employee must notify the employer as soon as possible and, generally, follow the employer’s usual procedures.

Employees do not have to share a medical diagnosis, but must provide enough information to the employer so it can determine if the leave qualifies for FMLA protection. Sufficient information could include informing an employer that the employee is or will be unable to perform his or her job functions, that a family member cannot perform daily activities, or that

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hospitalization or continuing medical treatment is necessary. Employees must inform the employer if the need for leave is for a reason for which FMLA leave was previously taken or certified.

Employers can require a certification or periodic recertification supporting the need for leave. If the employer determines that the certification is incomplete, it must provide a written notice indicating what additional information is required.

Employer Responsibilities Once an employer becomes aware that an employee’s need for leave is for a reason that may qualify under the FMLA, the employer must notify the employee if he or she is eligible for FMLA leave and, if eligible, must also provide a notice of rights and responsibilities under the FMLA. If the employee is not eligible, the employer must provide a reason for ineligibility.

Employers must notify its employees if leave will be designated as FMLA leave, and if so, how much leave will be designated as FMLA leave.

Enforcement Employees may file a complaint with the U.S. Department of Labor, Wage and Hour Division, or may bring a private lawsuit against an employer.

The FMLA does not affect any federal or state law prohibiting discrimination or supersede any state or local law or collective bargaining agreement that provides greater family or medical leave rights.

For additional information or to file a complaint: 1-866-4-USWAGE

(1-866-487-9243) TTY: 1-877-889-5627 www.dol.gov/whd

U.S. Department of Labor | Wage and

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http://www.dol.gov/whd

USERRA Notice Your Rights Under USERRA

A. The Uniformed Services Employment and Reemployment Rights ActUSERRA protects the job rights of individuals who voluntarily or involuntarily leave employment positions to undertake military service or certain types of service in the National Disaster Medical System. USERRA also prohibits employers from discriminating against past and present members of the uniformed services, and applicants to the uniformed services.

B. Reemployment Rights

You have the right to be reemployed in your civilian job if you leave that job to perform service in the uniformed service and:

• You ensure that your employer receives advance written or verbal notice of your service;• You have five years or less of cumulative service in the uniformed services while with that particular employer;• You return to work or apply for reemployment in a timely manner after conclusion of service; and• You have not been separated from service with a disqualifying discharge or under other than honorable conditions.

If you are eligible to be reemployed, you must be restored to the job and benefits you would have attained if you had not been absent due to military service or, in some cases, a comparable job.

C. Right To Be Free From Discrimination and Retaliation

If you:

• Are a past or present member of the uniformed service;• Have applied for membership in the uniformed service; or• Are obligated to serve in the uniformed service; then an employer may not deny you• Initial employment;• Reemployment;• Retention in employment;• Promotion; or• Any benefit of employment because of this status.

In addition, an employer may not retaliate against anyone assisting in the enforcement of USERRA rights, including testifying or making a statement in connection with a proceeding under USERRA, even if that person has no service connection.

D. Health Insurance Protection

• If you leave your job to perform military service, you have the right to elect to continue your existing employer-basedhealth plan coverage for you and your dependents for up to 24 months while in the military.

• Even if you do not elect to continue coverage during your military service, you have the right to be reinstated in youremployer's health plan when you are reemployed, generally without any waiting periods or exclusions (e.g., pre-existing condition exclusions) except for service-connected illnesses or injuries.

E. Enforcement

• The U.S. Department of Labor, Veterans' Employment and Training Service (VETS) is authorized to investigate andresolve complaints of USERRA violations.

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For assistance in filing a complaint, or for any other information on USERRA, contact VETS at 1-866-4-USA-DOL or visit its Web site at http://www.dol.gov/vets. An interactive online USERRA Advisor can be viewed at http://www.dol.gov/elaws/userra.htm.

• If you file a complaint with VETS and VETS is unable to resolve it, you may request that your case be referred to theDepartment of Justice or the Office of Special Counsel, as applicable, for representation.

• You may also bypass the VETS process and bring a civil action against an employer for violations of USERRA.

The rights listed here may vary depending on the circumstances. The text of this notice was prepared by VETS, and may be viewed on the Internet at this address: http://www.dol.gov/vets/programs/userra/poster.htm. Federal law requires employers to notify employees of their rights under USERRA, and employers may meet this requirement by displaying the text of this notice where they customarily place notices for employees. U.S. Department of Labor, Veterans' Employment and Training Service, 1-866-487-2365.

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Notice of Privacy Practices Damar Services 6067 Decatur Blvd. Indianapolis, Indiana 46241 (317) 856-5201https://www.damar.org/

Privacy Official: Jennifer Mann 6067 Decatur Blvd. Indianapolis, Indiana 46241 (317) 856-5201 x [email protected]

Your Information. Your Rights. Our Responsibilities. This notice describes how medical information about you may be used and disclosed and how you can get access to this information. Please review it carefully.

Your Rights You have the right to:

• Get a copy of your health and claims records• Correct your health and claims records• Request confidential communication• Ask us to limit the information we share• Get a list of those with whom we’ve shared your information• Get a copy of this privacy notice• Choose someone to act for you• File a complaint if you believe your privacy rights have been violated

Your Choices You have some choices in the way that we use and share information as we:

• Answer coverage questions from your family and friends• Provide disaster relief• Market our services and sell your information

Our Uses and Disclosures We may use and share your information as we:

• Help manage the health care treatment you receive• Run our organization• Pay for your health services• Administer your health plan• Help with public health and safety issues• Do research• Comply with the law• Respond to organ and tissue donation requests and work with a medical examiner or funeral director• Address workers’ compensation, law enforcement, and other government requests• Respond to lawsuits and legal actions

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Your RightsWhen it comes to your health information, you have certain rights. This section explains your rights and some of our responsibilities to help you.

Get a copy of health and claims records • You can ask to see or get a copy of your health and claims records and other health information we have about

you. Ask us how to do this.• We will provide a copy or a summary of your health and claims records, usually within 30 days of your request.

We may charge a reasonable, cost-based fee.

Ask us to correct health and claims records • You can ask us to correct your health and claims records if you think they are incorrect or incomplete. Ask us

how to do this.• We may say “no” to your request, but we’ll tell you why in writing within 60 days.

Request confidential communications • You can ask us to contact you in a specific way (for example, home or office phone) or to send mail to a different

address.• We will consider all reasonable requests, and must say “yes” if you tell us you would be in danger if we do not.

Ask us to limit what we use or share • You can ask us not to use or share certain health information for treatment, payment, or our operations.• We are not required to agree to your request, and we may say “no” if it would affect your care.

Get a list of those with whom we’ve shared information • You can ask for a list (accounting) of the times we’ve shared your health information for six years prior to the

date you ask, who we shared it with, and why.• We will include all the disclosures except for those about treatment, payment, and health care operations, and

certain other disclosures (such as any you asked us to make). We’ll provide one accounting a year for free butwill charge a reasonable, cost-based fee if you ask for another one within 12 months.

Get a copy of this privacy notice You can ask for a paper copy of this notice at any time, even if you have agreed to receive the notice electronically. We will provide you with a paper copy promptly.

Choose someone to act for you • If you have given someone medical power of attorney or if someone is your legal guardian, that person can

exercise your rights and make choices about your health information.• We will make sure the person has this authority and can act for you before we take any action.

File a complaint if you feel your rights are violated • You can complain if you feel we have violated your rights by contacting us using the information of the Privacy

Official on the first page of this notice.• You can file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by

sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201, calling 1-877-696-6775, or visitingwww.hhs.gov/ocr/privacy/hipaa/complaints/.

• We will not retaliate against you for filing a complaint.

Your Choices For certain health information, you can tell us your choices about what we share. If you have a clear preference for how we share your information in the situations described below, talk to us. Tell us what you want us to do, and we will follow your instructions.

In these cases, you have both the right and choice to tell us to:

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• Share information with your family, close friends, or others involved in payment for your care• Share information in a disaster relief situation

If you are not able to tell us your preference, for example if you are unconscious, we may go ahead and share your information if we believe it is in your best interest. We may also share your information when needed to lessen a serious and imminent threat to health or safety.

In these cases we never share your information unless you give us written permission:

• Marketing purposes• Sale of your information

Our Uses and Disclosures

How do we typically use or share your health information? We typically use or share your health information in the following ways.

Help manage the health care treatment you receive We can use your health information and share it with professionals who are treating you.

Example: A doctor sends us information about your diagnosis and treatment plan so we can arrange additional services.

Run our organization • We can use and disclose your information to run our organization and contact you when necessary.• We are not allowed to use genetic information to decide whether we will give you coverage and the price of that

coverage. This does not apply to long term care plans.

Example: We use health information about you to develop better services for you.

Pay for your health services We can use and disclose your health information as we pay for your health services.

Example: We share information about you with your dental plan to coordinate payment for your dental work.

Administer your plan We may disclose your health information to your health plan sponsor for plan administration.

Example: Your company contracts with us to provide a health plan, and we provide your company with certain statistics to explain the premiums we charge.

How else can we use or share your health information? We are allowed or required to share your information in other ways – usually in ways that contribute to the public good, such as public health and research. We have to meet many conditions in the law before we can share your information for these purposes. For more information see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/index.html.

Help with public health and safety issues We can share health information about you for certain situations such as:

• Preventing disease• Helping with product recalls• Reporting adverse reactions to medications• Reporting suspected abuse, neglect, or domestic violence• Preventing or reducing a serious threat to anyone’s health or safety

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Do research We can use or share your information for health research.

Comply with the law We will share information about you if state or federal laws require it, including with the Department of Health and Human Services if it wants to see that we’re complying with federal privacy law.

Respond to organ and tissue donation requests and work with a medical examiner or funeral director • We can share health information about you with organ procurement organizations.• We can share health information with a coroner, medical examiner, or funeral director when an individual dies.

Address workers’ compensation, law enforcement, and other government requests We can use or share health information about you:

• For workers’ compensation claims• For law enforcement purposes or with a law enforcement official• With health oversight agencies for activities authorized by law• For special government functions such as military, national security, and presidential protective services

Respond to lawsuits and legal actions We can share health information about you in response to a court or administrative order, or in response to a subpoena.

Our Responsibilities • We are required by law to maintain the privacy and security of your protected health information.• We will let you know promptly if a breach occurs that may have compromised the privacy or security of your

information.• We must follow the duties and privacy practices described in this notice and give you a copy of it.• We will not use or share your information other than as described here unless you tell us we can in writing. If

you tell us we can, you may change your mind at any time. Let us know in writing if you change your mind.

For more information see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/noticepp.html.

Changes to the Terms of this Notice We can change the terms of this notice, and the changes will apply to all information we have about you. The new notice will be available upon request, on our web site, and we will mail a copy to you.

Date The policies set forth in this notice have been updated October 1, 2017.

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Notice of Privacy Practices Damar Services 6067 Decatur Blvd. Indianapolis, Indiana 46241 (317) 856-5201https://www.damar.org/

Privacy Official: Ellen Guido 6067 Decatur Blvd. Indianapolis, Indiana 46241 (317) 856-5201 x [email protected]

Your Information. Your Rights. Our Responsibilities. This notice describes how medical information about you may be used and disclosed and how you can get access to this information. Please review it carefully.

Your Rights You have the right to:

• Get a copy of your health and claims records• Correct your health and claims records• Request confidential communication• Ask us to limit the information we share• Get a list of those with whom we’ve shared your information• Get a copy of this privacy notice• Choose someone to act for you• File a complaint if you believe your privacy rights have been violated

Your Choices You have some choices in the way that we use and share information as we:

• Answer coverage questions from your family and friends• Provide disaster relief• Market our services and sell your information

Our Uses and Disclosures We may use and share your information as we:

• Help manage the health care treatment you receive• Run our organization• Pay for your health services• Administer your health plan• Help with public health and safety issues• Do research• Comply with the law• Respond to organ and tissue donation requests and work with a medical examiner or funeral director• Address workers’ compensation, law enforcement, and other government requests• Respond to lawsuits and legal actions

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Your RightsWhen it comes to your health information, you have certain rights. This section explains your rights and some of our responsibilities to help you.

Get a copy of health and claims records • You can ask to see or get a copy of your health and claims records and other health information we have about

you. Ask us how to do this.• We will provide a copy or a summary of your health and claims records, usually within 30 days of your request.

We may charge a reasonable, cost-based fee.

Ask us to correct health and claims records • You can ask us to correct your health and claims records if you think they are incorrect or incomplete. Ask us

how to do this.• We may say “no” to your request, but we’ll tell you why in writing within 60 days.

Request confidential communications • You can ask us to contact you in a specific way (for example, home or office phone) or to send mail to a different

address.• We will consider all reasonable requests, and must say “yes” if you tell us you would be in danger if we do not.

Ask us to limit what we use or share • You can ask us not to use or share certain health information for treatment, payment, or our operations.• We are not required to agree to your request, and we may say “no” if it would affect your care.

Get a list of those with whom we’ve shared information • You can ask for a list (accounting) of the times we’ve shared your health information for six years prior to the

date you ask, who we shared it with, and why.• We will include all the disclosures except for those about treatment, payment, and health care operations, and

certain other disclosures (such as any you asked us to make). We’ll provide one accounting a year for free butwill charge a reasonable, cost-based fee if you ask for another one within 12 months.

Get a copy of this privacy notice You can ask for a paper copy of this notice at any time, even if you have agreed to receive the notice electronically. We will provide you with a paper copy promptly.

Choose someone to act for you • If you have given someone medical power of attorney or if someone is your legal guardian, that person can

exercise your rights and make choices about your health information.• We will make sure the person has this authority and can act for you before we take any action.

File a complaint if you feel your rights are violated • You can complain if you feel we have violated your rights by contacting us using the information of the Privacy

Official on the first page of this notice.• You can file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by

sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201, calling 1-877-696-6775, or visitingwww.hhs.gov/ocr/privacy/hipaa/complaints/.

• We will not retaliate against you for filing a complaint.

Your Choices For certain health information, you can tell us your choices about what we share. If you have a clear preference for how we share your information in the situations described below, talk to us. Tell us what you want us to do, and we will follow your instructions.

In these cases, you have both the right and choice to tell us to:

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• Share information with your family, close friends, or others involved in payment for your care• Share information in a disaster relief situation

If you are not able to tell us your preference, for example if you are unconscious, we may go ahead and share your information if we believe it is in your best interest. We may also share your information when needed to lessen a serious and imminent threat to health or safety.

In these cases we never share your information unless you give us written permission:

• Marketing purposes• Sale of your information

Our Uses and Disclosures

How do we typically use or share your health information? We typically use or share your health information in the following ways.

Help manage the health care treatment you receive We can use your health information and share it with professionals who are treating you.

Example: A doctor sends us information about your diagnosis and treatment plan so we can arrange additional services.

Run our organization • We can use and disclose your information to run our organization and contact you when necessary.• We are not allowed to use genetic information to decide whether we will give you coverage and the price of that

coverage. This does not apply to long term care plans.

Example: We use health information about you to develop better services for you.

Pay for your health services We can use and disclose your health information as we pay for your health services.

Example: We share information about you with your dental plan to coordinate payment for your dental work.

Administer your plan We may disclose your health information to your health plan sponsor for plan administration.

Example: Your company contracts with us to provide a health plan, and we provide your company with certain statistics to explain the premiums we charge.

How else can we use or share your health information? We are allowed or required to share your information in other ways – usually in ways that contribute to the public good, such as public health and research. We have to meet many conditions in the law before we can share your information for these purposes. For more information see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/index.html.

Help with public health and safety issues We can share health information about you for certain situations such as:

• Preventing disease• Helping with product recalls• Reporting adverse reactions to medications• Reporting suspected abuse, neglect, or domestic violence• Preventing or reducing a serious threat to anyone’s health or safety

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Do research We can use or share your information for health research.

Comply with the law We will share information about you if state or federal laws require it, including with the Department of Health and Human Services if it wants to see that we’re complying with federal privacy law.

Respond to organ and tissue donation requests and work with a medical examiner or funeral director • We can share health information about you with organ procurement organizations.• We can share health information with a coroner, medical examiner, or funeral director when an individual dies.

Address workers’ compensation, law enforcement, and other government requests We can use or share health information about you:

• For workers’ compensation claims• For law enforcement purposes or with a law enforcement official• With health oversight agencies for activities authorized by law• For special government functions such as military, national security, and presidential protective services

Respond to lawsuits and legal actions We can share health information about you in response to a court or administrative order, or in response to a subpoena.

Our Responsibilities • We are required by law to maintain the privacy and security of your protected health information.• We will let you know promptly if a breach occurs that may have compromised the privacy or security of your

information.• We must follow the duties and privacy practices described in this notice and give you a copy of it.• We will not use or share your information other than as described here unless you tell us we can in writing. If

you tell us we can, you may change your mind at any time. Let us know in writing if you change your mind.

For more information see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/noticepp.html.

Changes to the Terms of this Notice We can change the terms of this notice, and the changes will apply to all information we have about you. The new notice will be available upon request, on our web site, and we will mail a copy to you.

Date The policies set forth in this notice have been updated October 1, 2018.

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http://www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/noticepp.html

Customer Service Contacts

DISCLAIMER: This guide describes some of the benefit plans available to you as an employee of Damar. It is not a Summary Plan Description, and it does not provide all the details. The details of these plans are contained in the official Plan Documents, including some insurance contracts. If there are discrepancies between the information in this guide and the official Plan Documents, provisions of the Plan Documents will govern. Damar reserves the right to terminate, amend, suspend, withdraw or modify any plan in whole or in part at any time. Plan Documents are available upon request from HR.

Vendor Phone Number Web Address Anthem

Medical Prescription Drugs

1.800.295.4119 www.anthem.com

Delta Dental Dental 1.800.524.0149 www.deltadentalin.com

VSP Vision

1.800.877.7195 www.vsp.com

Discovery Benefits FSA

1.866.451.3399 www.DiscoveryBenefits.com

Sun Life Life and AD&D Short Term Disability Long Term Disability

1.800.247.6875 www.mysunlifebenefits.com

St. Vincent Stress Center Employee Assistance Program

1.800.544.9412 or 317.338.4900 N/A

OneAmerica 401(k) Retirement Plan

1.800.249.6269 www.damar401(k).org

Damar Services HR Human Resources Office

317.856.5201 N/A

http://www.anthem.com/

http://www.deltadentalin.com/

http://www.vsp.com/

http://www.discoverybenefits.com/

http://www.mysunlifebenefits.com/

http://www.damar401(k).org/