In 2019 Your benefits - Vidant Health

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In 2019 Your benefits - Vidant Health
Your benefits

in 2019
In 2019 Your benefits - Vidant Health
2019 Benefits Enrollment
Important:
   All benefit-eligible team members MUST
    enroll online to obtain benefits.

  Team members not enrolling are asked to
   log on and decline benefits.

  New hires and newly benefit-eligible team
   members must enroll within 30 days of
   date of hire or the date they become
   benefit-eligible.

  Go to the Vidant Employee Self-Service
   page and click on “Benefit Details” and then
   “Benefits Summary” to review your
   statement. If you need assistance logging
   in, contact the Benefits Department at (252)
   847-4479.
In 2019 Your benefits - Vidant Health
Your 2019 Benefits
 Your benefits are a valuable part of the rewards
 of being a Vidant team member. Vidant reviews
 current benefit offerings to ensure you have
 choices and are able to have coverage that fits                  NOTE:
 you and your family needs. Your feedback
 about choices is also part of our review process.
                                                                  Although the benefits described
                                                                  in this booklet generally apply to
 Each year, Vidant Health invests more than                       benefit-eligible team members,
 $500 million in its team members through a                       all organizations may not offer
 comprehensive package that represents much
 more than just competitive pay and benefits.                     all of the benefits described.

 To make the most of your benefits, use this                      Please note the benefits
 guide to understand how they work. Benefits
 enrollment is the time for you to take advantage
                                                                  described in this booklet may
 of those options that provide value and                          be changed at any time and do
 protection for you and your family.                              not represent a contractual
                                                                  obligation on the part of Vidant
 This booklet provides an overview of the benefits
 offered to team members of:
                                                                  Health.
     Vidant Beaufort Hospital
     Vidant Bertie Hospital
     Vidant Chowan Hospital
     Vidant Duplin Hospital
     Vidant Edgecombe Hospital
     Vidant Health
     Vidant Home Health
     Vidant Medical Center
     Vidant Roanoke-Chowan Hospital
     The Outer Banks Hospital
     Vidant Medical Group Staff
     Vidant Medical Group Providers

The details of the benefit plans are contained in official plan documents as well as insurance contracts. The
benefit booklet will cover highlights of each plan and does not replace summary plan descriptions, official
documents, or other policies about the benefit plan. If there is a question about one of the benefit plans or if
there is a conflict between information in the benefits booklet and the formal language in official documents,
the formal wording in the official documents will prevail.

Vidant Health Human Resources annual required notices are located on the Vidant Intranet under Team Central
– REQUIRED NOTICES. The Intranet is accessible from any Vidant workstation including those on your unit,
department or public access computers such as those in each Human Resources location. The annual required
notices contain general information about benefits with Vidant Health and you should take the opportunity to read
and review. You may also request at any time printed copies of these annual required notices by contacting
Human Resources via email at Benefits@vidanthealth.com. By providing electronic access of annual required
notices, Vidant Health can be a better steward of resources such as time, people and paper.

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In 2019 Your benefits - Vidant Health
Our Mission, Vision and Values
                     Health Care Mission
                     To improve the health and well-being of Eastern North Carolina.

                     Health Care Vision
                     To become the national model for rural health and wellness by creating a
 MISSION:            premier, trusted health care delivery and education system.
 The mission of      Our Values:
 an organization        Integrity – Do the right thing
 defines its                   Be honest and sincere
 reason for                    Consistently support our shared principles
                               Be fair and ethical in all actions
 existence,
                               Protect the confidentiality of work environment, especially patient
 reveals                        information
 its nature and          Compassion – Connecting, caring and comforting unconditionally
 expresses the                 Treat others in a culturally appropriate way
                               Show we understand through active listening
 organization’s
                               Focus on the person in front of you and be present in the moment
 commitment                    Demonstrate respect for all
 and aim.                Education – Learning, adapting, improving, and transforming
                               Learn from and apply best practices
                               Adapt to changing environments, expectations and knowledge
                               Use innovation and creativity to shape a better future
                               Stay up to date in your role
                               Take an active role in mentoring and educating others
 VISION:                 Accountability – Taking responsibility for what we do
                               Give and receive honest feedback and coaching
 A vision                      Work collaboratively
 statement is a                Equally shoulder individual, team and organizational goals
 company's road                Do what we say we will do
                               Own our work and rise above our circumstances to get it done
 map, indicating
                         Safety - Achieving zero harm to patients, visitors, families and
 both what the           staff
 company wants                 Provide an environment of safety
 to become and                 When uncertain, stop and get help
 guiding                       Anticipate and prevent potential harm
                               Follow Safety Habits and best practices
 transformation          Teamwork - Contributing to our goals
 initiatives by                Recognize the equal worth of each individual, including patients and
 setting a                      families
 defined                       Help each other do the right thing
                               Value what others have to offer
 direction for the             Identify and resolve inappropriate behaviors
 company's                     Communicate effectively and openly
 growth.

                                                                                               2|Page
Table of Contents
Your 2019 Benefits ................................................................................................................................................................. 1
Our Mission, Vision and Values .............................................................................................................................................. 2
Table of Contents ................................................................................................................................................................... 3
Contact Information ................................................................................................................................................................ 4
Eligibility .................................................................................................................................................................................. 5
Dependent Eligibility ............................................................................................................................................................... 6
Benefit Cost Sharing and Deduction Information ................................................................................................................... 7
How to Enroll .......................................................................................................................................................................... 8
Enrollment Steps .................................................................................................................................................................... 9
Making Changes ....................................................................................................................................................................10
Medical Coverage ................................................................................................................................................................. 11
Preventive Schedule of Benefits ........................................................................................................................................... 17
Prescription Drug Benefit ...................................................................................................................................................... 18
Dental ................................................................................................................................................................................... 20
Vision .................................................................................................................................................................................... 21
Flexible Spending Accounts (FSA) ....................................................................................................................................... 22
Health Savings Account (HSA)………………………………………………………………………………………………………24
Life Insurance ................................................................................................................................................................ 26
Disability Benefits ................................................................................................................................................................. 28
Critical Illness/Whole Life……………………………………………………………………………………………………………………...29
Paid Time Off (PTO) ............................................................................................................................................................. 30
Employee Assistance Program (EAP) .................................................................................................................................. 31
Retirement Program Highlights ............................................................................................................................................. 32
Other Benefits & Services ..................................................................................................................................................... 33

                                                                                                                                                                                         3|Page
Contact Information
Benefit                         Provider               Phone #                Web Site                           Description
Critical Illness                Allstate               800-521-3535           www.allstateatwork.com             Individually owned critical
                                                                                                                 illness policy
Dental Plan                     CIGNA                  800-244-6224           https://my.cigna.com/              Dental claims, EOB, Provider,
                                                                                                                 ID Card
Dependent                       Alight                 800-725-5810           www.yourdependentverification.co   Verification of dependent eligibility
Eligibility Vendor                                                            m/plan-smart-info
Disability – Short              Lincoln                800-213-3805           www.mylibertyconnection.com        Disability claims & covered
& Long Term                     Financial                                                                        benefits

Discounts, On-Line              BenePlace              800-683-2886           www.beneplace.com/vidanthealth     Discounts for a variety
Team Member                                                                                                      of merchants
Discount Program
Employee Assistance             Vidant Health          877-843-7207           https://myvidanthealth.com/Empl    Counseling Services, Behavioral
Program (EAP)                                          or                     o yee_Assistance_Program/          health, Legal advice & Substance
                                                       252-847-4357                                              abuse issues

Employee Wellness               Vidant                 252-847-5590           https://myvidanthealth.com/empl    Provides FREE health
                                                                              oyeewellness/                      coaching, disease
                                                                                                                 management, and wellness
                                                                                                                 challenges
FSA - Flexible                  Discovery              866-451-3399           https://www.discoverybenefits.com/ Flexible spending claims
Spending (Health and            Benefits                                                                         & covered benefits
Dependent Day Care)
Health Savings                  Discovery              866-451-3399           https://www.discoverybenefits.com/ Flexible spending claims & covered
Account (HSA)                   Benefits                                                                         benefits
Leave of Absence                Leave                  252-816-8600           E-mail at:                         Leave of absence
                                Management                                    LeaveManagement@Vidanthealth.
                                                                              com

Life Insurance                  Lincoln                800-213-3805           www.mylibertyconnection.com        Life claims & covered benefits
                                Financial
Medical Plan                    MedCost                800-795-1023           www.medcost.com                    Medical claims, EOB,
                                                                              Plan Group Number- 7488            Provider Network, Temporary
                                                                                                                 ID Card
Pharmacy -                      MedImpact              844-513-6009           www.medimpact.com                  Pharmacy claims &
Prescription Drug                                                                                                covered benefits
Benefit
Physician IDI                   UNUM                   800-633-7490                                              Supplemental Disability
                                                                                                                 Policy
Retirement – Pension*           VidantPension          866-261-3573                                              Pension information for
                                Center                                                                           eligible team members
Retirement Savings              Fidelity               800-343-0860           http://www.netbenefits.com         Online enrollment & customer
Plans: 401(k)                   Investments                                                                      service assistance

Physicians 457b                 Voya                   877-663-6565                                              Additional way to save for
                                                                                                                 retirement

SmartStarts                     MedCost                800-795-1023           http://www.medcost.com/CareMa      Assigns experienced
Pregnancy Wellness                                                            nagement/MaternityManagement       prenatal nurses to work with
Program                                                                                                          expectant mother’s physician

Tuition Assistance              Vidant Health          252-816-5893           E-mail at:                         The Vidant Health
                                Careers                                       healthcareers@vidanthealth.com     tuition assistance
                                                                                                                 program
Vision                          Superior               800-507-3800           www.superiorvision.com             Vision claims & covered benefits
                                Vision
Whole Life Insurance            UNUM                   866-679-3054           www.unum.com                       Individually owned whole
                                                                                                                 life insurance policy
                                                                                                                 information
*Only for eligible team members hired prior to 1/1/2010 at a pension entity

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Eligibility – All Vidant Entities
     Team members may make certain benefit changes during the announced annual enrollment period
     Mid-year benefit elections or changes must be made within 30 days of a qualifying life event/status
      change
     Your eligibility and contributions are based on your Full-Time Equivalent (FTE) status
     Please read each section carefully as there are waiting periods for some benefits

Benefit                                 When do benefits start?                      When do benefits end?           Who is eligible?
Medical and Prescription Drug           First of the month following your 30th day   End of the month in which you   Team members 0.5
Coverage                                of hire or benefit-eligible status change    are actively employed in a      (FTE) or greater
                                                                                     benefit-eligible status
Dental Coverage                         First of the month following your 30th day   End of the month in which you   Team members 0.5
                                        of hire or benefit-eligible status change    are actively employed in a      (FTE) or greater
                                                                                     benefit-eligible status

Vision Coverage                         First of the month following your 30th day   End of the month in which you   Team members 0.5
                                        of hire or benefit-eligible status change    are actively employed in a      (FTE) or greater
                                                                                     benefit-eligible status

Life Insurance – Basic,                 First of the month following your 30th day   Last day of active              Team members 0.5
Supplemental, Spouse and                of hire or benefit-eligible status change    employment in a benefit-        (FTE) or greater
Child                                                                                eligible status

Flexible Spending Accounts              First of the month following your 30th day   Last day of active              Team members 0.5
                                        of hire or benefit-eligible status change    employment in a benefit-        (FTE) or greater
                                                                                     eligible status

Health Savings Account (HSA)            First of the month following your 30th day                                   Team members 0.5
                                        of hire or benefit-eligible status change                                    (FTE) or greater

Short-Term Disability (STD)             First of the month following your 30th day   Last day of active              Team members 0.8
                                        of hire or benefit-eligible status change    employment in a benefit-        (FTE) or greater
                                                                                     eligible status

Long-Term Disability (LTD)              First of the month following your 30th day   Last day of active              Team members 0.5
                                        of hire or benefit-eligible status change    employment in a benefit-        (FTE) or greater
                                                                                     eligible status

Retirement Savings Plans:               Eligible to enroll in the 401(k) plan        Payroll deductions will         Team members 0.5
401(k)                                  immediately upon hire – all team             continue through your final     (FTE) or greater
                                        members hired in a benefit eligible status   Vidant paycheck in a benefit-
                                        will be automatically enrolled after 30      eligible status
                                        days if no action is taken

Employee Assistance Plan                Date of hire                                 Last day of active              All team members
(EAP)                                                                                employment

Paid Time Off (PTO)*                    Benefits begin accruing your first day of    Last day of active              Team members 0.5
                                        employment                                   employment in a benefit-        (FTE) or greater
                                                                                     eligible status

Adoption Assistance                     Twelve months of employment                  Last day of active              Team members 0.5
                                                                                     employment in a benefit-        (FTE) or greater
                                                                                     eligible status

Physicians 457b                         Date of hire                                 Last day of active              Team members 0.5
                                                                                     employment in a benefit-        (FTE) or greater
                                                                                     eligible status

    * VMG Providers and VMC Residents have separate leave plans

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Dependent Eligibility
Medical, Dental, and Vision Coverage
Eligible dependents may receive coverage under the medical, prescription drug, dental, and vision plans.

Eligible dependents:
      Spouse/Domestic Partner
      Children up to age 26

Losing Coverage
Coverage under the medical, prescription, dental, and vision benefits will terminate at the end of the month in which
the dependent child turns 26.

Life Insurance
Eligible dependents can also be covered under applicable life insurance policies.
If you and your spouse/domestic partner are benefit-eligible Vidant team members:
 You are ineligible to cover your spouse/domestic partner under the Spousal Life insurance plan.
 Only one parent is eligible to cover the child(ren) under the Dependent Child Life insurance plan.

Losing Coverage
Life insurance for children turning age 26 will end the on the date that the child turns 26.

Please note that an individual may not be covered under the medical, dental, vision or life insurance plans as
both a team member and a dependent. In addition, an individual may not be considered an eligible dependent
of more than one team member. Team members may not carry dual coverage under these plans for their
spouse/domestic partner and/or their dependent children.

Dependent Eligibility Verification
New team members, team members newly eligible for coverage (due to an increase in hours or a life event
such as marriage, birth, adoption, etc.) or team members electing a new benefit must provide documentation
regarding dependents you are adding on to the benefit plans.

Documentation (e.g. marriage license, temporary birth certificate, etc.) must be provided within 30 days of the date
of the event.

Your next opportunity to add your dependent to coverage will be during the next annual enrollment period or
qualifying life event, provided that proper documentation is submitted at that time.

                                             Dependent Eligibility Verification
        Medical, pharmacy and dental costs are shared between team members and Vidant Health. With
        health and welfare plan costs continuing to rise and to remain good stewards of team members and
        employer premiums, Vidant Health will verify dependent eligibility for health, dental, vision and life
        insurance coverage. You will be required to provide social security numbers and other documents to
        ensure the relationship meets benefit eligibility. Spousal employment verification form will be required.
        You will be contacted by our third party administrator to assist you in providing the appropriate
        documentation to complete the verification.

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Benefit Cost Sharing and Deduction Information
Each pay period, deductions for your share of the benefit cost will be taken either as a pre-tax or post-tax
deduction. Pre-tax deductions lower your taxable income; therefore, you pay less in taxes. The chart below
highlights which benefit plans are offered pre-tax or post-tax.
  Benefit                                           Who pays the cost?              Pre-tax or post-tax
  Medical and Prescription Drug Coverage*                Shared                     Pre-tax
  Dental Coverage*                                       Shared                     Pre-tax
  Vision Coverage*                                       You                        Pre-tax
  Life Insurance – Basic                                 Vidant                     No cost to team members
  Life Insurance – AD&D                                  Vidant                     No cost to team members
  Life Insurance – Supplemental & Whole                  You                        Post-tax
  Life Insurance – Supplemental AD&D                     You                        Post-tax
  Life Insurance – Spouse                                You                        Post-tax
  Life Insurance – Child                                 You                        Post-tax
  Flexible Spending Accounts – (Heath and                You                        Pre-tax
  Dependent Care)
  Health Spending Account (HSA)                          Shared                     Pre-tax**
  Short-Term Disability (STD)                            You                        Post-tax
  Long-Term Disability (LTD)                             You                        Post-tax
  Physician Individual Disability Insurance (IDI)        You                        Post-tax
  Critical Illness                                       You                        Post-tax
  Retirement Savings Plans: 401(k) Plan                  Shared                     Pre-tax
  Physicians 457b                                        You                        Pre-tax
  Employee Assistance Plan (EAP)                         Vidant                     No cost to team members
  Leave Time (Holiday, Sick, or Vacation)              Vidant                       No cost to team members
  Adoption Assistance                                  Vidant                       No cost to team members
   * IRS imputed income guidelines may apply
  **Shared only when contributions are through Vidant payroll deductions

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Meet ALEX!
                                          How does ALEX know what plan is best for me?

                                          ALEX takes the amount each plan would cost
                                          you out of your paycheck (your premium) and adds that
                                          to the amount it would cost for the services you said you
                                          might use. Then he’ll recommend the least expensive
                                          plan for your needs.

                                          Can I use ALEX on my phone?

                                          Oh yeah. ALEX is optimized for any device you’ve got.

                                          Can I trust ALEX with my secrets?

                                          Yes! Your ALEX experience is totally private. He
                                          doesn’t maintain personal info or submit it back to your
                                          employer (or anyone else), so it’s completely
                                          anonymous.
ALEX is an online tool that will help
you select the best benefit plan for
you and your family. When you talk
to ALEX he’ll ask you a few
questions about your health care                  Meet ALEX at
needs, crunch some numbers, and
point out what makes the most
sense for you. And anything you tell
ALEX remains anonymous, so don’t
                                          www.myalex.com/vidant-
be afraid to really let loose about          health/2019
that weird tooth thing!

How long will this take?

Most users spend about 7 minutes
with ALEX, but it really depends how
much guidance you would like. And
ALEX can save your place, so you
leave to get some peanut brittle and
then pick up right where you left off.

How should I prepare?

You don’t need to do much of
anything.

Alex will ask you to estimate what
type of medical care you might need
this year (doctors’ visits, surgeries,
ER visits, prescriptions, etc.), so you
may want to tally those up and talk to
your family about their needs, but
ALEX can also help you come up with
some estimates.
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How to Enroll
Process
   All team members will need to        Additional Considerations
    enroll online to obtain benefits     You must enroll online to receive benefits.
    during annual enrollment             As part of enrollment you should:
   Team members not enrolling are        Determine if the spousal/domestic
    asked to log on and decline             partner additional premium applies
    benefits                              Determine if the tobacco additional
   New hires must enroll within 30         premium applies
    days of the date of hire. Newly       Determine if the wellness additional
    benefit- eligible team members          premium applies
    must enroll within 30 days of the
    date they become benefit eligible.
    Please note once benefit elections
    have been submitted, changes
                                          Review Your
    cannot be made until the next
    annual enrollment period.
                                          Benefit Summary
                                              Once your elections have
What You Need                                  been processed by Benefits,
   Your Vidant Health Provider ID             you can review your
    and Password                               elections via Employee Self-
   Social Security numbers and                Service.
    dates of birth for your covered
    spouse and dependents                     Login to Employee Self-
   Beneficiary information (name,             Service, choose “Benefit
    date of birth, address and Social          Details”, then “Benefits
    Security numbers of beneficiaries)         Summary
   You will need to identify whether
    or not you or any of your family          Benefit elections are final
    members have other medical                 once submitted during new
    coverage, and details about that           hire/newly benefit eligible
    other coverage (if applicable)             enrollment.

                                              You may log in and make
                                               changes as often as you
                                               need only during the
                                               annual enrollment period.

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Enrollment Steps
About Your Enrollment Session                                                      Step 1
Enrolling and accessing your benefit      Please follow the on-screen
information is easy under Employee        instructions to make or waive your        In your internet
Self-Service. Employee Self-Service       elections. Please note, your             browser, type in:
saves all elections from each screen      enrollment is complete only after
                                          clicking “Submit”.                       www.vidanthealth.com
you have successfully completed.
                                                                                   To log in to your
                                                                                   Employee Self-
 To access your Employee Self-Service Page from home, go to                        Service page, you
 www.vidanthealth.com. Select the “Team members” link; then “Employee              don’t have to be at
 Self-Service”                                                                     work! You can do
                                                                                   this from any
                                                                                   computer with an
                                                                                   internet connection.
                                                                                   Step 2
                                                                                   Click on “Team
                                                                                   members”.
                                                                                   Step 3
                                                                                   Choose “Employee
                                             Quick link to Employee Self Service   Self-Service”.
                                                                                   From there, you will
                                                                                   enter in your Provider
                                                                                   ID and Password for
                                                                                   access to your
                                                                                   Employee Self-
                                                                                   Service Account.
                                                                                   Step 4
                                                                                   Choose “Benefit Details”,
                                                                                   then “Benefits Enrollment” to
                                                                                   start electing your benefits.
                                                                                   Important – you must elect or
                                                                                   waive each benefit to
                                                                                   successfully submit
                                                                                   elections.

                                                                                   After You Enroll
                                                                                   When you receive
                                                                                   your first paycheck
                                                                                   after your coverage
                                                                                   becomes effective,
                                                                                   make sure that the
                                                                                   correct deductions
                                                                                   have been taken
                                                                                   based on the benefits
                                                                                   you selected. If the
                                                                                   cost of your benefits is
                                                                                   not deducted
                                                                                   accurately, contact the
                                                                                   Benefits Department
                                                                                   immediately.         9
Making Changes
You may change your pre-tax benefit elections, as well as        Qualifying Life Events Include:
your *life and disability elections during annual enrollment.
                                                                     Marriage or divorce
To change your benefit elections during the plan year, you
must experience a qualifying life event as defined by IRS            Birth, adoption or
guidelines.                                                           placement for
You must complete a Qualifying Life Event (QLE) within 30             adoption of an
days of the Qualifying Life Event. Follow-up documentation            eligible child
will be required in most instances.
                                                                     Death of a spouse or covered
If you do not complete a Qualifying Life Event within 30
                                                                      child
days, you must wait until the next annual enrollment
period to make benefit changes, unless you have                      Change in your or your
another qualifying life event.                                        spouse’s work status
                                                                      affecting benefits eligibility.
*Life or disability elections during annual enrollment require
you to submit an Evidence of Insurability form to Lincoln             Examples include starting a
Financial. Lincoln Financial will notify you of approval or           new job, leaving a job,
denial.                                                               going from part-time to full-
                                                                      time and starting or
Visit “Benefits & Life Events” then choose “Updating                  returning from an unpaid
Benefit Information” under Team Central for more
                                                                      leave of absence.
information.
                                                                     Change in your child’s benefit
                                                                      eligibility
                                                                     Becoming eligible for Medicare or
                                                                      Medicaid during the year
                                                                     Receiving a Qualified Medical
                                                                      Child
                                                                      Support Order (QMCSO)

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Terms You Need to
                                                                                                                       Know
Medical Coverage                                                                                                       Coinsurance: The percentage of
Plan Options                                                                                                           covered expenses that you pay
Vidant Health provides health and pharmacy coverage through three self-insured medical plans. Self-                    after you meet your deductible.
insured means that claims for health and pharmacy expenses are paid for by premiums from team                          Deductible: The amount (before
members and Vidant. Your plan determines your co-pay, deductible and coinsurance when you have a claim.                coinsurance) you pay each year
For complete details, see the Summary Plan Descriptions as well as other relevant information available on             for health care expenses such as
Team Central.                                                                                                          inpatient hospital stays, radiology,
                                                                                                                       lab work, and other services.
    Basic
    Choice                                                                                                            Out-of-Pocket (OOP) Maximum
                                                                                                                       for Medical: The most you pay
    Medical Savings Plan                                                                                              under the medical plan. Includes
                                                                                                                       your deductible, medical
Coverage Categories                                                                                                    coinsurance and medical plan co-
     Single                                                                                                           pays. Excludes charges beyond
                                                                                                                       usual and customary. Separate
     + Children                                                                                                       pharmacy out-of- pocket
     + Spouse / Domestic Partner                                                                                      maximum.
     Family (covers you, your spouse and dependent children)                                                          Pharmacy Co-Pay/ Coinsurance:
                                                                                                                       Your cost for a prescription. There
Cost Share                                                                                                             are separate maximum dollar
Team members with an FTE of .5 to .79 share a larger portion of the premium than a .80 – 1.0 FTE                       amounts that you pay for each
                                                                                                                       prescription. Applies to your plan
                                                                                                                       pharmacy out-of-pocket maximum.
                                                                                                                       Does not apply to your medical
Medical Plan Provider Networks                                                                                         deductible.
In network will help you and the plan manage costs. You are strongly encouraged to select a primary care               Physician Office Visit Co- pay: A
physician for you and each covered family member. You may go to any doctor you choose, but your cost savings           flat fee you pay for a physician
                                                                                                                       office visit regardless of the actual
will be greater and out-of-pocket expenses are less when you seek services from in network providers.                  amount the provider charges.
                                                                                                                       Applies to your plan Out-of- Pocket
Medical Claims Administration                                                                                          Maximum but not your Deductible.
MedCost is our third party administrator and processes our medical claims. You may visit www.medcost.com to do
                                                                                                                       In Network: Group of physicians
the following:                                                                                                         and hospitals that have contracted
    Request Identification Cards                                                                                      with the plan to offer discounts for
    Print and View Explanation of Benefits (EOB)                                                                      participants who receive care
    Find a Provider                                                                                                   within the network.
 Vidant MedCost Group # - 7488

Vidant Now
Skip the Trip! Use Vidant Now to see a doctor 24/7 via video or phone. If enrolled in Vidant Medical Basic or Choice plans, use group code “Vidant”
to receive services at a $20 copay. Visit www.vidantnow.com or download the VidantNow App for a convenient way to receive care whenever you
need it!

                                                                                                                                              12 | P a g e
Premiums for Medical/Dental/Vision
*Includes domestic partner (DP) and/or domestic partner children; imputed income applies to domestic partner and children of domestic partner
coverage.

                                                  Full-time Team Members – Bi-Weekly Deductions

                                                       Medical                                   Dental
                         Tier            MSP          Basic          Choice            Basic              Choice          Vision

                        Single            $31           $36             $48              $8                 $16             $3.66

                     +Child(ren)*        $118           $138            $160             $15                $28             $6.03

                      +Spouse*           $185           $216            $242             $17                $33             $5.50

                       Family*           $203           $237            $265             $24                $47             $9.19

                                                 Part-time Team Members – Bi-Weekly Deductions

                                                       Medical                                  Dental
                         Tier                                                                                             Vision
                                         MSP          Basic          Choice            Basic              Choice

                        Single            $89           $103            $113             $8                 $16            $3.66

                     +Child(ren)*        $201           $235            $256             $15                $28            $6.03

                      +Spouse*           $255           $298            $326             $17                $33            $5.50

                       Family*           $301           $351            $378             $24                $47            $9.19

                                                                                                                                        13 | P a g e
Medical Coverage (continued)
 Plan Benefit Levels - MedCost
 Vidant Health medical plans will include tiered provider options. Here are some highlights of the coverage in each tier:
   Preventive care medical services performed by an in-network provider are covered at 100% under each medical plan - no charge to you.
   Tier A includes higher co-insurance coverage at 85%, lower copays and lower deductibles and out of pocket maximums.
   Tier B includes co-insurance coverage at 70% or 80%, slightly higher copays and deductibles and out of pocket maximums.
   When using providers and facilities not in the MedCost Network – Out of Network includes co-insurance coverage at 50%, higher copays and deductibles and
      out of pocket maximums.
                             If you stay in-network, the plan pays a greater portion of the cost of your care, and you pay less.

                                                    In Network – Tier A                       In Network – Tier B                    Out of Network
                                                Vidant Health and other select             Select providers and facilities
                                             providers and Vidant Health facilities           in the MedCost Network
                                                                 Medical Savings Plan
Wellness                                                 Covered at 100%                           Covered at 100%              Plan pays 60%, you pay 40%
Plan Co-insurance                                  Plan pays 85%, you pay 15%                Plan pays 70%, you pay 30%         Plan pays 50%, you pay 50%
Vidant PCP Visit                                   Plan pays 95%, you pay 5%                              N/A                       Ded, then 50% co-ins
Vidant Specialty Visit                                 Ded, then 15% co-ins                               N/A                       Ded, then 50% co-ins
Non-Vidant PCP Visit                                   Ded, then 15% co-ins                      Ded, then 30% co-ins               Ded, then 50% co-ins
Non-Vidant Specialty Visit                             Ded, then 15% co-ins                      Ded, then 30% co-ins               Ded, then 50% co-ins
VidantNow                                              Ded, then 15% co-ins                      Ded, then 30% co-ins               Ded, then 50% co-ins
Med Deductible (Single/Family)                            $2,000 / $4,000                           $2,500 / $5,000                    $6,000 / $12,000
Med Max OOP (Single/Family)                               $6,000 / $12,000                          $6,750 / $13,500                  $12,500 / $25,000
Rx Max OOP (Single/Family)                            Inc with Med OOP Max                      Inc with Med OOP Max               Inc with Med OOP Max
Combined OOP Max (Med + Rx)                               $6,000 / $12,000                          $6,750 / $13,500                  $12,500 / $25,000
Emergency Room                                         Ded, then 15% co-ins                  Tier A Ded, then 30% co-ins        Tier A Ded, then 50% co-ins
Urgent Care                                            Ded, then 15% co-ins                     Ded, then 30% co-ins                Ded, then 50% co-ins
Inpatient / Outpatient Hospital                        Ded, then 15% co-ins                     Ded, then 30% co-ins               Ded, then 50% co-ins
                                                        Vidant Pharmacy                                          Retail Pharmacy
Rx Deductible                                                Included w/ Medical                                       Included w/ Medical
Rx Max OOP (Single/Family)                                  Included w/Medical                                         Included /Medical
Generic (30 days)                                       Ded, then 10% co-insurance                                Ded, then 20% co-insurance
Preferred Brand (30 days)                               Ded, then 20% co-insurance                                Ded, then 30% co-insurance
Non-Preferred Brand (30 days)                           Ded, then 30% co-insurance                                Ded, then 40% co-insurance
Generic (90 days)                                       Ded, then 10% co-insurance                                Ded, then 20% co-insurance
Preferred Brand (90 days)                               Ded, then 20% co-insurance                                Ded, then 30% co-insurance
Non-Preferred Brand (90 days)                           Ded, then 30% co-insurance                                Ded, then 40% co-insurance
Preferred Brand Specialty Rx                            Ded, then 20% co-insurance                                Ded, then 30% co-insurance
Non-Preferred Specialty Rx                              Ded, then 30% co-insurance                                Ded, then 40% co-insurance
If cost exceeds $300 for all tiers and
number of day supply                                                 N/A                                                       N/A

                                                                                                                                                14 | P a g e
Medical Coverage (continued)
  Plan Benefit Levels - MedCost
  Vidant Health medical plans will include tiered provider options. Here are some highlights of the coverage in each tier:
    Preventive care medical services performed by an in-network provider are covered at 100% under each medical plan - no charge to you.
    Tier A includes higher co-insurance coverage at 85%, lower copays and lower deductibles and out of pocket maximums.
    Tier B includes co-insurance coverage at 70% or 80%, slightly higher copays and deductibles and out of pocket maximums.
    Out of Network includes co-insurance coverage at 50%, higher copays and deductibles and out of pocket maximums.
                              If you stay in-network, the plan pays a greater portion of the cost of your care, and you pay less.
                                                In Network – Tier A                                               In Network – Tier B
                                 Vidant Health and other select providers and Vidant                          Select providers and facilities
                                                   Health facilities                                             in the MedCost Network
                                           Basic                         Choice                           Basic                             Choice
Wellness                               Covered at 100%                Covered at 100%                 Covered at 100%                    Covered at 100%
Plan Co-insurance                Plan pays 85%, you pay 15%     Plan pays 85%, you pay 15%      Plan pays 70%, you pay 30%         Plan pays 80%, you pay 20%
Vidant PCP Visit                         $5 Copay                       $5 Copay                           N/A                                 N/A
Vidant Specialty Visit                   $50 Copay                      $40 Copay                          N/A                                 N/A
Non-Vidant PCP Visit                     $45 Copay                      $25 Copay                       $55 Copay                           $35 Copay
Non-Vidant Specialty Visit               $65 Copay                      $45 Copay                       $75 Copay                           $55 Copay
VidantNow                                $20 Copay                      $20 Copay                       $20 Copay                           $20 Copay
Med Deductible
(Single/Family)                        $1,200 / $2,400               $800 / $1,600                   $1,500 / $3,000                    $1,200 / $2,400
Med Max OOP (Single/Family)            $4,000 / $8,000              $3,200 / $6,400                  $5,000 / $10,000                   $4,000 / $8,000
Rx Max OOP (Single/Family)             $2,500 / $5,000              $2,500 / $5,000                  $2,500 / $5,000                    $2,500 / $5,000
OOP Max (Med + Rx)                    $6,500 / $13,000              $5,700 / $11,400                 $7,500 / $15,000                   $6,500 / $13,000
                                 $200 copay + ded/15% co-            $150 copay +                  $200 copay + Tier A                $150 copay + Tier A
Emergency Room                              ins                     ded/15% co-ins                   ded/30% co-ins                     ded/20% co-ins
Urgent Care                              $50 copay                      $40 copay                        $60 copay                          $50 copay
In / Outpatient Hospital           Ded, then 15% co-ins           Ded, then 15% co-ins             Ded, then 30% co-ins               Ded, then 20% co-ins
                                                                                Vidant Pharmacy                              Retail Pharmacy
                                                                          Basic and Choice                                   Basic and Choice
Rx Deductible                                                                     None                                              None
Rx Max OOP (Single/Family)                                                    $2,500/$5,000                                     $2,500/$5,000
Generic (30 days)                                                              $10 copay                                         $25 copay
Preferred Brand (30 days)                                                      $25 copay                                         $50 copay
Non-Preferred Brand (30 days)                                                  $50 copay                                         $100 copay
Generic (90 days)                                                              $30 copay                                         $75 copay
Preferred Brand (90 days)                                                      $75 copay                                         $150 copay
Non-Preferred Brand (90 days)                                                  $150 copay                                        $300 copay
Preferred Brand Specialty Rx                                                   $50 copay                                         $100 copay
Non-Preferred Specialty Rx                                                     $100 copay                                        $300 copay
If cost exceeds $300 for all tiers and number of day supply                 15% co-insurance                                  25% co-insurance

                                                                                                                                                 15 | P a g e
Medical Coverage (continued)
 Plan Benefit Levels - MedCost

     Out of Network includes plan co-insurance coverage at a lower percentage than preferred (Tier A) or in-network
      (Tier B), higher copays and deductibles and out of pocket maximums.

                                                                 Out of Network

                                                 Basic                                      Choice
Wellness                            Deductible, then 50% co-insurance                    Covered at 100%
Plan Co-insurance                     Plan pays 50%, you pay 50%                   Plan pays 60%, you pay 40%
Vidant PCP Visit                                  N/A                                         N/A
Vidant Specialty Visit                            N/A                                         N/A
Non-Vidant PCP Visit                Deductible, then 50% co-insurance           Deductible, then 40% co-insurance
Non-Vidant Specialty Visit          Deductible, then 50% co-insurance           Deductible, then 40% co-insurance
VidantNow                                         N/A                                         N/A
Med Deductible
(Single/Family)                             $4,500 / $2,400                             $3,000 / $6,000
Med Max OOP (Single/Family)                $10,000 / $20,000                           $7,500 / $15,000
Emergency Room                       $200 copay + ded/15% co-ins                 $150 copay + ded/15% co-ins
Urgent Care                         Deductible, then 50% co-insurance           Deductible, then 40% co-insurance
In / Outpatient Hospital            Deductible, then 50% co-insurance           Deductible, then 40% co-insurance

                                                                                                            16 | P a g e
Preventive Schedule of Benefits
                                         Recommended Preventive Screenings
 Well-baby care                            Office visits and immunizations – 0 through 24 months
                                           All immunizations are covered for adults and children. Recommended to
 Immunizations                             have one tetanus booster every 10 years, influenza annually,
                                           pneumococcal, one dose at age 65 or older.
 Routine diagnostic tests                  Labs for screenings such as cholesterol and glucose
                                            Women of average risk for breast cancer should begin conversations with
                                            their provider at age 40, discussing the risks and benefits of mammography
                                            and making an informed decision about regular screening. Women at high
 Routine mammograms                         risk for breast cancer due to family history of cancer or certain genetic
                                            mutations should talk with their provider about a breast cancer screening
                                            plan.
 Routine physical exams                     Annually age 2 and up
 Routine pap, pelvic and breast exams       Women of average risk for cervical cancer should begin conversations with
                                            their provider at age 21, discussing the risks and benefits of pap testing and
                                            making an informed decision about regular screening.

                                            Men of average risk for prostate cancer should begin conversations with
                                            their provider at age 50, discussing the risks and benefits of psa testing
 Routine PSA test and prostate exam         and making an informed decision about regular screening.
                                            African American men and men with a family history of prostate cancer
                                            should talk with their provider about psa testing beginning at age 45.

 Colon cancer screening                     Women and men of average risk for colorectal cancer should begin
                                            conversations with their provider between the ages of 45 and 50,
                                            discussing the risks and benefits of colorectal cancer screening and
                                            making an informed decision about method of screening. There are
                                            several types of screening for colorectal cancer, from simple take home
                                            tests to colonoscopies. In 2018, American Cancer Society released
                                            updated recommendations to start colorectal cancer screening at age 45.
                                            Other guidelines continue to recommend screening starting at age 50.
 Lung cancer screening                      Women and men who meet certain criteria should begin conversations with
                                            their provider starting at age 55, discussing the risks and benefits and lung
                                            cancer screening and making an informed decision about regular screening.
                                            Eligibility for lung cancer screening includes individuals aged 55 to 74 in fairly
                                            good health who currently smoke or have quit smoking in the past 15 years.
                                            Individuals must have at least a 30 pack-year smoking history.

Preventive Screenings
 The table above is not a complete list; for complete details, see the Summary Plan Descriptions as well as other relevant
 information available on the Team Central website. Your provider must code services as wellness and preventive if
 applicable. Most wellness and preventive screenings are covered at 100% while in- network without any out-of-pocket
 expense to you. If these services are not considered routine at the time of service, they may be subject to co-pays,
 deductibles and coinsurance. Also, if during a routine exam, a non- routine component is added (additional test,
 procedure or lab work), the non-routine/non-preventive care component may be subject to co-pays, deductibles and
 coinsurance. If you have questions regarding how your claim was processed, please contact MedCost at 800-795-1023.

                                                                                                                   17 | P a g e
Prescription Drug Benefits
Prescription drug coverage for you and your covered dependents is included with the Vidant Medical Plan.
MedImpact administers the prescription drug benefit for all Vidant Medical Plan participants. If you enroll in one
of the medical plans, your prescription drug coverage is provided.

When you or a family member need a prescription filled, you may use your medical/prescription identification
card at the Vidant Employee Pharmacy or a retail pharmacy that participates in the pharmacy network. You
pay a share of the cost of your prescription in the form of a co-pay or coinsurance. The amount you pay
depends whether you receive a generic, preferred brand, or non-preferred brand name drug and which
pharmacy you choose. Questions about Vidant prescription drug benefits? Contact MedImpact at 844-513-
6009 or www.medimpact.com.

Generic Drugs (lowest co-pay) are chemically and therapeutically equivalent to brand-name drugs, but are
available at a lower price.
Preferred Brand Drugs (middle co-pay) do not have less-costly generic equivalents because they are sold
only under a trademarked name. Preferred drugs are the most cost-effective brand drugs when a generic is not
available.
Non-Preferred Brand Drugs (highest co-pay) often have either a generic equivalent or a preferred-name brand
alternative.

Prior Authorization Requirements                             alternative is available, you will pay the appropriate
To ensure that drugs covered by your prescription            brand co-pay or coinsurance plus the difference in
drug benefit are used safely and appropriately,              cost between the brand-name drug and the generic
certain medications require that your physician              alternative.
obtain prior authorization from MedImpact before
they are covered. To determine if a medication                Drug Quantity Limits
requires prior authorization, contact MedImpact at            The Vidant Medical Plan prescription drug benefit
877-559-2955 or online through                                includes quantity limits on certain medications as
www.medimpact.com. Other drugs may be added                   recommended by the FDA. These limits are applied
based upon safety, efficacy and FDA-approved                  to address the problem of overuse of medications
therapies.                                                    that may be unsafe for the patient. To determine if
                                                              a medication that has been prescribed for you has
Wellness Program                                              quantity limits, you may contact MedImpact at 877-
Eligible participants may receive FREE medications            559-2955 or online through www.medimpact.com.
from Vidant Health by participating in Free: 1-on-1
disease management services with a Vidant                     Step Therapy Program
Employee Wellness Nurse Case Manager or Health                Step therapy is a clinical tool used to promote
Coach available for Vidant Health team members                effective, clinically appropriate medications that
and covered spouses who have high risk factors                may be less costly. This program requires the
and/or complex medical conditions such as high                member to try a clinically appropriate, lower cost
blood pressure, diabetes, high cholesterol, obesity,          medication first, or requires that their doctor has
asthma, congestive heart failure or coronary artery           documented why the patient is not a good
disease. Call Employee Wellness at 252-847-5590               candidate for the clinically appropriate, lower cost
for more information.                                         medication, or therapy. Step therapy is an
                                                              automated program that the pharmacist uses to
Mandatory Generic Drug Program                                review a patient’s medication history. Step
The prescription drug benefit limits payment for              therapy will often recommend an alternative
brand medication when a generic version is                    medication (sometimes a generic medication) to
available to the public. If either you or your doctor         replace the more costly medication.
requests a brand medication when a generic

                                                                                                          18 | P a g e
Medical Coverage (continued)
Coordination of Benefits (COB)
Coordination of benefits applies when you or your dependent(s) on the medical plan have additional coverage.
For example, you may have your family on both your Vidant MedCost plan and your spouse’s plan. COB
applies to medical only; it does not apply to prescription drug benefits.

Tobacco Additional Premiums
Additional medical premiums of $40 per pay period will be charged if anyone covered under your MedCost plan
is a tobacco user. Tobacco users include smoking, chewing, dipping, e-cigarettes, etc.

Tobacco users that have enrolled in a tobacco cessation program may apply to have the additional tobacco premium
waived. Team members must complete a certification stating that they are actively enrolled in a cessation
program. To find out more about the tobacco cessation program, please contact Employee Wellness at 252-
847-5590.

Spousal/Domestic Partner Additional Premiums
If you cover your spouse under one of the medical plan options offered by the organization, you will pay an
additional $50 premium if your spouse or domestic partner is eligible for medical coverage through his or her
employer. This addition will be added to premiums you pay for your medical coverage.

It does not apply when:

       You and your spouse are both team members of Vidant Health
       Your spouse has no group medical coverage available
       Your spouse is enrolled for Medicare coverage
       Your spouse is enrolled in TriCare

Wellness Additional Premium
Team members enrolled in the medical plan who opt not to complete their new hire/annual WellScreen exam and/or
Health Risk Assessment (HRA) will pay an additional premium of $25 per pay period.

WellScreen exams may be completed by Occupational Health or a Primary Care Physician within the fiscal year
(October 1st – September 30th). If you receive your WellScreen exam from your Primary Care Physician, all necessary
paperwork must be submitted and approved by Employee Wellness prior to the fiscal year deadline.

Health Risk Assessments are offered during the fiscal year. New team members hired after the close of Annual
Enrollment for 2019 that opt to not complete the WellScreen exam described above will pay an additional premium of
$25 per pay period.

If you are unable to participate in any of the health related activities or achieve any of the health outcomes required to
earn an incentive, you may be entitled to a reasonable accommodation or an alternative standard. You may request a
reasonable accommodation or an alternative standard by contacting Occupational Health to initiate the request for
accommodation.

                                                                                                                19 | P a g e
Dental
The Vidant Dental Plan, administered by Cigna, has been designed for team members to see any licensed
dentist; however the benefits (i.e. lowest out-of-pocket cost to you) are greatest when services are received
from a Cigna provider. Using a Cigna provider will eliminate the potential of charges exceeding usual and
customary guidelines. Dental implants are covered when medically necessary at the Major benefit level. You
can obtain a listing of providers at my.cigna.com or by calling Cigna at 800-244-6224.

Summary of Dental Coverage

                                            Vidant Dental Plan
                                            Basic                                   Choice
                                 In-Network    Out of Network            In-Network    Out of Network

                                You pay 20%         You pay 20%       Covered at 100%      Covered at 100%
    Preventive                   (deductible         (deductible         (deductible          (deductible
                                   waived)             waived)             waived)              waived)
    Deductible:
                                  $50/$100            $75/$150             $50/$100             $75/$150
    Individual/Family
                              You pay 40% after You pay 50% after You pay 20% after You pay 30% after
    Basic
                                 deductible        deductible        deductible        deductible
                              You pay 40% after You pay 50% after You pay 40% after You pay 50% after
    Major
                                 deductible        deductible        deductible        deductible
    Annual Maximum
                              $1,000 per person    $750 per person    $2,000 per person    $1,500 per person
    Dental Benefit
    Orthodontia                                                          You pay 40%      You pay 50% after
                                No Coverage         No Coverage
    (Under Age 19)                                                    (deductible waived)    deductible
    Orthodontia Lifetime
                                No Coverage         No Coverage       $1,000 per person    $1,000 per person
    Maximum
       *You may also be required to pay any amounts an out-of-network dentist charges that are over the
       Maximum Plan Allowance.

Coordination of Benefits (COB)

Coordination of Benefits applies if you or any family members are covered by another dental plan in addition to
the Vidant Dental Plan. If you are insured by two dental plans, you should advise your dental office so that
benefits can be coordinated accordingly. Please see the Vidant Dental Plan summary plan description located
on Team Central.

                                                                                                       20 | P a g e
Vision
  The Vision Care Plan is designed to encourage you to maintain your vision through regular exams and to help
  with expenses for prescription glasses and contact lenses. Superior Vision is the vision plan provider. With this
  voluntary plan, you may use in or out-of-network providers, but the level of benefit is higher when you receive
  care from an in-network provider. A listing of in-network providers can be found at www.superiorvision.com or
  by calling Superior Vision directly at 800-507-3800.

                               Superior Vision                                                                 Superior Vision
                       In Network Benefit Coverage                                                  Out of Network Benefit Coverage
   Benefit          Description                                        Copay        Benefit        Description
                     Focuses on your eyes and overall                               Well           Focuses on your eyes and overall
   Well               wellness                                                       Vision          wellness                                        Covered up
                                                                         $20
   Vision            Every calendar year                                            Exam           Every calendar year                             to $44 retail
   Exam
   Prescription Glasses                                                  $20         Prescription Glasses

                     $150 allowance for a wide selection of                                        Every calendar year
                      frames                                          Included in                                                                    Covered up
   Frame             20% off amount over your allowance              Prescriptio    Frame                                                           to $77 retail
                     Every calendar year                              n Glasses

                     Single vision, lined bifocal, and lined         Included in                   Single vision, lined bifocal, and lined
                      trifocal lenses                                 Prescriptio                    trifocal lenses*                                 Covered up
   Lenses                                                                            Lenses
                     Every calendar year                              n Glasses                    Every calendar year                             to $64 retail*

                     Scratch Coat                                       $13
                     Ultraviolet coat                                   $15
                     Tints, solid or gradients                          $25
   Lens              Anti-reflective coat                              $50**
   Option
   s                 Polycarbonate                                     $40**
                     High index 1.6                                    $55**
                     Photochromics                                     $80**

   Contacts      $150 allowance for contacts; copay does not                        Contacts      $100 allowance for contacts; copay does not
  (instead of     apply                                                             (instead of     apply                                        Contact lenses
  glasses)       Contact lens exam (fitting and evaluation)          Up to $50     glasses)       Contact lens exam (fitting and evaluation)  fitting co-pay not
                 Every calendar year                                                              Every calendar year                               covered

                      30% off any non-covered exam, frames and prescription
                       lenses
                      20% off lens options, contacts and other prescription
                       materials
                      10% off disposable contact lenses
  Extra                                                                             Extra
  Savings and                                                                       Savings and      *Discounts may not be available for out of network providers
                       Laser Vision Correction
  Discounts                                                                         Discounts
                      Discount on LASIK – Discounts range from 15% to 50;
                       discounts only available from contracted Superior Vision
                       facilities.

 *Single covered up to $34 retail; bifocal covered up to $48 retail; trifocal covered up to $64 retail
 **Prices reflected are for single lenses. Bifocal and trifocal lenses have a 20% discount available

Coverage with a retail chain affiliate may be different. Once your benefit is effective, visit
www.superiorvision.com for details.

For more information, including plan limitations, exclusions and discounted services; please refer to the Vision
Care summary plan description located on the Team Central website. Your provider will verify eligibility of your
vision benefits. Go to www.superiorvision.com for details.

                                                                                                                                                     21 | P a g e
Flexible Spending Accounts (FSA)
Flexible Spending Accounts are an easy way for you to keep more of your take-home pay by using “pre-tax”
dollars for eligible expenses. Simply present your FSA debit card for the purchase of eligible services and goods.
Using the debit card allows you to directly tap into your Health Care and Dependent Day Care FSA, meaning
better cash flow for you and no waiting for reimbursement.

   Types of              Eligible Expenses* & Guidelines
                            $2,650 annual maximum
                            Medical plan office visit co-pays, deductibles and coinsurance
                            Certain over-the-counter (OTC) items prescribed by your provider
                            Dental plan co-pays, deductibles and coinsurance
   Health Care              Orthodontia expenses
   Flexible                 Vision care expenses including contacts, glasses, & LASIK surgery
   Spending                 Expenses can be for you or anyone you claim as a dependent on your
   Account                   Federal tax return**
                            Your entire election is available immediately regardless of actual payroll
                             deduction amounts
                            Carry over up to $500 for the following calendar year
                            Expenses must be incurred by December 31 and submitted for
                             reimbursement by April 30th of the following year
                          $5,000 annual maximum
   Dependent              Used for dependent day care expenses while you and your spouse work, look for
   Day Care                work or attend school full-time
   Flexible               Dependents include children under age 13 or dependents that are physically or
   Spending                mentally unable to care for themselves
   Account                Can only be reimbursed up to what you have had payroll deducted (pay as you go)
                          Expenses must be incurred by March 15 of the following year and submitted for
                           reimbursement by April 30th of the following year
 * This is only an example of eligible expenses.
 **Visit www.irs.gov for definition of eligible tax dependent

How it Works:
   Estimate your expenses and make an annual election for the accounts that apply to you
   Your annual election is calculated on a per pay period basis and deducted from your paycheck and
       deposited into your personal account. Payroll deductions begin from the effective date of your election and
       continue through the end of the calendar year.
   A debit card will be issued to new participants.
   When you incur expenses throughout the year, present your debit card for payment.
   Eligible expenses are only reimbursable if they occur on or after the date of benefit eligibility

Filing Claims & the Reimbursement Process:
      Keep all receipts. IRS requires documentation for many expenses to confirm they are eligible under the
        plan.
      Use your debit card at the time of service or submit your receipts with a completed reimbursement
        claim form. Some debit card transactions may still require a receipt

For more information on the FSA accounts, visit www.discoverybenefits.com or call 866-451-3399

                                                                                                          22 | P a g e
Limited Purpose Flexible Spending Accounts (Limited Purpose FSA)
    The Limited Purpose FSA is for team members who are enrolled in the Medical Savings Plan and contributing to
    a Health Savings Account (or whose spouse is contributing to a HSA) in which case the regular Flexible
    Spending Account is not allowed.

    The Limited Purpose FSA can be used for any non-medical health related expenses such as dental and vision.

         Types of Account                                 Eligible Expenses & Guidelines
                                     $2,650 annual maximum
                                     Dental plan co-pays, deductibles and coinsurance
                                     Orthodontia expenses
                                     Vision care expenses including contacts, glasses, & LASIK surgery
                                     Expenses can be for you or anyone you claim as a dependent on your
                                      Federal tax return
       Limited Purpose FSA           Your entire election is available immediately regardless of
                                      actual payroll deduction amounts
                                    Carry over up to $500 for the following calendar year
                                     Expenses must be incurred by December 31 and submitted for
                                      reimbursement by March 31 of the following year

How it Works:                                                     Filing Claims & the Reimbursement
     Estimate your expenses and make an annual                   Process:
      election for the accounts that apply to you                    Please consider enrolling in direct deposit;
                                                                      it’s FREE and the fastest way to get
     Your annual election is calculated on a per pay                 reimbursed
      period basis and deducted from your paycheck
      and deposited into your personal account.                      Keep all receipts. IRS requires
      Payroll deductions begin from the effective date                documentation for many expenses to
      of your election and continue through the end of                confirm they are eligible under the plan.
      the calendar year.
                                                                     Use your debit card at the time of service or
     A debit card will be issued to new participants.                submit your receipts with a completed
                                                                      reimbursement claim form. Some debit card
     When you incur expenses throughout the year,                    transactions may still require a receipt.
      present your debit card for payment.

     Eligible expenses are only reimbursable if they
      occur on or after the date of benefit eligibility

    For more information on the FSA accounts, including available balance, savings calculator, expense planning
    worksheets, reimbursement claim forms, and IRS publications, www.discoverybenefits.com or call 866-451-
    3399

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Health Savings Accounts (HSA)
If you are enrolled in the Medical Savings Plan, you may elect to open a HSA.

    HSA is an optional savings account used to pay for qualified medical expenses directly with your HSA
     debit card or to reimburse yourself at any time for medical expenses you paid out of pocket. There is no
     time limit to reimburse yourself.

    You can contribute to a HSA only if you are enrolled in the High-Deductible Plan and you are not covered
     by any other medical plan (including spouse’s plan or Medicare) or flexible spending account.

    Vidant will make a contribution to all HSAs for 2019: up to $600 for single coverage or up to $1,200 for
     “family” coverage, based upon your enrollment date. Family coverage for this plan is defined as any
     coverage other than single.

    Maximum contributions set by the IRS. For 2019, the maximum contribution is $3,500 if single
     coverage, or $7,000 if “family” coverage. An annual catch-up amount of $1,000 is available for team
     members ages 55-65.

    In order to contribute to a HSA starting January 1, 2019, you cannot maintain a Flexible Spending
     Account (FSA) except for a Limited Purpose Flexible Spending Account. If you have a balance of $500
     or less in your FSA as of December 31, 2018, your account will be converted to a Limited Purpose FSA
     for 2019. Any amounts over $500 in your FSA as of December 31, 2018 will be forfeited.

    In future years, if you change medical plans and are no longer enrolled in the High-Deductible Plan, you
     can no longer add to your HSA, but you can still use any funds in your HSA to pay for qualified medical
     expenses.

     Discovery Benefits
     www.discoverybenefits.com

      866-451-3399
         Triple tax advantage – money saved is pre-tax, grows tax-free and withdrawn tax free if used
          to pay for qualified medical expenses
         You own your HSA! Your account carries over from year to year and goes with you if
          you take another job.

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