2020 Open Enrollment Guide - Explain My Benefits ...

 
2020 Open Enrollment Guide - Explain My Benefits ...
2020 Open Enrollment Guide
2020 Open Enrollment Guide - Explain My Benefits ...
2             Open Enrollment Guide

Table of Contents
Benefit Resource Center ......................................................................................................................................... 3
A Message to Our Employees ................................................................................................................................. 4
Benefits for You & Your Family ............................................................................................................................... 5
EMB Enroll ............................................................................................................................................................... 6
Medical Benefits Overview ..................................................................................................................................... 7
Prescription Discounts .......................................................................................................................................... 12
Baer's Furniture’s Wellness Initiatives .................................................................................................................. 13
Health Savings Accounts ....................................................................................................................................... 14
Health Savings Accounts – Frequently Asked Questions...................................................................................... 15
Health Savings Accounts – Frequently Asked Questions...................................................................................... 16
Health Savings Accounts Banking Information ..................................................................................................... 17
Dental Insurance ................................................................................................................................................... 18
Vision Insurance .................................................................................................................................................... 19
Voluntary Life and Accidental Death & Dismemberment Insurance ................................................................... 20
Voluntary Disability Insurance .............................................................................................................................. 21
Voluntary Critical Illness ....................................................................................................................................... 22
2020 Payroll Deductions ....................................................................................................................................... 23
Supplemental Benefits .......................................................................................................................................... 24
Supplemental Benefits .......................................................................................................................................... 25
Contacts ................................................................................................................................................................ 36
Important Legal Notices........................................................................................................................................ 37

 This brochure summarizes the benefit plans that are available to Baer's Furniture Company, Inc. eligible employees and their dependents. Official
 plan documents, policies and certificates of insurance contain the details, conditions, maximum benefit levels and restrictions on benefits. These
 documents govern your benefits program. If there is any conflict, the official documents prevail. These documents are available upon request
 through the Human Resources Department. Information provided in this brochure is not a guarantee of benefits.
2020 Open Enrollment Guide - Explain My Benefits ...
3     Open Enrollment Guide

Benefit Resource Center
         Call the Benefit Resource Center (“BRC”), We’re Here to Help!

               We speak insurance. Our Benefits Specialists can help you with:
                              Deciding which plan is the best for you
                              Benefit plan & policy questions
                              Eligibility & claim problems with carriers
                              Information about claim appeals & process
                              Allowable family status election changes
                              Transition of care when changing carriers
                              Claim escalation, appeal & resolution
                              Medicare basics with your employer plan
                              Coordination of benefits
                              Finding in-network providers
                              Access to care issues
                              Obtaining case management services
                              Group disability claims
                              Filing claims for out-of-network services

BRCSouth@usi.com | Toll Free: 855-874-0835 | Monday-Friday 8am-5pm EST
2020 Open Enrollment Guide - Explain My Benefits ...
4        Open Enrollment Guide

A Message to Our Employees
The Benefits Open Enrollment Period Is Here!
Baer’s Furniture is committed to provide a comprehensive benefits package to our employees for the
following year. As healthcare costs continue to rise, Baer’s Furniture strives to keep pace with healthcare
trends and to provide choices for medical insurance to meet the needs of our employees and to manage the
increased costs. Considering present inflation and increased government regulation, we are very pleased to
announce a minimal annual increase in the cost of medical insurance for our employees. All other insurance
plans will continue for the next year with no increase in current premium costs. We will have our open
enrollment meetings to provide information about our benefits at all our locations. It is very important that all
our employees attend a meeting to be informed. Family members are welcome to attend as well. We will
continue to use our online benefits system with Explain My Benefits to renew enrollment or make changes in
benefits for 2020. All the information and pricing will be available when the portal is open during the first two
weeks of December 2019.

The Baer Family.
2020 Open Enrollment Guide - Explain My Benefits ...
5        Open Enrollment Guide

Benefits for You & Your Family
Baer's Furniture is pleased to announce our 2020       When and How Do I Enroll?
benefits program. Please read the information          Open enrollment meetings will begin to be
provided in this guide carefully. For full details     conducted in November. Our enrollment portal will
about our plans, please refer to the summary plan      open in December.
descriptions. Listed below are the Baer's Furniture
benefits available during open enrollment:             All eligible employees are required to complete the
         Medical                                       enrollment process, even if you do not wish to make
         Dental                                        any changes to your benefits.
         Vision
         Short Term Disability                         You can sign up for Benefits at any of the following
         Long Term Disability                          times:
         Voluntary Life                                    • After completing initial eligibility period;
         Wellness Plan                                     • During the annual open enrollment period;
         Accident Insurance                                • Within 30 days of a qualified family-status
         Critical Illness                                      change.
                                                       If you do not enroll at one of the above times, you
Who is Eligible?                                       must wait for the next annual open enrollment
Full-Time employees working at least 30 hours a        period.
week and their eligible dependents may participate
in the Baer's Furniture benefit program.               When is My Coverage Effective?
                                                       The effective date for your benefits is January 1,
Generally, for the Baer's Furniture benefit program,   2020. If you are a New Hire your benefit effective
dependents are defined as:                             date will be first of the month following 60 days.
        Your spouse, unless you are legally
        separated or divorced, domestic partner
        same or opposite gender;
                                                       Changing Coverage During the Year
                                                       You can change your coverage during the year when
        Your married or unmarried natural
                                                       you experience a qualified change in status, such as
        children, step-children living with you,
                                                       marriage, divorce, birth, adoption, placement for
        legally adopted children and any other
        children for whom you have legal               adoption, or loss of coverage. The change must be
        guardianship,                                  reported to the Human Resources Department
        Newborn to age 30.                             within 30 days of the event. The change must be
        A dependent who is older than 26 years of      consistent with the event.
        age, but less than 30 years of age may be      For example, if your dependent child no longer
        eligible for medical benefits through the      meets eligibility requirements, you can drop
        end of the calendar year with no               coverage only for that dependent.
        qualifications or coverage restrictions.
2020 Open Enrollment Guide - Explain My Benefits ...
6        Open Enrollment Guide

EMB Enroll

    WHEN IS OPEN ENROLLMENT?
    Online Benefit Enrollment system open: December 2nd – 13th

    All Enrollments must be completed using EMB ENROLL.

    HOW TO ENROLL IN YOUR BENEFITS
    1. Access the On-Line Enrollment at: www.explainmybenefits.com/baers

    2. Review your Benefit Guide along with the brochures and videos on the page.

    3. Click the Open Enrollment Button

    4. Please follow the instructions on the page and proceed to your enrollment

    5. Complete your enrollment

    6. IMPORTANT: RECORD YOUR CONFIRMATION NUMBER _________________________

       IMPORTANT THIS YEAR: All benefit eligible employees must confirm a benefit enrollment using EMB
       ENROLL whether you are electing benefits, keeping benefits the same, making changes, or waiving all
       benefits. This is a requirement this year.

    HOW YOU CAN BE PREPARED?

    1. Please have the dates of birth and social security numbers of dependents when you enroll.
    2. Look for emails, brochures and other information to be distributed prior to your Open Enrollment!!!
    3. View Benefit Resource Portal for more information about the Open Enrollment Process, review your
       benefit guide and learn about the voluntary benefits offered.

       www.explainmybenefits.com/baers
2020 Open Enrollment Guide - Explain My Benefits ...
7           Open Enrollment Guide

Medical Benefits Overview
Baer's Furniture offers 2 medical plans the HNOnly (Core Plan) and the HNOption w/ HSA (Buy Up). Both plans
utilize the Aetna provider network. In order to verify a participating provider please visit ww.mymeritain.com,
Scroll down to the Provider Network Finder, enter provider network name: Aetna. Once you click Aetna, start
your search. One can chose from provider types, hospitals and facilities, medical conditions or procedures.
The chart on the following page is a brief outline of the plan. Please refer to the summary plan description for
complete plan details.
                                                                         Dual Option
                                                      HNOnly (Core Plan)           HNOption w/HSA (Buy Up)
Benefit Coverage                                         ScheduleofBenefits                         In-NetworkBenefits
 In-Network
    Plan Year / Contract Year Basis                       Calendar Year                              Calendar Year
    Deductible (Individual / Family)                     $5,500 / $11,000                           $2,500 / $5,000
    Maximum Out-of-Pocket
                                                         $6,350 / $12,700                          $4, 500 / $ 6,750
    (Individual / Family)
                                                     Deductible, coinsurance,                   Deductible, coinsurance,
    Out of Pocket Max Includes
                                                          copays & Rx                                copays & Rx
    Lifetime Major Medical Maximum                          Unlimited                                  Unlimited
    Coinsurance                                                50%                                        80%
 Preventative
    Wellness                                                  100%                                       100%
 Copays
     Open Access                                               Yes                                        Yes
    Office Visits/Consultations for
                                                            $35 copay                                20% after CYD
    llness/Injury
    Specialist Visits                                       $75 copay                                20% after CYD
    Inpatient Hospital                                    50% after CYD                              20% after CYD
    Outpatient Surgery                                    50% after CYD                              20% after CYD
    Emergency Room                                         $300 copay                                20% after CYD
    Urgent Care                                             $50 copay                                20% after CYD
    Complex Diagnostic                                      $300 copay                               20% after CYD
 Prescriptions*
    RX Deductible (per calendar year)              $200 Individual / $400 Family                          CYD
    Retail Pharmacy (30 Day Supply)                       $15/$20/50%                                30%/30%/50%
    Mandatory Mail Order
                                                          $30/$40/50%                                30%/30%/50%
    (90 day supply)
Out of Network
    Deductible (Ind/Fam)                                                                           $5,000 / $10,000
    Maximum Out-of-Pocket (Ind/Fam)                                                                $10,000 / $20,000
                                                           Not Covered
    Lifetime Major Medical Maximum                                                                     Unlimited
   Coinsurance                                                                                             60%
CYD: Calendar Year Deductible
*After two retail fills for maintenance medication the member would be notified that they must use the mail order pharmacy or
local CVS retail pharmacy for any future fills of their maintenance medication.
2020 Open Enrollment Guide - Explain My Benefits ...
Reach a doctor 24/7
The Teladoc® solution
Baer’s Furniture Company, Inc.
Teladoc is the on-demand healthcare solu on that
gives you the medical care you need, when you need
it. You can talk to a doctor any me, anywhere about              There’s more than one way to reach
non-emergent medical condi ons.                                  a doctor
Benefits of Teladoc                                                        By phone. Just call 1.800.362.2667.

   Saves me and money                                                     Online. Simply request a video consulta on
     There is no copay for this service                                   online at www.MyDrConsult.com.
   Quicker recovery from illness                                          On the go. You can download the Teladoc
   Convenient prescrip ons                                                mobile app by visi ng the App Store or
                                                                           Google Play.
   Choice of consulta on method
   Great health means peace of mind
                                                             Common conditions treated:
With Teladoc, you can talk to a doctor 24/7/365 by
phone, online video or mobile app. Use Teladoc for              Allergies                                  Rash/skin infec ons
medical advice and care when:                                   Bronchi s                                  Sinus infec ons
                                                                Cold/flu                                   Stomachache/
   Your primary care doctor is not open.                                                                     diarrhea
                                                                Headaches/migraines
   You are at home, traveling or do not want to take                                                       Urinary tract
                                                                Eye/ear infec on
     me off work to see a doctor.                                                                              infec ons
   You need a prescrip on or refills*.
*Please note, there is no guarantee you will be prescribed       Our members love Teladoc
medicaƟon.                                                       “We had a good experience with the doctor. She
                                                                 called and talked to me, and gave great service. I
Highly qualified, experienced doctors                            had no problem picking up my prescription. This is a
When you use Teladoc, your medical questions will                really good service.”
be answered by a highly qualified doctor. Teladoc
doctors are:                                                 Contact a Teladoc physician at 1.800.362.2667, or by
 Experienced—with an average of over 10–15 years            visiting www.MyDrConsult.com.
   in practice.
                                                             © 2015 Teladoc, Inc. All rights reserved. Teladoc and the Teladoc logo are
   Progressive—using the latest technology to               registered trademarks of Teladoc, Inc. and may not be used without wri en
                                                             permission. Teladoc does not replace the primary care physician. Teladoc does not
    provide excellent care.                                  guarantee that a prescrip on will be wri en. Teladoc operates subject to state
                                                             regula on and may not be available in certain states. Teladoc does not rescribe
   U.S. board certified and state licensed.                 DEA controlled substances, non therapeu c drugs and certain other drugs which
                                                             may be harmful because of their poten al for abuse. Teladoc physicians reserve the
   Specially trained in telemedicine.                       right to deny care for poten al misuse of services. Teladoc phone consulta ons are
                                                             available 24 hours, 7 days a week while video consulta ons are available during the
                                                             hours of 7am to 9pm, 7 days a week.
2020 Open Enrollment Guide - Explain My Benefits ...
10/22/2019

Baer's Furniture Prescription Drug Benefits
Maintenance Medications Requirement – Effective January 1,
2019                                                                       Maintenance
                                                                           Medications
Effective January 1, 2019, all maintenance medications must be
obtained through CVS or WellDyneRx Prescription Delivery Service
                                                                           Maintenance medications
pharmacy provider. WellDyneRx offers free delivery of medications to
                                                                           are prescription drugs
your home, work or doctor’s office.
                                                                           commonly used to treat
                                                                           chronic or long-term
If you and/or your covered dependent(s) are taking a maintenance
                                                                           conditions. These
medication, please follow the important steps detailed below to start
                                                                           conditions usually require
filling your prescriptions with WellDyneRx.
                                                                           regular, daily use of
                                                                           medicines.
Important Things to Do
                                                                           Examples of maintenance
1. Register for WellDyneRx Prescription Delivery Service
                                                                           medications are those used
   You will need to create an account by providing your insurance,         to treat conditions such as:
   contact, health, and payment information. Register online or by mail:        • Asthma
     • Online: www.WellDyneRx.com                                               • Depression
     • Mail: Complete and mail the enclosed registration form. You              • Diabetes
        will need to provide a payment method before ordering your              • High blood pressure
        first prescription by entering a credit, debit, FSA, or HSA card        • High cholesterol
        online or by calling Member Services at 1-888-479-2000.

2. Ask your doctor to send a NEW 90-day prescription to
   WellDyneRx. Prescriptions cannot be transferred from a retail
   pharmacy.
    • E-prescribe: WellDyneRx Prescription Delivery
    • Fax: 1-877-221-1259 or 1-888-830-3608

For more information about WellDyneRx Prescription Delivery Service,
visit our website at www.WellDyneRx.com.

Sincerely,

WellDyneRx

Enclosure: WellDyneRx Prescription Delivery Registration Form
2020 Open Enrollment Guide - Explain My Benefits ...
Member Materials

         UNDERSTANDING
         STEP THERAPY

         Your WellDyneRx Benefit Plan
         Medicines can be expensive, and WellDyneRx provides ways to help members
         manage their prescription drug costs. Your benefit plan uses one of these options,
         called step therapy.
         What is step therapy?
         Step therapy is a program that helps you and your doctor choose medicine that is right for you.
         WellDyneRx has certain medicines that we recommend you try first when treating some
         health conditions. Trying certain drugs first before trying others is called step therapy.
             »» Step One Drugs – Lower-cost options
                This first step requires you to use a lower-cost medicine before you can use a more
                expensive Step Two drug. The lower-cost options are usually generic medicines. They can
                provide the same health benefits as higher-cost medicines.

             »» Step Two Drugs – Brand name drugs
                Step Two drugs are brand name medicines that usually cost more than Step One or generic
                medicines. They’re recommended only if a Step One medicine doesn’t work for you.

         What if my doctor prescribes a Step Two drug?
         When a pharmacist puts your prescription into the system, they receive an alert if the
         medication is part of the step therapy program.
         Your pharmacy will not automatically change your prescription if you have a Step Two drug.
         Your doctor must write a new prescription for you to switch to a Step One drug. If your doctor
         thinks a Step One drug is not a good choice for you, they can request approval of a Step Two
         medicine from WellDyneRx.
         If you have questions about your pharmacy benefits, please visit www.WellDyneRx.com and
         click “Members” or call the Member Services number shown on your member ID card.

      Y      our benefit plan uses tools such as step therapy
             that can help control your costs.

For questions, please contact WellDyneRx Member
Services at the number listed on your ID Card.
www.WellDyneRx.com
                                                                                                  6.2018 © WellDyneRx
ADVANCED SPECIALTY
PHARMACY SERVICES

      US Specialty Care, WellDyneRx’s wholly-owned specialty pharmacy, is an industry-leading provider of
      specialty medications. We are committed to providing personalized care to each member, ensuring
      they have the tools necessary to understand and manage their condition. We will work with you, your
      doctors and nursing staff to create a personalized treatment plan that will provide you with the best
      possible outcomes. Our experienced pharmacy staff will provide you with complete patient support.

      Working together to improve your health

      US Specialty Care understands that patients who use specialty medications require special,
      personalized care, that’s why we will pair you with a Patient Care Advocate. Your Patient Care
      Advocate will work with you to deliver the right care. Our pharmacy fully supports you through:

         »» Medication delivery: We know that getting your medication on time is important. Your
            medications will be carefully packaged in a temperature controlled pack and discreetly
            shipped to ensure confidentiality and stability.

         »» Insurance and financial assistance coordination: US Specialty Care will coordinate your
            benefits and insurance coverage, assist with obtaining prior authorizations, and identify
            additional options to lower costs. When possible, they will direct you to grants and/or other
            financial assistance to help bridge benefit gaps.

         »» Expert Support: Once you enroll, you will be assigned a Patient Care Advocate who is familiar
            with your disease state. Your Patient Care Advocate will provide you with the support needed
            to manage your condition and schedule prescription refills.

      Getting started
      To get started, ask your doctor to send your prescription to US Specialty Care electronically or by fax to
      800-530-8589. Your doctor can also speak with our experienced team of pharmacists by calling 800-
      641-8475. Your Patient Care Advocate will contact you to help you enroll in our specialty pharmacy
      program, schedule your medication delivery, and help you manage your medical supplies.

      With US Specialty Care, you’ll have the peace of mind knowing that you have access to the
      medications, tools and resources to manage your health. To learn more about US Specialty Care,
      contact us at 800-641-8475 or visit www.USSpecialtyCare.com.

www.USSpecialtyCare.com
                                                                                                    9.2018 © WellDyneRx
12       Open Enrollment Guide

Prescription Discounts
Baers Furniture is always looking to protect its employees pockets when it can. Take a look at the various
pharmacy discounts available to you simply for being a consumer. You do not need to be a member of the
medical plan in order to participate in any of these programs. For more information please visit the websites
below and keep in mind that certain restrictions will apply.

Publix offers a variety of prescription medications free for as long as your doctor prescribes them, 30 days’
worth at a time. Those include:
            • Metformin (for diabetes).
            • Lisinopril (for high blood pressure).
            • Amlodipine (for high blood pressure and angina).
Publix also offers a free 14-day supply of some common antibiotics:
            • Amoxicillin
            • Ampicillin
            • Sulfamethoxazole/Trimethoprim (SMZ-TMP)
            • Ciprofloxacin (excluding Ciprofloxacin XR)
            • Penicillin VK
Visit: www.publix.com

Walmart $4 Prescriptions. Save big on 30-day generic medications & spend just $10 on 90-day
prescriptions. No insurance necessary. Find your medication list at: www.walmart.com

GoodRx gathers current prices and discounts to help you find the lowest cost pharmacy for your
prescriptions. The average GoodRx customer saves $276 a year on their prescriptions.
            • GoodRx is 100% free.
            • No personal information required.
Visit their website at www.goodrx.com or download their app.
13         Open Enrollment Guide

Baer's Furniture’s Wellness Initiatives
As most of you now know, Baer’s Furniture launched a new employee wellness program in 2015 which
offered employees the opportunity to save on their future medical premiums.

Participating in the Baer’s Furniture Wellness Program helps all of us better manage or avoid chronic
conditions such as hypertension, diabetes, high cholesterol, and depression, which can subtract years from
our lives. The journey toward a better lifestyle is never easy, however with support, commitment, and
consistency, each of us can achieve our individual health and wellness goals. Today, it is more important than
ever to take an active role in your personal health and therefore, Baer’s Furniture wants you to know that we
are here to provide the tools and incentives to help.

Going to see your doctor for a yearly wellness exam is one of the best ways to manage your health. Preventive
care often leads to identifying health problems early and increasing your chances for successful treatment
and/or cure. Now that these services are covered by all health plans, it's just that much easier to achieve and
maintain optimal health.

Just 3 steps to improve your health and save…..
Step 1 Complete an annual physical with your primary care physician (PCP). Your doctor will need to
complete & sign the company-provided Physician Form to confirm you had your annual physical. Physician
visits completed between November 1, 2019 & October 31, 2020 will be accepted. If enrolled in the health
plan, your annual physical and standard preventive lab work should be covered in full once every 365 days.

Step 2 Complete the Preventive Screening form. Take the preventive screening form to your scheduled
doctor’s visit to be completed and signed by the attending physician. One exam needs to be completed
between November 1, 2019 & October 31, 2020. For the list of screenings that are accepted please refer to
the wellness packet.

Step 3 Send both forms to Wellworks on or prior to November 1, 2020. Submit BOTH your physician form and
preventive screening form together to Wellworks. See instructions listed on the forms regarding how to send
them.
                                  *New hires: Hired after 5/1/20 will receive incentive.

By completing the above steps, you will receive…
Incentives: For completing the annual physical and the preventive screening form, you will receive a discount
on your medical premiums beginning January 1, 2021.
Your health plan is committed to helping you achieve your best health. Rewards for participating in a wellness program are available
to all employees. If you think you might be unable to meet a standard for a reward under this wellness program, you might qualify for
an opportunity to earn the same reward by different means. Contact us 954-946-8001 ext. 215 and we will work with you (and, if you
wish, with your doctor) to find a wellness program with the same reward that is right for you in light of your health status.

Be Healthy & Save!
14       Open Enrollment Guide

Health Savings Accounts
A health savings account (HSA) is an account funded to help you save for future medical expenses not covered
by your insurance plan, including the deductible, coinsurance and even vision and dental expenses. You must
be enrolled in an HSA compatible health plan to be eligible, there are certain advantages to putting money into
these accounts, including favorable tax treatment and the ability to roll unused funds over from year to year.

Who Can Have an HSA?
Any adult can contribute to an HSA if you:
       · Have coverage under an HSA-qualified, high-deductible health plan (HDHP)
       · Have no other first-dollar medical coverage (other types of insurance, including specific injury or
         accident, disability, dental care, vision care, or long-term care insurance are permitted)
       · Are not enrolled in Medicare or Tricare
       · Cannot be claimed as a dependent on someone else’s tax return

Contributions to your HSA would be made by you. The total contributions are limited annually. If you make a
contribution, you can deduct the contributions (even if you do not itemize deductions) when completing your
federal income tax return. Contributions to the account must stop once you are enrolled in Medicare. However,
you can keep the money in your account and use it to pay for medical expenses tax-free.

HDHPs
You must have coverage under the Baer's Furniture HDHP to open and contribute to an HSA.

HSA Contributions
You can make a contribution to your HSA each year that you are eligible. Contributions from all sources can be
no more than:
        · Self-only coverage: $3,550 in 2020
        · Family coverage: $7,100 in 2020
Individuals ages 55 and older can also make additional “catch-up” contributions. The maximum annual catch-
up contribution is $1,000.
15       Open Enrollment Guide

Health Savings Accounts – Frequently Asked Questions
How do I manage my HSA?
Your Health Savings Account (HSA) is your account; the HSA dollars are your dollars. Since you are the account
holder or HSA beneficiary, you manage your HSA account. You may choose when to use your HSA dollars or
when not to use your HSA dollars. HSA dollars pay for any eligible expense. Most commonly, the HSA account
holder will use HSA dollars to pay the out-of-pocket expenses (i.e., deductible and coinsurance) associated
with their high deductible plan.
What expenses are eligible for reimbursement from my HSA?
HSA dollars may be used for qualified medical expenses incurred by the account holder and his or her spouse
and dependents. Qualified medical expenses are outlined within IRS Section 213(d). In summary the IRS
Section 213(d) states that “the expense has to be primarily for the prevention or alleviation of a physical or
mental defect or illness”.
In addition to qualified medical expenses, the following insurance premiums may be reimbursed from an HSA:
· COBRA premiums
· Health insurance premiums while receiving unemployment Benefits
· Any health insurance premiums paid, other than for a Medicare supplemental policy, by individuals ages 65
and over
Are dental and vision care qualified medical expenses under an HSA?
Yes, as long as these are deductible under the current rules. For example, cosmetic procedures, like cosmetic
dentistry, would not be considered qualified medical expenses.
What expenses are NOT eligible for reimbursement from my HSA?
The following expenses may not be reimbursed from an HSA:
· Premiums for Medicare supplemental policies
· Expenses covered by another insurance plan
· Expenses incurred prior to the date the HSA was established
· Over-the-counter drugs purchased without a prescription (except insulin)
What is a coverage gap?
This is the gap between total out-of-pocket expenses associated with your high-deductible health plan and
your HSA dollars. For example, assume that you have a $2,000 deductible, a $4,000 maximum out-of-pocket,
and either you or your employer has contributed $2,000 to your HSA account. If your medical costs incurred
exceed $4,000 for the year, then you are financially obligated to pay the difference between your total
maximum out-of-pocket ($4,000) and your HSA balance ($2,000) - ($4,000 - $2,000 = $2,000)
What happens when my HSA funds run out?
You may be financially responsible for any eligible medical expenses that fall within the coverage gap.
Can I use my HSA dollars for non-eligible expenses?
Money withdrawn from an HSA account to reimburse non-eligible medical expenses is taxable income to the
account holder and subject to a 20 percent tax penalty - unless over age 65, disabled or upon death of the
account holder.
When can I start using my HSA dollars?
You can use your HSA dollars immediately following your HSA account activation and once contributions have
been made.
16       Open Enrollment Guide

Health Savings Accounts – Frequently Asked Questions
How do I pay my physician or network facility at time of service with my HSA dollars?
You may request that the network provider submit your claim to your health plan. You should make sure that
your provider has your most up-to-date insurance information. Once the medical claim has been processed, if
applicable, out-of-pocket expenses will be billed. At this time, you may choose to use your HSA Debit card to
pay for any out-of-pocket expenses, or you may choose to pay with your own money and receive
reimbursement at a later date. You should always ask that your medical claim be submitted to the health plan
before you seek reimbursement from your HSA. This procedure will ensure that provider discounts are
applied. Also, remember to keep all medical receipts and Explanation of Benefits (EOBs) for tax purposes.
What if I have HSA dollars left in my account at year-end?
The money is yours to keep. It will continue to be available for you and your health care costs next year.

What happens to my HSA dollars if I leave Baer's Furniture?
The funds are yours to keep. You may elect one of the following options:
· Leave your funds in your current HSA account
· Transfer your funds to an HSA with your new employer
· Transfer your funds to another qualifying account within 60 days
Can I use the money in my account to pay for my dependents’ medical expenses?
You can use the money in your account to pay for medical expenses for yourself, your spouse or your
dependent children. You can pay for the unreimbursed expenses of your spouse and dependent children even
if they are not covered by your HDHP.
Can couples establish a “joint” account and both make contributions to the account, including “catch-up”
contributions?
“Joint” HSA accounts are not permitted. Each spouse should consider establishing an account in their own
name. This allows you both to make catch-up contributions when each spouse is 55 or older.
My employer offers an FSA – can I have both an FSA and an HSA?
You can have both types of accounts, but only under certain circumstances. General Flexible Spending
Accounts (FSAs) will probably make you ineligible for an HSA. If your employer offers a “limited purpose”
(limited to dental, vision or preventive care) or “post-deductible” (pay for medical expenses after the plan
deductible is met) FSA, then you can still be eligible for an HSA.
Can I shift my IRA funds to my HSA?
Owners of individual retirement accounts that are enrolled in a high-deductible health plan can shift IRA funds
to an HSA without facing a tax penalty. The IRS allows a one-time transfer that does not exceed your
maximum HSA contribution limit.
Can I borrow against the money in my HSA?
No. You may not borrow against it or pledge the funds in it. For more information on prohibited activities see
Section 4975 of the Internal Revenue Code.
17        Open Enrollment Guide

Health Savings Accounts Banking Information

Opening your Health Savings Account
Follow the steps below to open your Health Savings Account (HSA).

Step 1: Medical Plan Enrollment
Enroll in the Baer’s HSA compatible HDHP Plan.

Step 2: Contribution
Determine how much you plan to contribute to your HSA account before taxes.

Step 3: HSA Establishment
Varies by bank, use their instructions. Chose a bank of your choice, open and deposit money into your HSA right away so
you are prepared if you have a health event. You or anyone else can deposit money into the HSA at any time.
18         Open Enrollment Guide

Dental Insurance
Baer's Furniture offers two dental plans through Guardian. Guardian’s DHMO is an in-network only dental
plan. There are no benefits for out-of-network dentists. There are no plan maximums or deductibles.
The DPPO Plan allows you to use in-network or out-of-network benefits. If out-of-network dentists are used,
you will be responsible to pay the difference between Guardian’s allowed amount and what the dentist may
charge.
                                                Guardian                             Guardian
                                             DHMO 30 Low Plan                   DPPO K7 Buy Up Plan
Benefit Coverage                               ScheduleofBenefits       In-NetworkBenefits   Out-of-NetworkBenefits
Deductible
  Individual                                          $0                      $50                    $100
  Family                                              $0                     $150                    $300
  Waived for Preventive Care                         N/A                      Yes                    Yes
Annual Maximum
  Per Person                                      Unlimited                 $1,000                 $1,000
  Diagnostic & Preventive        CDT Codes        No Charge            Deductible Waived     Deductible Applies
       Exams                       D0120
       Cleanings                   D1110
       Fluoride                    D1203              $0                     100%                    80%
       X-Rays                      D0272
       Sealants                    D1351
  Regular Restorative Services CDT Codes     Various copays apply      Deductible Applies    Deductible Applies
       Amalgam Fillings            D2150              $0
       Extractions Single Tooth    D7140              $0
                                                                              80%                    70%
       Endodontics (Root Canal)    D3320         $120 - $170
       Periodontics (Gum Disease) D4211               $0
  Major                         CDT Codes    Various copays apply      Deductible Applies    Deductible Applies
       Crowns                      D2791             $395
       Bridges                     D6211         $381 - $575                  50%                    40%
       Dentures                    D5110         $381 - $575
Orthodontia
  Age Limitation                               Child to age 19
                                                                         Not Covered            Not Covered
  Lifetime Maximum                             $2,500 - $2,800
19            Open Enrollment Guide

Vision Insurance
Baer's Furniture provides Vision Insurance through Guardian. The chart below is a brief outline of the plan.
Please refer to the summary plan description for complete plan details.

Benefit Coverage                                                            Guardian
                                                                             Vision
Copay                                              In-Network Benefits                             Out-of-Network Benefits
     Routine Exams (Annual)                              $15 copay                                       $50 Allowance
Vision Materials
     Materials Copay                                                        $25 copay
     Lenses                                                          Covered every 12 months
          Single                                                                                         $48 Allowance
          Bifocal                                        $25 copay                                       $67 Allowance
          Trifocal                                                                                       $86 Allowance
  Contact Lenses                                                     Covered every 12 months
          Elective                               85% of amount over $120                                 $105 Allowance
          Medically Necessary                                $0                                          $210 Allowance
     Frames                                                          Covered every 24 months
          Covered Services                       80% of amount over $120                                 $48 Allowance
                                Members receive additional fixed copayments on lens options including anti-reflective and Scratch-
     Lens Options               resistant coatings. After copay, standard polycarbonate available at no charge for dependents less
                                 than 19 years old. (Tints, coating, UV, anti-reflective lenses, polycarbonate & progressive lenses)
                                Courtesy discount on a second pair of eyeglasses. This discount is available for 12 months after the
     Additional Pairs           covered eye exam and available through the Davis Vision Network provider who sold the initial pair
                                                                            of eyeglasses.
     Laser Vision Correction                 Up to 25% off the usual charge or 5%. No discounts off promotional price.
20        Open Enrollment Guide

Voluntary Life and Accidental Death & Dismemberment
Insurance
Baer’s Furniture provides all active employees working 30 or more hours per week the option to purchase life
insurance coverage through a group plan with Mutual of Omaha.
The chart below provides an overview of the plan.

Benefit Coverage                                            Voluntary Term Life/AD&D
  Eligible Employees                                All Full-Time employees working 30 hours or more
  Employee                                   Minimum: $10,000, Maximum: 5x annual salary, up to $300,000
  Spouse                                 Minimum: $5,000, Maximum: 100% of employee benefit, up to $150,000
  Dependent Life                         Minimum: $10,000, Maximum: 100% of employee benefit, up to $10,000
                                                        Employee: 5x annual salary, up to $200,000
  Guarantee Issue                                       Spouse:    100% of employee benefit, up to $30,000
                                                        Dependent: 100% of employee benefit
  Accelerated Death Benefit                                 80% death benefit, $240,000 max
  Waiver of Premium Benefit                                                Yes
  Portable / Convertible                          Yes, without having to provide Evidence of Insurability
                                                           At age 70, amounts reduce to 65%
  Benefit Reduction
                                                           At age 75, amounts reduce to 30%
   AD&D                                                         For you and your spouse;
(Accident Death & Dismemberment)        The Principal Sum amount is equal to the amount of life insurance benefit.

The only time you can enroll in guaranteed issue voluntary life insurance, is at the date you first become
eligible to enroll. If you do not enroll then and later decide that you would like to enroll, you may be required
to complete a medical questionnaire and go through medical underwriting. The insurance carrier reserves the
right to decline coverage based on medical information obtained on the medical questionnaire.
21        Open Enrollment Guide

Voluntary Disability Insurance
Baer’s Furniture provides all active employees working 30 or more hours per week the option to purchase
Short Term and Long-Term Disability coverage through a group plan. When you enroll in short term or long-
term disability you pay the full cost through payroll deductions.

In the event you become disabled from a non-work-related injury or sickness, disability benefits are provided
as a source of income. You are not eligible to receive short-term disability benefits if you are receiving
workers’ compensation benefits.

Short-Term Disability Insurance
Baer's Furniture offers a short-term disability option through Mutual of Omaha Insurance Company This
benefit covers 60% of your weekly base salary up to $1,000/week. The benefit begins after 14 days of injury or
illness and lasts up to 11 weeks. Please see the summary plan description for complete plan details.
Benefit Coverage                                                      Short-Term Disability
   Employee Definition                                   All Full-Time employees working 30 hours or more
   Weekly Benefit                                       60% of your before-tax weekly earnings, up to $1,000
   Elimination Period                                     On the 15th day of your disabling injury or illness
                                   Any condition you receive medical attention for in the 3 months prior to your effective date of
  Pre-Existing Limitation
                                      coverage that results in a disability during 6 months of coverage, would not be covered.
   Duration of Benefits                                                    Up to 11 weeks

Long-Term Disability Insurance
Baer's Furniture offers long-term income protection through Mutual of Omaha Insurance in the event you
become unable to work due to a non-work-related illness or injury. This benefit covers 60% of your monthly
base salary up to $5,000 Benefit payments begin after 90 days of disability. See Certificate of Coverage for
benefit duration. Please see the summary plan description for complete plan details.

Benefit Coverage                                                      Long-Term Disability
   Employee Definition                                   All Full-Time employees working 30 hours or more
   Monthly Benefit                                     60% of your before-tax monthly earnings, up to $5,000
   Elimination Period                                                         90 days
   Duration of Benefits              If you become disabled prior to age 62, benefits are payable to age 65, your Social Security
                                     Normal Retirement Age or 3.5 years, whichever is longest. At age 62 (and older), the benefit
                                                       period will be based on a reduced duration schedule.
   Own Occupation                                                                2 years
   Pre-Existing Conditions         Any condition you receive medical attention for in the 3 months prior to your effective date of
                                   coverage that results in a disability during 12 months of coverage, would not be covered.

The only time you can enroll in Long Term Disability is at the date you first become eligible to enroll. If you do not enroll
then and later decide that you would like to enroll, you will be required to a complete a medical questionnaire and go
through medical underwriting. The insurance carrier reserves the right to decline coverage based on medical
information obtained on the medical questionnaire.
22        Open Enrollment Guide

Voluntary Critical Illness
The signs pointing to a critical illness are not always clear and may not be preventable, but our coverage can
help offer financial protection in the event you are diagnosed. Mutual of Omaha Insurance group voluntary
critical illness coverage provides a lump-sum cash benefit to help you cover the out-of-pocket expenses
associated with a critical illness.

Benefit Category & Condition                                                              Voluntary Critical Illness
   Heart/Circulatory:
        Heart Attack, Heart Transplant, Stroke:                                                     100%
        Heart Valve Surgery, Coronary Artery Bypass, Aortic Surgery:                                 25%
   Organ
        Major Organ Transplant/Placement on UNOS List, End-Stage Renal                              100%
        Failure:
        Acute Respiratory Distress Syndrome (ARDS):                                                  25%
   Childhood/Developmental (Benefits only available to children)
        Cerebral Palsy, Structural Congenital Defects, Genetic Disorders,                           100%
        Congenital Metabolic Disorders, Type 1 Diabetes:
   Cancer
        Cancer (Invasive)                                                                           100%
        Bone Marrow Transplant                                                                       50%
         Carcinoma in Situ, Benign Brain Tumor                                                       25%

             Coverage                         Minimum                       Guarantee Issue                Maximum
For you (Available as a flat benefit)          $10,000                          $10,000                     $10,000
Spouse (Available as a flat benefit)           $10,000                          $10,000                     $10,000
Child(ren) (Benefit for each child)              N/A                            $3,000                      $3,000
23        Open Enrollment Guide

2020 Payroll Deductions
The Charts below show the bi-weekly payroll deduction amounts for each of the benefits offered.

 Medical

 Employee Bi-Weekly Contributions
                                 HNOnly              HNOnly                HN Option               HN Option
           Aetna
                              with wellness      without wellness       HSA with wellness      HSA without wellness
  Employee                         $44.00            $64.00                  $72.00                   $104.00
  Employee & Spouse                $399.00           $432.00                $408.00                   $506.00
  Employee & Child(ren)            $298.00           $354.00                $357.00                   $453.00
  Family                           $623.00           $720.00                $714.00                   $800.00

 Dental

 Employee Bi-Weekly Contributions
                   Guardian                      DHMO 30 Low Plan                      DPPO K7 Buy Up Plan
  Employee                                             $5.62                                 $15.96
  Employee & Spouse                                    $11.24                                $33.40
  Employee & Child(ren)                                $12.51                                $40.02
  Family                                               $18.14                                $53.44

 Vision

Employee Bi-Weekly Contributions
Vision
  Employee                                                                $2.75
  Employee & Spouse                                                       $4.63
  Employee & Child(ren)                                                   $4.72
  Family                                                                  $7.47

Please note that rates for voluntary life, voluntary STD, voluntary LTD, critical care, accident, and group
universal life will be available on the EMB enrollment site
24          Open Enrollment Guide

Supplemental Benefits

Accident and Universal Life
          Customer Service: 1-800-918-8877
          Claims: 1- 877-201-9373

                                                  Employee &              Employee &
 Trustmark                    Employee                                                          Family
                                                  Spouse                  Children
 Bi-weekly Rates              $9.50               $16.14                  $22.92                $29.58

 Sample rates are shown for illustrative purposes only; actual payroll deduction amount may vary based on rounding calculations.

 American Public Life Group Hospital Indemnity Insurance.
 Customer Service & Claims: 1-800-256-8606

                                                Employee &             Employee &
 Bi-Weekly Rates            Employee                                                        Family
                                                Spouse                 Children

 Plan 1                     $9.87               $18.35                 $13.27               $21.44

 Plan 2                     $14.99              $27.81                 $20.89               $33.35

The premium and amount of benefits vary dependent upon plan selected at time of application. Premium includes the plan selected and any
applicable rider premium.

*For questions on claims or benefits contact applicable carrier above for the supplemental benefits.

Note: Please see your Benefits Representative for a Beneficiary Designation Form.
The only time you can enroll in guaranteed issue voluntary life insurance, is at the date you first become eligible to enroll. If you do not enroll then
and later decide that you would like to enroll, you will be required to complete a medical questionnaire and go through medical underwriting. The
insurance carrier reserves the right to decline coverage based on medical information obtained on the medical questionnaire.
25          Open Enrollment Guide

Supplemental Benefits
Baer’s Furniture provides Supplemental Limited Benefit Group Hospital Indemnity insurance through
American Public Life. This benefit helps cover out-of-pocket expenses related to Hospital Confinement and/or
medically necessary Outpatient Treatment related to an injury or sickness.
 Summary of Benefits                                                                                  Plan 1                                Plan 2
 Daily Hospital Confinement Benefit (per day)                                                          $100                                  $100
 Benefit Riders
 Intensive Care/Coronary Care Unit Rider (per day)                                                     $200                                  $200
 Annual First Occurrence Hospital Rider (per calendar year)                                           $1,000                                 $2,000
 Base Policy
 Daily Hospital Confinement Benefit-Pays a daily indemnity benefit when a covered person is confined as an inpatient in a Hospital for at least 24
 hours for a covered injury or sickness. The maximum benefit period for any one period of confinement is 180 days unless the confinement is due to a
 mental or emotional disorder. When the confinement is due to a mental or emotional disorder, the maximum benefit period for any one period of
 confinement will not exceed 30 days. The Hospital confinement must be at the direction of or under the supervision of a physician for benefits to be
 payable.
 Exclusions
 APL does not cover Hospital confinements or other losses in the policy or riders: due to hernia, adenoids, tonsils, varicose veins and appendix. For
 the complete listing of exclusions please refer to your benefit booklet from American Public Life.
 Termination of Policy
 APL may end the coverage of a policyholder if fewer persons are insured than the policyholder’s application requires. The policyholder or APL may
 terminate the policy on any premium due date after the first policy anniversary date, subject to 60 days written notice.
 Premium Changes
 The premium rates may be changed by APL on the first anniversary date of the policy or any premium due date thereafter.
 Benefit Rider(s)
 All riders are part of the policy/certificate to which it is attached and are subject to all the provisions, conditions, limitations and exclusions of the
 policy/certificate that are not in conflict with the provisions of the rider.
 Intensive Care/Coronary Care Unit Rider
 Pays a daily indemnity benefit when a covered person is confined in a Hospital’s intensive care or coronary care unity due to a covered injury or
 sickness. The maximum benefit period for any one period of confinement in an intensive care or coronary care unit is 20 days. Each period of
 confinement must be separate by at least 30 days. This benefit pays in addition to the Hospital confinement benefit. A step-down unit is not
 considered an intensive care unit.
 Annual First Occurrence Hospital Rider
 Pays an indemnity benefit the first time in a calendar year a covered person is confined as an inpatient in a Hospital. The Hospital confinement must
 be due to a covered injury or sickness; begin while this rider is in force; and be at the direction of and under the supervision of a physician. The
 benefit is payable once each calendar year for each covered person and the first day of confinement must be in a calendar year the rider is in effect
 in order for the benefit to be payable.
 Termination of Rider(s) Coverage
 The rider(s) will terminate: when the insured’s coverage terminates under the policy/certificate to which the rider is attached; when any premium for
 the rider is not paid by the end of the grace period; or when the insured gives APL a written request to terminate the rider. Coverage on a dependent
 terminates under the rider when the dependent ceases to meet the definition of dependent as defined in the policy/certificate.
26   Open Enrollment Guide
27   Open Enrollment Guide
28   Open Enrollment Guide
29   Open Enrollment Guide
30   Open Enrollment Guide
31   Open Enrollment Guide
32   Open Enrollment Guide
33   Open Enrollment Guide
2020 Special Benefits Opportunity for
Baer’s Furniture Employees
Protect your family, finances and future with these
valuable benefits from Trustmark.

         Trustmark Universal LifeEvents® Insurance
         with Accelerated Death Benefit for Long-
         Term Care Services
         Two-in-one protection to fit your needs.
         Trustmark Universal LifeEvents is permanent
         life insurance. In addition to providing a death
         benefit, it can help pay for long-term care
         services. Universal LifeEvents® gives you a higher
         death benefit during your working years and an
         accelerated death benefit that never reduces.
         Your price won’t increase due to age, and your
         policy builds cash value over time.

         Death benefit reduces to one-third at the latter of age 70 or the
         15th policy anniversary.

     You get a higher benefit for the same rate with                         Up to double your max life insurance benefit!
     Universal LifeEvents than you would with a                              Example: $50,000 policy
     standard plan. It’s more affordable because the
     death benefit reduces after age 70 (when you
     may need it less.) Your benefits to help with                                           Collect 4% of your benefit amount per month
     long-term care never reduce.
                                                                                $50,000      for up to 25 months to help pay for long-term
                                                                                             care services.
       Universal                    Death                   Living
       LifeEvents                   Benefit                Benefits                          Plus, if you collect living benefits, your full death
                                                                                $50,000
                                                                                             benefit is still available for beneficiaries.
 Before Age 70                     $50,000                 $50,000

 After Age 70                      $16,667                 $50,000
                                                                               $100,000      Total max benefit!
Benefit amounts shown are samples and not a guarantee.

                                           See reverse for more information on available benefits.

Voluntary Benefits
Trustmark Accident Insurance
                                                                                                            Accidents happen – you can be prepared.
                                                                                                            Accident insurance from Trustmark pays you
                                                                                                            to help with the cost of covered accidents, at
                                                                                                            work or outside of work. It can help with stuff like
                                                                                                            medical co-pays and deductibles, getting to and
                                                                                                            from the hospital, and your everyday expenses.
                                                                                                            It covers accidental injuries like broken bones,
                                                                                                            burns and concussions. It also covers services
                                                                                                            like using an ambulance, checking into a hospital
                                                                                                            and getting physical therapy. Benefits are paid
                                                                                                            in cash, and you can use them for whatever you
                                                                                                            need most. You can also get paid for certain
                                                                                                            health screening tests.

      With all Trustmark plans:                                                                              Trustmark®: 100+ Years of Service
                                                                                                             and Financial Strength
                        Take your policy with you if you change                                              Trustmark was founded in 1913 by railroad
                        jobs or retire.                                                                      employees who wanted to provide more
                                                                                                             security for injured or disabled coworkers.
                         asy payments with automatic
                        E                                                                                    They formed an association called
                        payroll deduction.                                                                   Brotherhood of All Railway Employees and
                                                                                                             for more than a century since, Trustmark
                        Apply for family members.                                                           has provided reliable insurance protection to
                                                                                                             workers and families across the nation. With
                        Benefits paid in addition to any other                                              a personalized, caring approach to insurance,
                         insurance you have.                                                                 Trustmark today remains committed to the
                                                                                                             same principles that inspired those founding
                        Cash benefits to use however you like.                                               workers: helping people increase their well-
                                                                                                             being and achieve peace of mind.

      You care.
      We listen.

      Products underwritten by Trustmark Insurance Company, Lake Forest, Illinois. In New York, Universal Life and Universal LifeEvents are underwritten by Trustmark Life
      Insurance Company of New York, Albany, New York. Trustmark®, LifeEvents®, Trustmark Critical HealthEvents® and Trustmark Paycheck Protect® are registered trademarks
      of Trustmark Insurance Company. Trustmark Hospital StayPaySM is a trademarks of Trustmark Insurance Company. Underwriting conditions may vary, and determine
      eligibility for the offer of insurance. A waiting period may apply before benefits are payable. Benefits may not be available in all states; benefits, availability, exclusions
      and limitations may vary by state and may be named differently. Pre-existing condition limitations may apply. For more details on costs, coverage details and available
      benefits, speak with a benefit counselor or enroller and/or consult additional pre-enrollment materials; you may also write to the company. Your policy/certificate and
      outline of coverage, if applicable, will contain complete information.

                                                                  Products underwritten by Trustmark Insurance Company
                                                                    and Trustmark Life Insurance Company of New York.
                                                                   Rated A- (Excellent) for financial strength by A.M. Best.
                                                                             trustmarksolutions.com

©2019 Trustmark Insurance Company                                                                                                                                       A112-2424_Baers (10-19)
36        Open Enrollment Guide

Contacts

Have Questions? Need Help?
Baer's Furniture is excited to offer access to the USI Benefit Resource Center (BRC), which is designed to
provide you with a responsive, consistent, hands-on approach to benefit inquiries. Benefit Specialists are
available to research and solve elevated claims, unresolved eligibility problems, and any other benefit issues
with which you might need assistance. The Benefit Specialists are experienced professionals and their primary
responsibility is to assist you.

The Specialists in the Benefit Resource Center are available Monday through Friday 8:00am to 5:00pm Eastern
& Central Standard Time at 855-874-0835 or via e-mail at BRCSouth@usi.com. If you need assistance outside
of regular business hours, please leave a message and one of the Benefit Specialists will promptly return your
call or e-mail message by the end of the following business day.

Please note, the BRC cannot answer any questions for Supplemental Benefits with American Public Life,
Trustmark or Critical Illness with Mutual of Omaha, as these products can be specific to the individual.
Please contact those carriers directly.

Please contact Human Resources to complete any changes to your benefits that are not related to your initial
or annual enrollment.

Carrier Customer Service
  BENEFITS PLAN                             CARRIER                  PHONE NUMBER              WEBSITE
  Medical: HMO, PPO & RX        Meritain Health - An Aetna Company    1-800-925-2272       www.meritain.com
  Dental: DHMO & DPPO                       Guardian                  1-888-600-1600   www.guardiananytime.com
  Vision                                    Guardian                  1-888-600-1600   www.guardiananytime.com
  Voluntary Life AD&D               Mutual of Omaha Insurance         1-800-877-5176    www.mutualofomaha.com
  Short Term Disability (STD)       Mutual of Omaha Insurance         1-800-877-5176    www.mutualofomaha.com
  Long Term Disability (LTD)        Mutual of Omaha Insurance         1-800-877-5176    www.mutualofomaha.com
  Voluntary Critical Illness        Mutual of Omaha Insurance         1-800-877-5176    www.mutualofomaha.com
  Supplemental Benefits            Trustmark Insurance Company        1-800-918-8877   www.trustmarksolutions.com
  Supplemental Benefits                American Public Life           1-800-256-8606       www.ampublic.com
37          Open Enrollment Guide

Important Legal Notices
                            THE WOMEN’S HEALTH CANCER RIGHTS ACT OF 1998 (WHCRA)

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.

                                            NEWBORNS ACT DISCLOSURE - FEDERAL

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).

                                            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).

In addition, 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.

Further, if you decline enrollment for yourself or eligible dependents (including your spouse) while Medicaid coverage or coverage under a State CHIP
program is in effect, you may be able to enroll yourself and your dependents in this plan if:

          coverage is lost under Medicaid or a State CHIP program; or
          you or your dependents become eligible for a premium assistance subsidy from the State.
In either case, you must request enrollment within 60 days from the loss of coverage or the date you become eligible for premium assistance. To request
special enrollment or obtain more information, contact person listed at the end of this summary.

                                                     MICHELLE'S LAW DISCLOSURE

Under the ACA, dependent children are covered by the group health plan until age 26. Baer’s Furniture group health plan extends dependent coverage
beyond the ACA requirements, to age 30, so long as the child is covered as a student. If your child has extended coverage as a student but loses their
student status because they take a medically necessary, leave of absence from school your child may continue to be covered under the plan for up to
one year from the beginning of the leave of absence. This is available if, immediately before the first day of the leave of absence, your child was (1)
covered under the plan and (2) enrolled as a student at a post-secondary educational institution (includes colleges and universities). To obtain more
information, contact person listed at the end of this summary.

                                            NOTICE REGARDING WELLNESS PROGRAMS

Baer’s Furniture wellness program is a voluntary wellness program available to all employees. The program is administered according to federal rules
permitting employer-sponsored wellness programs that seek to improve employee health or prevent disease, including the Americans with Disabilities
Act of 1990, the Genetic Information Nondiscrimination Act of 2008, and the Health Insurance Portability and Accountability Act, as applicable, among
others. If you choose to participate in the wellness program you will be asked to complete a voluntary health risk assessment or "HRA" that asks a series
of questions about your health-related activities and behaviors and whether you have or had certain medical conditions (e.g., cancer, diabetes, or heart
disease). You will also be asked to complete a biometric screening, which will include a blood test for total cholesterol, HDL, LDL, Triglyercides,
Glucose. You are not required to participate in the blood test or other medical examinations.
However, employees who choose to participate in the wellness program will receive incentives. Although you are not required to participate in the
biometric screening (onsite or with your doctor), only employees who do so will receive the incentive.
You can also read