UNDERSTANDING YOUR RETIREMENT BENEFIT PLAN OPTIONS 2021 ICUBA

UNDERSTANDING YOUR RETIREMENT BENEFIT PLAN OPTIONS 2021 ICUBA RETIREE BENEFITS PRESENTATON

• Qualifying for retiree benefits TOPICS OF DISCUSSION • Your Enrollment Options • ICUBA Retiree Plans vs. COBRA • Enrolling as a Retiree • ICUBA Retiree Medical (BCBS) Plan Offerings • Schedule of Medical Benefits • Prescription Drug Plan • Aetna BH Benefits • Additional Benefits Information • ICUBA (BCBS) Medical Plan Costs • Humana Dental Plan Option(s) • Humana Dental Plan Costs • Eye. Med Vision Plan Option(s) • Eye. Med Vision Plan Costs • FAQ’s & Additional Benefits Information • Payment Options • Contacts

QUALIFYING FOR RETIREE BENEFITS through ICUBA DO I QUALIFY FOR RETIREE BENEFITS? Retirees must meet the “Member Institution’s” definition of Eligible Retiree in order to be covered under the ICUBA Retiree Plan. ICUBA ELIGIBLE RETIREE DEFINITION Eligible Retiree shall mean each Employee who (1) is a Participant in the Plan during the 3 -month period immediately prior to retirement from a Member Institution; (2) was Actively at work on the day prior to retirement; and (3): • • • is at least 55 years of age and has 10 years of continuous service with a Member Institution; is at least 56 years of age and has 9 years of continuous service with a Member Institution; is at least 57 years of age and has 8 years of continuous service with a Member Institution; is at least 58 years of age and has 7 years of continuous service with a Member Institution; is at least 59 years of age and has 6 years of continuous service with a Member Institution; or is at least 60 years of age and has at least 5 years of continuous service with a Member Institution. Retirees and their Dependents MUST enroll in coverage within 30 days of retirement unless the Eligible Retiree or Dependent chooses COBRA Continuation Coverage in lieu of the Retiree Plan.

RETIREE ENROLLMENT OPTIONS EARLY RETIREES Retirees under the age of 65 will be offered, during their initial retire enrollment to continue the same benefits, he/she was enrolled in directly proceeding their retirement. OVER 65 RETIREES Retirees who are age 65 and over will be offered, during their initial retiree enrollment a choice between the Retiree Medicare Supplemental plan or to continue to be enrolled in the same benefits, he/she was enrolled in directly proceeding their retirement.

ENROLLING AS A RETIREE To enroll in benefits as a Retiree, you must complete and return an enrollment form or make your benefit elections: Within 30 days of retirement and becoming eligible for Retiree benefits. If you do not enroll within the 30 -day enrollment period, you will permanently forfeit your eligibility for all Retiree insurance coverage. During annual enrollment by the stated deadline. If you do not make any benefit changes, you will automatically be enrolled in your current benefit elections or to the stated default coverage if your existing plan(s) is/are changing. When you have a mid-year qualifying event (marriage, birth or adoption of a child, loss or gain of eligibility for other health insurance coverage - voluntarily canceling other health insurance does not constitute loss of eligibility) and want to make an allowed midyear change in benefit elections. This change must be made within 30 days of the event. Documentation to support the change will be required. No Exceptions

ICUBA RETIREE PLANS vs. COBRA ICUBA RETIREE MEDICAL PLANS • You do not pay an administration fee • Your coverage will continue until you cancel it (or your coverage is cancelled for non-payment of premiums • You will have the option of enrolling in the Medicare Supplemental plan when you turn 65 • No payment fee for monthly premiums paid by credit card or EFT. COBRA • A 2% administration fee is added to you COBRA premium each month. • Your coverage ends after 18 months • You will not have the option to enroll in any other plans once you are enrolled in COBRA you forfeited the right to any of your retiree benefits. • There is a payment fee if you make COBRA payments by credit card or EFT.

RETIREE MEDICAL, PRESCRIPTION DRUG & BEHAVIORAL HEALTH PLANS 7

ICUBA Medical Plan Highlights (In-Network Only) In-Network Benefit Summary Comparison Preferred PPO Premier Copay PPO Deductible (Individual/Family) Coinsurance Out-of-Pocket Maximum (Individual/Family—Includes all $2, 500/$5, 000 20% $4, 000/$8, 000 Ded PPO $4, 000/$8, 000 30% $4, 000/$8, 000 $5, 350/$10, 700 20% $30 Copay 20% $300 Copay 20% AD* 0% - Quest 20% - Outpatient Setting $25 Copay $50 Copay $300 Copay 20% AD* 0% - Quest 20% - Outpatient Setting $35 Copay $70 Copay $40 Copay $500 Copay 30% ALD** 30% AD* 0% - Quest 30% - Outpatient Setting 20% AD* $25 Copay $0 $5 Copay $10 Copay 0% 30% AD* $35 Copay medical copays, deductibles and coinsurance) Physician Office Visits Specialist Office Visits Urgent Care Center Outpatient Therapy - PT, ST and OT Emergency Room Services (Copay waived if admitted) Durable Medical Equipment and Prosthetic Appliances Hospital Inpatient Independent Clinical Labs (free standing facilities and office visits) Mental Health & Substance Abuse Inpatient Outpatient Blue Distinction Total Care PCP Teladoc (1 -800 -Teladoc) Convenient Care Clinics Preventive Care Outpatient Diagnostic Imaging (MRI, MRA, CAT Scan, PET Scan) Ambulance * After Deductible ** After Limited Deductible: $2, 000 of the $4, 000 Individual Deductible Up to $500 Copay $250 Copay 8

ICUBA Prescription Drug Plan 90 -Day saves $$$! 30 -day (Retail Only) $0 90 -day (Retail & Mail) $0 90 -Day (Mail Only) N/A Preferred Generics $5 $10 Non-Preferred Generics $10 $20 Preferred Brands $40 $80 Non-Preferred Brands $75 $150 Specialty (Briova Rx)* $75 N/A Tier Preferred Generics at NSU Pharmacy * Specialty medications are limited to a 30 -day supply. Copay Assistance Cards are acceptable to Preferred Specialty products. Please refer to Summary or contact Optum/ICUBAcares for more information. Prescription Drug FREEBIES! Prescribed diabetic supplies including meters, lancing devices, lancets, test strips, control solution, needles, and syringes; prescribed Aspirin for adults, prescribed generic folic acid and generic prenatal vitamins for pregnancy and prescribed generic statins (if eligible) Prescription Drug Out of Pocket Maximum $ In-network Rx copays will be applied toward an individual maximum out-ofpocket of $2, 000 and $4, 000 for family. 9

Behavioral Health & Substance Abuse Benefits Professional Counseling Speak with a licensed clinician to manage a diagnosed behavioral health condition over the phone, televideo or in the office Psychiatric Medication Evaluation Medication management for diagnosed behavioral health conditions Applied Behavioral Analysis Therapy* Behavioral health services related to Autism Spectrum Disorder (ASD) diagnosis Intensive Services* Hospitalization Detoxification Residential treatment * Prior Authorization required 10

Free visits @ BDTC Providers Primary Care Blue Distinction Total Care Providers are always $0 (Medically necessary services from Family Practice, Internal Medicine and Pediatrician BDTC are always FREE) Care Connected in your corner! • • • Help with claim questions Concierge assistance for billing Assistance finding a BDTC Provider Lifestyle coaching Chronic condition coaching 1 -855 -258 -9029 (Also listed on the back of your BCBS ID Card) 11

ICUBAcares Pharmacist Advocate Program • Do you have side effects from a new medication? • Were you denied at the pharmacy for a prior authorization and misplaced your letter from Optum? • Were you told you need to try step-therapy before you can take a certain drug? • Want to learn how you can save money by switching to a generic? These are all great reasons to call 1 -877 -286 -3967 Monday through Friday 9 AM – 5 PM Real Pharmacists -- Real Advocates -- Real Solutions ICUBAcares Rally Incentive: If you are a candidate for a qualified medication change, the ICUBAcares team will assist with your transition to a medication less costly to the plan and reward once complete. Call for a prescription check-up to find out more! 12

Take a doctor with you: 1 -800 -TELADOC! • Single Sign-On available through My. Health. Toolkit! • Telemedicine and Video Consultations available anytime – If your doctor is unavailable, no time, vacation/business trip, etc. ! • Members must establish an account prior to seeking treatment; Company: ICUBA • Teladoc physicians are a national group of NCQA qualified physicians, contracted with Teladoc. TOP DIAGNOSES • • • Sinus problems Pink eye Bronchitis Allergies Flu Cough • Ear infection • Urinary tract • • infection Upper respiratory infection Nasal congestion PRESCRIPTIONS AS NEEDED $5 Copay ! This benefit is meant to supplement an ongoing relationship with a PCP and be used as an alternative to Urgent Care. Please make sure you share your Teladoc records with your PCP! • No controlled substances, psychiatric or • • lifestyle drugs Member convenience through e-prescribing Appropriate prescribing following CDC guidelines Please note: Restrictions apply as it relates to number of consults during the year and severity of condition for consultation. This benefit provides national coverage, excluding Arkansas. 13

PRE-65 RETIREE MEDICAL PLAN COSTS

RETIREE VOLUNTARY BENEFIT PLAN OPTIONS 15

Welcome to Delta Dental PPO – We've got you covered Click to edit Master title style The Delta Dental Difference® • Visit a PPO dentist to save the most. • You can visit any licensed dentist. • You won’t be charged more than your expected share of the bill. Delta Dental PPO Delta Dental Premier® Non–Delta Dental

Your PPO coverage Click to edit Master title style BASE PLAN BUY-UP PLAN

Delta. Care® USA DHMO

Coverage beyond Florida Click to edit Master title style Delta. Care USA DHMO: Coverage across the Unites States (limitations apply)* The DHMO is available in the following states: • • • Alabama Arizona Arkansas California Colorado Delaware Florida Georgia Illinois Indiana Kansas • • • Maryland Michigan Mississippi Missouri Nevada New Jersey New York North Carolina Ohio Oregon Pennsylvania • • • South Carolina Tennessee Texas Virginia Washington DC Wisconsin *The Delta DHMO is only available in approved states!

Your Delta. Care coverage Click to edit Master title style Delta. Care USA DHMO: a prepaid, fixed copayment plan Once enrolled, select a primary dentist from the Delta. Care USA network to start enjoying: • Set copays • No annual maximums • No deductibles • No claim forms • Low premiums DHMO benefit enhancements include: • 178 more covered DHMO procedures; all-inclusive copays • Posterior composite fillings covered • No missing tooth exclusion • Implants covered • Tooth whitening covered

PRE-65 RETIREE DELTA DENTAL PLAN COSTS

Eye. Med Vision Plans Base Plan Buy Up Plan Once every 12 months Once every 24 months Once every 12 months “In-Network Member Cost” $5 Copay $0 Copay; $130 allowance; 20% off balance over $100 $0 Copay; $160 allowance; 20% off balance over $130 Standard Plastic Lenses Single Vision, Bifocal, Trifocal $15 Copay Standard Progressive Lens $65 Copay Conventional Contacts $0 Copay; $100 allowance; 15% off balance $0 Copay; $130 allowance; 15% off balance Disposable Contacts $0 Copay; $100 allowance; plus balance $0 Copay; $130 allowance; plus balance Frequency Limitations Examination Frame Lenses or Contact Lenses Vision Care Services* Exam With Dilation as Necessary Frames Visit www. eyemed. com or call 1 -866 -804 -0982 | ICUBA is on the INSIGHT Network! * Please refer to Eye. Med Plan Summary for more detailed information and out of network options. 22

PRE-65 RETIREE EYEMED VISION PLAN COSTS

FAQ’s & ADDITIONAL BENEFITS INFORMATION

VESTING A Participant will become fully vested in his or her HRA after: (a) he or she has remained an Eligible Employee for 36 consecutive months AND (b) the Employer has made continuous contributions to such Participant’s HRA for a consecutive 36 -month period. Being “vested” in your HRA allows you to continue using your remaining HRA balance and your ICUBA Benefits Master Card for eligible medical, dental, vision and prescription out-of-pocket expenses until your balance is exhausted. As a RETIRED employee you will unfortunately, no longer have access to your ICUBA Master. Card portal via icubabnefits. org To view your current HRA balance please log-on to www. mywealthcareonline. com/icubamastercard There is a $10. 60 monthly administration fee that will be automatically deducted from your available vested HRA balance.

WHAT ABOUT DEPENDENTS? May I add dependents when I retiree? No, you can only elect retirement coverage for those eligible dependents currently enrolled on your medical plan at the time of retirement. May I add a dependent to my retiree coverage once I am already on the retiree plan? You are permitted to add a dependent acquired after the date your retiree coverage goes into effect if you acquire the dependent due to a life status change such as marriage, birth or adoption. What if I am over 65 and my spouse is under 65 or vice versa? The individual that is over 65 will have the option of choosing the: ICUBA Retiree Medical Plan (BCBS) or ICUBA Retiree Supplemental Medical Plan. The individual that is under 65 may enroll in the ICUBA Retiree Medical Plan (BCBS)Note: when age 65 is attained, you will have the option of switching to the ICUBA Retiree Supplemental Medical Plan.

FREQUENTLY ASKED QUESTIONS Can you provide me with a letter of credible coverage? You can request a letter of credible coverage by emailing benefitsadministation@icuba. org Does my retiree health insurance coverage change when I, or my covered dependent, reaches age 65? Yes, when you and/or your covered dependent reach age 65, you must apply for Medicare A & B, which will become your primary health insurance coverage. Your ICUBA medical plan insurance plan will be your secondary coverage. Note: an active election is required to continue medical coverage beyond the age of 64.

FREQUENTLY ASKED QUESTIONS I will be turning 65 soon, what is the difference in the two plans offered to me? The Medicare supplemental plan acts a supplemental coverage, the plan will usually cover all expenses not covered by Medicare after your deductible and OOP has been met. The ICUBA medical plan functions not as supplemental but secondary coverage; once the claim has been processed by Medicare it will be sent to BCBS and the claim will be processed in line with ICUBA plan benefits. When and how do I apply for Medicare B? Approximately three months before you and/or your covered dependent reach age 65 or, within 3 months of your retirement date at age 65 or older, contact your local Social Security Administration office to apply.

FREQUENTLY ASKED QUESTIONS Is there a cost associated with Medicare B? Yes, the monthly cost of Medicare B usually changes each year on January 1 and is automatically deducted each month from your social security check. Please contact the Social Security Administration to determine the current cost of Medicare B coverage. I am a retiree. Will retiree coverage be extended to my eligible survivors when I die? No, If you predecease your covered dependents, they will be offered 36 months of continuation coverage through COBRA. Notification of passing must be received by ICUBA within 60 days of your death.

FREQUENTLY ASKED QUESTIONS Can I make changes to my coverage at any time? You cancel coverage for yourself or a dependent at any time but if you cancel your medical coverage, you will not be allowed to re-enroll in the program at a later date; otherwise, you must experience a Qualifying Life event and make changes within the 30 -day life event window. Will I receive a new health insurance identification card after I retire? For your Medical, Vision and Behavioral Health coverage, No new cards will be issued Prescription and Dental- New ID cards will be issued.

PAYMENT OPTIONS Once your enrollment form is received and processed (2 -3 business days), you will be sent billing coupons and information about your payment options such as: • Vested HRA funds (ICUBA Master. Card) • Credit Card • Check • Electronic Funds Transfer Payments are due on the first of each month. Coverage will be cancelled, and reinstatement not allowed, if the first premium payment is not made within 60 days of the date of the original election of retiree coverage.

RETIREE BRAND PARTNER CONTACT INFORMATION ICUBA RETIREE ADMINISTRATION (Wex, formerly Discovery Benefits) 1 -866 -377 -5102 Option 3 E-mail: cobraadmin@discoverybenefits. com Escalations: retireeadministration@icuba. org BCBS CARE CONNECTED TEAM Customer Service: 1 -855 -258 -9029 24/7 Essential Advocate: 1 -888 -521 -2583 Teladoc ($5): 1 -800 -TELADOC OPTUMRX Optum Healthcare Advisor: 1 -855 -811 -2213 ICUBACares Pharmacist: 1 -877 -286 -3967 AETNA Mental Health and Substance Abuse Customer Service: 1 -877 -398 -5816 Option 1: Employee Assistance Program Option 2: Behavioral Health DELTA DENTAL Customer Service: 800 -521 -2651 Website: www. deltadentalins. com EYEMED Customer Service: 1 -866 -800 -5457 Provider Network: Insight AMWINS 1. 888. 883. 3757

ICUBA RETIREE DROPBOX EARLY RETIREE PLAN INFORMATION https: //www. dropbox. com/home/Early%20 Retiree%20 Plan%20 Information 65+RETIREE PLAN INFORMATION https: //www. dropbox. com/sh/31 bozaxxhr 88 f 0 m/AADp. Rk 1 Q 2 RQt. RXFMq. Kxy 7 s. Ypa? dl=0

THANK YOU, AND HAPPY RETIREMENT! Additional Plan information can be found in the ICUBA Retiree Dropbox