2017 – 2018

BENEFITS GUIDEAugust 1, 2017 – July 31, 2018

Provider

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BENEFITS FOR YOU AND YOUR FAMILYWelcome to the Pediatric Associates family! We are delighted you are joining our team. Your role is critical in fulfilling the mission of Pediatric Associates. We offer you a specialized and affordable benefits package designed with you and your family in mind.

WHO IS ELIGIBLE?When reading this guide, please be mindful of the following icons, designating which employee group is eligible for each benefit:

All full-time physicians, physician assistants, and ARNPs are eligible to participate in the benefits featuring the blue full-time label.

All part-time physicians, physician assistants, and ARNPs are eligible to participate in the designated benefits featuring the orange part-time label.

Pediatric Associates employees who choose to enroll dependents in coverage will need to provide:

• For Children up to age 26 – Certificate of Birth, Adoption, or Legal Guardianship

• For Spouses – Certificate of Marriage or your most recent tax filing

• For a child age 26 or older who is mentally or physically disabled – A statement of disability verified by your medical provider

• For a child age 26 or older who lives with you AND is unmarried AND has no dependent children of his/her own – Proof of your child’s residence via a copy of his/her driver’s license or an official joint bill or bank account statement

• For a child age 26 or older who is a full-time or part-time student AND is unmarried AND has no dependent children of his/her own – Proof of your child’s current student status via a copy of the most recent semester’s enrollment

Please provide your required documents verifying dependent eligibility to the HR/Benefits Department or fax them to 954-965-7338.

WELCOME...

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ELIGIBILITY...

BENEFITS EFFECTIVE DATE COMPANY PAID AMOUNT

Cigna Medical Insurance (for yourself and qualified dependents)

Start Date (Up to $22,800 annual savings)

Long Term Care Start Date $1,000/month

Cigna Dental Insurance (for yourself and qualified dependents)

First of the month following start date

Cigna Vision Insurance (for yourself and qualified dependents)

First of the month following start date

Cigna Basic Life Insurance

First of the month following 90 days of employment

$500,000 (Providers)

or $250,000 (ARNP & PA)

Cigna Voluntary Term Life Insurance

You are eligible to enroll on the first of the month

following 90 days of employment.

Effective once Medical Underwriting is complete

and your policy is delivered

Up to $500,000

Cigna Long Term Disability

First of the month following 90 days of employment

$15,000 per month (Providers) or

$5,000 per month (ARNP & PA)

Cigna Short Term Disability

First of the month following 90 days of employment

Empower 401(k) Retirement Plan

First of the month following 90 days of employment

Voluntary Benefits Portal

First of the month following start date

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CIGNA MEDICALPediatric Associates pays the total health premium for employee only coverage and 95 percent of the difference in cost for those electing to cover dependent spouses and/or children — a value of up to $22,800 per year!

The Pediatric Associates medical plan is an Open Access Plan. There are no plan design changes for the 2017–2018 plan year.

CIGNA OPEN ACCESS PLAN

In-Network Out-of-Network

MEDICAL

Deductible- Individual/Family $2,000/$4,000 $4,000/$8,000

Out-of-Pocket Max – Individual/Family $3,250/$6,500 $6,250/$12,500

Deductible Reimbursement Fund – Your Requirement

Individuals are responsible for the first $500/Families for $1,000

Deductible Reimbursement Fund – PA’s Commitment

Individuals: up to $2,750Families: up to $5,500

Coinsurance 80% 60%

PCP Copay $30 60% after deductible

CCN Specialist Copay/Non-CCN Specialist Copay $60/$90 60% after deductible

Preventive Care (copays/deductibles may apply) 100% 60%

ER Copay $325 $325

Urgent Care Copay $50 $50

PRESCRIPTION DRUG - Separate Out-of-pocket maximum of $1,500 individual/$3,000 family

Retail• Generic• Preferred Brand• Non-Preferred Brand

$10$70$140

Mail Order• Generic• Preferred Brand• Non-Preferred Brand

$20$140$280

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MEDICAL CONTRIBUTIONS – PER PAYCHECK COSTSCIGNA OPEN ACCESS PLAN

Tier Per Paycheck 2017-2018 Increase

Employee Only $0.00 $0.00

Employee + Child(ren) $27.04 $0.00

Employee + Spouse $32.88 $0.00

Family $66.83 $0.00

TELEMEDICINENeed to speak to a doctor about a minor health condition quickly and conveniently? The Pediatric Associates medical plan offers telemedicine services for employees and family members who are enrolled. For the 2017 - 2018 plan year, services will be available through AmWell and MDLIVE at the low cost of only a $5 copay per visit!

To access telemedicine services:

AmWellwww.AmWellforCigna.com855-667-9722

MDLIVEwww.MDLIVEforCigna.com888-726-3171

CIGNA MEDICAL

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MEDICAL REIMBURSEMENT PROGRAMPediatric Associates has established a fund to reimburse you and your dependents for your out-of-pocket costs for medical care as outlined in the table below.

Please note: if you did not complete your Health Assessment and Biometric Screening, you may still be eligible for the medical reimbursement program at a higher deductible. Please contact the HR department for more information.

MEDICAL REIMBURSEMENT REQUIREMENTSIn order to receive the full medical expense reimbursement, you will need to complete a biometric screening and a health assessment within 30 days of the new plan year or within 30 days of joining the medical plan (whichever is applicable).

1. Biometric ScreeningAs a new hire, you can take the biometric screening in one of our offices by our Clinical Managers or you can have it done by your own primary care physician using the form found on the ADP Portal. Instructions on how to complete your biometric screening during Open Enrollment will be communicated to you.

2. Health Risk Assessment Through taking the online HRA, Cigna will determine your wellness score and show you where to start improving your health. Sign onto www.myCigna.com and click the “My Health” tab.

Forms must be completed no later than October 31, 2017 for reimbursement for the previous plan year.

MEDICAL REIMBURSEMENT PROCESS1. Fill out the Medical Expense Credit Form that aligns with the plan you are

enrolled in. These forms are located on the ADP Portal.

2. Attach a deductible/maximums tracker from www.mycigna.com.

3. Submit to the Benefits Department via fax at 954-965-7338 or via email at benefits@pediatricassociates.com.

CIGNA MEDICAL

HEALTH ASSESSMENT & BIOMETRIC SCREENING: COMPLETE

Tier Deductible you must satisfy

OAP Plan Maximum Reimbursement

Employee Only Coverage $500 $2,750

Dependent Coverage $1,000 $5,500

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Pediatric Associates offers two dental plan options through Cigna: the Cigna DPPO and Cigna DHMO.

PLAN DESIGN CIGNA DPPO CIGNA DHMO

In-Network Out-of-Network In-Network

Annual Maximum $1,500 $1,000 None

Deductible (Individual/Family)

$50/$150 $100/$300 None

Preventive and Diagnostic Care

100% no deductible

100% no deductible

Refer to fee schedule KASV9

Basic Services80%

after deductible80%

after deductibleRefer to fee

schedule KASV9

Major Services50%

after deductible10%

after deductibleRefer to fee

schedule KASV9

Orthodontia50%

after deductible50%

after deductibleRefer to fee

schedule KASV9

Orthodontia Lifetime Maximum (Separate from Annual Max)

$1,500 $1,500Refer to fee

schedule KASV9

DHMO INFORMATIONThe DHMO plan offers benefits only to covered Dentists in the Cigna DHMO network. Please visit www.cigna.com and reference benefit schedule “KASV9” for a complete listing. Once a provider is selected, ID cards will be provided to new enrollees only.

DENTAL RATES Based on 24 Pay Periods

Enrollment Tier DPPO DHMO

Employee Only $15.93 $7.93

Employee + Child(ren) $34.07 $17.94

Employee + Spouse $30.79 $13.36

Family $49.70 $23.56

CIGNA DENTAL

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CIGNA VISIONPediatric Associates also offers you the option to enroll in vision coverage through Cigna.

PLAN DESIGN CIGNA

In-Network Out-of-Network

Exam Copay $10 N/A

Materials Copay $20 N/A

Exam Covered in Full After Copay $45 allowance

Single Vision Lenses Covered in Full After Copay $32 allowance

Bifocal Lenses Covered in Full After Copay $55 allowance

Trifocal Lenses Covered in Full After Copay $65 allowance

Lenticular Lenses Covered in Full After Copay $80 allowance

Frames (Retail Allowance) $100 allowance $55 allowance

Contact Lenses (Retail Allowance)- Elective

$100 allowance $87 allowance

Contact Lenses (Retail Allowance)- Therapeutic

Covered in Full After Copay $210 allowance

Frequency of Service

Exam Copay Every 12 months

Lenses Every 12 months

Frames Every 24 months

VISION RATES Based on 24 Pay Periods

Enrollment Tier Rate

Employee Only $2.91

Employee + Child(ren) $5.86

Employee + Spouse $5.81

Family $9.24

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EMPOWER 401(k) RETIREMENT PLAN

The Pediatric Associates 401(k) Plan provides you the opportunity to save money on a pre-tax basis to help you on your journey to and through retirement. To jump start your efforts, Pediatric Associates provides automatic enrollment in the 401(k) plan the first of the month following 90 days of employment. This benefit is provided to all full and part-time employees.

• You are automatically enrolled at a predetermined pre-tax contribution rate, invested in a default asset allocation model.

Accessing the PlanOur mobile-optimized participant website gives you the ability to access your account wherever and whenever you want. Use the website to:

• Adjust contributions and rebalance your portfolio

• Request a loan, model a new loan or obtain outstanding loan information (if applicable)

To access your account online, visit www.empower-retirement.com/participant and select REGISTER from the Login box.

You can also access your account by phone at 1-800-338-4015. Automated services are available 24 hours a day, 7 days a week. Participant Service

Representatives are available weekdays between 8 a.m. – 8 p.m. CT.

Plan AdvisorsIf you have questions about choosing fund selections, you can contact the Plan Advisors at Dwyer and Associates at 888-657-3767 to assist in this process as well as provide education on the funds available for investment. Questions related to the company’s 401(k) plan should be directed to the Plan Administrator, Director of Human Resources.

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If you know your PIN:• Choose I have a PIN.

• Enter your Social Security number and PIN and click CONTINUE.

• Provide your contact information and create a username and password. Click REGISTER.

If you do not know your PIN:• Choose I do not have a PIN.

• Complete the requested personal information and click CONTINUE.

• Provide your contact information and create a username and password. Click REGISTER.

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LIFE AND DISABILITY

Pediatric Associates offers life and disability benefits through Cigna. All life and disability benefits are effective on the first of the month following 90 days of employment.

LIFE BENEFITS

Benefit Who Pays Benefit Amount Pre-requisites

Basic Life and Accidental Death and Dismemberment (AD&D)

Pediatric Associates

$500,000 (Providers) $250,000 (ARNPs/PAs)

N/A

Voluntary Term Life (Employee)

You$10,000 increments up

to $500,000

Amounts above $100,000 and election after initial

enrollment require Evidence of Insurability.

Voluntary Term Life (Spouse)

You$10,000 increments up

to 50% of employee election or $250,000

Amounts above $50,000 require Evidence of Insurability. Must be enrolled in employee

voluntary life plan.

Voluntary Term Life (Child)

You$2,500 increments,

up to $10,000

Must be enrolled in employee voluntary life plan. Maximum benefit from birth

to 6 months is $250.

DISABILITY BENEFITS

Benefit Who Pays Benefit Amount Pre-requisites

Group Long Term Disability

Pediatric Associates

60 percent of your regular earnings, up to a maximum monthly benefit of $15,000

(Providers) or $5,000 (ARNPs/PAs)

Elimination period: 90 days

Short Term Disability

You

60 percent of your regular earnings, up to

$2,000 per week for up to three months after becoming disabled

Elimination period: 7 days (accident)/7 days (sickness)

For group long term disability and short term disability plans, pre-existing conditions up to three months prior to the plan effective date will be excluded from benefit eligibility for the first 12 months of the policy.

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VOLUNTARY BENEFITS ENROLLMENT PORTALVisit the AlliantCHOICE Plus enrollment portal at www.pediatricassociates.alliantchoiceplus.com or call 800-504-1853 to shop for all the voluntary benefits listed below. More information on the benefits provided by each plan are available online. The products and vendors available to you include the following:

VOLUNTARY BENEFITS

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LEGAL: Hyatt Legal

PET: Nationwide

(VPI)

PURCHASING: Purchasing

Power

ACCIDENT: Unum

AUTO & HOME:

Liberty Mutual, MetLife, Travelers

DISCOUNT PROGRAM: BenPlace

NEW! HOSPITAL

INDEMNITY: Aflac

ID THEFT PROTECTION:

LifeLock

CRITICAL ILLNESS:

Unum

UNUM LONG TERM CARELong Term Care coverage provides care for yourself and/or a variety of your family members, including spouse, parents, siblings, grandparents and in-laws. You are eligible on the first of the month following 90 days of employment. For more information or to enroll in coverage, please visit http://unuminfo.com/pedassoc002/index.aspx.

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ADP SELF-SERVICE ENROLLMENT ONLINEHOW TO ENROLL IN ALL YOUR BENEFITSMost new hire benefit elections and changes during Open Enrollment will be made through the ADP Portal. New hires must log in and elect their coverages within 60 days of their start date. Open Enrollment occurs annually, typically during the month of July. Details on when to log in to add, change or delete your benefits will be communicated separately.

1. Log on to the ADP Payroll Portal.

2. Navigate to the Benefits Tab and select Review/Change Benefits.

3. A wizard-based Enrollment Tool begins the Enrollment process. You can check your progress while you make changes, or stop in the middle to return later, and the system will remember where you left off.

The following three benefit enrollment options are available:

• Walk me through this process (recommended for new hires)• I know the changes I want to make (recommended for Open Enrollment)• Review my benefits coverage

4. When you are finished making your changes, click View/Print Summary of Changes for a print out of your changes. You can log out of ADP Payroll Portal by clicking Logout on the top navigation bar.

If you have any questions using the ADP Payroll Portal, or if you’ve made an enrollment error, please contact your Benefits Team.

Note: Make sure to visit www.pediatricassociates.alliantchoiceplus.com to make your voluntary benefit elections/changes.

Discover how Pediatric Associates is providing mobile access to key HR functions — and enjoying improved productivity and worker satisfaction along the way.

Visit www.adp.com/mobilesolutions for more information.

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ADDITIONAL BENEFITS

PER DIEM EMPLOYEE RATESPediatric Associates offers medical, dental, and vision benefits to Per Diem employees working over 130 hours per month in accordance with ongoing ACA compliance.

PER DIEM EMPLOYEE RATES – PER PAYCHECK

Tier Medical DPPO DHMO Vision

Employee Only $257.97 $15.93 $7.93 $2.91

Employee + Child(ren) $484.97 $34.07 $17.94 $5.86

Employee + Spouse $533.99 $30.79 $13.36 $5.81

Family $819.03 $49.70 $23.56 $9.24

Once you are eligible, you will be notified by the Benefits Department.

DISCOUNT PROGRAMSAs an employee of Pediatric Associates, you are eligible for discounts and benefits from a variety of vendors.

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AT&T SPRINT SAM’S CLUB

TICKETS AT WORK

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Did you know that Pediatric Associates Employee Assistance Program through Cigna’s Life Assistance Program offers FREE benefits to you and to any immediate family members?

YOUR FREE LIFE ASSISTANCE PROGRAM OFFERS:• Confidential guidance and resources for short-term issues, via phone and web

access, 24/7 :

• In-person help with short-term issues (up to three sessions per person, per issue, per year)

• A 25 percent discount on in-person consultations with network lawyers

To learn more about the Cigna Life Assistance Program, visit www.cignabehavioral.com/CGI or call 800-538-3543.

EMPLOYEE ASSISTANCE PROGRAM

– Family Concerns

– Child/Parenting

– Developmental/Attention Issue

– Marital/Partner

– Any form of abuse

– Physical Health

– Stress/Anxiety

– Sexual Disorders

– Depression Concerns

– Alcohol Problems

– Drug Problems

– Suicidal /Homicidal

– Grief and Loss issues

– Eating Disorder Issues

– Anger Management

– Job/Career Issues

– Workplace Aggression

– Gambling

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NEWBORNS’ AND MOTHERS’ HEALTH PROTECTION ACTThe following is the amended sample notice that a group health plan may use to satisfy the Newborns’ and Mothers’ Health Protection Act disclosure requirement: Group health plans and health insurance issuers generally may not, under federal law, restrict benefits for any hospital length of stay in connection with childbirth for the mother or newborn child to less than 48 hours following a vaginal delivery, or less than 96 hours following a cesarean section. However, federal law generally does not prohibit the mother’s or newborn’s attending provider, after consulting with the mother, from discharging the mother or her newborn earlier than 48 hours (or 96 hours as applicable). In any case, plans and issuers may not, under federal law, require that a provider obtain authorization from the plan or the issuer for prescribing a length of stay not in excess of 48 hours (or 96 hours).

NOTICE OF SPECIAL ENROLLMENT RIGHTS FOR MEDICAL/HEALTH PLAN COVERAGEOur records indicate that you are potentially eligible to participate in our Group Health Plan (the “Plan”). A federal law called HIPAA requires that we notify you about a very important provision in the Plan. The provision is your right to enroll in the Plan under its “special enrollment provision” if you acquire a new dependent, or if you decline coverage under this Plan for yourself or an eligible dependent while other coverage is in effect and later lose that other coverage for certain qualifying reasons.

Special Enrollment ProvisionLoss of Other Coverage (Excluding Medicaid or a State Children’s Health Insurance Program). If you decline enrollment for yourself or for an eligible dependent (including your spouse) while other health insurance or group health plan coverage is in effect, you may be able to enroll yourself and your dependents in this Plan if you or your dependents lose eligibility for that other coverage (or if the employer stops contributing toward your or your dependents’ other coverage). However, you must request enrollment within 30 days after your or your dependents’ other coverage ends (or after the employer stops contributing toward the other coverage).

Loss of Coverage For Medicaid or a State Children’s Health Insurance Program. If you decline enrollment for yourself or for an eligible dependent (including your spouse) while Medicaid coverage or coverage under a state children’s health insurance program is in effect, you may be able to enroll yourself and your dependents in this Plan if you or your dependents lose eligibility for that other coverage. However, you must request enrollment within 60 days after your or your dependents’ coverage ends under Medicaid or a state children’s health insurance program.

New Dependent by Marriage, Birth, Adoption, or Placement for Adoption. If you have a new dependent as a result of marriage, birth, adoption, or placement for adoption, you may be able to enroll yourself and your new dependents. However, you must request enrollment within 30 days after the marriage, birth, adoption, or placement for adoption.

Eligibility for Medicaid or a State Children’s Health Insurance Program. If you or your dependents (including your spouse) become eligible for a state premium assistance subsidy from Medicaid or through a state children’s health insurance program with respect to coverage under this Plan, you may be able to enroll yourself and your dependents in this Plan. However, you must request enrollment within 60 days after your or your dependents’ determination of eligibility for such assistance.

MEDICARE PART DIf you (and/or your dependents) have Medicare or will become eligible for Medicare in the next 12 months, a federal law gives you more choices about your prescription drug coverage. A copy of the notice is available upon request in the Human Resources Department.

HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT (HIPAA)Pediatric Associates, in accordance with HIPAA, protects your Protected Health Information (PHI). Pediatric Associates will only discuss your PHI with medical providers and third party administrators when necessary to administer the plan that provides your health and welfare benefits or as mandated by law. A copy of the Notice of Privacy Practices is available upon request in the Human Resources Department.

LEGAL NOTICES

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WOMEN’S HEALTH AND CANCER RIGHTS ANNUAL NOTICEThe Women’s Health and Cancer Rights Act (“WHCRA”) requires us to notify participants and beneficiaries of our Group Health Plan (the “Plan”), of their rights to mastectomy benefits under the Plan. Participants and beneficiaries have rights to coverage to be provided in a manner determined in consultation with the attending Physician for:• All stages of reconstruction of the breast on

which the mastectomy was performed; • Surgery and reconstruction of the other breast

to produce a symmetrical appearance; • Prostheses and treatment of physical

complications of the mastectomy, including lymphedema.

These benefits are subject to the same deductible and copayments applicable to other medical and surgical benefits provided under this Plan. For further details, please refer to the Plan’s Summary Plan Description.

MICHELLE’S LAW NOTICEIf you live in certain states, our plan may extend medical coverage for dependent children if they lose eligibility for coverage because of a medically necessary leave of absence from school. Coverage may continue for up to a year, unless your child’s eligibility would end earlier for another reason.

Extended coverage is available if a child’s leave of absence from school — or change in school enrollment status (for example, switching from full-time to part-time status) — starts while the child has a serious illness or injury, is medically necessary and otherwise causes eligibility for student coverage under the plan to end. Written certification from the child’s physician stating that the child suffers from a serious illness or injury and the leave of absence is medically necessary may be required.

If your child will lose eligibility for coverage because of a medically necessary leave of absence from school and you want his or her coverage to be extended, contact Human Resources as soon as the need for the leave is recognized. In addition, contact your child’s health plan to see if any state laws requiring extended coverage may apply to his or her benefits.

CONTINUATION REQUIRED BY FEDERAL LAW FOR YOU AND YOUR DEPENDENTSThe Continuation Required by Federal Law does not apply to any benefits for loss of life, dismemberment or loss of income.

Federal law enables you or your dependent to continue health insurance if coverage would cease due to a reduction of your work hours or your termination of employment (other than for gross misconduct). Federal law also enables your dependents to continue health insurance if their coverage ceases due to your death, divorce or legal separation, or with respect to a dependent child, failure to continue to qualify as a dependent. Continuation must be elected in accordance with the rules of your employer’s group health plan(s) and is subject to federal law, regulations and interpretations.

NOTICE REGARDING WELLNESS PROGRAMSPediatric Associates’ Wellness Program is a voluntary wellness program available to all employees. The program is administered according to federal rules permitting employer-sponsored wellness programs that seek to improve employee health or prevent disease, including the Americans with Disabilities Act of 1990, the Genetic Information Nondiscrimination Act of 2008, and the Health Insurance Portability and Accountability Act, as applicable, among others. If you choose to participate in the wellness program you will be asked to complete a voluntary health risk assessment or “HRA” that asks a series of questions about your health-related activities and behaviors and whether you have or had certain medical conditions (e.g., cancer, diabetes, or heart disease). You will also be asked to complete a biometric screening, which will include a blood test for blood glucose and cholesterol. You are not required to complete the HRA or to participate in the blood test or other medical examinations.

However, employees who choose to participate in the wellness program will receive an incentive of Medical Expense Credit program eligibility for participation. Although you are not required to complete the HRA or participate in the biometric screening, only employees who do so will receive access to the Medical Expense Credit program.

LEGAL NOTICES

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Additional incentives of up to $600 via medical premium discount may be available for employees who achieve certain health outcomes, such as a BMI of less than 30 or a demonstrated 2 point improvement in BMI from the previous year’s health screening. 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 the Human Resources Department at 954-965-7375.

The information from your HRA and the results from your biometric screening will be used to provide you with information to help you understand your current health and potential risks, and may also be used to offer you services through the wellness program, such as Cigna health coaching programs. You also are encouraged to share your results or concerns with your own doctor.

Protections from Disclosure of Medical InformationWe are required by law to maintain the privacy and security of your personally identifiable health information. Although the wellness program and Pediatric Associates may use aggregate information it collects to design a program based on identified health risks in the workplace, Pediatric Associates’ Wellness Program will never disclose any of your personal information either publicly or to the employer, except as necessary to respond to a request from you for a reasonable accommodation needed to participate in the wellness program, or as expressly permitted by law. Medical information that personally identifies you that is provided in connection with the wellness program will not be provided to your supervisors or managers and may never be used to make decisions regarding your employment.

Your health information will not be sold, exchanged, transferred, or otherwise disclosed except to the extent permitted by law to carry out specific activities related to the wellness program, and you will not be asked or required to waive the confidentiality of your health information as a condition of participating in the wellness program or receiving an incentive. Anyone who receives your information for purposes of providing you services as part of the wellness program will

abide by the same confidentiality requirements. The only individual(s) who will receive your personally identifiable health information is (are) our registered vendor partners such as Cigna and Alliant in order to provide you with services under the wellness program.

In addition, all medical information obtained through the wellness program will be maintained separate from your personnel records, information stored electronically will be encrypted, and no information you provide as part of the wellness program will be used in making any employment decision. Appropriate precautions will be taken to avoid any data breach, and in the event a data breach occurs involving information you provide in connection with the wellness program, we will notify you immediately.

You may not be discriminated against in employment because of the medical information you provide as part of participating in the wellness program, nor may you be subjected to retaliation if you choose not to participate.

If you have questions or concerns regarding this notice, or about protections against discrimination and retaliation, please contact the Human Resources Department at 954-965-7375.

HEALTH INSURANCE MARKETPLACE COVERAGE OPTIONS AND YOUR HEALTH COVERAGEPart A: General InformationWhen key parts of the health care law take effect in 2014, there will be a new way to buy health insurance: the Health Insurance Marketplace. To assist you as you evaluate options for you and your family, this notice provides some basic information about the new Marketplace and employment- based health coverage offered by your employer.

What is the Health Insurance Marketplace?The Marketplace is designed to help you find health insurance that meets your needs and fits your budget. The Marketplace offers “one-stop shopping” to find and compare private health insurance options. You may also be eligible for a new kind of tax credit that lowers your monthly premium right away. Open Enrollment for health insurance coverage through the Marketplace begins in November 2017 for coverage starting as early as January 1, 2018.

LEGAL NOTICES

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Can I Save Money on my Health Insurance Premiums in the Marketplace?You may qualify to save money and lower your monthly premium, but only if your employer does not offer coverage, or offers coverage that doesn’t meet certain standards. The savings on your premium that you’re eligible for depends on your household income.

Does Employer Health Coverage Affect Eligibility for Premium Savings through the Marketplace?Yes. If you have an offer of health coverage from your employer that meets certain standards, you will not be eligible for a tax credit through the Marketplace and may wish to enroll in your employer’s health plan. However, you may be eligible for a tax credit that lowers your monthly premium, or a reduction in certain cost-sharing if your employer does not offer coverage to you at all or does not offer coverage that meets certain standards. If the cost of a plan from your employer that would cover you (and not any other members of your family) is more than 9.5% of your household income for the year, or if the coverage your employer provides does not meet the “minimum value” standard set by the Affordable Care Act, you may be eligible for a tax credit.**

Note: If you purchase a health plan through the Marketplace instead of accepting health coverage offered by your employer, then you may lose the employer contribution (if any) to the employer-offered coverage. Also, this employer contribution – as well as your employee contribution to employer-offered coverage – is often excluded from income for Federal and State income tax purposes. Your payments for coverage through the Marketplace are made on an after-tax basis.

How Can I Get More Information?For more information about your coverage offered by your employer, please check your summary plan description or contact Melanie Marques at mmarques01@pediatricassociates.com or Beth Gorelick at bgorelick@pediatricassociates.com

The Marketplace can help you evaluate your coverage options, including your eligibility for coverage through the Marketplace and its cost. Please visit HealthCare.gov for more information, including an online application for health insurance coverage and contact information for a Health Insurance Marketplace in your area.

Part B: Information About Health Coverage Offered by Your EmployerThis section contains information about any health coverage offered by your employer. If you decide to complete an application for coverage in the Marketplace, you will be asked to provide this information. This information is numbered to correspond to the Marketplace application.

3. Employer name Pediatric Associates

4. Employer Identification Number (EIN): 59-1198552

5. Employer address900 S. Pine Island Road: Suite 800

6. Employer phone number954-965-7375

7. CityPlantation

8. StateFL

9. Zip Code33324

10. Who can we contact about employee health coverage at this job?Beth Gorelick – Benefits Supervisor

11. Phone number (if different from above)

12. Email addressbgorelick@pediatricassociates.com

Here is some basic information about health coverage offered by this employer:

As your employer, we offer a health plan to: � Some Employees. Eligible employees are: Full Time Employees (30 plus hours per week)

With respect to dependents: � We do offer coverage. Eligible dependents are: Spouse and/or Child(ren)

� If checked, this coverage meets the minimum value standard, and the cost of this coverage to you is intended to be affordable, based on employee wages.

*Even if your employer intends your coverage to be affordable, you may still be eligible for a premium discount through the Marketplace. The Marketplace will use your household income, along with other factors, to determine whether you may be eligible for a premium discount. If, for example, your wages vary from week to week (perhaps you are an hourly employee or you work on a commission basis), if you are newly employed mid-year, or if you have other income losses, you may still qualify for a premium discount.

LEGAL NOTICES

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If you decide to shop for coverage in the Marketplace, HealthCare.gov will guide you through the process. Here’s the employer information you’ll enter when you visit HealthCare.gov to find out if you can get a tax credit to lower your monthly premiums.

The information below corresponds to the Marketplace Employer Coverage Tool. 13. Is the employee currently eligible for coverage offered by this employer, or will the employee be eligible in the next 3 months?

� Yes

13a. If the employee is not eligible today, including as a result of a waiting probationary period, when is the employee eligible for coverage? All regular full-time employees of Pediatric Associates who are scheduled to work a minimum of 30 hours per week are eligible for benefits, effective the first of the month following 60 days of employment unless stated otherwise. Management with a supervisory role are eligible to participate in the health plan on their date of hire; dental and vision plans the first of the month following date of hire. If you are a part-time employee working 24 – 28 hours a week, you are eligible for designated benefits the first of the month following 60 days of employment, unless stated otherwise.

14. Does the employer offer a health plan that meets the minimum value standard**? � Yes

15. For the lowest-cost plan that meets the minimum value standard** offered only to the employee (don’t include family plans): If the employer has wellness programs, provide the premium that the employee would pay if he/she received the maximum discount for any tobacco cessation programs, and didn’t receive any other discounts based on wellness programs.a. How much would the employee have to pay in premiums for this plan? $73.50b. How often? Twice a month.

**An employer-sponsored health plan meets the “minimum value standard” if the plan’s share of the total allowed benefit costs covered by the plan is no less than 60 percent of such costs.

This brochure is only a summary of the healthcare and income protection benefits that are available to Pediatric Associates employees and their eligible dependents. Official plan documents, policies, and certificates of insurance contain the details, conditions, maximum benefit levels and restrictions on benefits. These documents govern your benefits program. If there is any conflict, the official documents prevail. These documents are available upon request through the Human Resources Department. Information provided in this brochure is not a guarantee of benefits.

LEGAL NOTICES

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MEDICAID AND THE CHILDREN’S HEALTH INSURANCE PROGRAM (CHIP)If you or your children are eligible for Medicaid or CHIP and you’re eligible for health coverage from your employer, your state may have a premium assistance program that can help pay for coverage, using funds from their Medicaid or CHIP programs. If you or your children aren’t eligible for Medicaid or CHIP, you won’t be eligible for these premium assistance programs but you may be able to buy individual insurance coverage through the Health Insurance Marketplace. For more information, visit www.healthcare.gov.

If you or your dependents are already enrolled in Medicaid or CHIP and you live in a State listed below, contact your State Medicaid or CHIP office to find out if premium assistance is available.

If you or your dependents are NOT currently enrolled in Medicaid or CHIP, and you think you or any of your dependents might be eligible for either of these programs, contact your State Medicaid or CHIP office or dial 1-877-KIDS NOW or www.insurekidsnow.gov to find out how to apply. If you qualify, ask your state if it has a program that might help you pay the premiums for an employer-sponsored plan.

If you or your dependents are eligible for premium assistance under Medicaid or CHIP, as well as eligible under your employer plan, your employer must allow you to enroll in your employer plan if you aren’t already enrolled. This is called a “special enrollment” opportunity, and you must request coverage within 60 days of being determined eligible for premium assistance. If you have questions about enrolling in your employer plan, contact the Department of Labor at www.askebsa.dol.gov or call 1-866-444-EBSA (3272).

If you live in one of the following states, you may be eligible for assistance paying your employer health plan premiums. The following list of states is current as of January 31, 2017. Contact your State for more information on eligibility.

To see if any other states have added a premium assistance program since January 31, 2017, or for more information on special enrollment rights, contact either:

U.S. Department of LaborEmployee Benefits Security Administrationwww.dol.gov/agencies/ebsa1-866-444-EBSA (3272)

U.S. Department of Health and Human ServicesCenters for Medicare & Medicaid Serviceswww.cms.hhs.gov1-877-267-2323, Menu Option 4, Ext. 61565

OMB Control Number 1210-0137 (expires 12/31/2019)

LEGAL NOTICES

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ALABAMA – Medicaidhttp://myalhipp.com/1-855-692-5447

ALASKA – MedicaidThe AK Health Insurance Premium Payment Programhttp://myakhipp.com/ 1-866-251-4861CustomerService@MyAKHIPP.com Medicaid Eligibility: http://dhss.alaska.gov/dpa/Pages/medicaid/default.aspx

ARKANSAS – Medicaidhttp://myarhipp.com/1-855-MyARHIPP (855-692-7447)

COLORADO – Health First Colorado (Colorado’s Medicaid Program) & Child Health Plan Plus (CHP+)Health First Colorado: https://www.healthfirstcolorado.com/ 1-800-221-3943/ State Relay 711CHP+: Colorado.gov/HCPF/Child-Health-Plan-Plus1-800-359-1991/ State Relay 711

FLORIDA – Medicaidhttp://flmedicaidtplrecovery.com/hipp1-877-357-3268

GEORGIA – Medicaid http://dch.georgia.gov/medicaid- Click on Health Insurance Premium Payment (HIPP)404-656-4507

INDIANA – Medicaid Healthy Indiana Plan for low-income adults 19-64http://www.in.gov/fssa/hip/1-877-438-4479All other Medicaidhttp://www.indianamedicaid.com1-800-403-0864

IOWA – Medicaidhttp://dhs.iowa.gov/ime/members/medicaid-a-to-z/hipp1-888-346-9562

KANSAS – Medicaidhttp://www.kdheks.gov/hcf/1-785-296-3512

KENTUCKY – Medicaidhttp://chfs.ky.gov/dms/default.htm1-800-635-2570

LOUISIANA – Medicaidhttp://dhh.louisiana.gov/index.cfm/subhome/1/n/3311-888-695-244

MAINE – Medicaidhttp://www.maine.gov/dhhs/ofi/public-assistance/index.html1-800-442-6003TTY: Maine relay 711

MASSACHUSETTS – Medicaid and CHIPhttp://www.mass.gov/eohhs/gov/departments/masshealth/1-800-462-1120

MINNESOTA – Medicaidhttp://mn.gov/dhs/people-we-serve/seniors/health-care/health-care-programs/programs-and-services/medical-assistance.jsp1-800-657-3739

MISSOURI – Medicaidhttp://www.dss.mo.gov/mhd/participants/pages/hipp.htm573-751-2005

MONTANA – Medicaidhttp://dphhs.mt.gov/MontanaHealthcarePrograms/HIPP1-800-694-3084

NEBRASKA – Medicaidhttp://dhhs.ne.gov/Children_Family_Services/AccessNebraska/Pages/accessnebraska_index.aspx 1-855-632-7633

NEVADA – Medicaidhttps://dwss.nv.gov/1-800-992-0900

NEW HAMPSHIRE – Medicaidhttp://www.dhhs.nh.gov/oii/documents/hippapp.pdf603-271-5218

NEW JERSEY – Medicaid and CHIPMedicaid: http://www.state.nj.us/humanservices/dmahs/clients/medicaid/609-631-2392CHIP: http://www.njfamilycare.org/index.html1-800-701-0710

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NEW YORK – Medicaidhttps://www.health.ny.gov/health_care/medicaid/1-800-541-2831

NORTH CAROLINA – Medicaidhttps://dma.ncdhhs.gov/ 919-855-4100

NORTH DAKOTA – Medicaidhttp://www.nd.gov/dhs/services/medicalserv/medicaid/1-844-854-4825

OKLAHOMA – Medicaid and CHIPhttp://www.insureoklahoma.org1-888-365-3742

OREGON – Medicaidhttp://healthcare.oregon.gov/Pages/index.aspxhttp://www.oregonhealthcare.gov/index-es.html1-800-699-9075

PENNSYLVANIA – Medicaidhttp://www.dhs.pa.gov/provider/medicalassistance/healthinsurance premiumpaymenthippprogram/index.htm1-800-692-7462

RHODE ISLAND – Medicaidhttp://www.eohhs.ri.gov/401-462-5300

SOUTH CAROLINA – Medicaidhttps://www.scdhhs.gov1-888-549-0820

SOUTH DAKOTA - Medicaidhttp://dss.sd.gov1-888-828-0059

TEXAS – Medicaidhttp://gethipptexas.com/1-800-440-0493

UTAH – Medicaid and CHIPMedicaid: https://medicaid.utah.gov/CHIP: http://health.utah.gov/chip1-877-543-7669

VERMONT– Medicaidhttp://www.greenmountaincare.org/1-800-250-8427

LEGAL NOTICESVIRGINIA – Medicaid and CHIPMedicaid: http://www.coverva.org/programs_premium_assistance.cfm1-800-432-5924CHIP: http://www.coverva.org/programs_premium_assistance.cfm1-855-242-8282

WASHINGTON – Medicaidhttp://www.hca.wa.gov/free-or-low-cost-health-care/program-administration/premium-payment-program1-800-562-3022 ext. 15473

WEST VIRGINIA – Medicaidhttp://www.dhhr.wv.gov/bms/Medicaid%20Expansion/Pages/default.aspx1-877-598-5820, HMS Third Party Liability

WISCONSIN – Medicaid and CHIPhttps://www.dhs.wisconsin.gov/publications/p1/p10095.pdf1-800-362-3002

WYOMING – Medicaidhttps://wyequalitycare.acs-inc.com/307-777-7531

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NOTES PAGE