2020 Health Coverage - Prime, Inc.

NAWP Benefit Guide to 2020 Health Coverage

Call 866-951-8419 M - F, 8am - 7pm EST ?Hablamos Espa?ol! Shop Online at prime.

Visit Dave Brill on the Oasis Campus and TH/F in Cafeteria

Medical Dental Vision

Disability Accident Critical Illness

401k(i) Life

Let's Get Started

Become a Member!

As a member of The National Association of Workplace Programs (NAWP) your $10.00 membership benefits and discounts are designed to give you confidence as you plan for the future.

u $10,000 Term Life Coverage u Sleep Apnea Testing u 24-Hour Nurse Line & more! u Exclusive 401K(i) Retirement Plan

u Telephonic Assistance Program u Chiropractic u Financial Helpline u Identity Theft Protection

u Discount Program: ? Discounts on Diabetic Supplies ? Discounts on Prescriptions

4 step enrollment process:

1 2

Choose Daily Care Options

Daily care platform for routine screenings and doctor office visits that fit your needs and budget.

? Guaranteed Acceptance

Choose Hospital Indemnity Options

Hospital Indemnity provides the hospitalization benefits not covered by the daily care plans. This coverage is paid direct to you from the provider.

? Guaranteed Acceptance

SelectMed..............................Pg 4 ? SelectMed Base ? SelectMed Pro ? SelectMed Max

Hospital Indemnity.................Pg 5 ? Option 1 ? Option 2

3

Choose Additional Health Options

Pick and choose additional coverage that compliments your medical coverage.

4

Choose Life Coverage Options

Financial planning is important. ? Guaranteed Acceptance up to $50,000 for 10 Year Term and Permanent coverage. ? Coverage available up to $500,000.

Dental & Vision...................... Pg 6 Disability & Accident............. Pg 7 Critical Illness........................ Pg 8 401k(i).................................... Pg 9

Group Term Life.................. Pg 10 Universal Life...................... Pg 11

Individual Major Medical is available and pricing is based on your zip code, age and income. Call us today to learn if you qualify.

There is an additional $4.00 admin fee for ACH processing.

2 Questions? Call 866-951-8419

Monday - Friday, 8AM - 7PM EST

Medical Coverage Options

Individual Major Medical

Individual Major Medical is available and pricing is based on your zip code, age and income. Call us today to learn if you qualify.

? Open Enrollment is November 1st, 2019 to December 15th, 2019

NOV

DEC

1 to 15

? If you want to enroll out side of Open Enrollment, you will have to have a qualifying life event (QLE). ? What is a QLE? If you have had any of the following events in your life, you may be able to enroll in coverage.

Loss of coverage

Had a baby

Recently moved Got married to a new state

Turned 26

Daily Medical Options and Enhanced Coverage

SelectMed is for everyday medical needs and has benefits like doctor's visits, blood work, urgent care and more. Call us today to enroll!

? Available year-round ? Guaranteed Acceptance! ? Always open for enrollment or upgrades!

Hospital Indemnity is for hospitalization specific services and provides you with enhanced medical coverage. Call us today to enroll!

? Available year-round ? Guaranteed Acceptance! ? Always open for enrollment or upgrades! ? No Deductibles! ? No Coinsurance! ? First Dollar Coverage

Individual Individual + Spouse Individual + Child Family

Popular Plan Designs

SelectMed Pro

HIP Plan 1

$102.25/month

$60.37/month

$168.17/month

$113.85/month

$161.55/month

$86.72/month

$221.25/month

$130.50/month

SelectMed Pro and HIP Plan 1 $162.62/month $282.02/month $248.27/month $351.75/month

Questions? Call 866-951-8419

Monday - Friday, 8AM - 7PM EST

3

1. SelectMed

Key Benefits

Primary Care Visits Diagnostic Testing Prescription Benefits

Urgent Care CT/MRI/Pet Scans Mental Health and More

Evidence of insurability PPO Network Deductible Individual Family Out-of-Pocket Maximum Individual Family SelectMed Medical Services MedCall Now Preventative & Wellness* Primary Care Visit to Treat Injury or Illness Specialist Visit Outpatient Diagnostic Test (X-Ray, Blood Work)

Prescription Benefit

Urgent Care Outpatient CT/MRI /Pet Scans Outpatient Services: Mental Health, Behavioral Health or Substance Abuse Services Rehabilitation Services & Habilitation Services

Individual Individual + Spouse Individual + Child Family

SelectMed Base

SelectMed Pro

SelectMed Max

Guaranteed Acceptance

Guaranteed Acceptance

Guaranteed Acceptance

First Health?

In-Network Provider (No Out of Network Coverage)

In-Network Provider (No Out of Network Coverage)

In-Network Provider (No Out of Network Coverage)

n/a

n/a

$2,000

n/a

n/a

$4,000

In-Network Provider (No Out of Network Coverage)

In-Network Provider (No Out of Network Coverage)

In-Network Provider (No Out of Network Coverage)

n/a

$7,900

$7,900

n/a

$15,800

$15,800

In-Network Provider (No Out of Network Coverage)

In-Network Provider (No Out of Network Coverage)

In-Network Provider (No Out of Network Coverage)

Included (No Copay)

Included (No Copay)

Included (No Copay)

100% Covered in Network-No copay and No deductibles

$25.00 Copay Max 5 Visits Per Calendar Year 1

$25.00 Copay per visit

Not Covered

$25.00 Copay Max 5 Visits Per Calendar Year 1

$50.00 Copay per visit

$25.00 Copay Max 5 Tests Per Calendar Year

$50.00 Copay per test

No Copay for ACA Compliant covered prescription drugs

No Copay for ACA Compliant covered prescription drugs

No Copay for ACA Compliant covered prescription drugs

20% Copay-Generic Only 12 Prescriptions Maximum

30 day supply Maximum

Brand/Generic, $10 Formulary Generic / $50 Formulary Brand; Mail $30 Formulary Generic / $150

Formulary Brand, $750 Per Member / $1,500 Per

Family Annual Maximum 2

Not Covered

$25.00 Copay Max 5 Visits Per Calendar Year 1

$50.00 Copay per visit

50% Coinsurance per test 3 Subject to deductible

Not Covered

$75.75 $130.10 $120.40 $173.75

Monthly Rates

$102.25 $168.17 $161.55 $221.25

$50.00 Copay per visit

$50.00 Copay per visit Combined limit for all therapies of

20 visits per plan year

$194.80 $328.65 $337.02 $491.98

Not available in Alaska, Hawaii, Massachusetts, and New Hampshire. 1. Combined 5 visits per year includes Primary Care Visit to Treat Injury or Illness, Specialist Visit and Urgent Care Visit. 2. The prescription provided by DataRx is not available in AZ, CA, CO, CT, ID, KS, ME, MD, MI, MN, MT, NC, ND, NJ, NM, NY, PA, RI, UT, VA, VT, WA, WV. In the states noted, $20 co-pay generic only, 30 day supply max. 3. Pre-authorization required. For additional information, visit: as benefits are subject to change. Or reference the Summary Plan Description for a list of Wellness & Preventative services offered In-Network. First Health is a brand name of First Health Group Corp., an indirect, wholly-owned subsidiary of Aetna Inc.

NAWP-9.20.2019.06

4 Questions? Call 866-951-8419

Monday - Friday, 8AM - 7PM EST

2. Hospital Indemnity

Key Benefits Daily In-Hospital Off-the Job Accident Surgical and Anesthesia Hospital Confinement

Guaranteed Acceptance No Deductibles! No Coinsurance! First Dollar Coverage

Enhance your SelectMed Coverage by adding this plan to Minimize out-of-

pocket expenses.

Policy Benefits

Daily In-Hospital Indemnity Benefit

Pays each day an insured person is confined to a hospital (but not an emergency room, outpatient stay or stay in an observation unit) as the result of a covered accident or sickness.

Additional Indemnity Benefits

Intensive Care Indemnity Benefit Rider

Pays each day an insured person is confined to an intensive care unit as the result of a covered accident or sickness.

Hospital Confinement Indemnity Benefit Rider

Pays each day an insured person is confined to a hospital (but not an emergency room, outpatient stay or stay in an observation unit) as the result of a covered accident or sickness lasting a minimum of 24 continuous hours from time of admission.

Off-the-Job Accidental Injury Indemnity Benefit Rider

Pays each day an insured person receives treatment for a covered accident. Treatment must be provided by a physician within 96 hours of the accident.

Inpatient Miscellaneous Indemnity Benefit Rider

Pays each day an insured person is confined to a hospital as the result of a covered accident or sickness.

Surgical and Anesthesia Indemnity Benefit Rider

Pays each day an insured person undergoes surgery, as follows:

Inpatient surgery Outpatient surgery Outpatient minor surgery Anesthesia percentage

Non-Insurance Discount Programs

PPO Network offered by Multiplan

Employee Discount Card offered by New Benefits Ltd.

Option 1

$300 31 days

Option 1 $300 10 days

$500 1 day

$200/ 1 day per accident/5 days per calendar year $50 31 days $500/1 day $250/1 day $50/1 day 20%

Included Included

Option 2

$500 31 days

Option 2 $500 10 days

$1,000 1 day

$300/ 1 day per accident/5 days per calendar year $100 31 days $1,000/1 day $500/1 day $100/1 day 20%

Included Included

OPTION 1 OPTION 2

Hospital Indemnity Insurance Monthly Premiums

Member

Member + Spouse

Member + Child

$60.37

$113.85

$86.72

$94.85

$190.60

$142.86

Family $130.50 $221.09

THIS IS NOT MAJOR MEDICAL INSURANCE AND IS NOT A SUBSTITUTE FOR MAJOR MEDICAL INSURANCE. IT DOES NOT QUALIFY AS MINIMUM ESSENTIAL COVERAGE (MEC) AS DEFINED BY THE FEDERAL AFFORDABLE CARE ACT (ACA).

This is a brief summary of Hospital Indemnity Insurance. Insurance may not be available in all jurisdictions. Limitations and exclusions apply. Refer to the policy, certificate and riders for complete details. Issue Age 18 to 65 (Eligible Children under the age of 26).

Questions? Call 866-951-8419

Monday - Friday, 8AM - 7PM EST

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