PDF 2018 BENEFITS GUIDE

2018 BENEFITS GUIDE

WELCOME TO YOUR GOLD'S

GYM 2018 BENEFITS!

As a valued Team Member of Gold's Gym, we're proud to provide you with a comprehensive benefit package. We work hard every year to evaluate the benefit offerings to make sure we provide the right plans that take the best care of you and your family's needs, so you can always be at your best, both at work and at home.

This year, we are introducing a new, easy-to-use enrollment system called SmartBen. You'll go online during the enrollment period to enroll in your 2018 coverage. The system is available 24/7 and from any internet browser! See page 1 for details.

We encourage you to review this guide so you are familiar with the many benefits available to you and your family. We hope you find this guide to be a helpful tool as you make your benefit choices.

Our 2018 Changes

CIGNA MEDICAL PLANS

? Prices lowered in the Bronze Plan for Team Member only coverage

? New Bronze Plus Medical Plan added! Now there is a lowcost plan that includes copays for prescriptions and doctor's visits

? Increased deductibles on the Gold and Silver Plans

? Out-of-network benefits removed from Silver Plan

? The employee and spousal tobacco surcharge is increasing to $50 bi-weekly

VSP VISION PLAN

? Benefit enhancements including greater frame allowance and inclusion of Walmart in the network

VOLUNTARY PLANS

? New Accident Plan offered through Lincoln

? New Critical Illness Plan offered through Lincoln

? New Hospital Indemnity Plan offered through Voya

? New Whole Life Insurance Plan offered through Unum

TABLE OF CONTENTS

2018 Annual Enrollment Benefit Basics Medical Health Care Reform Medical Plan Comparisons Health and Wellness Supplementing Your Medical Plan Dental and Vision Flexible Spending Accounts Life Insurance Disability Other Benefits 401(k) Savings Plan Fee Disclosure When Does Coverage End? Legal Notices Benefit Contacts

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4 4 5 6 7 8 9-10 11 12 12 13 14-17 18 19-21 Back

2018 ANNUAL ENROLLMENT

New SmartBen System

We're excited to bring you a new enrollment system this year, SmartBen. This online platform is not only where you go to enroll, but houses all of your benefit information in one spot, including a copy of this guide and important plan documents like Summary Plan Descriptions. Don't own a computer? No problem! The system is available on any internet browser, including your smart phone or tablet.

How to Enroll

Annual Enrollment this year is November 6 ? November 21. This is your one time of year where you can enroll or make changes in your benefit plans. You are required to log in and enroll for benefits if you want coverage for 2018. Your existing benefits will not roll over to next year. The only way to enroll is through SmartBen. Follow these steps to log on and enroll:

1. Visit .

? Enter your username, which is GOLDS + your 9-digit Social Security number (SSN) without the dashes. For example, Jody's SSN is 987-65-4321, so her username is GOLDS987654321.

? Enter your initial password, which is your date of birth as MMDDYYYY. For example, Jody was born on April 12, 1974, so she enters 04121974. You will be asked to create a new password after you log in the first time.

2. On the home page, click the Begin Enrollment button.

3. Select the Annual Enrollment button to begin your enrollment session.

4. You will enter the Enrollment process at the Benefit Manager page. To make changes to a benefit, click on the benefit name. To make an election, click on the option you want to elect. You will first need to select which individuals are being covered by making your selection in the Who Is Being Covered box on the right. Then select the plan you want to enroll in. The selection you made will turn green. Click the green Continue button at the top right of the page when you are finished.

? Manage People: This is where your Personal, Spouse/ Dependent, and Beneficiary information is stored. Adding people into the People Manager section DOES NOT assign them to coverage. You will assign your spouse, dependents, and beneficiaries in the enrollment process. To return to enrollment simply click Manage Benefits or Return to Lights.

5. Once your elections are complete, each benefit will have a green light. To proceed to the next step, click the green button labeled Elect & Continue.

6. If you have not entered all required information, SmartBen will not process your enrollment. Click on each item in the Enrollment Task List and SmartBen will take you to the required page for corrections. Make your corrections, click Submit, Enroll, or Save, whichever is applicable. Be sure to review any

items in the Information box on this task page, click on Click Here to make changes, and then click the green Continue button. 7. You will now review your confirmation. Examine your elections thoroughly, including dependent and beneficiary assignments, and enter your initials to acknowledge your agreement before clicking Continue. 8. Congrats! You have successfully completed the enrollment process! Select the Click Here link for a copy of your Confirmation Statement.

Be Prepared

? When you are ready to log on to SmartBen and enroll, be sure to have important information with you. This includes:

? Your SSN and birthdate ? SSN and birthdate for your dependent(s) ? Proof of each dependent(s) relationship you are adding to

coverage for the first time. Please see the chart on the next page for acceptable documentation.

Need Help with SmartBen?

Just in case you have any technical issues in SmartBen, you can call the Assist line toll-free number at 855-210-1940. This includes password resets or Internet problems you may be experiencing. Representatives can assist you Monday ? Friday from 8 a.m. to 8 p.m. ET.

Tobacco Declaration

In SmartBen, you will be able to declare your tobacco status. If you or your spouse use tobacco products, you are each assessed a surcharge of $50 bi-weekly. If you complete Cigna's Quit Today program, we will remove the surcharge and refund you for the full plan year in September 2018. To avoid additional surcharges in 2019, quit using tobacco products. You'll get healthier and save money at the same time! See page 6 for tobacco cessation program information.

ENROLLMENT REQUIRED FOR 2018

If you do not enroll by November 21, 2017 you will not have benefits in 2018.

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BENEFIT BASICS

Eligibility

You can cover the following dependents under your medical plan. When you add a new dependent, or experience a Qualifying Life Event, you must provide proof of your relationship as indicated in this chart. During this year's Annual Enrollment, you will not be required to submit documentation. You will receive a packet in the mail after the close of Annual Enrollment with instructions on how to provide dependent verification documents.

ELIGIBILITY

DEPENDENT(S)

REQUIRED DOCUMENTATION*

Spouse Individual to whom you are legally married who is not eligible for medical coverage through their own employer. Both opposite-sex and same-sex marriages are included

Copy of your state issued marriage certificate or required documents for your common law marriage, or the first page of last year's tax return AND Spouse Affidavit

Children Dependent child under the age of 26, including: ? Biological child ? Adopted child and a child placed for adoption ? Foster child ? Stepchild ? A child for whom legal guardianship has been awarded to the employee or

employee's spouse ? Child covered under a Court Order or Qualified Medical Support Order.

Biological Child: Copy of the child's state issued birth certificate showing your name as parent, or the first page of last year's tax return. If your child was just born, you may provide the proof of birth provided by the hospital. Stepchild: Copy of the child's state issued birth certificate showing the employee's spouse's name as a parent or the first page of last year's tax return. AND A copy of the marriage certificate showing you and your spouse's name. Legal Guardian, Adopted or Foster Child: Final Court Order with presiding judge's signature and seal, or Adoption Final Decree with presiding judge's signature and seal. Court Order or Qualified Medical Child Support Order: Original Court Order

HEALTH CARE REFORM--WHAT IT MEANS TO YOU

We continue to comply with all Affordable Care Act (ACA) requirements. There are Health Care Reform regulations for both the employers and Team Members. You will need to comply with the individual mandate, which requires you to have health care coverage or pay a penalty.

Individual Requirements

If you are an eligible Team Member electing one of the major medical plans during Annual Enrollment, you will satisfy the individual mandate and will not be subject to any penalties. You can also enroll for coverage through your spouse's plan or an exchange offered through your state. If you do not have coverage, you will be subject to the ACA penalty. The penalty is based on a percentage of your household income.

IMPORTANT

If you do not have medical coverage under a qualified plan, you will be subject to the penalty AND be responsible for 100% of the cost of medical care.

Employer Requirements

Employers must offer full-time employees a medical plan option that meets requirements of a comprehensive and affordable medical care plan as defined by the ACA. An "affordable" plan means that a company must cover 60% of the total cost of health care benefits. Our medical major plans meet these requirements. When you receive care, Gold's Gym will pay the majority of your medical costs. Because all the major medical plans meet the ACA standards of affordability, you will not be eligible for a subsidy if you choose to receive coverage in a public marketplace.

Please refer to the Health Care Reform Made Simple website () for current ACA updates.

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BENEFIT BASICS

Changing Benefits During the Plan Year

In compliance with Section 125 of the IRS Code, medical, dental, vision, life, and spending account plan elections may be changed during the plan year only if you have a Qualifying Life Event that is consistent with the change, such as:

? A change in your legal marital status, including marriage, divorce, death of your spouse, or annulment ? A change in the number of your tax dependents through birth, adoption, placement for adoption, or death ? Termination or commencement of employment by you, your spouse, or your dependent ? A change in your work schedule, such as a reduction or increase in hours by you, your spouse, or your dependent that

would make you eligible or ineligible for benefits ? Your dependent's ability or inability to satisfy dependent eligibility requirement, including losing other coverage upon turning 26 years old ? Receipt of a Qualified Medical Child Support Order or letter from the Attorney General ordering you to provide, or allowing

you to drop coverage for a child ? Changes made by a spouse or dependent child during their annual enrollment period with another employer

? You, your spouse, or your dependent child becoming eligible or ineligible for Medicare or Medicaid ? Changes in day care costs due to a change in provider, provider's fees, or the number of hours the child needs day care

(Dependent Care FSA only) ? Coverage gained or lost through the Marketplace will not be a Qualifying Life Event ? Your pay status changes from Full Time to Part Time. If you are already enrolled in medical coverage, your coverage may

continue until the end of the stability period ? If you move from salaried to hourly (or vice versa), you must make a new disability benefit election

When you need to make a mid-year change, log in to SmartBen to start this process. Once on the homepage, you will see a Life Event Enrollment box. Click here and complete all of the required information you see on screen. After the information is entered into SmartBen, you'll receive a packet in the mail outlining acceptable documents you can provide to verify the newly added dependent. Be sure to submit your documentation in a timely manner.

Please refer to the following chart for a list of required documentation:

LIFE EVENT

Marriage Divorce/Annulment Birth of a Child Adoption

Gain of Coverage

QUALIFYING LIFE EVENT

REQUIRED DOCUMENTATION FOR QUALIFYING LIFE EVENTS

Copy of your state issued marriage certificate

If you are adding new stepchildren to your coverage, a copy of the child's state issued birth certificate showing your spouse/partner's name as a parent AND a copy of the marriage/partnership certificate showing your name and the parent's name

Copy of your final divorce or annulment decree

If your child is under six months old, you may provide the proof of birth provided by the hospital Copy of the child's state issue birth certificate showing the employee's name as parent

Copy of Affidavits of Dependency, Final Court Order with presiding judge's signature and seal, or Adoption Final Decree with presiding judge's signature and seal

If you have gained coverage elsewhere, you must provide one of the following: ? A letter from a government agency indicating your eligibility for state coverage ? A letter from your spouse's employer indicating that you have enrolled in other coverage ? An ID card from another carrier indicating you are enrolled for coverage Note: All forms of proof above must indicate what coverage was obtained and the date when coverage became effective

Loss of Coverage Change in Day Care Provider

If you have lost your other coverage, you must provide one of the following: ? A letter from a government agency indicating your ineligibility for state coverage ? A letter from your spouse or parent's employer indicating that you are no longer eligible for coverage Note: All forms of

proof above must indicate what coverage was lost and the date when coverage was lost

Letter from the current day care provider indicating services have commenced or ended

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MEDICAL

Medical and Prescription Drugs

We understand the importance of good health as the foundation for a productive life at home and at work. That is why we offer four medical plans, administered through Cigna, to fit your needs and budget. They all use the Open Access Plan (OAP) or Local Plus network.

When comparing the Gold, Silver, Bronze Plus, and Bronze plans, it's important to look at the following:

? Calendar Year Deductible

? Coinsurance ? or the percentage the plan pays after Deductible

? Calendar Year Out-of-Pocket Maximum

? HRA, HSA, and FSA Contributions to help you pay out-ofpocket costs

? Premiums you pay out of your paycheck

The Cigna Network

The network available to you depends on the plan you choose and where you work. If your home address is within a Cigna Local Plus network area, this is the network that will be available to you when you sign up for the Gold, Bronze Plus, or Bronze Plan. The Local Plus network is a "narrow" network with a limited selection of providers, so it is important to consider this as you make your enrollment decisions.

Cigna's "broad" network, Open Access Plus (OAP), is offered with the Silver Plan. Within the OAP network, there are primary care physicians and specialists with the Cigna Care Designation. When you receive care from these designated physicians, you receive a richer benefit. To find providers in your area, go to , click on Find a Doctor, then select a plan for your search (either Open Access Plus or Local Plus) and select the type of provider you are looking for.

Here's How the Gold and Bronze Plus Plans Work:

Here's How the Silver Plan with HRA Works:

Here's How the Bronze Plan with Optional HSA Works:

You pay nothing for eligible in-network preventive care. Preventive care doesn't apply

toward the deductible.

For certain health care services you pay only a copay and that's it! The copay applies to your

deductible.

You pay nothing for eligible in-network preventive care. Preventive care

doesn't apply toward the deductible.

You pay nothing for eligible in-network preventive care. Preventive care

doesn't apply toward the deductible.

You pay your non-preventive medical and prescription expenses out-ofpocket until you reach your annual deductible. This would be the ideal time to use the money in your HRA and/or FSA.

HRA and FSA

You pay your non-preventive medical and prescription expenses out-of-pocket until you reach your annual deductible. You are allowed to open your own Health Savings Account with this medical plan. This would be the ideal time to use HSA

money for these expenses.

For services that require coinsurance, once you meet the deductible, Anthem will pay 80% for

in-network services.

Once the deductible is met, you pay coinsurance for

non-preventive medical and prescription expenses. Your

HRA and/or FSA can be used to pay these expenses.

Once the deductible is met, you pay coinsurance for

non-preventive medical and prescription expenses. If you wish, you can use an HSA to

pay for these expenses.

If your out-of-pocket costs reach the annual maximum,

the plan pays 100% for eligible care the remainder

of the plan year.

If your out-of-pocket costs reach the annual maximum,

the plan pays 100% for eligible expenses the

remainder of the plan year.

If your out-of-pocket costs reach the annual maximum,

the plan pays 100% for eligible expenses the

remainder of the plan year.

You can also set aside funds into a Health Care FSA. This account can be used to help pay your out-of-pocket maximum, which includes your deductible, coinsurance and prescription costs.

You can also set aside funds into a Health Care FSA and have the HRA. Both of these accounts can be used to help pay your out-of-pocket maximum, which includes your deductible, coinsurance and

prescription costs.

If you have a Health Savings Account, you cannot also have a Health Care Flexible Spending

Account (FSA). You can only pay for medical and prescription expenses through your HSA.

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MEDICAL PLAN COMPARISON

BENEFITS MEDICAL PLAN

Health Reimbursement Account Health Savings Account Deductible (Ind/Fam) Coinsurance Out of Pocket Maximum (Ind/Fam) Preventive Care Telehealth Visit Primary Office Visit Specialist Office Visit Urgent Care Visit

IP Hospital Copay

ER Copay Laboratory OP/PR Services X-rays & Diagnostics Imaging

RETAIL PHARMACY

Generic Incentive Generic Preferred Brand Drugs Non-Preferred Brand Drugs Specialty High Cost Drugs

GOLD

LOCAL PLUS/OAP IN NETWORK

N/A

N/A $1,000/$2,000

20%

$3,750/$7,500

0% $25 Copay $25 Copay $40 Copay $75 Copay $500 per Admit Copay 20% after CYD 20% after CYD

20% after CYD

20% after CYD

$4 Copay $15 Copay 25%; $35 min/$75 max

40%; $60 min/$120 max

50%; $150 min/$300 max

SILVER

OAP ONLY IN NETWORK

$250/$500 N/A

$2,000/$4,000 20%

$5,500/$11,000 0%

20% after CYD 20% after CYD 20% after CYD 20% after CYD 20% after CYD 20% after CYD 20% after CYD

20% after CYD

$4 Copay $15 Copay 30%; $40 min/$75 max 50%; $80 min/$150 max

50%; $150 min/$300 max

BRONZE PLUS

LOCAL PLUS/OAP IN NETWORK

N/A N/A $4,000/$8,000 0% $6,000/$12.000 0% $40 Copay $40 Copay $80 Copay 0% after CYD 0% after CYD 0% after CYD 0% after CYD

0% after CYD

$15 Copay $15 Copay

50% 50%

50%

BRONZE

LOCAL PLUS/OAP IN NETWORK

N/A HSA Eligible $6,350/$1,2700

0% $6,350/$12,700

0% 0% after CYD 0% after CYD 0% after CYD 0% after CYD 0% after CYD 0% after CYD 0% after CYD

0% after CYD

0% after CYD 0% after CYD 0% after CYD 0% after CYD

0% after CYD

COVERAGE LEVEL

Team Member Team Member & Spouse Team Member & Children Family

GOLD

$134.86 $377.78

$304.56 $513.03

MEDICAL RATES PER PAY PERIOD

YEARLY SALARY: UNDER $25,000

YEARLY SALARY: OVER $25,000

SILVER

BRONZE PLUS

BRONZE

GOLD

SILVER

BRONZE PLUS

$72.69

$58.10

$39.64

$141.47

$76.24

$65.63

BRONZE

$54.09

$232.45

$203.36

$166.04

$396.30

$243.85

$229.71

$199.68

$173.37 $319.07

$145.26 $261.47

$125.49 $255.59

$319.49 $538.17

$181.88 $334.73

$164.08 $295.34

$152.78 $265.83

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HEALTH AND WELLNESS

Wellness

Your health and wellbeing are a top priority for not only you, but for Gold's Gym. Being in the wellness industry, it's important that our Team Members practice what they preach. That includes not using tobacco products. Did you know tobacco use is a leading cause of cancer and of death from cancer? If you or your spouse are using tobacco, now's the time to quit.

For those who do not currently use tobacco or agree to participate in a tobacco cessation program, you and/or your spouse will avoid additional costs in your premiums--$50 per person per pay period for a total of $100 bi-weekly.

There will be a Tobacco Surcharge for 2018 if:

? You and/or your spouse are a tobacco user or use smokeless tobacco products or electronic cigarettes, or

? You do not declare your tobacco status during your enrollment process in SmartBen

To help you kick the tobacco habit ? and reward you for doing so ? we encourage you to participate in the tobacco cessation program. If you complete your first coaching session by March 31, 2018, and finish the program by June 30, 2018, surcharges you incurred during the year will be refunded in September 2018.

The benefits of

AFTER

Quitting

Smoking

Quit Smoking at any ages to live longer:

Age You're 90% less likely to die young from 30 smoking-related diseases.

Age You're 50% less likely to die young from

50 smoking-related diseases.

It's never

too late to

Age 60

You'll live longer.

benefit from quitting

Telemedicine

If you have medical questions or are not feeling well, you can connect to HealthiestYou via phone, video, and email for the diagnosis and treatment of illness, or to get second opinions and consultations. Their board-certified, licensed physicians can even prescribe medication.

PHYSICIAN ACCESS Three easy steps to speak with a physician anytime and anywhere. HealthiestYou offers 24/7/365 licensed physician access via phone, email, or video in all 50 states.

Visit and log in to your account or call 1-866-703-1259

A HealthiestYou care coordinator will initiate your request

PAY LESS FOR YOUR MEDICATION

Save money today on your medications!

1. Go to , enter your medication, and choose your location

2. Compare drug prices at local and mail-order pharmacies and discover free coupons and savings tips. Find huge savings on drugs not covered by your insurance plan. You may even find savings versus your typical copayment

You will be connected with a licensed physician in your state that can consult, diagnose and prescribe

Once you enroll, it's three easy steps to get started... Visit to log in to your account, or simply download the HealthiestYou app. ? Launch your personalized wellness program by completing your health

assessment ? Begin your path to feeling better

HEALTHIESTYOU

BI-WEEKLY RATES

PREMIUM

Team Member Only

$4.62

Team Member & Spouse

$6.00

Team Member & Children

$6.00

Team Member & Family

$6.93

Top 9 Treated Conditions

1. allergies 2. bronchitis 3. earache

4. sore throat 7. strep throat 5. sinusitis 8. upper respiratory infection 6. pink eye 9. urinary tract infection

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