2020-2021 Benefit Guide

Employee Benefits Guide Open Enrollment 2020-2021 * Please Remember * You must complete your elections using BenXpress, the employee online benefits portal enrollment system. See the BenXpress Online Enrollment Guide for step-by-step details to enroll on page 9. If you have any questions about enrollment or if you have any trouble while electing coverage on the BenXpress online benefits portal, please contact Kristen Gann or Peter Mitchell or Lau & Lau Associates, LLC 1 | Page

What is in this guide? 2 Welcome & Benefits Enrollment 3 Eligibility for Benefits 3 Changing Benefit Elections 4-5 Medical Benefits Summary 6 Dental Benefits Summary 7 Vision Benefits Summary 7 Employer Paid Life and Disability Benefits Summary 8 Employee Voluntary Benefits Summary 9 BenXpress Online Benefits Portal – Online Enrollment Guide 11 Contact Information for Your Plans Welcome & Benefits Enrollment Welcome! to your 2020-2021 Plan Year Benefits Guide. This Benefits Guide provides you with highlights of your benefit options. Some of these benefits require an employee contribution toward coverage, so please review these materials closely. Please also refer to the additional information provided on the BenXpress online benefits portal to obtain complete details about your benefit options. Important Note: The medical coverage offered to you meets the requirements for coverage and affordability under the Affordable Care Act. In most cases, this means that you are not eligible to receive advance premium tax credits (also known as subsidies) toward coverage purchased on the Health Care Reform Marketplace based on your eligibility for the coverage offered by Healing Haven. Customer Service phone numbers and web addresses are included on the last page of this guide and are also available on the BenXpress online benefits portal. Things to know before you make your 2020-2021 Plan Year elections: • The medical plans offered have not changed except for slight carrier required changes to the H.S.A. plan. • There are no changes to your per-pay cost for the medical plans. • The voluntary dental plans offered have not changed, but there is a small increase to your per-pay cost. • The voluntary vision plan has not changed and the cost to enroll has not changed. • If you enrolled in the Principal voluntary life benefits you do not need to reenroll unless you want to change your benefit amount. Note: This document does not constitute official plan documents. If there are any discrepancies between the information contained herein and the official plan documents, the plan documents will govern. 2 | Page

Welcome & Benefits Enrollment (cont’d) During this May 1, 2020 enrollment opportunity, you can: • Review your personal benefit levels and important plan information on BenXpress • Enroll yourself and your eligible dependents for medical, dental, and vision benefits • Change your eligible dependents for medical, dental, and vision benefits • Change your current medical plan election • Elect contributions to your H.S.A. account, if you enroll in the High Deductible Health Plan • Elect for the first time, or increase as allowed, voluntary life coverage for yourself and your dependents Your next opportunity to elect or change your benefit elections will be at open enrollment for May 1, 2021 or if you have a qualified event during the plan year. Eligibility for Benefits: An employee of Healing Haven is eligible for benefits as long as that employee is working at least thirty (30) or more hours each week and that employee has met any waiting period that applies. A change in hours worked may affect eligibility for benefits. Employees may enroll their eligible dependents for coverage. Dependents that are eligible for enrollment include your legally married spouse and your child(ren). Dependent children are covered at least until the end of the month they turn age 26. Changing Benefit Elections IRS regulations require that the pre-tax elections you make during this open enrollment period remain in effect until next year’s open enrollment period unless you experience a qualified event during the plan year. Additionally, if you do not enroll for benefits at this time, you must wait until the next annual open enrollment period to elect coverage unless you experience a qualified event during the plan year. Open enrollment will take place each year prior to May 1. You will be given the opportunity to change your elections at that time without needing a qualified event. If you have a qualifying status change prior to next year’s open enrollment, you may be able to change your benefit elections. Please keep in mind that any changes must be consistent with the qualifying event. You may be asked to provide documentation for proof of a qualified event. Additionally, you must notify Healing Haven within thirty (30) days of a qualifying event for a change in benefit elections to be made. Common qualifying events include marriage, birth, adoption, divorce, loss of other coverage, and a new offer of coverage at a spouse’s employer. 3 | Page

Medical Benefit Plans Summary This is a brief summary. Additional detail can also be found BenXpress. Option 1 Plan Year May 1, 2020 to April 30, 2021 Medical Plan (Calendar Year Deductible) HMO Gold $2,000 Blue Care Network Network $2,000 / 30% to $1,000 In-Network Single $6,600 Deductible/Coinsurance Family Maximum = 2X Single Limits Out-of-Pocket Maximum Emergency Care Only – See Benefit Summary Out-of-Network Covered 100% Deductible and Coinsurance Apply In-Network Preventive Care Benefit Covered 100% (In-Network) Hospital Admission Deductible and Coinsurance Apply Deductible Applies, then $150 Copay Diagnostic Laboratory $20 Diagnostic X-rays $40 when referred Diagnostic Advanced Imaging $20 Primary Care Physician $50 Virtual Visit Deductible Applies, then $150 Copay Copays Specialist See Benefit Summary Chiropractic Medicare Creditable Behavioral Health Custom Select Drug List Behavioral Health Virtual Visit No Urgent Care Copay Tier 1A $4 / Tier 1B $15 Emergency Room Copay $40 $80 Therapy Visits Maximum 20% ($200 maximum) 20% ($300 maximum) Rx Pharmacy Copay (1-30 Day Supply) Mandated ACA Rx Covered 100% Option 1 Medicare Rx Creditable or Non-Creditable Rx Drug Listing Medical Deductible applies to Rx Tier 1 (Generic) Tier 2 (Preferred Brand) Tier 3 (Non- Preferred Brand) Tier 4 (Preferred Specialty) Tier 5 (Non-Preferred Specialty) Medical Employee Contribution via payroll deduction for 26 pays Your cost to enroll will be reflected in Employee $66.62 BenXpress. Deductions will be taken Two Person $224.51 $292.17 pre-tax Family 4 | Page

Option 2 Option 3 H.S.A. HDHP HMO Gold $2,000 Simply Blue PPO Gold $1,500 Blue Cross Blue Shield of Michigan Blue Care Network $2,000 / 0% $1,500 / 20% to $1,000 $3,500 $6,600 $4,000 / 0% $7,000 Maximum = 2X Single Limits See Benefit Summary Emergency Care Only – See Benefit Summary Covered 100% Covered 100% Deductible and Coinsurance Apply Deductible and Coinsurance Apply $20 (Medical Virtual Visit cost is $49, subject $40 to Deductible) $30 See Benefit Summary Deductible and Coinsurance Apply $60 $150 See Benefit Summary Medicare Creditable Medicare Creditable Custom Select Drug List Custom Select Drug List Medical Deductible Applies, then Copay Tier 1A $10 / Tier 1B $30 No $15 $60 $50 $80 50% ($70 minimum / $100 maximum) 20% ($200 maximum) 20% ($200 maximum) 20% ($300 maximum) 25% ($300 maximum) Option 2 Option 3 $63.21 $134.84 $216.31 $388.23 $281.93 $496.83 Health Savings Account (H.S.A.) Medical plan Option 2 is a H.S.A. high deductible health plan. If you enroll in this plan you are eligible to make contributions into an H.S.A. Be sure to make your H.S.A. election in BenXpress if you choose Option 2. 5 | Page

Voluntary Dental Benefit Plans Summary This is a brief summary. Additional detail can also be found in BenXpress. Plan Year May 1, 2020 to April 30, 2021 Option 1 – Core PPO Option 2 – Buy-Up PPO Network Principal Principal Member’s Responsibility In-Network Out-of-Network In-Network Out-of-Network PPO Dentist PPO Dentist May be balance billed Deductible Single $50 $50 Family $150 $150 $1,000 Calendar Year Benefit Maximum Included Not Covered – $1,000 None Member is Annual Carryover allowed up to $250 with Included $1,000 Maximum Accumulation 0% responsible for full cost if services are None Calendar Year Out-of-Pocket Maximum out-of-network 0% 0% Preventive Services Coinsurance 20% 20% Basic Services Coinsurance 20% 50% 50% EHB benefits for Pediatric Members Major Services Coinsurance 50% (age 0 to 18) Essential Health Benefits (EHB) EHB benefits for Pediatric Members $100 (age 0 to 18) Deductible Single Pediatric Member $300 Family Pediatric Member $100 10% 10% $300 30% 30% Preventive Services Coinsurance 10% 10% 60% 60% Basic Services Coinsurance 30% 30% None Major Services Coinsurance 60% 60% $350 Single Pediatric Member / $700 Two or More Pediatric Members Calendar Year Benefit Maximum None Calendar Year Out-of-Pocket Maximum $350 Single Pediatric Member / $700 Two or More Pediatric Members Voluntary Dental Employee Contribution Option 1 – Core PPO Option 2 – Buy-Up PPO via payroll deduction for 26 pays Your cost to enroll Employee $7.31 $15.31 will be reflected in $14.37 $30.54 Employee plus $17.50 BenXpress. Spouse $23.93 $37.56 Deductions will be $55.92 Employee plus taken pre-tax Child(ren) Family 6 | Page

Voluntary Vision Benefit Plan Summary This is a brief summary. Additional detail can also be found in BenXpress. Plan Year May 1, 2020 to April 30, 2021 Voluntary Vision Plan Network Principal / VSP Choice Network Member’s Responsibility Calendar Year In-Network One Exam covered every 12 months Eye Exam Coverage One pair of Lenses every 12 months Coverage for Lenses / Contact Lenses (members may obtain either One Frame every 12 months eyeglasses or contact lenses, but not both) $150 Frame Allowance Voluntary Vision Plan Frames Coverage $3.86 Voluntary Vision Employee Contribution via payroll deduction for 26 pays $6.50 Employee $6.62 Your cost to enroll will be Employee plus Spouse $10.49 reflected in BenXpress. Employee plus Child(ren) Deductions will be taken pre-tax Family Employer Paid Life/AD&D Benefits Summary Life / Accidental Death & Dismemberment Benefits Healing Haven provides you with a life insurance benefit that includes accidental death and dismemberment benefits through Principal at no cost to you. This benefit provides a flat benefit of $25,000. Please be sure to check that your beneficiary on BenXpress is up to date. 7 | Page

Voluntary Benefits Summary You will find benefit summaries and additional information regarding voluntary benefits on the BenXpress online benefits portal. Voluntary Life Benefits As part of your initial benefit selections with Healing Haven, you were offered the opportunity to enroll for group voluntary life benefits through Principal. If you enrolled in this benefit and wish to maintain your current coverage then there is nothing to do as your enrollment will not change because of open enrollment. If you are enrolled and want to increase your coverage, Healing Haven's Principal coverage allows you to add or increase existing coverage up to two benefit increments without proving proof of good health. If your current benefit is over the guaranteed coverage of $100,000, you can increase up to two increments up to the maximum benefit*. You can also increase spousal coverage up to two increments as long as the spousal benefit does not exceed 100% of your benefit. You may also add or increase the child benefit during this open enrollment. If you did not enroll at your initial enrollment opportunity you can enroll during open enrollment. You can elect one or two increments ($10,000 increment) of coverage without a statement of good health*. If you would like a benefit over two increments then you will need to provide a statement of good health to Principal. Coverage must be approved by Principal if a statement of good health is submitted. *If you were previously declined for any amount you cannot increase coverage without a statement of good health submitted to Principal. Coverage must be approved by Principal if a statement of good health is submitted. Remember, if you have a life event change (i.e., marriage) before the next open enrollment cycle, you must add spousal coverage within thirty (30) days of the marriage to enroll without evidence of insurability. If you wait until the next open enrollment opportunity following the marriage, then your spouse will be required to complete evidence of insurability forms to apply for coverage. Voluntary Short-Term Disability Benefit As part of your initial benefit selections with Healing Haven, you were offered the opportunity to enroll for group voluntary short-term disability coverage through Principal. If you enrolled in this benefit and wish to maintain your current coverage then there is nothing to do as your enrollment will not change because of open enrollment. If you did not enroll at your initial enrollment opportunity you can enroll during open enrollment as long as you provide a statement of good health to Principal. Coverage must be approved by Principal if a statement of good health is submitted. 8 | Page

Online Benefits Portal If you have any questions about enrollment or if you have any trouble while electing coverage on the BenXpress online benefits portal, please contact the Kristen Gann, Peter Mitchell or Lau & Lau Associates, LLC. BenXpress Online Enrollment Guide What do you need to enroll online? • A secure network connection as your account contains personal information • Dependent(s) Social Security Number(s) and date(s) of birth • Your choice of plans and beneficiaries System Tips Start Enrolling • Turn off your Pop-up Blocker • Go to www.BenXpress.com/Healing • The system works best in Mozilla Firefox Haven • Use the Blue Navigation arrows at the top • Log in using the following criteria of each screen instead of the browser o Username: back arrows  First initial of first name • The enrollment process will take  plus full last name approximately 30 – 45 minutes. Please  plus last 4-digits of your Social keep in mind, you cannot save your Security Number progress and continue the enrollment o Password: Your birthdate in process at a later time. MMDDYYYY format • Print your confirmation statement for your records • Follow the prompts through the enrollment process to make your benefit elections. • Once you have successfully logged in, you will be asked to read and agree to the Legal Authorization and Terms and Conditions before entering the BenXpress System. • Once you have read through the Legal Authorization and if you agree with the Terms and Conditions, click on “Yes, I Agree”. If you do not agree with the terms and choose “No, I disagree”, the session will end without selecting any benefits. 9 | Page

BenXpress Mobile App • Visit the App Store to download the BenXpress App • Link your account to the app by logging in to the web browser on your phone - www.BenXpress.com/Healing Haven • Click the “Link My App” icon in the Home Screen and follow the instructions to receive a link code • Designate your preference for two-factor authentication – email address or cell number • Receive the code, open the app, and enter to code to finish linking your account • Begin using the mobile app 10 | P a g e

Contact Information for Your Plans Use this contact listing if you have questions. Benefit Carrier Customer Service Website Online Benefit 24-Hour Nurse Line www.benxpress.com/healinghaven Portal and Online Visits username: first initial of first name + full last name + last 4 Enrollment Site digits of your SSN Medical password: your birthdate in MMDDYYYY format (313) 225-9000 www.bbsm.com BCBSM (877) 790-2583 BCN (800) 662-6667 BCBSM (800) 775-BLUE or (800) 775-2583 BCN (855) 624-5214 (844) 606-1608 bcbsmonlinevisits.com Experian (877) 736-4495 www.experianidworks.com/bcbsm IdentityWorks (866) 346-5800 Code MICHIGAN20 Health Savings Engagement number: DB14217 Account www.healthequity.com Vision (800) 877-7195 www.vsp.com Dental (800) 986-3343 www.principal.com/dentist (800) 986-3343 www.principal.com Life and Disability (800) 450-1327 N/A Telephonic Assistance (800) 986-3343 www.principal.com Program Lau & Lau Associates, LLC www.lau-lau.com 401(k) 866.858.5020 or 248.258.5020 or [email protected] General Individual and Medicare, David Greene Questions 248.203.7610 or [email protected] 11 | P a g e