2015 non-union team member benefits booklet

FONTAINEBLEAULIVE YOUR LIFE FAMOUSLY

Class 2 T E A M M E M B E R B E N E F I T S 2 0 1 6 - 2 0 1 7

FONTAINEBLEAULIVE YOUR LIFE FAMOUSLY 2527

Dear Team Members,

We are pleased to announce a variety of new and exciting enhancements to the 2016 – 2017 benefits plan.

Because you are our #1 investment, we believe it’s important to take care of you and your loved ones.

With this said, we offer excellent choices in healthcare coverage and other benefits, so each of our Team

Members can attain and maintain a healthy and balanced lifestyle.

NEW ENHANCEMENTS

• bswift: We are pleased to introduce bswift, an online platform that allows our eligible

Non-Union Team Members to enroll and manage all benefit selections by simply accessing the Fontainebleau

enrollment website at myFB.bswift.com. The website has helpful tools to assist Team Members such as:

• Enhanced Call Center: Allows Team Members to contact 844.781.9048 (toll free) regarding eligibility,

benefit plans, enrollment periods, or any other additional plan design questions.

• Mobile Application for bswift Benefit Enrollment.

• Ask Emma Avatar: Avatar program named Emma to explain benefit plans to Team Members.

• $250 Credit for the Cigna Select Health Savings Account (HSA) Plan. Fontainebleau will provide a $250

credit to all eligible Non-Union Team Members who join the Cigna HSA Plan. The Health Savings Account

allows Team Members to select more cost-effective, appropriate care.

• New Ancillary Benefit Plan Provider: Aetna has replaced Colonial as our provider for critical illness,

accident, and hospital confinement offering better rates. An Aetna representative will be at Open

Enrollment.

• Wellness Raffle Prizes: Raffle prizes will be extended for a chance to win from numerous healthy prize

selections for those that enroll on the website on Monday, July 18.

Choosing the right health care and benefits package for you and your loved ones is very important to your

well-being and peace-of-mind. Please do not miss your opportunity to take advantage of this exclusive

benefits program during Non-Union Team Member Benefits Open Enrollment

Monday, July 18, 2016 – Friday, July 22, 2016.

Sincerely,

LIVE YOUR L IFE FAMOUSLY

FONTAINEBLEAU’S VIEW

Phil Goldfarb

President and Chief Operating Officer


PLAY YOUR PART. . . . KNOW YOUR BENEFITSThe Fontainebleau benefits program is designed to recognize the diverse needs of our Team Members. Our plan strives to:

Provide competitive and comprehensive benefit options that allow you to design your own plan based on your individual needs

Maintain benefit options that best suit Fontainebleau Team Members

Offer plans to provide long-term financial security for you and your family

The ability to make individual choices regarding your coverage is an important aspect of your Fontainebleau benefits program.

However, it is not always easy to make decisions about your health and financial benefits. It is natural to review the cost of each

benefit, but it is also important to think through other issues.

With choice comes responsibility. So, take the time to educate yourself on the specifics of Fontainebleau’s benefits plan. We want

you to understand all your options and make informed decisions. Only you can determine which benefits best fit you and your

family.

You are eligible for the benefits program if you are a Non-Union Full-Time Team Member working at Fontainebleau at least 30 hours

per week. Benefits are available to newly hired team members on the first of the month following 60 days of employment from the

date of hire. Your eligible dependents include:

Your legally married spouse or domestic partner

Dependent child(ren) to age 26; to age 30*. Definition of child is birth child, adopted child, step child and foster child

Adult child(ren) with a disability

Domestic Partner – refer to page 13 for details (Certification form required)

Benefit Basics

Once you elect your benefit options for 2016, your elections remain in effect

from August 1, 2016 through July 31, 2017. You may only change coverage during

Open Enrollment for the next plan year or due to a qualified “lift event.” If

a qualifying life event should occur, you must log on to bswift and initiate

the change within 30 days of the event date. You will be required to upload

supporting documentation to finalize the change.

Life Events

Marriage

Divorce or legal separation

Birth of your child

Death of your spouse or dependent child

Adoption of/placement for adoption of your child

Termination or commencement of your spouse’s employment

Change of employment status by you or your spouse qualification by the

Plan Administrator of a Medical Child Support Order

A significant change in your or your spouse’s health coverage due to your

spouse’s employment

Entitlement to Medicare or Medicaid

A participating Team Member’s hours of service are reduced so that the

Team Member is expected to average less than 30 hours of service per

week but for whom the reduction does not affect the eligibility for

coverage under Fontainebleau’s group health plan

A Team Member participating in Fontainebleau’s group health plan who

would like to cease coverage under the group health plan and purchase

coverage through a marketplace without that resulting either in a period

of duplicate coverage under Fontainebleau’s group health plan and the

coverage purchased through a Marketplace or in a period of no coverage

Enrollment

You must enroll or waive/decline coverage. Log on

to myFB.bswift.com for more information and to

submit your enrollment or waiver form. If you do

not plan to enroll in any benefits, you still must

log on to complete the waiver of coverage and

the beneficiary information for the Basic Life

Employer-Paid benefit.

*Unmarried; live in FL or a full-time/part-time student; have

no dependents; have no coverage elsewhere; have no gap in

Deductible – The amount you pay towards medical and dental

expenses each calendar year before the plan begins paying benefits.

Copayment – A flat dollar amount that you pay for medical

or prescription drug services, regardless of the actual amount

charged by your doctor or another provider.

Coinsurance – The percentage of the total bill that you pay

after you pay the deductible.

In-Network – Use of a health care provider that participates

in the plan’s network. For access to the most savings visit an

in-network provider.

Out-of-Network – Use of a health care provider that is not in

the plan’s provider network. The medical plans generally pay

reduced benefits for out-of-network services, except in the

event of an emergency.

Explanation of Benefits (EOB) – A statement sent to you by the

health/dental carrier explaining what treatment and/or services

were paid for by the carrier. An EOB typically describes:

The service performed including date, description,

name of provider and name of the patient.

The doctor’s fee, and what the insurer allows—the amount

initially claimed by the doctor/provider minus any payments

made by the insurer.

The amount the patient is responsible for payment.

Guaranteed Issue (GI) – The maximum amount of coverage

provided without completing a Statement of Health.

Statement of Health (SOH) – Additional medical information

will be required for any amount above the Guarantee Issue

amount, for late enrollees or increase in insurance.

Accelerated Death Benefit – This provides an option to

withdraw a percentage of your life insurance coverage when

diagnosed as terminally ill (as defined by policy). The death

benefit will be reduced by the amount withdrawn. To qualify,

you must have satisfied the Active Work rule and have been

covered under this policy for the required amount of time as

defined by the policy.

Portability – If Life coverage has been in force for at least 12

months, you may continue your coverage for a specified period

of time after your employment ends by paying the required

premium. Portability is available if your employment ends for a

reason other than total disability.

Conversion – If you terminate or become ineligible for Life

coverage, you have the option to convert all or part of the

amount of coverage in force to an individual life policy on the

date of termination.

HSA – A Health Savings Account (HSA) is a tax-exempt trust or

custodial account you set up with a qualified HSA trustee to

pay or reimburse certain medical expenses you incur. You must

be an eligible individual to qualify for an HSA.

Contracted Rates – The amounts that health insurance

companies will pay to healthcare providers in their networks

for services. These rates are negotiated and established in the

insurers’ contracts with in-network providers. Team Members

on the Select Plan will pay the contracted rate for In-Network

Services.

Out of Pocket Maximum – The maximum amount you will pay

in coinsurance during the calendar year.

KEY DEFINITIONS

Make sure you always review your CIGNA “Explanation of

Benefits” (EOB)

What if I receive an invoice from a provider or a facility and I

verified they were contracted with CIGNA?

Retrieve your EOB from CIGNA for that specific claim/

date of service.

If the amount that you owe on the EOB is equal to the

amount on the invoice, then the invoice should be paid.

If the amount that you owe on the EOB is less than the

amount on the invoice (the invoice is greater) and you are

certain you went to a contracted CIGNA provider, send

a copy of your EOB with the invoice and the amount

that CIGNA states you owe to your CIGNA contracted

provider/facility.

Please contact PatientCare, your dedicated benefits advocates

at 1-800-640-1898.

When you visit your Contracted CIGNA provider for your

Annual Physical/Exam make sure you’re stating that this is your

“Preventive Visit” so that you are not charged.

(Remember, if you are treated for an illness during this visit it

will no longer be considered a preventive visit and you will be

charged the applicable copay/coinsurance).

If you DO NOT have a life threatening emergency, you have the

option to contact Teladoc or visit an Urgent Care Center or a

Contracted Convenience Care Center for Medical services.

CVS Minute Clinics

Walgreens Take Care Clinics

Do not forget about the Generic Drug Discount programs that

are available at most retail chains.

Publix-free antibiotics

Walmart

Target

TIPS FOR MEMBERS

0302


There are a few simple steps to enroll in your benefits:

ENGAGEUtilize this guide to understand your benefits to build the best benefit package for you.

ADD-ONEnroll eligible dependents in your benefit plans. Due to Healthcare Reform Provisions, you are able to enroll your child

to age 26 regardless of tax-dependency status or to age 30*. Be prepared with all Social Security numbers and dates

of birth for enrollments.

COMPARECompare each benefit plan design to determine details such as deductibles, copays and coinsurance.

Please read carefully to determine which plan is best for you and your family.

BUDGETReview your benefit cost options and determine your budget for health and welfare benefits.

Please notice the rates and budget accordingly.

FINDIt is important to find a doctor or dentist that participates in your plan for cost savings.

It is necessary to identify a dentist facility number when electing SafeGuard SGX245.

ENROLLOnce you have built your benefits package, complete the enrollment materials and return to the Benefits Office

within Human Resources.

You can access Fontainebleau’s enrollment website at www.myFB.bswift.com.

Once you reach the log in page follow the instructions below to enter your username and password.

USERNAME: Team Member Number

INITIAL PASSWORD: Last 4 digits of your SSN

You will be required to change your password after your initial login.

* Unmarried; live in FL or a full-time/part-time student; have no dependents; have no coverage elsewhere; have no gap in coverage of more than 63 days.

OUR COMMITMENT TO YOU LOGGING INTO BSWIF T

PLAY YOUR PART…GETTING STARTED

04 05


FONTAINEBLEAU BENEFITS EFFECTIVE DATES

If you are a New Hire, please note your Insurance Effective dates below:

If you were hired this

year in:

Your insurance effective

date is:

Turn in your enrollment forms no later than:

January April 1 March 5

February May 1 April 5

March June 1 May 5

April July 1 June 5

May August 1 July 5

June September 1 August 5

July October 1 September 5

August November 1 October 5

September December 1 November 5

October January 1 December 5

November February 1 January 5

December March 1 February 5

IMPORTANT INFORMATION

Enrollments and Waivers must be submitted on-line via bswift by the above dates as indicated.

If you choose not to enroll in Fontainebleau benefits, we still require a waiver of coverage to be submitted via bswift before the

enrollment effective date.

The Employer Health Coverage offered by Fontainebleau does meet the “minimum value” standard of coverage as defined by the

Affordable Care Act; therefore, you would not be eligible for coverage through the Health Insurance Marketplace.

06

MEDICAL BENEFITS

We need health care that protects our physical health as much as healthcare that protects our financial well-being. That is why

Fontainebleau believes it is important to invest in quality plans that are cost effective, easy to use and valuable to you. Fontainebleau

provides the following options:

understanding your medica l p lan opt ions with CIGNA

Medical Deluxe (CIGNA OAPD)The CIGNA Open Access Plus Deluxe (OAPD) Plan allows members to see

any licensed provider they choose, though benefits are less costly when they

receive care from a provider in the Open Access Plus network. You have the

flexibility to go to any doctor or to any hospital you wish, and no referral

is required.

Medical Select P lan (CIGNA HSA)The CIGNA Select HSA Plan allows members to see any licensed provider they

choose and pay the contracted rate for In-Network Services. Members on this

plan will be able to contribute to the HSA, which provides a tax-advantaged

way to save for future medical expenses and greater flexibility over how their

healthcare dollars are used.

Medical Standard (CIGNA OAPS)The CIGNA Open Access Plus Standard (OAPS) Plan allows you to see

doctors who are in the CIGNA Open Access Plus network. The OAPS

Plan provides the ability to use the network without certain restrictions.

Specifically, you do not have to elect a primary care physician and you do not

need a referral to see an in-network specialist. This plan does not cover the

cost of care you receive from a non-Open Access Plus provider.

Make Sure You Are Always Seeing Contracted Providers !How do I locate a CIGNA Contracted provider?

Online:

Register on MyCigna.com

1. Go online to www.mycigna.com

2. Under the Welcome Tab, select “Find a Doctor”

3. Select Health Care Professional Type (Physician, Pharmacy, Hospital)

4. If you are selecting a facility, enter in the facility type (Urgent Care, MRI Center, etc.)

5. Enter your location criteria

6. Select your plan/network which is (Open Access Plus) then click “Search” and your provider/facility listing will populate.

Phone:

1. Call 1-800-244-6224

2. PatientCare 1-800-640-1898

07


MEDICAL BENEFITS

Important Note: While the plan you select may not require you to use a primary care physician; it remains your responsibility to make sure

you are using In-Network providers in order to enjoy the benefits of the plan’s In-Network benefit schedule.

Benefit Standard CIGNA OAPS(In-Network Only)

Embedded or Non-EmbeddedSingle

Single

Benefits Highlights

Family

Family

HSA Funding

Coinsurance

SingleFamily

Out-of-Pocket Includes

Lifetime Maximum

PCP Office Visits

Specialist Visits

Well Child Care

Routine Adult Physical Exam

Well Woman/GYN Exam

Mammograms

Outpatient

Inpatient

Emergency Room

Urgent Care Center

Diagnostic Lab Facility

Diagnostic X-ray Facility

Major Services - PET Scans, MRI, CT Scans

Tier 1

Tier 2

Tier 3

Tier 4

Mail Order - 90 day supply

Embedded

N/AN/A

N/AN/A

N/A

$250 per Team Member

N/A

$500$1,00010%

$6,350$12,700

Deductible, Copays, Coinsurance, Rx

Unlimited

$25

$50

Covered in fullCovered in full

Covered in full

Covered in full

10% after ded

10% after ded

$200

$50

$0$0

10% after ded

$10

$35

$60

30% coinsurance

2x retail

In NetworkIn Network In Network

Embedded$250 $1,500$750 $3,0000% 10%

$6,350 $4,000$12,700 $8,000

Unlimited Unlimited

$40

$50

Covered in full Covered in fullCovered in full Covered in full

Covered in full Covered in full

Covered in full Covered in full

$250 per day,

max $1,000 per

$300 per visit,

then 100% after ded

$200

$50

$0$0

$250 after ded

$15

$35

$55

25%

2x Retail

Out of NetworkOut of Network Out of Network

$1,500 $3,000$3,000 $6,00030% 30%

$8,000 $8,000$16,000 $16,000

30% after ded 30% after ded10% after ded10% after ded30% after ded 30% after ded

30% after ded 30% after ded





30% after ded



30% after ded30% after ded

30% after ded

30% after ded

30% after ded

30% coinsurance

30% coinsurance

30% coinsurance

30% coinsurance30% coinsurance

30% after ded

30% after ded

30% after ded

30% after ded

10% after ded

10% after ded


10% after ded

10% after ded

10% after ded

10% after ded

10% after ded

10% after ded

10% after ded10% after ded

10% after ded

$200

30% after ded

DeluxeCIGNA OAPD(In/Out of Network)

Select CIGNA (HSA)

Emergency Services

Diagnostic X-ray/Lab

Prescription Drugs

Hospital Services

Preventive Care

Physician Services

Out-of-Pocket Limit

Retail - 30 day supply

Deductible, Copays, Coinsurance, Rx Deductible, Copays, Coinsurance, Rx

Non-Embedded

08

HEALTH SAVINGS ACCOUNT (HSA)

Lower ing your taxes with re imbursement accounts

Using your HSAWhen you open an HSA, you may contribute to your account which is established through JPMorgan Chase.

You can choose to pay for your share of the costs (deductible and coinsurance) for eligible services up to your plan’s

out-of-pocket maximum by using your HSA, other personal funds or both.

The amount used from your account for services covered under the health plan helps you meet your annual deductible.

You can also use your HSA to pay for qualified expenses not covered through your medical plan, such as dental and vision expenses. Visit Cigna.com/expenses for more information.

The money you don’t use earns interest tax-free.* You can save for future medical costs and have the option to open an

investment account when your balance reaches $2,000.

You may take the account with you when you leave the plan, change jobs or retire.

If you enroll in the CIGNA Select Plan (HSA), you can set aside money in a Health Savings Account (HSA) before taxes are deducted

to pay for eligible medical, dental and vision expenses. The HSA will be administered by JP Morgan Chase. Other significant key

advantages:

Your account balance in an HSA can be carried forward from one year to the next.

If you have any money remaining in your HSA after your retirement, you may withdraw the money as cash.

A debit card is available for convenient payment of your eligible expenses including doctor visits.

No Use I t or Lose I t feature!The IRS Amounts for 2016 are $3,350 for individual coverage and $6,750 for family coverage. The IRS Amounts for 2017 are $3,400 for

individual coverage and $6,750 for family coverage.

When can I make “catch-up” contr ibut ions to an HSA? If you are 55 or older, or turning 55 during the calendar year, you can make additional “catch-up” contributions to your HSA. The

“catch-up” contribution is $1,000. If you have high deductible health plan (HDHP) coverage for the full year, you can make the

full catch-up contribution regardless of when your 55th birthday falls during the year. If you do not have HDHP coverage for the

full year, you must prorate your catch up contribution for the number of full months you were eligible, i.e., had HDHP coverage.

However, if you are covered on December 1, you’re treated as an eligible individual for that entire year and can make the full

contribution, provided you also elect the HDHP for the following year.

Which services are covered by my plan, and which wil l I have to pay for out of my own pocket?Covered services vary depending on your plan, so visit myCigna.com or check your plan materials for specific information. In

addition, you’ll pay:

Any health care service or costs not covered by your plan.

Costs for any services you receive until you meet your deductible.

Your share of the cost for your covered health care expenses (coinsurance), after you meet the deductible and your medical

plan coverage begins, and up to your plan’s out-of-pocket maximum.

Important HSA Fees to keep in Mind!HSA Monthly Fee= $1.85

Monthly Paper Statements = $1.25 (You have the option to choose paper or online statements)

Online Paper Statements = No charge

** There may be additional standard banking fees such as check and overdraft fees. This information will be included in your CIGNA

packets**

Additional questions regarding the CIGNA Select (HSA) Plan? Contact Patient Care at 1-800-640-1898 OR CIGNA at 1-800-244-6224

and reference Group #3337185.

For members enrol led in CIGNA Select P lan only

09

Deductible


TELADOC

CONSULT WITH A DOCTOR 24/7/365

Fontainebleau now provides members with access to Teladoc, giving you 24/7 access to board-certified physicians. Teladoc allows

you to resolve your routine medical issues anytime you need care. It’s healthcare made simple!

WHAT IS TELADOC?

Teladoc is a national network of board-certified physicians who provide quality healthcare through the convenience of phone or

online video consultations for members of any age. Teladoc physicians can diagnose, treat, and write prescriptions, when necessary

for routine medical conditions, including:

Sore throat and stuffy nose.

Sinus infection

Bronchitis

Allergies

Pink eye

Urinary tract infection

WHEN SHOULD YOU USE IT?

If you’re considering the ER or urgent care center for a non-emergency medical issue.

When you can’t reach your primary care physician due to time, weather, remote location, or a disability

When you’re on vacation or a business trip

For short-term prescription refills

The cost for TelaDoc services is $15 per call if you are on the Open Access and Open Access Plus plans. If you are on the HSA plan

the cost is $40 per call. Payment information will need to be provided at the time of the call.

Take a doctor with you

Teladoc.com

1-800-Teladoc (835-2362)

10

DENTAL BENEFITS

Taking care of your teeth is as important as taking care of the rest of your body. That’s why Fontainebleau offers dental plans that cover

routine check-ups and additional services needed for your health through MetLife.

Dental Health Maintenance Organizat ion P lan (DHMO)The DHMO gives you access to the MetLife DHMO through the SafeGuard network of providers. The DHMO covers costs for

services rendered by providers within the network. The costs of any services performed by an out-of-network provider will not be

covered by the DHMO plan. You must choose your dentist and list the facility number on the enrollment form. A Safeguard Dental

card will be mailed to your address. Your dentist can be changed by contacting SafeGuard Dental directly.

Dental Preferred Provider Organizat ion P lan (DPPO)The DPPO plan gives you the freedom to access both in-network and out-of-network providers. In a DPPO plan, costs are typically

reduced when you receive covered care from network providers. Also, dental specialists can be chosen from the network without

a referral for covered services. You will not receive a Dental Card if you choose this plan. Please advise your Dentist that your

coverage is through MetLife.

Compare the following Fontainebleau Dental options through MetLife:

Dental Benefit DHMO DPPO

Basic Treatment 100%/ Copays Ded & 80% Ded & 50%

Major Treatment Copays Ded & 50% Ded & 50%

Annual Maximum Benefit N/A $5000 $5000

Orthodontia Copays 50% Lifetime Max $1500 50% Lifetime Max $1500

Preventive and Diagnostic 100%/ Copays 100% 80%

Annual Deductible Single Family

$0

$0

$50

$150

$50

$150

In-Network In-Network Out-of-Network

1 1


VISION BENEFITS

It is proven that routine vision check-ups and care are not only beneficial to your eyes but are crucial to your long-term health.

That is why Fontainebleau offers vision coverage.

EyeMed Vis ion Care P lanYour vision benefit is a voluntary plan offered by Fontainebleau through EyeMed Vision Care. This program allows you to access

care from participating providers for a greater level of benefit and no claim forms. You may also access care from non-participating

providers and receive reimbursement for your exam and/or supplies by filing a claim form.

Extra Vis ion Benef itsYou receive 20% savings on numerous lens options and 15% savings on retail price of Laser Vision Correction or 5% savings on

promotional pricing.

Visit www.enrollwitheyemed.com for more information.

Fonta inebleau offers the fol lowing Vis ion opt ions through EyeMed Vis ion Care :

Vision Benefit

Lenses (every 12 months)

Contacts (every 12 months)

Medically Necessary

Exams (every 12 months)

Frames (every 12 months)

EyeMed

$10 Copay

$0 Copay; $120 Allowance then 15% off balance over $120

$0 Copay; Paid-in-Full

$10 Copay

$130 Allowance then 20% off balance over $130

12

PATIENT CARE

At no cost to you, Fontainebleau provides this advocacy program to assist you in locating specialists, resolving with claim issues,

and providing clear, objective health information so that you can make informed decisions. A Personal Advocate will assist you

with clinical and insurance-related issues, serve as a liaison with healthcare providers, insurance plans and health-related community

services. Contact Patient Care at 1-800-640-1898.

Patient Care’s services are available to all eligible employees enrolled in a Fontainebleau Medical plan. Services are also available to

employees and their dependents

What are the features of the Core Advocacy service?

Advocacy

Travel expenses to and from treatment centers

Answer benefit questions

Resolve claims and billing issues

Clarify out-of-pocket costs for services

Assist with referrals and prior authorization

Coordinate appeals

Research in-network physicians/facilities

Identify a primary care physician (PCP)

Make doctor’s appointments

Explain pharmacy benefits

Arrange for mail order prescription services

Transparency

Review benefits for a health care test/procedure

Research in-network physicians and facilities

Compare cost and quality between providers

Explain impact (savings) for member choices

Educate members about their options

Track decisions made by members

Report member and plan savings

13


Conversion & Portability

Your Life Insurance Plan through MetLife provides Conversion and Portability Options. Conversion is the option to convert all or

part of the amount of coverage in force to an individual life policy on the date of termination without a SOH. Portability is available

for coverage that has been in force for a minimum of 12 months and is the option to continue your coverage for a specified period

of time after your employment by paying the required premium. You must provide a written application to MetLife for Conversion

or Portability within 31 days of your termination.

How Coverage WorksThe Life Insurance Plans pay a lump sum benefit to your beneficiary in the

event of your death while actively employed by Fontainebleau. The Plan can

also pay a living benefit (Accelerated Death Benefit). If you become terminally

ill, the Plan will pay out a benefit while you are still living. Any amount you

receive will reduce the benefit paid to your beneficiary. The Dependent Life

Insurance Plan pays a lump sum benefit to you in the event of your spouse or

child’s death while you are actively employed by Fontainebleau.

Life and AD&DLife insurance can provide valuable financial protection. Fontainebleau offers

you a choice of different levels of coverage to meet your needs. The Life

Insurance Plans are insured and administered by MetLife. In addition to the

Basic Life and AD&D insurance that is provided to you at no cost by Fontainebleau,

you can purchase Supplemental Life Insurance for yourself and Dependent Life for

your spouse or domestic partner and dependent children.

Statement of Health (SOH)You must provide a Statement of Health, which is a statement of your medical

history, to determine if you are approved for coverage when the amount of

requested life insurance is in excess of the Guaranteed Issue Amount. You will

be asked to complete a SOH if:

You are a late enrollee,

You are increasing your original life coverage amount; or

You are age 60 or above

The SOH must be completed entirely and approved by MetLife before the

coverage will take effect. All SOHs must be submitted to the Benefits Office

within Human Resources.

LIFE AND AD&D BENEFITSUnderstanding Your L i fe and Acc ident Coverage With MetL i fe

14

LIFE AND AD&D BENEFITS

For supplemental Life and AD&D coverage, Fontainebleau offers the following options for Team Member, spouse, domestic partner

and/or child(ren) through MetLife:

WILL PREPARATION SERVICE:By enrolling in Supplemental Term Life coverage, you will have access to Hyatt Legal Plans’ network of 11,500+ participating attorneys.

Services include Wills (Simple, Complex or Living) along with a Power of Attorney.

When you use a participating plan attorney there will be no charge for the services.

Fontainebleau covers 100% of the cost for following Basic Life and AD&D benefit through MetLife:

SUPPLEMENTAL AD&D:

SUPPLEMENTAL L IFE :

Provisions

Dependent Life Insurance for your spouse/

domestic partner

Optional Life Insurance for you

Dependent Life Insurance for your child(ren)

Detail

Up to 50% of Team Member election in $5,000

increments (GI- $25,000) Above GI requires SOH

Up to 5 x base annual salary in $10,000 increments (GI- $100,000)

Above GI requires SOH

$10,000; if 14 days to 6 months old- $250 (GI- $10,000)

Provisions

Dependent AD&D Insurance for your spouse

Optional AD&D Insurance for you

Dependent AD&D Insurance for your child(ren)

Detail Rate

Amount equal to Supplemental Life

Amount equal to Supplemental Life $0.02 per $1,000 of elected coverage

$0.02 per $1,000 of elected coverage

$0.05 per $1,000 of elected coverageAmount equal to Supplemental Life

Provisions

Maximum Issue

Waiver of Premium

Seat Belt Benefit

Benefit Amount

Guaranteed Issue Amount

Airbag Benefit

Common Carrier Benefit

Benefit Amount

$500,000

Included if disabled before age 60

5% up to $10,000

10% up to $25,000

2 times your base annual salary

$500,000 (No SOH required)

100% or full amount

15


LIFE INSURANCE BENEFIT RATESMonthly Costs for Supplementa l Term L i fe Insurance With MetL i fe

You have the option to purchase Supplemental Term Life Insurance. L isted below are your monthly rates

as well as those for your spouse (based on your age and the amount of coverage) . Rates to cover your

chi ld(ren) are also shown. The premiums are paid 100% by you and deducted from your paycheck after taxes.

Please refer to the table below to est imate your monthly premiums.

Employee Age Your Monthly Cost per $1,000 of

Term Life Coverage

Spouse/Domestic Partner Monthly Cost

Per $1,000 of Term Life Coverage

Under 25 $0.06 $0.06

25 - 29 $0.06 $0.06

30 - 34 $0.08 $0.08

35 - 39 $0.09 $0.09

40 - 44 $0.10 $0.10

45 - 49 $0.16 $0.16

50 - 54 $0.26 $0.26

55 - 59 $0.44 $0.44

60 - 64 $0.66 $0.66

65 - 69 $1.27 $1.27

70 + $2.14 $2.14

Cost for your Child(ren)* $0.11* Covers all eligible children

Use the above table to calculate your premium based on the amount of life insurance you choose:

Example: $100,000 Supplemental Coverage Your Estimated Coverage Cost

Enter the rate from the table above (example: age 36) $0.09

Enter the amount of insurance in thousands of dollars

(example: for $100,000 of coverage, enter 100)

100

Monthly premium = Line 1 x Line 2 $9.00

Bi-Weekly Payroll Deduction = Line 3 x 12 divided by 26 $4.15

Repeat the four easy steps above to determine the cost for the coverage selected.

RESTRICTIONS:

1. YOU must be enrolled in Supplemental Life Insurance in order to enroll your spouse or domestic partner.

2. If you or your spouse/domestic partner were previously eligible to enroll and declined, you must now complete the MetLife

Statement of Health (SOH) form and submit it to HR Benefits Office. The application must be approved by MetLife before

the Supplemental benefits become effective or before payroll deductions begin.

3. If you or your spouse/domestic partner are newly eligible to enroll and are applying for an amount that is greater than the

GTD issue amount, you must complete the MetLife Statement of Health (SOH) form. The application must be approved by

MetLife before your Supplemental benefits become effective or before payroll deductions begin.

4. If employee is age 60 or above, there is no guarantee issue for spouse coverage. A Statement of Health must be

submitted for any coverage requested for spouse. See benefit administrator for additional restrictions due to age.

16

AD&D SUPPLEMENTAL RATES

Monthly Costs for Acc identa l Death & Dismemberment (AD&D) Insurance

With MetL i fe

To purchase Supplemental AD&D coverage, you and your dependants must also be enrolled in Supplemental Life coverage.

Supplemental AD&D Coverage

Dependant Spouse/Domestic Partner

Dependant Child

Employee

Monthly Cost Per $1,000 of AD&D Coverage

$0.020

$0.020

$0.050

Example: $100,000 AD&D Insurance

Monthly premium = Line 1 x Line 2

Bi-Weekly Payroll Deduction = Line 3 x 12 divided by 26

Enter the rate from the table above (example “Employee”)

Your Estimated Coverage Cost

100

$0.020

$2.00

$0.92

Enter the amount of insurance in thousands of dollars

(Example: for $100,000 of coverage enter 100)

Repeat the four easy steps above to determine the cost for the coverage selected.

17


DISABIL ITY BENEFITS

Fontainebleau offers a Voluntary Short Term Disability and Long Term Disability plan. These benefits replace a portion of your

pre-disability earnings*, less the income that was actually paid to you for the same disability from other sources.

Understanding VoluntarySTD & VoluntaryLTD Insurance through MetL i fe

Voluntary Long-Term Disabi l i ty (VLTD)If you are disabled due to a qualified non work-related accident or sickness lasting more than 90 days, your long-term disability

coverage provides for tax-advantaged payments.

This benefit pays you 60% of your defined monthly earnings* up to $6,000 per month.

*Definition of Earnings: Disability coverage is determined by the average weekly or average monthly earnings based on the prior 52 weeks of earnings

(or a pro-ration if applicable) at the time of initial enrollment and updated at each Annual Open Enrollment.

Voluntary Short-Term Disabi l i ty (VSTD)There is a 14 day waiting period for illness. Pre-existing condition restrictions may affect the benefits paid to you.

The benefit amount is 60% of your pre-disability weekly earnings up to a maximum weekly benefit of $1,000.

For VoluntarySTD Premium Rates

RESTRICTIONS:

1. If you were previously eligible to enroll and declined, you must now complete the MetLife SOH form. The application must be

approved by MetLife before your Voluntary STD and/or LTD benefits become effective or payroll deductions begin.

Example

B. Weekly Earnings = A divided by 52

C. Weekly Benefit Coverage = B x 60%

D. Value per $10 = C divided by 10

A. Annual Earnings

576.92

346.15

34.62

8.48

30,000

E. Estimated Monthly Contribution =

(D multiplied by 0.245)

3.91F. Estimated Bi-Weekly deduction =


For VoluntaryLTD Premium Rates Rate / $100 of monthly earnings

0.418

Example

B. Monthly Earnings = A divided by 12

C. Value per $100 of earnings =

(Bdivided by 100)

A. Annual Earnings

2,5000

25.00

10.45

4.82

30,000

D. Estimated Monthly Contribution =

(C multiplied by 0.418)

E. Estimated Bi-Weekly deduction =

(C multiplied by 12 divided by 26)


Rate / $10 of weekly benefit coverage

0.245

18

VOLUNTARY PLANS

19

Aetna Accident P lan

The Aetna Accident Plan pays cash benefits directly to you

when you have a covered accident. You can use the money

to pay for everyday expenses like mortgage payments, day

care or utility bills. Or you can use the cash for expenses like

coinsurance or to help cover your medical plan’s deductible.

It’s up to you. Benefits are payable no matter what other

medical coverage you might have.

Crit ica l I l lness

The Aetna Critical Illness Plan pays cash benefits directly

to you when you are diagnosed with a covered condition.

You can use the money to pay for everyday expenses like

mortgage payments, day care or utility bills. Or you can use

the cash for expenses like coinsurance or to help cover your

medical plan’s deductible. It’s up to you. Benefits are payable

no matter what other medical coverage you might have.

Aetna Hospita l P lan

Pays fixed cash benefits when you are in the hospital.


We Al l Need Help Every Now and ThenProblems are just a part of everyday life. In addition to the benefits provided under your MetLife Group Insurance coverage, you and

your household members now have access to MHN’s Employee Assistance Program (EAP) to help with the everyday challenges of life that

may affect your health, family life and desire to excel at work. (EAP services provided through an agreement with MHN, Inc. MHN is not a

subsidiary or affiliate of MetLife and the services provided are separate and apart from the insurance and services provided by MetLife.)

Employee Ass istance Program (EAP)Many of life’s problems can grow into major issues that can disrupt an employee’s life and their ability to function at work, at home and

in their personal relationships. Fontainebleau now provides an Employee Assistance Program (EAP) through MetLife free of charge to all

employees and their dependents for confidential support and direction.

OTHER EMPLOYEE BENEFITS

Benef i ts that he lp you and your fami ly

Consultation and SupportYou and the members of your household are entitled to up to 3 consultations with a licensed clinician per incident, per individual, per

calendar year. You choose between telephone consultations, for maximum convenience and anonymity, or web-video consultations, for

convenience with the warmth of a face-to-face conversation. Please call 1-800-511-3920 anytime to speak with a clinician or schedule an

appointment.

Work and L i fe Serv icesTelephone consultations are available in the following areas:

Financial Services: Budgeting, credit and financial guidance (investment advice, loans and bill payments not included), retirement

planning and assistance with tax issues.

Childcare and Eldercare Assistance: Needs assessment plus referrals to childcare and eldercare providers.

Identity Theft Recovery Services: Information on ID theft prevention, plus an ID theft emergency response kit and help from a fraud

resolution specialist if you are victimized.

Legal Services: Consultations for issues relating to civil, consumer, personal and family law, financial matters, business law, real

estate, estate planning and more (excluding disputes or actions between you and MetLife or MHN).

Daily Living Services: Referrals to consultants and businesses that can help with event planning, transportation services, pet services

and more (does not cover the cost nor guarantee delivery of vendors’ services).

Online Member Services: MHN’s EAP member website features a wide range of tools and information to help you take charge of

your well-being and simplify your life. Log on to members.mhn.com and enter the following company code: metlifeeap1

20

DOMESTIC PARTNER COVERAGE

ELIGIBIL ITYTo be eligible for Domestic Partner benefits, you and your Domestic Partner must meet the following eligibility requirements:

1. Are each 18 years of age or older;

2. Live together in a serious, committed relationship and are responsible for each other’s common welfare;

3. Are each other’s sole domestic partner;

4. Are not legally married to anyone and/or have not had another domestic partner within the prior 12 months;

5. Have shared the same regular and permanent residence for at least 6 months, with the intent to continue doing so indefinitely;

6. Share “basic living expenses,” defined as the basic cost of food, shelter and medical expenses; and

7. Are not related by blood to a degree of closeness, which would prohibit legal marriage in the state in which we reside.

A Declaration of Domestic Partnership form is required before enrollment is approved

and processed. See the Human Resources Benefits Office for forms.

Additional taxation may be imposed as a result of Domestic Partner Coverage. See processed. See the Human Resources Benefits

Office for more information.

Domestic Partner benefits coverage is avai lable to Fontainebleau Team Members .

21


401 (K ) RETIREMENT

Fontainebleau understands that retirement is probably your most important financial goal.

Welcome to Transamer ica 401 (k) Advantage

As you probably already know, saving for retirement takes you down one of two paths…saving on your own, or participating in

a pension or retirement savings plan through Fontainebleau. The 401(k) Advantage Plan is an important benefit available to Team

Members to save for retirement on a pre-tax basis with the added feature of employer matching!

401 (k)Fontainebleau gives you the option to enroll in the 401(k) Advantage Plan through Transamerica/TAG to make saving for retirement

easy and painless. There are many different investments available within the 401(k) Advantage Plan for you to choose from. Best of

all, you do not pay any taxes today on your deferrals. You will receive an enrollment information packet at your home address prior

to meeting your eligibility requirements. All enrollments are done online or via telephone. Please choose a deferral percentage, do

not choose a flat dollar amount for your biweekly payroll contributions.

Amount to SaveAmount to Save – Save up to 75% of your gross earnings per pay period up to the IRS limit of $18,000 in the tax year of 2016.

Participants over 50 years of age can contribute an additional $6,000 for the 2016 tax year.

Vest ingYour contributions as well as the Fontainebleau’s matching contributions to the plan are immediately 100% vested.

Catch-up Contr ibut ionsIf you are 50 or older, you may qualify to make additional before-tax “Catch-up” contributions as a flat dollar amount. (Do not

select a catch-up %). The Federal limit for the 2015 tax year is $6,000.00.

El ig ib i l i ty RequirementYou are eligible to participate in the 401(k) plan if you are a Non-Union Team Member over 18 years of age, have completed 6 months of

service, and have worked 500 hours within the 6 months of service.” Your plan entry date will be the first day of any month after meeting

the eligibility requirements.

22

Important Notice from Fontainebleau Florida Hotel, LLC Regarding Your Prescription Drug Coverage under the CIGNA Medical

Plans and Medicare

Please read this notice carefully and keep it where you can find it. This notice has information about your current prescription drug

coverage with Fontainebleau and prescription drug coverage available for people with Medicare. It also explains the options you

have under Medicare prescription drug coverage and can help you decide whether or not you want to enroll. At the end of this

notice is information about where you can get help to make decisions about your prescription drug coverage.

1. Medicare prescription drug coverage became available in 2006 to everyone with Medicare through Medicare prescription

drug plans and Medicare Advantage Plans that offer prescription drug coverage. All Medicare prescription drug plans provide

at least a standard level of coverage set by Medicare. Some plans may also offer more coverage for a higher monthly premium.

2. Fontainebleau has determined that the prescription drug coverage offered by the CIGNA Medical Plans are, on average for

all plan participants, expected to pay out as much as the standard Medicare prescription drug coverage will pay and is

considered Creditable Coverage.

Because your existing coverage is on average at least as good as standard Medicare prescription drug coverage, you can keep this

coverage and not pay extra if you later decide to enroll in Medicare prescription drug coverage.

Individuals can enroll in a Medicare prescription drug plan when they first become eligible for Medicare and each year from October

15th through December 7th. Beneficiary’s leaving employer/union coverage may be eligible for a Special Enrollment Period to sign

up for a Medicare prescription drug plan.

You should compare your current coverage, including which drugs are covered, with the coverage and cost of the plans offering

Medicare prescription drug coverage in your area.

If you do decide to enroll in a Medicare prescription drug plan and drop your Fontainebleau prescription drug coverage, be aware

that you and your dependents may not be able to get this coverage back. Please contact us for more information about what

happens to your coverage if you enroll in a Medicare prescription drug plan.

You should also know that if you drop or lose your coverage with Fontainebleau and don’t enroll in Medicare prescription drug

coverage after your current coverage ends, you may pay more (a penalty) to enroll in Medicare prescription drug coverage later.

If you go 63 days or longer without prescription drug coverage, that’s at least as good as Medicare’s prescription drug coverage,

your monthly premium will go up at least 1% per month for every month that you did not have that coverage. For example, if you

go nineteen months without coverage, your premium will always be at least 19% higher than what many other people pay. You’ll

have to pay this higher premium as long as you have Medicare prescription drug coverage. In addition, you may have to wait until

the following November to enroll.

For more information about this notice or your current prescription drug coverage…

Contact Fontainebleau for further information. NOTE: You will receive this notice annually and at other times in the future such as

before the next period you can enroll in Medicare prescription drug coverage, and if this coverage through Fontainebleau changes.

You also may request a copy.

For more information about your options under Medicare prescription drug coverage…

More detailed information about Medicare plans that offer prescription drug coverage is in the “Medicare & You” handbook. You’ll

get a copy of the handbook in the mail every year from Medicare. You may also be contacted directly by Medicare prescription

drug plans. For more information about Medicare prescription drug plans:

Visit www.medicare.gov

Call your State Health Insurance Assistance Program (see your copy of the Medicare & You handbook for their telephone

number) for personalized help.

Call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048.

For people with limited income and resources, extra help paying for Medicare prescription drug coverage is available. Information

about this extra help is available from the Social Security Administration (SSA) online at www.socialsecurity.gov, or you call them at

1-800-772-1213 (TTY 1-800-325-0778).

Remember: Keep this notice. If you enroll in one of the new plans approved by Medicare, which offer prescription drug coverage, you may be required to provide a copy of this notice when you join to show that you are not required to pay a higher premium amount.

PRESCRIPTION DRUG COVERAGE

Date:

Name of Entity/Sender:

Contact-Position/Office:

Address:

Phone Number:

August 1, 2016

Fontainebleau Florida Hotel, LLC

Human Resources Benefits Office

4441 Collins Avenue, Miami Beach, FL 33140

(305) 535-3224

23


HIPAA Specia l Enrol lment R ightsIf you are declining enrollment for yourself or your dependents (including your spouse) because of other health insurance or group

health plan coverage, you may be eligible to enroll yourself or your dependents in this plan if you or your dependents lose eligibility

for that other coverage (or if the employer stops contributing towards your or your dependents’ other coverage.) However, you

must request enrollment within 30 days after yours or your dependent’s other coverage ends.

In addition, 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 dependents. However, you must enroll within 30 days after the marriage, birth, adoption, or placement for

adoption.

Effective April 1, 2009 special enrollment rights exist in the following circumstances:

If you or your dependents experience a loss of eligibility for Medicaid or your State Children’s Health Insurance Program

(SCHIP) coverage; or

If you or your dependents become eligible for premium assistance under an optional state Medicaid or SCHIP program that

would pay the Team Member’s portion of the health insurance premium.

Note: In the two above listed circumstances only, you or your dependents will have sixty (60) days to request special enrollment in the group health plan coverage. An individual must request this special enrollment within sixty (60) days of the loss of coverage described at bullet one, and within sixty (60) days of when eligibility is determined as described at bullet two.

To request special enrollment or obtain more information, contact your Human Resources Department.

Notice of Avai labi l i ty : HIPAA Pr ivacy Pract icesThis communication is intended to alert you to the availability of our notice of privacy practices as required by the HIPAA Privacy

Rule of 2003. You can obtain a copy of this notice by contacting the Fontainebleau plan administrator at (305) 674-4719. Should you

have any questions regarding this notice, please contact the Human Resource Department.

Notice L i fet ime L imit No Longer Appl ies and Enrol lment OpportunityThe lifetime limit on the dollar value of benefits under Independent Health no longer applies. Individuals whose coverage ended

by reason of reaching a lifetime limit under the plan are eligible to enroll in the plan. Individuals have 30 days from the date of this

notice to request enrollment. For more information contact the Fontainebleau plan administrator at (305) 674-4719.

Fami ly and Medica l Leave Act of 1993You are eligible for leave under the Family and Medical Leave Act (FMLA) if you have been employed for a total of 12 months and

worked at least 1,250 hours during the 12 months preceding the leave.

Eligible employees will receive up to 12 weeks of leave within any rolling 12 month period for the birth or adoption of a child, for

the employee’s own serious health condition, or to care for a child, spouse, or parent with a serious health condition.

Eligible employees may also be eligible for FMLA leave to care for a family member who is a member of the Armed Forces under

certain circumstances.

REQUIRED DISCLOSURE NOTICES

24

Notice of Women’s Health and Cancer R ights Act of 1998The Women’s Health and Cancer Rights Act (WHCRA) requires group health plans to provide participants with notices of their rights

under WHCRA, to provide certain benefits in connection with a mastectomy, and to provide other protections for participants

undergoing mastectomies.

If you have had or are going to have a mastectomy, you may be entitled to certain benefits under the Women’s Health and Cancer

Rights Act of 1998 (WHCRA). For individuals receiving mastectomy-related benefits, coverage will be provided in a manner determined

in consultation with the attending physician and the patient, 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 will be provided subject to the same deductibles and Fontainebleau coinsurance amounts applicable to other medical

and surgical benefits provided under the health plan offered by your employer. Please keep this information with your other group

health plan documents. If you have any questions about the Plan’s coverage of mastectomies and reconstructive surgeries, please

contact the Human Resource Department.

MetLifeOur Privacy Notice

We know that you buy our products and services because you trust us. This notice explains how we protect your privacy and treat

your personal information. It applies to current and former customers. “Personal information” as used here means anything we know

about you personally.

Plan Sponsors and Group Insurance Contract Holders

This privacy notice is for individuals who apply for or obtain our products and services under an employee benefit plan, or group

insurance or annuity contract. In this notice, “you” refers to these individuals.

Protecting Your Information

We take important steps to protect your personal information. We treat it as confidential. We tell our employees to take care in

handling it. We limit access to those who need it to perform their jobs. Our outside service providers must also protect it, and use

it only to meet our business needs. We also take steps to protect our systems from unauthorized access. We comply with all laws

that apply to us.

Col lect ing Your Informat ionWe typically collect your name, address, age, and other relevant information. We may also collect information about any business

you have with us, our affiliates, or other companies. Our affiliates include life, car, and home insurers. They also include a bank, a

legal plans company, and securities broker-dealers. In the future, we may also have affiliates in other businesses.

How We Get Your Informat ionWe get your personal information mostly from you. We may also use outside sources to help ensure our records are correct and

complete. These sources may include consumer reporting agencies, employers, other financial institutions, adult relatives, and others.

These sources may give us reports or share what they know with others. We don’t control the accuracy of information outside

sources give us. If you want to make any changes to information we receive from others about you, you must contact those sources.

Using Your Informat ionWe collect your personal information to help us decide if you’re eligible for our products or services. We may also need it to verify

identities to help deter fraud, money laundering, or other crimes. How we use this information depends on what products and

services you have or want from us. It also depends on what laws apply to those products and services. For example, we may also

use your information to:

Administer your products and services

Process claims and other transactions

Perform business research

Confirm or correct your information

Market new products to you

Help us run our business

Comply with applicable laws

25


Shar ing Your Informat ion With OthersWe may share your personal information with others with your consent, by agreement, or as permitted or required by law. For

example, we may share your information with businesses hired to carry out services for us. We may also share it with our affiliated

or unaffiliated business partners through joint marketing agreements. In those situations, we share your information to jointly offer

you products and services or have others offer you products and services we endorse or sponsor. Before sharing your information

with any affiliate or joint marketing partner for their own marketing purposes, however, we will first notify you and give you an

opportunity to opt out.

Other reasons we may share your information include:

Doing what a court, law enforcement, or government agency requires us to do (for example, complying with Search warrants

or subpoenas)

Telling another company what we know about you if we are selling or merging any part of our business

Giving information to a governmental agency so it can decide if you are eligible for public benefits

Giving your information to someone with a legal interest in your assets (for example, a creditor with a lien on your account)

Giving your information to your health care provider

Having a peer review organization evaluate your information, if you have health coverage with us

Those listed in our “Using Your Information” section above

HIPAAWe will not share your health information with any other company – even one of our affiliates – for their own marketing purposes.

If you have dental, long-term care, or medical insurance from us, the Health Insurance Portability and Accountability Act (“HIPAA”)

may further limit how we may use and share your information.

Access ing and Correct ing Your Informat ionYou may ask us for a copy of the personal information we have about you. Generally, we will provide it as long as it is reasonably

retrievable and within our control. You must make your request in writing listing the account or policy numbers with the

information you want to access. For legal reasons, we may not show you anything we learned as part of a claim or lawsuit, unless

required by law. If you tell us that what we know about you is incorrect, we will review it. If we agree, we will update our records.

Otherwise, you may dispute our findings in writing, and we will include your statement whenever we give your disputed

information to anyone outside MetLife.

Quest ionsWe want you to understand how we protect your privacy. If you have any questions about this notice, please contact us.

When you write, include your name, address, and policy or account number.

Send privacy questions to:

MetLife Privacy Office

P. O. Box 489

Warwick, RI 02887-9954

[email protected]

We may revise this privacy notice. If we make any material changes, we will notify you as required by law. We provide

this privacy notice to you on behalf of these MetLife companies:

Metropolitan Life Insurance Company MetLife Insurance Company of Connecticut

General American Life Insurance Company SafeGuard Health Plans, Inc.

SafeHealth Life Insurance CompanyInsuran

CPN-Inst-Ann-2009v2

26

Newborn’s and Mothers ’ Health Protect ion Act of 1996The Newborns’ and Mothers’ Health Protection Act of 1996 prohibits group and individual health insurance policies from restricting

benefits for any hospital length of stay for the mother or newborn child in connection with childbirth; (1) following a normal vaginal

delivery to less than 48 hours; and (2) following a cesarean section, to less than 96 hours. Health insurance policies may not require

that a provider obtain authorization from the health insurance plan or the issuer for prescribing any such length of stay. Regardless

of these standards, an attending health care provider may, in consultation with the mother, discharge the mother or newborn child

prior to the expiration of such minimum length of stay.

Further, a health insurer or health maintenance organization may not:

Deny to the mother or newborn child eligibility, or continued eligibility, to enroll or to renew coverage under the terms of

the plan, solely to avoid providing such length of stay coverage.

Provide monetary payments or rebates to mothers to encourage such mothers to accept less than the minimum coverage.

Provide monetary incentives to an attending medical provider to induce such provider to provide care inconsistent with such

length of stay coverage.

Require a mother to give birth in a hospital.

Restrict benefits for any portion of a period within a hospital length of stay described in this notice.

These benefits are subject to the plan’s regular deductible and copay. For further details, refer to you (SPD) Summary Plan Description.

Genet ic Informat ion Nondiscr iminat ion Act 2008 (GINA) Title II of the Genetic Information Nondiscrimination Act of 2008 protects applicants and employees from discrimination based

on genetic information in hiring, promotion, discharge, pay, fringe benefits, job training, classification, referral, and other aspects of

employment. GINA also restricts employers’ acquisition of genetic information and strictly limits disclosure of genetic information.

Genetic information includes information about genetic tests of applicants, employees, or their family members; the manifestation

of diseases or disorders in family members (family medical history); and requests for or receipt of genetic services by applicants,

employees, or their family members. Our Plan complies with these requirements.

Offer Free Or Low-Cost Health Coverage To Chi ldren And Fami l ies If you are eligible for health coverage from your employer, but are unable to afford the premiums, Florida has premium

assistance programs that can help pay for coverage. Florida uses funds from their Medicaid or CHIP programs to help people who

are eligible for employer-sponsored health coverage, but need assistance in paying their health premiums.

If you or your dependents are already enrolled in Medicaid or CHIP and you live in Florida, you can 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, you can contact your Florida Medicaid or CHIP office or dial 1-877-KIDS NOW or

www.insurekidsnow.gov to find out how to apply. If you qualify, you can ask the State if it has a program that might help you pay

the premiums for an employer-sponsored plan.

Once it is determined that you or your dependents are eligible for premium assistance under Medicaid or CHIP, your employ-

er’s health plan is required to permit you and your dependents to enroll in the Medicaid or CHIP plan – as long as you and your

dependents are eligible. This is called a “special enrollment” opportunity, and you must request coverage within 60 days of being

determined eligible for premium assistance.

For further information on eligibility contact; www.flmedicaidtplrecovery.com/ 1-877-357-3268

27


Michel le’s Law

The law allows for continued coverage for dependent children who are covered under your group health plan as a student if they lose their

student status because of a medically necessary leave of absence from school. This law applies to medically necessary leaves of absence that

begin on or after January 1, 2010

If your child is no longer a student, as defined in your Certificate of Coverage, because he or she is on a medically necessary leave of absence,

your child may continue to be covered under the plan for up to one year from the beginning of the leave of absence. This continued coverage

applies if your child was (1) covered under the plan and (2) enrolled as a student at a post-secondary educational institution (includes colleges,

universities, some trade schools and certain other post-secondary institutions).

Your employer will require a written certification from the child’s physician that states that the child is suffering from a serious illness or injury

and that the leave of absence is medically necessary.

Premium Ass istance Under Medica id and the Chi ldren’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).

FLORIDA – Medica id

Website: www.flmedicaidtplrecovery.com

Phone: 1-877-357-3268

28

This not ice appl ies to employees and

covered dependents who are e l ig ib le for

Medicare Part D.

Please read this notice carefully and keep it where you can find it.

This notice has information about your current prescription drug

coverage with CIGNA and about your options under Medicare’s

prescription drug coverage. This information can help you

decide whether or not you want to join a Medicare drug plan.

Information about where you can get help to make decisions

about your prescription drug coverage is at the end of this notice.

1. Medicare prescription drug coverage became available in

2006 to everyone with Medicare. You can get this coverage if

you join a Medicare Prescription Drug Plan or join a Medicare

Advantage Plan (like an HMO or PPO) that offers prescription

drug coverage. All Medicare drug plans provide at least a

standard level of coverage set by Medicare. Some plans may

also offer more coverage for a higher monthly premium.

2. CIGNA has determined that the prescription drug

coverage offered by CIGNA is, on average for all plan

participants, expected to pay out as much as standard

Medicare prescription drug coverage pays and is therefore

considered Creditable Coverage. Because your existing

coverage is Creditable Coverage, you can keep this coverage

and not pay a higher premium (a penalty) if you later decide

to join a Medicare drug plan.

You should also know that if you drop or lose your coverage with

CIGNA and don’t enroll in Medicare prescription drug coverage

after your current coverage ends, you may pay more (a penalty)

to enroll in Medicare prescription drug coverage later..

When Can You Jo in A Medicare Drug P lan?

You can join a Medicare drug plan when you first become eligible

for Medicare and each year from October 15th to December 7th.

However, if you lose your current creditable coverage, through

no fault of your own, you will be eligible for a two (2) month

Special Enrollment Period (SEP) to join a Medicare drug plan.

What Happens To Your Current Coverage I f

You Decide to Jo in A Medicare Drug P lan?

If you decide to join a Medicare drug plan, your current CIGNA

coverage will not be affected. You can keep this coverage if you

elect Part D and this plan will coordinate with Part D coverage.

If you decide to join a Medicare drug plan and drop your current

CIGNA coverage, be aware that you and your dependents will be

able to get this coverage back.

When wi l l you pay a h igher premium (penalty)

to jo in a Medicare drug P lan?

You should also know that if you drop or lose your current

coverage with CIGNA and don’t join a Medicare drug plan within

63 continuous days after your current coverage ends, you may

pay a higher premium (a penalty) to join a Medicare drug plan

later.

If you go 63 continuous days or longer without creditable

prescription drug coverage, your monthly premium may go

up at least 1% of the Medicare base beneficiary premium per

month for every month that you did not have that coverage.

For example, if you go nineteen months without creditable

coverage, your premium may consistently be at least 19% higher

than the Medicare base beneficiary premium. You may have to

pay this higher premium (a penalty) as long as you have Medicare

prescription drug coverage. In addition, you may have to wait

until the following October to join.

For More Informat ion About This Not ice Or

Your Current Prescr ipt ion Drug Coverage…

Contact our office for further information (see contact

information below) NOTE: You’ll get this notice each year. You

will also get it before the next period you can join a Medicare

drug plan and if this coverage through CIGNA changes. You also

may request a copy of this notice at any time.

For More Informat ion About Your Options

Under Medicare Prescr ipt ion Drug Coverage…

More detailed information about Medicare plans that offer

prescription drug coverage is in the “Medicare & You” handbook.

You’ll get a copy of the handbook in the mail every year from

Medicare. You may also be contacted directly by Medicare drug

plans. For more information about Medicare prescription drug

coverage:

Visit www.medicare.gov

Call your State Health Insurance Assistance Program (see

the inside back cover of your copy of the “Medicare & You”

handbook for their telephone number) for personalized help

Call 1-800-MEDICARE (1-800-633-4227). TTY users should call

1-877-486-2048.

If you have limited income and resources, extra help paying for

Medicare prescription drug coverage is available. For information

about this extra help, visit Social Security on the web at www.

socialsecurity.gov, or call them at 1-800-772-1213 (TTY 1-800-325-

0778).

REMEMBER : Keep this notice. If you enroll in one of the

new plans approved by Medicare which offer prescription drug

coverage, you may be required to provide a copy of this notice

when you join to show that you are not required to pay a higher

premium amount.

Name of Entity/Sender: Miami Fontainebleau, LLC

Contact-Position/Office: Human Resources Benefits Office

Address: 4441 Collins Ave, Miami Beach, FL 33140

Phone Number: (305) 535-3224

MEDICARE PART D NOTICE

29


VENDOR CONTACTS

This guide describes the benefit plans available to you as a Team Member of Fontainebleau. The details of these plans are contained

in the official Plan documents, including some insurance contracts. This guide is meant only to cover the major points of each

plan. It does not contain all of the details that are included in your Summary Plan Description (SPD) (as described by the Employee

Retirement Income Security Act).

If there is ever a question about one of these plans, or if there is a conflict between the information in this guide and the formal

language of the Plan documents, the formal wording in the Plan documents will govern.

Note that the benefits described in this guide may be changed at any time and do not represent a contractual obligation on the

part of Fontainebleau.

Plan Administrator Phone NumbersWebsite

Medical Benefits CIGNA 800-244-6224www.mycigna.com

Dental Benefit DMO SafeGuard 800-880-1800www.safeguard.net

Vision Benefits Eyemed 866-939-3633www.eyemedvisioncare.com

Life and AD&D Plan MetLife 800-638-6420For filing claims see Human Resources

Short/ Long Term Disability MetLife For existing claims800-300-4296

For filing claims see Human Resources

401 (k) Advantage Plan Transamerica/TAG 800-401-8726www.TA-RETIREMENT.com

Will Preparation through Hyatt Legal

Hyatt Legal 800-821-6400Must have voluntary supplemental life insurance

Compass EMP Mike Organ 866-376-7890Individual investment advice, regardless of 401k asset balance, at no additional fee.

Patient Care Patient Care

Teladoc Teladoc

800-640-1898

800-Teladoc (835-2362)

www.patientcare4u.com

www.teladoc.com

Dental Benefit PPO MetLife 800-438-6388www.metlife.com/mybenefits

Employee Assistance Program

Available 24 hours 7 days a week

MetLife Members.mhn.com

Company code: metlifeeap1

800-511-3920

TDD callers on call:

800-327-0801

Voluntary Benefits Aetna www.aetna.com 1-888-772-9268

30

NOTES

31


NOTES

32 33

2015 non-union team member benefits booklet

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