coast real estate benefit plan · real estate services on behalf of its employees and the...

HOBANANDASSOCIATES,INC.d/b/aCOASTREALESTATESERVICES

BENEFITPLAN

OriginallyEffectiveJanuary1,1998AmendedandRestatedasofAugust1,2016

TABLEOFCONTENTS

SECTION1–ESTABLISHMENTANDPURPOSE...............................................................................................11.1 EstablishmentandPurpose...................................................................................................................................11.2 OriginalEffectiveDate..........................................................................................................................................11.3 AmendmentandRestatement..............................................................................................................................11.4 ThePlan................................................................................................................................................................11.5 HealthInsurancePortabilityandAccountabilityAct.............................................................................................11.6 PatientProtectionandAffordableCareAct..........................................................................................................1

SECTION2–PLANSPONSORANDPLANADMINISTRATOR...........................................................................22.1 PlanSponsorandPlanAdministrator....................................................................................................................22.2 NamedFiduciary...................................................................................................................................................22.3 AmendmentandTermination...............................................................................................................................3

SECTION3–ELIGIBILITYANDBENEFITS.......................................................................................................43.1 GeneralEligibilityforBenefits...............................................................................................................................43.2 EnrollmentProcedures..........................................................................................................................................43.3 ChangeinCoverage...............................................................................................................................................43.4 TerminationofCoverage.......................................................................................................................................43.5 Benefits.................................................................................................................................................................43.6 SourceofBenefits.................................................................................................................................................43.7 Deductibles,Co-paymentsandOut-of-PocketLimits............................................................................................43.8 CoordinationofBenefits.......................................................................................................................................53.9 RecoveryofOverpayment.....................................................................................................................................53.10 SpecialOpenEnrollmentRights..........................................................................................................................53.11 Michelle’sLaw.....................................................................................................................................................53.12 MentalHealthParityandAddictionEquity.........................................................................................................63.13 GeneticInformationNondiscriminationActof2008..........................................................................................63.14 FMLA:FamilyandMedicalLeaveActof1993(FMLA).........................................................................................63.15 USERRA:EmployeesonMilitaryLeave................................................................................................................73.16 ConsolidatedOmnibusBudgetReconciliationActof1985.................................................................................7

SECTION4–PATIENTPROTECTIONANDAFFORDABLECAREACT.................................................................84.1 ACAReportingObligationsonHealthCareCoverage...........................................................................................84.2 CoverageforDependentsUptoAge26................................................................................................................84.3 EssentialHealthBenefits.......................................................................................................................................84.4 LifetimeandAnnualDollarLimitsonEssentialHealthBenefits............................................................................94.5 PreexistingConditionExclusions(PCEs)................................................................................................................94.6 Rescissions............................................................................................................................................................94.7 90-DayWaitingPeriodLimit..................................................................................................................................94.8 InsuranceIssuerRebates.......................................................................................................................................94.9 PatientProtections..............................................................................................................................................104.10 PreventiveCare.................................................................................................................................................104.11 Cost-SharingLimitationsonEssentialHealthBenefits(Out-of-PocketMaximums)..........................................114.12 CoverageforClinicalTrials................................................................................................................................114.13 ClaimsAppealProcess.......................................................................................................................................11

SECTION5–CLAIMSANDAPPEALPROCEDURES........................................................................................135.1 NonHealthClaims...............................................................................................................................................135.2 HealthClaims......................................................................................................................................................135.3 WhenHealthClaimsMustBeFiled.....................................................................................................................14

5.4 TimingofClaimDecisions...................................................................................................................................145.5 ClaimsAppealProcedure....................................................................................................................................165.6 TimingofanAppeal............................................................................................................................................165.7 TimingofNotificationofBenefitDeterminationonReview...............................................................................165.8 InternalReviewandDecision..............................................................................................................................175.9 ExternalReview...................................................................................................................................................17

SECTION6–THEUSEANDDISCLOSUREOFPROTECTEDHEALTHINFORMATION.......................................196.1 HealthPlans........................................................................................................................................................196.2 HealthPlanPayments.........................................................................................................................................196.3 HealthCareOperations.......................................................................................................................................196.4 BusinessAssociates.............................................................................................................................................206.5 ThirdPartieswithAuthorization.........................................................................................................................206.6 PlanSponsor.......................................................................................................................................................206.7 ConditionsandLimitationsonUseandDisclosurebyPlanSponsor...................................................................206.8 OrganizedHealthCareArrangement..................................................................................................................216.9 AccesstoPHI.......................................................................................................................................................216.10 LimitationsofPHIAccessandDisclosure..........................................................................................................216.11 NoncomplianceIssues.......................................................................................................................................216.12 SecurityRules....................................................................................................................................................216.13 BreachNotificationRules..................................................................................................................................226.14 HITECHRules.....................................................................................................................................................22

SECTION7–GENERALPROVISIONS...........................................................................................................237.1 Expenses.............................................................................................................................................................237.2 Nonassignability..................................................................................................................................................237.3 EmploymentNoncontractual..............................................................................................................................237.4 PremiumsandCertainBenefitsSolelyfromGeneralAssets...............................................................................237.5 LimitationofBenefits..........................................................................................................................................237.6 NoGuaranteeofTaxConsequences...................................................................................................................237.7 IndemnificationofCoastRealEstateServicesbyParticipants............................................................................237.8 Notices................................................................................................................................................................247.9 GoverningLaw....................................................................................................................................................247.10 GenderandNumber.........................................................................................................................................24

APPENDIXA..............................................................................................................................................25InsurancePolicyIssuersandContractAdministrator...................................................................................................25

APPENDIXB..............................................................................................................................................26ComponentHealthPlansClaimsAppealsContactInformation....................................................................................26

APPENDIXC..............................................................................................................................................27EligibilityandParticipationRequirements....................................................................................................................27DependentEligibility.....................................................................................................................................................27EligibilityRulesforVariableHourEmployees...............................................................................................................27BreaksinService...........................................................................................................................................................28

HobanandAssociates,Inc.d/b/aCoastRealEstateServicesBenefitPlanAmendedandRestatedasofAugust1,2016

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SECTION1– ESTABLISHMENTANDPURPOSE

1.1 EstablishmentandPurposeHobanandAssociates,Inc.d/b/aCoastRealEstateServices(CoastRealEstateServices)hasestablishedtheHobanandAssociates,Inc.d/b/aCoastRealEstateServicesBenefitPlan(Plan)forthepurposeofprovidingwelfare benefits to its eligible employees and their eligible dependents. This Plan is established inconformancewithandistobeconstruedasanemployerprovidedwelfarebenefitplanasdefinedinSection3(1) of the Employee Retirement Income Security Act of 1974 (ERISA), with the documentationrequirementsoftheHealthInsurancePortabilityandAccountabilityActof1996anditsregulations(HIPAA)for purposes of the health plan components contained herein, and with the requirements imposed onhealthplansunderthePatientProtectionandAffordableCareAct(ACA).

1.2 OriginalEffectiveDateThisPlanoriginallytookeffectonJanuary1,1998.

1.3 AmendmentandRestatementThis Restatement reflects all changes made to the Plan, including all changes required to achievecompliancewithapplicablefederalregulationsasofAugust1,2016.

1.4 ThePlanThecompletetermsandconditionsofthePlanarecontainedintheinsurancepoliciespurchasedbyCoastReal Estate Services on behalf of its employees and the self-insured plan documents (Component Plans).Thesepoliciesandself-insuredplandocumentswhentakenwiththisPlandocumentconstitutetheentirePlanwhichisintendedtoconformtothewrittenplanrequirementsunderSection402ofERISA.

1.5 HealthInsurancePortabilityandAccountabilityActThisPlandocumentcontainsacompletedescriptionoftheHealthPlanComponent’suseanddisclosureofProtectedHealth Information(PHI)aspermittedbyHIPAAwithregardtohealthcaretreatment,paymentforhealthcareandhealthcareoperations.ItalsosetsforththeagreementbyCoastRealEstateServicestouseanddisclosePHIonlyaspermittedbyHIPAA.TheHIPAAprovisionsdescribedhereinapplytothehealthplancomponentsdescribedinthisPlan.Theydonotapplytonon-healthcomponentcoveragecontainedinthisPlan.

1.6 PatientProtectionandAffordableCareActComponent Health Plans also have become subject to certain provisions of the ACA. This Plan has beenwrittentocomplywiththerelevantprovisionsofACAcurrentlyineffect.


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SECTION2– PLANSPONSORANDPLANADMINISTRATOR

2.1 PlanSponsorandPlanAdministratorCoastRealEstateServicesisthePlanSponsorandPlanAdministratorasdefinedbyERISA.

CoastRealEstateServicesshallhavethedutyandauthoritytointerpretandconstruethePlanwithregardtoallquestionsofeligibility,thestatusandrightsofanypersonunderthePlan,andthemanner,time,andamountofpaymentofanybenefitsunderthePlan.EachEmployeeshall,fromtimetotime,uponrequestofCoast Real Estate Services, furnish toCoast Real Estate Services suchdata and information as Coast RealEstateServicesshallrequireintheperformanceofitsdutiesunderthePlan.

Coast Real Estate Services may adopt such rules and procedures, as it deems desirable for theadministrationofthePlan,providedthatanysuchrulesandproceduresshallbeconsistentwithprovisionsofthePlanandERISA.

Coast Real Estate Services shall discharge its duties with respect to the Plan (i) solely in the interest ofpersons eligible to receive benefits under the Plan, (ii) for the exclusive purpose of providing benefits topersonseligible to receivebenefitsunder thePlanandofdefrayingreasonableexpensesofadministeringthePlanand(iii)withthecare,skill,prudenceanddiligenceunderthecircumstancesthenprevailingthataprudent person acting in a like capacity and familiar with suchmatters would use in the conduct of anenterpriseofalikecharacterwithlikeaims.

CoastRealEstateServicesmayemploysuchcounselandagentsandmayarrangeforsuchclericalandotherservicesasitmayrequireincarryingouttheprovisionsofthePlan.

Coast Real Estate Services, as Plan Administrator, shall retain the authority to delegate to officers andemployeesofCoastRealEstateServicessuchresponsibilitiesasareimposedonCoastRealEstateServicesby ERISA and by the terms of this instrument, together with the authority to control and manage theoperationandadministrationofthePlan.

2.2 NamedFiduciaryPursuant to ERISA Section 402(a)(1), Coast Real Estate Services is a Named Fiduciary of the Hoban andAssociates,Inc.d/b/aCoastRealEstateServicesBenefitPlan.

Coast Real Estate Services also hereby appoints each group insurance policy issuer (issuer) listed inAppendixAasaNamedFiduciarywithsuchpowersasmaybenecessarytodeterminethebenefitspayableunder the insurance policies and resolve all questions pertaining to the applicability of the benefitprovisionsoftheinsurancepolicies.

Coast Real Estate Services hereby intends that each issuer shall be deemed to have complied with therequirementsofERISASection503(claimsprocedure)initsexerciseofitsauthorityunlessithasabuseditsdiscretionhereunderbyactingarbitrarilyandcapriciously.

CoastRealEstateServicesalsoherebyappointstheContractAdministratorasaNamedFiduciaryoftheself-insured(ComponentHealthPlans)withsuchpowersasmaybenecessarytodeterminethebenefitspayablewith respect to said plans and to resolve all questions pertaining to the applicability of the benefitprovisionsofthoseplans.

Coast Real Estate Services hereby intends that the Contract Administrator shall be deemed to havecomplied with the requirements of ERISA Section 503 (claims procedure) in its exercise of its authority,unlessithasabuseditsdiscretionhereunderbyactingarbitrarilyandcapriciously.


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2.3 AmendmentandTerminationCoastRealEstateServices intendstomaintainthePlanindefinitely,but isundernoobligationtocontinuethePlan and can terminate thePlanbyprovidingwrittennotice to thePlanparticipants. In amendingorterminating the Plan, Coast Real Estate Services cannot retroactively reduce the benefits to which aparticipantisentitledpriortotheterminationoramendment.


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SECTION3– ELIGIBILITYANDBENEFITS

3.1 GeneralEligibilityforBenefitsEachpersonwhoisanEmployeewillbecomeaparticipant inthePlanonthefirstdayafterheorshehassatisfied the applicable eligibility requirements of the applicable Component Plan, provided that suchpersonmakesatimelycoverageelectionandmakesallcontributionsrequiredunderthePlan,atthetimeand in the manner specified by Coast Real Estate Services. The eligibility requirements with respect toEmployeescoveredundereachoftheComponentPlansaresetforthinAppendixCofthisPlandocument.

EachSpouse,domesticpartner(ifeligible),childorotherdependentofaCoveredEmployeewillbecomeadependent and a participant on the first day after he or she has satisfied the applicable eligibilityrequirementsfordependentcoverageundertheapplicableComponentPlanthatprovidessuchdependentcoverage, provided that the dependent or the Covered Employeemakes a timely coverage election andmakes all contributions required under the Plan at the time and in the manner specified by Coast RealEstate Services. The eligibility requirements for dependent coverage under those Component Plans thatprovidedependentcoveragearesetforthintheofficialdocumentsforeachplan.

3.2 EnrollmentProceduresCoastRealEstateServicesmayfromtimetotimeprescribeenrollmentproceduresthatareconsistentwiththe terms of the Plan. Such enrollment procedures may require an Employee’s authorization of payrolldeductions forallapplicablecontributions requiredunder thePlanwith respect to theEmployeeandanycovereddependents.

3.3 ChangeinCoverageCoast Real Estate Servicesmay from time to time prescribe the terms, conditions and procedures underwhich a Plan participant may modify or terminate coverage under the Plan or under one or moreComponentPlans.

3.4 TerminationofCoverageThecoverageofaPlanparticipantwill terminate inaccordancewiththetermsandconditionssetforth intheSummaryPlanDescriptionandEvidenceofCoveragefortheapplicableComponentPlan.

3.5 BenefitsThe applicable benefits and coverage options provided under the Component Plans are set forth in theCertificateBookletsorEvidenceofCoverageforeachsuchplan.TheavailabilityofcoverageoptionswillbedeterminedbyCoastRealEstateServicesfromtimetotimeandmaydifferamonggroupsofparticipantsonthebasisofanyfactorsdeterminedbyCoastRealEstateServicesinitsdiscretion.

3.6 SourceofBenefitsBenefitsunderanyComponentPlanwillbeprovidedandpaidsolelybythePlanpursuanttothetermsoftheapplicable insurancepolicyorserviceagreementorapplicableself-insuredplandocument.CoastRealEstateServicesneitherguaranteesnorhasanyresponsibility for thequalityof thehealthcareorservicesprovidedorthelevelofbenefitspaidunderanyinsurancepolicyorServiceAgreement.

3.7 Deductibles,Co-paymentsandOut-of-PocketLimitsCoastRealEstateServicesmayestablishfromtimetotime(i)anyamountthatmustbepaidbyaparticipantasadeductiblebeforeaComponentPlanwillreimbursetheparticipantforexpensesthatotherwisewouldbeeligible forbenefits, (ii)anyco-paymentwhichmustbepaidbyaparticipant toaproviderat the timeservices are received under a coverage option, and (iii) any maximum out-of-pocket amount that aparticipantmustpayduringanyonePlanYear.Deductibles,co-paymentsandout-of-pocketlimitsmayvary


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amongthecoverageoptionsavailableundertheComponentPlans,amongthedifferentfeaturesofasinglecoverage option, among groups of participants, or in any othermanner determined in the discretion ofCoastRealEstateServices.CoastRealEstateServiceswillhavethefullpowertodeterminetheapplicabledeductibles, co-payments and out-of-pocket maximums under each coverage option, and to adjust suchannuallimitsfromtimetotime.Inestablishingtheamountofanysuchannuallimitorcondition,CoastRealEstate Services may rely on tables, appraisals, valuations, projections, opinions or reports furnished byagents employed or engaged by Coast Real Estate Services, andmay take into account the projected oranticipatedcostsandexpensesrelatingtothePlanoranyComponentPlan,includingadministrativecosts.Notwithstandingtheforegoing,innoeventshalltheout-of-pocketlimitfornon-grandfatheredplansexceedamountspermissibleunderPHSActSection2707(b),asapplicable.

3.8 CoordinationofBenefitsTheapplicablecoordinationofbenefitsprovisionsfortheComponentPlansaresetforth intheCertificateBookletandEvidenceofCoverageforeachsuchplan.

3.9 RecoveryofOverpaymentAnyamountpaidtoanypersoninexcessoftheamounttowhichheisentitledunderthePlanwillberepaidtothePlanor,ifapplicable,theInsurer,promptlyfollowingreceiptbythepersonofanoticeofsuchexcesspayments. In the event such repayment is notmade, such repaymentmaybemade, at thediscretionofCoastRealEstateServicesor,ifapplicable,theInsurer,byreducingorsuspendinganyfurtherpaymentsdueunder the Plan to the person and by taking such other or additional action as may be permitted byapplicablelaw.

The applicable insurance contracts (including the certificate of insurance booklets) or self-funded plandocuments or other governing documentation may contain information regarding the Plan’s right tosubrogateorseekreimbursementoferroneouslypaidbenefits(includingpaymentsinexcessoftheamountappropriatelypayable).

3.10 SpecialOpenEnrollmentRightsIf aneligibleemployeedeclinesenrollment in this grouphealthplan for theemployeeor theemployee’sspouse or dependents because of other health insurance or group health plan coverage, the eligibleemployeemaybeabletoenrollhim/herselfandeligibledependents inthisplan ifeligibility is lostfortheother coverage (or because the employer stops contributing toward this other coverage). However, theeligibleemployeemustrequestenrollmentwithin31daysaftertheothercoverageends(or31daysaftertheemployerceasescontributions for thecoverage). If theothercoverage isCOBRAcoverage, theentireCOBRAcontinuationcoverageperiodmustbeexhaustedbeforetheemployeecanbeenrolledinthisPlan.

In addition, if an eligible employee acquires a newdependent as a result ofmarriage, birth, adoption orplacement for adoption, the eligible employee may be able to enroll him/herself and any eligibledependents, provided that the eligible employee requests enrollmentwithin 31 days after themarriage,birth, adoption, or placement for adoption. If the eligible employee otherwise declines to enroll, he/shemayberequiredtowaituntilthegroup’snextopenenrollmenttodoso.Theeligibleemployeealsomaybesubjecttoadditionallimitationsonthecoverageavailableatthattime.

Furthermore, eligible employees and their eligible dependents who are eligible for coverage but notenrolled, shall be eligible to enroll for coveragewithin 60 days after (a) becoming ineligible for coverageunderaMedicaidorChildren’sHealthInsurancePlan(CHIP)planor(b)beingdeterminedtobeeligibleforfinancialassistanceunderaMedicaid,CHIP,orstateplanwithrespecttocoverageunderthePlan.

3.11 Michelle’sLawAllgrouphealthcarecoveragemaintainedunderthisPlanthatrequiresacertificationofstudentstatusforany period of dependent coverage shall comply with Michelle’s Law. Eligibility for such coverage for a


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dependent child who is enrolled in an institution of higher education at the beginning of a medicallynecessaryleaveofabsencewillbeextendediftheleavenormallywouldcausethedependentchildtoloseeligibility for coverageunder thegrouphealth care coveragedue to lossof student status. This eligibilityextension shall last up to one year beginning on the first day of the leave of absence or the date thecoveragewouldotherwiseterminateduetolossofstudentstatus,whicheverisearlier.

3.12 MentalHealthParityandAddictionEquityAllgrouphealthcarecoveragemaintainedunderthisPlan,whichprovidebothmedicalandsurgicalbenefitsandoffermentalhealthorsubstanceusedisorderbenefitsthereundershallprovidesuchbenefitssubjecttothefollowing:

§ Thefinancialrequirementsapplicabletosuchmentalhealthorsubstanceusedisorderbenefitsarenomore restrictive than thepredominant financial requirementsapplied to substantially allmedical andsurgical benefits covered by the Plan (or coverage), and there are no separate cost sharingrequirementsthatareapplicableonlywithrespecttomentalhealthorsubstanceusedisorderbenefits;and

§ The treatment limitationsapplicable to suchmentalhealthor substanceusedisorderbenefitsarenomore restrictive than the predominant treatment limitations applied to substantially all medical andsurgicalbenefitscoveredbythePlan(orcoverage)andtherearenoseparatetreatmentlimitationsthatareapplicableonlywithrespecttomentalhealthorsubstanceusedisorderbenefits.

§ Theplan administrator or insurermustmake available to participants or beneficiaries, upon request,thecriteriaformedicalnecessitydeterminationsformentalhealthandsubstanceusedisorderbenefitsandprovidethereasonforanydenialofreimbursementorpaymentforservices.

UnderACA, group health plans are prohibited from imposing annual or lifetime dollar limits on EssentialHealth Benefits, including mental health and substance use disorder services and behavioral healthtreatment.

3.13 GeneticInformationNondiscriminationActof2008The Genetic Information Nondiscrimination Act of 2008 (GINA) prohibits employers and other entitiescoveredbyGINATitleIIfromrequestingorrequiringgeneticinformationofanindividualorfamilymemberoftheindividual,exceptasspecificallyallowedbyGINA.Ingeneral,GINA:

§ ProhibitsthisPlanfromadjustingpremiumsorcontributionamountsforagrouponthebasisofgeneticinformation;

§ Prohibits thisPlan fromrequestingormandatingthatan individualor familymemberofan individualundergo a genetic test, providing that such prohibition does not limit the authority of a health careprofessional to requestan individual toundergoagenetic test,orprecludeagrouphealthplan fromobtainingorusingtheresultsofaagenetictestinmakingadeterminationregardingpayment;

§ AllowsthisPlantorequest,butnotmandate,thataparticipantorbeneficiaryundergoagenetictestforresearchpurposesifthePlandoesnotusetheinformationforunderwritingpurposesandmeetscertaindisclosurerequirements;and,

§ Prohibits this Plan from requesting, requiring, or purchasing genetic information for underwritingpurposes, or with respect to any individual in advance of or in connection with such individual’senrollment.

3.14 FMLA:FamilyandMedicalLeaveActof1993(FMLA)Notwithstanding the above rule regarding termination of participation or any other provision to thecontraryinthisPlan,whenaPlanParticipantcommencesaqualifyingleaveunderFMLA,thefollowingruleswillapply.


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§ TotheextentrequiredbyFMLA,healthbenefitsshallbecontinuedonthesametermsandconditionsasthoughthePlanparticipantwerestillanactiveemployee.

§ Except as otherwise provided by FMLA, Plan participationwill cease prior to the expiration of FMLAleave, when the Plan Administrator learns that the employee does not intend to return to workfollowing FMLA leave. Otherwise, Plan participationwill cease upon expiration of FMLA leave, if theemployeefailstoreturntoworkatthattime.

§ If the employee fails to return to work after the FMLA leave, the employee will be required toreimbursethePlanforthecostofthecoverageprovidedtotheemployeewhileonFMLAleave.

§ Eligibleemployeesmaytakeupto12weeks’leaveduringa12-monthperiodforthebirthoradoptionoftheemployee’schild;theserious illnessoftheemployee’sspouse,child,orparent;theemployee’sowndisablingseriousillness;andtheemployee’sspouse,son,daughter,orparentisonactivedutyinthemilitaryoriscalledupforactiveduty(qualifyingexigencyleave).

ú Eligibleemployeeswhoare familymembersofactivedutymilitarypersonnel injuredor ill in theline ofmilitary duty, and perhapsmedically unfit to perform the duties of themember’s office,grade,rank,orratingmaytakeupto26workweeksofjob-and-benefits-protectedleaveduringa12-month period to care for the servicemember. The same provisions apply to a relative of aveteranwhowaspreviously amemberof theArmed Forcesduring the five years preceding thedateoftreatment,recuperation,ortherapy.

ú Eligibleemployeesmaytakeupto15calendardaysofqualifyingexigencyleavetospendtimewitha servicemember who is on ordered short-term temporary, rest and recuperation leave duringdeployment.

3.15 USERRA:EmployeesonMilitaryLeaveEmployees going into or returning from military service will have rights mandated by the UniformedServicesEmploymentandReemploymentRightsActof1994withregardtotheirbenefitplans.Theserightsincludeupto24monthsofextendedhealthcarecoverageuponpaymentoftheentirecostofcoverageplusareasonableadministrationfeeandimmediatecoveragewithnopreexistingconditionsexclusionsappliedinthePlanuponreturnfromservice(andwillrunconcurrentlywithanyCOBRAcontinuationcoverage,totheextentallowedbylaw).TheserightsapplyonlytoEmployeesandtheirdependentscoveredunderthePlanbeforeleavingformilitaryservice.

3.16 ConsolidatedOmnibusBudgetReconciliationActof1985NotwithstandinganythinginthePlantothecontrary,totheextentrequiredbyCodeSection4980BandIRSRegulationsthereunder(COBRA),aqualifiedbeneficiarywhowouldlosecoverageunderahealthcareplanupon the occurrence of a qualifying event (as defined in Code Section 4980B(f)(3)) shall be permitted tocontinuecoverageunderthePlanbyelectingtomaketheapplicablecontributions,onanafter-taxbasis,inaccordancewithproceduresestablishedby theAdministrator thatare consistentwithCOBRA.CoastRealEstateServicesshallprovidenoticetoeachcoveredEmployeeandhisSpouseoftheirrightsunderCOBRAinaccordancewithapplicablelaw.


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SECTION4– PATIENTPROTECTIONANDAFFORDABLECAREACT

4.1 ACAReportingObligationsonHealthCareCoverageUnder thePatient Protection andAffordableCareAct’s (ACA) IndividualMandate (Code Section5000A(f)andanyaccompanyingregulationsorguidance)each individual is requiredtohavebasichealth insurancecoverage(knownasminimumessentialcoverage),qualifyforanexemption,ormakeasharedresponsibilitypaymentwhenfilingtheirfederalincometaxreturn.FailuretoenrollinaplanofferingminimumessentialcoveragemayresultintheIRSapplyingpersonalfinancialpenalties.

InadditiontotheIndividualMandate,applicablelargeemployers(ALE)maybesubjecttoapenaltytaxforfailing toofferminimumessential coverage tomost full-timeemployeesand theirdependent childrenoroffering health care coverage that is not “affordable” (exceeds a specified percentage of the employee’shouseholdincome)ordoesnotoffer“minimumvalue”(planpaysatleast60%ofthetotalcostofbenefits).

Effective as of the 2015 calendar year the ACA requires employers, insurance carriers, and ACAMarketplacestoreporttotheInternalRevenueService(IRS),andseparatelytocoveredindividuals,onthehealthcarecoverageprovidedto individualsforpurposesoftheIndividualandEmployerMandatesnotedabove.

4.2 CoverageforDependentsUptoAge26Grouphealthplansmustmakedependentcoveragetoadultchildrenavailableuntil theyturnage26.Themandateapplies toanyadultchildwhetherornotheorshe iseligible toenroll insomeotheremployer-sponsored group health plan. Adult children shall include those who are a child of the Plan participant,whetherornottheyliveathomeoraremarriedornotmarried,adependentontheemployee’staxreturn,orastudent.Adultchildrenunderage26mustbeofferedcoverageeveniftheydonotliveinaparticularservicearea(butplansarenotrequiredtocoverout-of-networkservicesfortheseadultchildren).

4.3 EssentialHealthBenefitsACA generally defines Essential Health Benefits to include the following broad categories of health carebenefits. EssentialHealthBenefits coveredunder this Plan are subject to certain additional requirementsunderACA.§ Ambulatorypatientservices(i.e.outpatientcarereceivedwithoutbeingadmittedtothehospital)

§ Emergencyservices

§ Hospitalization

§ Maternityandnewborncare

§ Mentalhealthandsubstanceusedisorderservices,includingbehavioralhealthtreatment

§ Prescriptiondrugs

§ Rehabilitativeandhabilitativeservicesanddevices

§ Laboratoryservices

§ Preventiveandwellnessservices,includingchronicdiseasemanagement

§ Pediatricservices,includingoralandvisioncare

ACAregulations furtherdefineEssentialHealthBenefitsbasedonstate-specific“benchmark”plans,or forself-insuredplans,ontheFederalEmployeesHealthBenefitProgram.


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4.4 LifetimeandAnnualDollarLimitsonEssentialHealthBenefitsUnderACA, thisPlan isprohibited from imposing lifetimeorannual limitson thedollarvalueofEssentialHealthBenefitsprovided toany individual, regardlessofwhether thebenefitsareprovided in-networkorout-of-network.ThisPlanisnotprohibited,however,fromplacinglifetimeorannualdollarlimitsonspecificcoveredbenefits that arenot EssentialHealthBenefits to the extent such limits areotherwisepermittedunderapplicablefederalorstatelaw.

4.5 PreexistingConditionExclusions(PCEs)Grouphealthplansareprohibitedfromdenyingcoverageorexcludingspecificbenefitsfromcoveragedueto an individual’s preexisting condition, regardless of the individual’s age. A PCE includes any healthconditionorillnessthatispresentbeforethecoverageeffectivedate,regardlessofwhethermedicaladviceortreatmentwasactuallyreceivedorrecommended.

4.6 RescissionsThe Component Health Plans in this Plan are generally prohibited from rescinding the coverage of aparticipant.Rescissionmeansacancellationordiscontinuanceofcoveragethathasaretroactiveeffect.Acancellationordiscontinuanceisnotaprohibitedrescissionif:

§ It is initiatedbyan individual and theplan, issuer, employeror sponsordoesnot takeanyactions toinfluencetheindividual’sdecisiontoretaliateagainsttheindividual;

§ ItisinitiatedbytheMarketplace;

§ Itonlyhasaprospectiveeffect;or,

§ Itiseffectiveretroactivelyduetoafailuretotimelypayrequiredpremiumsorcontributionstowardthecostofcoverage,includingnonpaymentofCOBRApremiums.

Rescissions are permitted for fraud or the intentional misrepresentation of fact by the participant asprohibitedbythetermsoftheplan.Theplanmustprovideatleast30days’advancenoticetotheaffectedparticipant before coverage may be rescinded, and only as permitted under Section 2702(c) or Section2742(b)ofACA.Rescissionsaresubjecttointernalclaimsandappealsandexternalreview.

4.7 90-DayWaitingPeriodLimitGrouphealthplansmaynotapplyawaitingperiodforcoveragethatexceeds90days.Awaitingperiod isdefined as the period thatmust pass before coverage for an eligible employee or his or her dependentbecomeseffectiveunderthePlan.ACAregulationspermitplanstoconditionhealthcoverageeligibilityonan employee’s completion of an employment-based orientation period of up to one month beforeapplicationofthe90-daywaitingperiodlimits.Areasonableandbonafideemploymentbasedorientationperiodispermissibleifitisnotdesignedtoavoidcompliancewiththe90-daywaitingperiodlimitation.

4.8 InsuranceIssuerRebatesIntheeventthatCoastRealEstateServicesqualifiesandreceivesareturnofpremium(Rebate)asaresultoftheissuer'sfailuretomeettheMedicalLossRatio(MLR)requirementsunderACA,thePlanSponsor,atitsoptionshalleither:

§ Reimburse Plan participants through a payroll adjustment in the amount determined under the ACAregulations;or,

§ Reduceemployeecontributions(currentorfuture)byanamountdeterminedunderACAregulationstoreflecttheemployee’sshareoftheRebate;or,

§ UsetheRebatetoenhancebenefitsunderthePlanbyanamountdeterminedunderACAregulations.


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4.9 PatientProtectionsEmergency Services. If a non-grandfathered Component Health Plan provides benefits for emergencyservices, the Component Health Plan may not require preauthorization and must provide emergencyservices coverage regardless ofwhether the provider is in- or out-of-network. The plan generally cannotimpose any copayment or coinsurance for out-of-network emergency services that is greater than whatwouldbe imposed if theserviceswereprovided in-network.ACAregulationsset forthminimumpaymentstandardstoensurethataplandoesnotpayanunreasonablylowamounttoanout-of-networkemergencyserviceproviderwhomay, in turn, “balancebill” thepatient. Emergency care is not limited to treatmentwithin 24 hours of the onset of an emergency. A plan or issuer must provide for emergency services,withoutanytimelimitwithinwhichtreatmentmustbesought.

Plansarerequiredtodisclosehowtheyreachedtheout-of-networkpaymentamountwithin30daysofarequestbyaParticipantandaspartofanyclaimsreview.

Primary Care Provider Designation. If this Plan requires or allows participants to designate primary careproviders, or if the Plan automatically designates a primary care provider for a participant, then theparticipanthastherighttodesignateanyprimarycareproviderwhoparticipatesinthePlan’snetworkandwhoisavailabletoaccepttheparticipantorparticipant’sfamilymembers.Forchildren,theparticipantmaydesignateapediatricianastheprimarycareprovider.Classificationofaprimarycareproviderisdeterminedbasedontheplanorpolicytermsandinaccordancewithapplicablestatelaw.

Access to Obstetrical or Gynecological Care. A participant, regardless of age, shall not need priorauthorizationfromthePlanorfromanyotherperson(includingaprimarycareprovider)inordertoobtainaccess to obstetrical or gynecological care from a health care professional in the Plan’s network whospecializesinobstetricsorgynecology.

AccesstoPediatricCare.IfthePlanrequiresorprovidesforthedesignationofaparticipatingprimarycareprovider for a dependent child, the Plan shall permit such person to designate a physician (allopathic orosteopathic) who specializes in pediatrics (including pediatric subspecialties) as the child’s primary careproviderifsuchproviderparticipatesinthenetworkofthePlanorissuer.

4.10 PreventiveCareNon-grandfatheredgrouphealthplanssubject to thepreventiveservicescoveragemandatemustprovidecoverage for all of the following preventive services without imposing any co-payments, co-insurance,deductibles, or other cost-sharing requirements. If the attending provider determines that the service ismedicallynecessary,aplanmustprovidecoverage regardlessof sexassignedatbirth,gender identity,orgenderoftheindividualasrecordedbytheplan:

§ Evidence-based items or serviceswith anA or B rating currently recommendedby theUnited StatesPreventiveServicesTaskForce(USPSTF)withrespecttotheindividualseekingcare;

§ Immunizations for routine use in children, adolescents, or adults currently recommended by theAdvisory Committee on Immunization Practices (ACIP) of the Centers for Disease Control andPrevention;

§ Forinfants,childrenandadolescents:Evidence-informedpreventivecareandscreeningssupportedbythe Health Resources and Services Administration (HRSA), including well-woman preventive servicesandpreconception/prenatalcarethatareage-anddevelopmentally-appropriate;and,

§ Forwomen:Evidence-informedpreventivecareandscreeningprovidedforincomprehensiveguidelinessupportedbyHRSA,totheextentnotincludedincertainrecommendationsoftheUSPSTF.

ú HRSA guideline recommendation includes all FDA-approved contraceptivemethods, sterilizationprocedures, and patient education and counseling for all women with reproductive capacity.EffectiveforplanyearsbeginningonorafterJuly10,2015,Plansmustcoveratleastoneformof


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contraception in each of the currently 18 distinct methods the FDA has identified in its BirthControlGuide.

ú USPSTF recommended genetic counseling and BRCA testing to determine a family historypotentially associatedwith an increased risk formutations in breast cancer susceptibility genesmustbeprovided towomenwithpositive screen resultsaswell aswomenwhopreviouslyhavehad breast cancer, ovarian cancer or other non-BRCA-related cancer who are currentlyasymptomaticandcancer-free.

4.11 Cost-SharingLimitationsonEssentialHealthBenefits(Out-of-PocketMaximums)ACArequiresgrouphealthplanstoapplyauniformmaximumlimitforout-of-pocketexpenses(deductibles,co-insurance,co-pays,orsimilarcharges)onallEssentialHealthBenefitsofnogreaterthanthemaximumamountssetannuallybytheInternalRevenueService(IRS)forHSA-eligiblehigh-deductiblehealthplansasadjustedforinflationusingthe“premiumsadjustmentpercentage.”

§ Theoverallcost-sharing limitonlyappliestobenefitsprovided in-network.Aplanmay includeout-of-networkexpensesatitsdiscretion.

§ Out-of-pocket expenditures on all Essential Health Benefits must accrue to one out-of-pocketmaximum,withoutconsiderationforwhetheraplanusesmorethanoneserviceprovidertoadministerbenefits.

§ Plansarenotrequiredtoapplytheannual limitationonout-of-pocketmaximumstobenefitsthatarenotEssentialHealthBenefits.

§ EmbeddedRule: Forplanyearsbeginning in2016, the self-only cost-sharing limitmustapply toeachcoveredindividual,whethertheindividualhasself-only,family,orothercoverage.

4.12 CoverageforClinicalTrialsNon-grandfatheredgrouphealthplansmustprovidebenefitcoverage(includingphysiciancharges, labs,x-rays, professional fees and other routine medical costs) for certain routine patient costs for qualifiedindividuals who participate in an approved clinical trial. Approved clinical trialsmust be covered for thetreatmentofcancerandotherlife-threateningdiseasesorconditions.Thecoveragedoesnotapplyfortheactual device, equipment, or drug that is typically given to participating patients free of charge by thecompanysponsoringthetrial.Inaddition,ifaParticipantexperiencescomplicationsasaresultoftheclinicaltrial,anytreatmentofthosecomplicationsmustbecoveredonthesamebasisthatthetreatmentwouldbecoveredforindividualsnotintheclinicaltrial.

4.13 ClaimsAppealProcessIn addition to the claims appeals procedures described in this Plan and the Summary PlanDescription, anon-grandfatheredgrouphealthplanshallimplementaneffectiveappealsprocessforappealsofcoveragedeterminationsandclaims,underwhichthePlanorissuershall,ataminimum:

§ Haveineffectaninternalclaimsappealprocess;

§ Providenotice to enrollees, in a culturally and linguistically appropriatemanner, of available internaland external appeals processes, and the availability of any applicable office of health insuranceconsumerassistanceorombudsmantoassistsuchenrolleeswiththeappealsprocesses;and

§ Allowenrolleestoreviewtheirfiles,topresentevidenceandtestimonyaspartoftheappealsprocess,andtoreceivecontinuedcoveragependingtheoutcomeoftheappealsprocess.

§ Agrouphealthplanshallalso:


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§ ComplywiththeapplicablestateExternalReviewprocessforsuchplansandissuersthat,ataminimum,includestheconsumerprotectionssetforthintheUniformExternalReviewModelActpromulgatedbytheNationalAssociationofInsuranceCommissionersandisbindingonsuchplans;or,

§ Implement an effective External Review process that meets minimum standards established by theSecretarythroughguidanceandthatissimilartotheprocessapplicabletotheinternalclaimsprocess:

ú iftheapplicablestatehasnotestablishedanExternalReviewprocessthatmeetstherequirementsapplicabletotheinternalclaimsprocess;or

ú iftheplanisaself-insuredplanthatisnotsubjecttostateinsuranceregulation(includingastatelawthatestablishesanExternalReviewprocesswhosetermsaresimilartotheprocessapplicabletotheinternalclaimsprocess.)


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SECTION5– CLAIMSANDAPPEALPROCEDURES

InsofarastheseproceduresareconsistentwiththeprovisionsofACA,theproceduresoutlinedbelowmustbefollowedbyPlanparticipants(“claimants”)toobtainpaymentofbenefitsunderthisPlan.

5.1 NonHealthClaimsFor purposes of all non-health insured welfare plan coverage (disability, Life, AD&D, etc.) the certificatebookletprovidedbythe issuerscontainsadetaileddescriptionofthe issuer’sclaimssubmissionrulesandclaimsappealprocedures.

5.2 HealthClaimsThe procedures outlined belowmust be followed by claimants to obtain payment of benefits under thisPlan.

For purposes of the Health Claims and Claims Appeal Procedure contained in this Plan, the term“Administrator”willmean either the issuer or the PlanAdministrator depending upon the policy or planunderwhichtheclaimhasbeenfiled.

AllclaimsandquestionsregardinghealthclaimsshouldbedirectedtotheAdministrator.TheAdministratorshall have final authority for adjudicating all claims and a full review of the decision on such claims inaccordancewiththefollowingprovisionsandwithERISA.

EachclaimantclaimingbenefitsunderthePlanshallberesponsibleforsupplying,atsuchtimesandinsuchmanner as the Administrator in its sole discretion may require, written proof that the expenses wereincurred or that the benefit is covered under the Plan. If the Administrator in its sole discretion shalldetermine that theclaimanthasnot incurredacoveredexpenseor that thebenefit isnotcoveredunderthe Plan, or if the claimant has failed to furnish such proof as is requested, no benefits shall be payableunderthePlan.

UnderthePlan,therearefourtypesofclaims:UrgentPre-Service,Non-urgentPre-Service,ConcurrentandPost-Service.

§ Pre-Service Claims. A "Pre-Service Claim" is a claim for a benefit under the Plan where the Planconditionsreceiptofthebenefit,inwholeorinpart,onapprovalofthebenefitinadvanceofobtainingmedicalcare.

A"Pre-ServiceUrgentCareClaim"isanyclaimformedicalcareortreatmentwithrespecttowhichtheapplicationof the timeperiods formakingnon-urgent caredeterminations could seriously jeopardizethelifeorhealthoftheclaimantortheclaimant’sabilitytoregainmaximumfunction,or,intheopinionofaphysicianwithknowledgeoftheclaimant’smedicalcondition,wouldsubjecttheclaimanttoseverepainthatcannotbeadequatelymanagedwithoutthecareortreatmentthatisthesubjectoftheclaim.

Itisimportanttorememberthat,ifaclaimantneedsmedicalcareforaconditionwhichcouldseriouslyjeopardizehis life,there isnoneedtocontactthePlanforpriorapproval.Theclaimantshouldobtainsuchcarewithoutdelay.

Further,ifthePlandoesnotrequiretheclaimanttoobtainapprovalofamedicalservicepriortogettingtreatment,thenthereisno"Pre-ServiceClaim."TheclaimantsimplyfollowsthePlan'sprocedureswithrespect toanynoticewhichmayberequiredafterreceiptof treatment,andfiles theclaimasaPost-ServiceClaim.

§ Concurrent Claims. A "Concurrent Claim" arises when the Plan has approved an ongoing course oftreatment to be provided over a period of time or number of treatments, and either (a) the Plan


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determinesthatthecourseoftreatmentshouldbereducedorterminated,or(b)theclaimantrequestsextensionofthecourseoftreatmentbeyondthatwhichthePlanhasapproved.

If the Plan does not require the claimant to obtain approval of amedical service prior to gettingtreatment,thenthereisnoneedtocontacttheAdministratortorequestanextensionofacourseoftreatment.TheclaimantsimplyfollowsthePlan'sprocedureswithrespecttoanynoticewhichmayberequiredafterreceiptoftreatment,andfilestheclaimasaPost-ServiceClaim.

§ Post-Service Claims. A "Post-Service Claim" is a claim for a benefit under the Plan after the serviceshavebeenrendered.

5.3 WhenHealthClaimsMustBeFiledHealthclaimsmustbefiledwiththeAdministratorwithinoneyearofthedatechargesfortheserviceswereincurred.BenefitsarebaseduponthePlan'sprovisionsatthetimethechargeswereincurred.Chargesareconsidered incurredwhentreatmentorcare isgivenorsuppliesareprovided.Claims filed later thanthatdateshallbedenied,unlessitisshownthatitwasnotreasonablypossibletofilewithinthistimeframe.

ThePlan,uponreceiptofawrittennoticeofaclaim,willfurnishtotheparticipantaformforfilingproofofloss.Ifsuchformsarenotfurnishedwithin15daysafternoticeisgiven,theparticipantwillbeconsideredtohavecompliedwiththerequirementofthePlanwithrespecttoproofoflossandwrittenproofcoveringtheoccurrence,thecharacter,andtheextentofthelossforwhichtheclaimismade.

APre-ServiceClaim(includingaConcurrentClaimthatalsoisaPre-ServiceClaim)isconsideredtobefiledwhen the request for approval of treatment or services is made and received by the Administrator inaccordancewith thePlan’sprocedures.However, a Post-Service claim is considered tobe filedwhen thefollowinginformationisreceivedbytheAdministrator:

§ Thedateofservice;§ Thename,address,telephonenumberandtaxidentificationnumberoftheprovideroftheservicesor

supplies;§ Theplacewheretheserviceswererendered;§ Thediagnosisandprocedurecodes;§ Theamountofcharges;§ ThenameofthePlan;§ Thenameoftheparticipant;and,§ Thenameofthepatient.

Uponreceiptofthisinformation,theclaimwillbedeemedtobefiledwiththePlan.TheAdministratorwilldetermineifenoughinformationhasbeensubmittedtoadjudicatetheclaim.Ifnot,theAdministratormayrequestmore information. TheAdministratormust receive the additional informationwithin 45 days (48hours in the case of Pre-Service Urgent Care Claims) from receipt by the claimant of the request foradditionalinformation.Failuretodosomayresultinclaimsbeingdeclinedorbenefitsreduced.

5.4 TimingofClaimDecisionsTheAdministratorshallnotify theclaimant, inaccordancewiththeprovisionsset forthbelow,ofadenial(and, in thecaseofPre-ServiceClaimsandConcurrentClaims,ofdecisions thata claim ispayable in full)withinthefollowingtimeframes:

§ Pre-Service Urgent Care Claims. If the claimant has provided all of the necessary information, theAdministratorwillnotifytheclaimantofitsdecisionassoonaspossible,takingintoaccountthemedicalexigencies,butnotlaterthan72hoursafterreceiptoftheclaim.

If the claimant has not provided all of the information needed to process the claim, then theAdministratorwillnotifytheclaimantastowhatspecificinformationisneededassoonaspossible,but


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not later than 24 hours after receipt of the claim. The Administrator will notify the claimant of itsdetermination of benefits as soon as possible, but not later than 48 hours, taking into account themedicalexigencies,aftertheearlierof(i)thePlan'sreceiptofthespecifiedinformation,or(ii)theendoftheperiodaffordedtheclaimanttoprovidetheinformation.

§ Pre-Service Non-urgent Care Claims. If the claimant has provided all of the information needed toprocesstheclaim,theAdministratorwillnotifytheclaimantofitsdecisionwithinareasonableperiodoftimeappropriatetothemedicalcircumstances,butnotlaterthan15daysafterreceiptoftheclaim.Ifanextensionhasbeenrequested,theAdministratorwillnotifytheclaimantofitsdecisionpriortotheendofthe15-dayextensionperiod.

Iftheclaimanthasnotprovidedalloftheinformationneededtoprocesstheclaim,theAdministratorwillnotifytheclaimantastowhatspecificinformationisneededassoonaspossible,butnotlaterthan5daysafterreceiptoftheclaim.Theclaimantwillbegivenatleast45daysfromreceiptofthenoticewithinwhichtoprovidethespecifiedinformation.

§ ConcurrentClaims:

ú Plan Notice of Reduction or Termination. If the Administrator is notifying the claimant of areductionorterminationofacourseoftreatment(otherthanbyPlanamendmentortermination),theAdministratorwillnotifytheclaimantofitsdecisionsufficientlyinadvanceofthereductionorterminationtoallowtheclaimanttoappealandobtainadeterminationonreviewofthatadversebenefitdeterminationbeforethebenefitisreducedorterminated.

ú Request by Claimant Involving Urgent Care. If the Administrator receives a request from aclaimant toextend thecourseof treatmentbeyond theperiodof timeornumberof treatmentsthat isaclaim involvingUrgentCare, theAdministratorwillnotify theclaimantof itsdecisionassoon as possible, taking into account themedical exigencies, but not later than 24 hours afterreceipt of the claim, as long as the claimant makes the request at least 24 hours prior to theexpirationof theprescribedperiodof timeornumberof treatments. If theclaimantsubmitstherequestwithlessthan24hourspriortotheexpirationoftheprescribedperiodoftimeornumberoftreatments,therequestwillbetreatedasaclaiminvolvingUrgentCareanddecidedwithintheUrgentCaretimeframe.

ú RequestbyClaimantInvolvingNon-urgentCare.IftheAdministratorreceivesarequestfromtheclaimant toextend thecourseof treatmentbeyond theperiodof timeornumberof treatmentsandtheclaimdoesnotinvolveUrgentCare,therequestwillbetreatedasanewbenefitclaimandwillbedecidedwithinthetimeframeappropriatetothetypeofclaim(eitherasaPre-ServiceNon-urgentClaimoraPost-ServiceClaim).

§ Post-ServiceClaims.Iftheclaimanthasprovidedalloftheinformationneededtoprocesstheclaim,theAdministratorwillnotify theclaimantof itsdecisionwithina reasonableperiodof time,butnot laterthan30daysafterreceiptoftheclaim,unlessanextensionhasbeenrequested,thenpriortotheendofthe15-dayextensionperiod.

If the extension described above is necessary because the claimant failed to submit the informationnecessary to decide the claim, the notice of extension must describe specifically the requiredinformation.Theclaimantshallbeaffordedatleast45daysfromthereceiptofsuchnoticewithinwhichtoprovidethespecifiedinformation.

§ Extensions – Pre-Service Urgent Care Claims. No extensions are available in connection with Pre-ServiceUrgentCareClaims.

§ Extensions–Pre-ServiceNon-urgentCareClaims.ThisperiodmaybeextendedbythePlanforupto15days, provided that the Administrator both determines that such an extension is necessary due tomattersbeyondthecontrolofthePlanandnotifiestheclaimant,priortotheexpirationoftheinitial15-


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dayprocessingperiod,ofthecircumstancesrequiringtheextensionoftimeandthedatebywhichthePlanexpectstorenderadecision.

§ Extensions–Post-ServiceClaims.ThisperiodmaybeextendedbythePlanforupto15days,providedthattheAdministratorbothdeterminesthatsuchanextensionisnecessaryduetomattersbeyondthecontrol of the Plan and notifies the claimant, prior to the expiration of the initial 30-day processingperiod,ofthecircumstancesrequiringtheextensionoftimeandthedatebywhichthePlanexpectstorenderadecision.

§ Calculating Time Periods. The period of timewithinwhich a benefit determination is required tobemade shallbeginat the timea claim isdeemed tobe filed inaccordancewith theproceduresof thePlan.

5.5 ClaimsAppealProcedureNatureofDenial.Thenoticeofadenialofaclaimshallbewrittenorinelectronicform(incompliancewithERISAregulations),ororalinthecaseofaPre-ServiceUrgentCareclaim,aslongasawrittenorelectronicnoticeisfurnishedtotheclaimantwithin3daysoftheoralnotice,andshallsetforth:

§ Thespecificreasonforthedenial;

§ SpecificreferencestothepertinentPlanprovisionsonwhichthedenialisbasedincludingacopyofanyinternalguidelineusedinthebenefitdeterminationornoticeofwhereandhowtoobtainacopyfreeofcharge;

§ Adescriptionofanyadditionalmaterialorinformationnecessaryfortheclaimanttoperfecttheclaimandanexplanationastowhysuchinformationisnecessary;

§ AnexplanationofthePlan’sclaimsappealsprocedures;

§ Claimant’srighttobringacivilactionunderERISASection502(a);

§ If the claim is denied based on medical necessity, experimental treatment, or similar exclusion orlimitation,anexplanationofthescientificorclinicaljudgmentappliedinthebenefitdetermination,ornoticeofwhereandhowtoobtainacopyfreeofcharge;and,

§ ForpurposesofPre-ServiceUrgentCareClaims,adescriptionoftheexpeditedreviewprocess.

5.6 TimingofanAppeal§ Pre-ServiceClaims For Pre-ServiceUrgentCareClaims,AppendixB contains thenamesof all appeals

contacts,addressesandphonenumbers.

§ All Other Claims.Within 180 days after the receipt of the abovematerial, the claimant shall have areasonableopportunity toappeal theclaimdenial to theAdministrator fora full and fair review.Theclaimantorhisdulyauthorizedrepresentativemay:

ú RequestareviewbyprovidingwrittennoticetotheAdministrator;

ú Submitwrittencomments,documents,recordsandotherinformationrelatingtotheclaim;and,

ú Upon request, have reasonable access to and copies of all documents, records, and otherinformationrelevanttotheclaim.

5.7 TimingofNotificationofBenefitDeterminationonReviewThe Administrator shall notify the claimant of the Plan’s benefit determination on review within thefollowingtimeframes:

§ Pre-ServiceUrgentCareClaims.Assoonaspossible,takingintoaccountthemedicalexigencies,butnotlaterthan72hoursafterreceiptoftheappeal.


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§ Pre-Service Non-urgent Care Claims.Within a reasonable period of time appropriate to themedicalcircumstances,butnotlaterthan30daysafterreceiptoftheappeal.

§ ConcurrentClaims.Theresponsewillbemadeintheappropriatetimeperiodbaseduponthetypeofclaim:Pre-ServiceUrgent,Pre-ServiceNon-urgentorPost-Service.

§ Post-ServiceClaims.Withinareasonableperiodoftime,butnotlaterthan60daysafterreceiptoftheappeal.

§ Calculating Time Periods.Theperiodof timewithinwhich thePlan'sdetermination is required tobemadeshallbeginatthetimeanappealisfiledinaccordancewiththeproceduresofthisPlan,withoutregardtowhetherallinformationnecessarytomakethedeterminationaccompaniesthefiling.

5.8 InternalReviewandDecisionFull and Fair Review. The Plan Administrator, as Plan Fiduciary, shall take into account all comments,documents, andother information submittedby the claimantwithout regard towhether the informationwas submittedwith the original claim andwithout deference to the original determination. The decisionshall be based in whole or in part on a medical judgment, with consultation with the appropriateindependenthealth careprofessionals, if the claim involves investigational or experimental treatment, orissuesofmedicalnecessity,andshallidentifysuchprofessionals.

Decision.ThedecisionofthePlanAdministratorshallbewrittenandshall includespecificreasonsforthedecision,withspecificreferencesandcopiesofthepertinentPlanprovisionsorinternalguidelineonwhichthedecisionisbased.TheclaimantshallalsohavearighttobringacivilactionunderERISASection502(a)following the denial of the appeal. If the appeal is denied based on medical necessity, experimentaltreatment, or similar exclusion or limitation, the claimant will receive an explanation of the scientific orclinicaljudgmentappliedonthebenefitdetermination,ornoticeofwhereandhowtoobtainacopy.

Second Appeal. Should the claimant receive an adverse determination of the appeal, the claimant shallhavetherighttofileasecondappeal.Thesecondappealmustbefilednolaterthan30daysfromthedateindicatedon the response letter to the firstappeal.The timingof response to thesecondappeal shallbemadeinaccordancewiththesameguidelinesasthoseoutlinedforthefirstappeal.

5.9 ExternalReviewNon-grandfatheredgrouphealthplanssubjecttoACAmustalsoofferclaimantstheopportunitytopursueExternalReviewfollowingexhaustionoftheInternalAppealsproceduressetforthinthissection.

§ Requesting an External Review. In the event that an Internal Appeal results in a denial based uponmedicaljudgmentorarescission(inwholeorinpart),theclaimantmayrequestanExternalReviewbygivingwrittennoticeoftheappealtothePlanAdministratorwithin120daysaftertheclaimantreceivesthenoticeofdecisionontheInternalAppeal.

§ Eligibility for External Review. Within 5 business days following the date of receipt of the ExternalReviewrequest,thePlanAdministratorwillcompleteapreliminaryreviewoftherequesttodeterminewhether thematter is eligible for External Review. Amatter is eligible for External Review only if itmeetsallofthefollowingrequirements:

ú The claimant is orwas covered under the Plan at the time the health care item or servicewasrequested;

ú Thedenialdoesnotrelatetotheclaimant’sfailuretomeettheeligibilityrequirementsundertheterms of the Plan (in other words, the External Review process does not apply to eligibilitydeterminations);

ú TheclaimanthasexhaustedthePlan’sInternalAppealprocess;and

ú TheclaimanthasprovidedalltheinformationrequiredtoprocessanExternalReview.


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§ Noticeof ExternalReviewEligibility.Withinone (1)businessdayaftercompletionof thepreliminaryreview,thePlanwillissueanotificationinwritingtotheclaimant.Thenotificationwilladviseclaimantthat:

ú TheclaimisnoteligibleforExternalReview;

ú TheclaimiseligibleandreadyforExternalReview;or

ú ItisunclearwhethertheclaimiseligibleforExternalReviewbecauseclaimanthasnotprovidedalltheinformationrequired.

§ ExternalReviewProcess. IftheclaimiseligibleandreadyforExternalReview,thePlanAdministratorwill assign an Independent Review Organization (IRO) that is accredited by URAC (a nonprofitorganization promoting healthcare quality by accrediting healthcare organizations) or by a similarnationallyrecognizedaccreditingorganizationtoconducttheExternalReview.

ú The IROwill timely notify the claimant in writing of the request’s eligibility and acceptance forExternalReview,includingastatementthattheclaimantmaysubmitinwriting,within10businessdays, additional information which the IRO must then consider when conducting the ExternalReview;and

ú Within5businessdaysafterthedateofassignmenttotheIRO,thePlanAdministratorwillprovidethe IRO the documents and any information considered in deciding the Initial Claim and theInternalAppeal.

ú Within 45days after it receives the request for External Review, the IROwill deliver a noticeofdecisiontoclaimant.

ú The IRO’s decision shall be binding on all parties unless and until there is a judicial decisionotherwise.

§ EligibilityforExpeditedExternalReview.Claimantmayrequestan“expedited”ExternalReviewinthefollowingcircumstances:

ú Claimant(a)hasreceivedadecisiononan initialclaiminvolvingeitherurgentcareorconcurrentcare,(b)hasfiledarequestforanappeal,and(c)hasamedicalconditionforwhichthetimeframefor completion of an appeal would seriously jeopardize claimant’s life or health or wouldjeopardizeclaimant’sabilitytoregainmaximumfunction.

ú Claimant (a) has completed an Internal Appeal, and (b) has a medical condition for which thetimeframeastandardExternalReviewwouldseriously jeopardizeclaimant’s lifeorhealth,wouldjeopardizeclaimant’sabilitytoregainmaximumfunction.

ú Claimant(a)hascompletedanInternalAppeal, (b)theAppealconcernsanadmission,availabilityof care, continued stay, or health care item or service for which claimant received emergencyservices,and(c)Claimanthasnotbeendischargedfromthefacility.

§ ExpeditedExternalReviewProcess:

ú A request for an expedited External Reviewmust be accompanied by awritten statement fromclaimant’sphysicianthatclaimant’smedicalconditionmeetsthecriteriaabove.

ú The IROwill provide notice of its decision on an expedited External Review as expeditiously asclaimant’smedicalconditionorcircumstances require,but innoeventmorethan72hoursaftertheIRO’sreceiptofclaimant’srequest. Ifthenoticeisnotinwriting,theIROwillprovidewrittennoticetoclaimantwithin48hoursafteritsdecision.


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SECTION6– THEUSEANDDISCLOSUREOFPROTECTEDHEALTHINFORMATION

6.1 HealthPlansThegrouphealthplanscontained in thisPlanwilluseprotectedhealth information (PHI) to theextentofand in accordance with the uses and disclosures permitted by the Health Insurance Portability andAccountabilityActof1996 (HIPAA).Specifically, thePlanwilluseanddisclosePHI forpurposes related tohealthcaretreatment,paymentforhealthcareandhealthcareoperations.

6.2 HealthPlanPaymentsPayment includes activities undertaken by the Plan to obtain premiums or determine or fulfill itsresponsibilityforcoverageandprovisionofPlanbenefitsthatrelatetoanindividualtowhomhealthcareisprovided.Theseactivitiesinclude,butarenotlimitedto,thefollowing:

§ determination of eligibility, coverage and cost sharing amounts (for example, cost of benefit, planmaximumsandco-paymentsasdeterminedforanindividual’sclaim);

§ adjudicationofhealthbenefitclaims(includingappealsandotherpaymentdisputes);

§ subrogationofhealthbenefitclaims;

§ establishingemployeecontributions;

§ riskadjustingamountsduebasedonenrolleehealthstatusanddemographiccharacteristics;

§ billing,collectionactivitiesandrelatedhealthcaredataprocessing;

§ claimsmanagementandrelatedhealthcaredataprocessing,includingauditingpayments,investigatingandresolvingpaymentdisputesandrespondingtoparticipantinquiriesaboutpayments;

§ obtainingpaymentunderacontractforreinsurance(includingstop-lossandexcessoflossinsurance);

§ medicalnecessityreviewsorreviewsofappropriatenessofcareorjustificationofchanges;

§ utilization review, including precertification, preauthorization, concurrent review and retrospect livereview;

§ disclosuretoconsumerreportingagenciesrelatedtothecollectionofpremiumsorreimbursement(thefollowingPHImaybedisclosedforpaymentpurposes:nameandaddress,dateofbirth,SocialSecuritynumber,paymenthistory,accountnumberandnameandaddressofproviderand/orhealthplan);and,

§ reimbursementtothePlan.

6.3 HealthCareOperationsHealthCareOperationsinclude,butarenotlimitedto,thefollowingactivities:

§ qualityassessment

§ population-based activities relating to improving health or reducing health care costs, protocoldevelopment, casemanagement and care coordination, diseasemanagement, contacting health careprovidersandpatientswithinformationabouttreatmentalternativesandrelatedfunctions;

§ ratingproviderandPlanperformance,includingaccreditation,certification,licensingandcredentialingactivities;

§ underwriting,premiumrating,andotheractivitiesrelatingtothecreation,renewalorreplacementofacontract of health insurance or health benefits, and ceding, securing or placing a contract for


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reinsurance of risk relating to health care claims (including stop-loss insurance and excess of lossinsurance);

§ conductingor arranging formedical review, legal servicesandauditing functions, including fraudandabusedetectionandcomplianceprograms;

§ business planning and development, such as conducting cost-management and planning-relatedanalyses related to managing and operating the Plan, including formulary development andadministration,developmentorimprovementofpaymentmethodorcoveragepolicies;

§ businessmanagementandgeneraladministrativeactivitiesofthePlan,including,butnotlimitedto:

ú management activities relating to the implementation of and compliance with HIPAA’sadministrativesimplificationrequirements,or

ú customerservice,includingtheprovisionofdataanalysesforpolicyholders,PlanSponsorsorothercustomers.

§ resolutionofinternalgrievances;and,

§ duediligenceinconnectionwiththesaleortransferofassetstoapotentialsuccessorininterest,ifthepotentialsuccessorininterestisa“coveredentity”underHIPAAor,followingcompletionofthesaleortransfer,willbecomeacoveredentity.

6.4 BusinessAssociatesThePlanmaydisclosePHItoitsBusinessAssociates(assuchtermisdefinedunderHIPAA)whohaveagreedinwritingtocomplywithallapplicableHIPAAregulationsforpurposesrelatedtotheadministrationofthePlan.

6.5 ThirdPartieswithAuthorizationWiththeexceptionofusesanddisclosuresofPHI forhealthcaretreatment,paymentforhealthcareandhealthcareoperations,thePlanwilldisclosePHItothirdpartiesonlyuponauthorizationbytheparticipant.The Plan will not require any participant to complete an authorization as a condition of payment,enrollmentoreligibilityforbenefits.

6.6 PlanSponsorThePlanwilldisclosePHItoHobanandAssociates,Inc.d/b/aCoastRealEstateServicesonlyuponreceiptofa certification from the Plan Sponsor that this Plan document contains the limitations and conditionsrequiredbyHIPAAandcontainedinthisSection.

6.7 ConditionsandLimitationsonUseandDisclosurebyPlanSponsorThePlanSponsoragreesto:

§ notuseorfurtherdisclosePHIotherthanaspermittedorrequiredbythePlandocumentorasrequiredbylaw;

§ ensure that any agents, including a subcontractor, to whom the Plan Sponsor provides PHI receivedfromthePlanagree inwriting to thesamerestrictionsandconditions thatapply to thePlanSponsorwithrespecttosuchPHI;

§ notuseordisclosePHIforemploymentrelatedactionsanddecisionsunlessauthorizedbyanindividual;

§ not use or disclose PHI in connection with any other benefit or employee benefit plan of the PlanSponsorunlessauthorizedbyanindividual;

§ notuseordisclosePHIthatisgeneticinformationforunderwritingpurposes;


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§ reporttothePlananyPHIuseordisclosurethatisinconsistentwiththeusesordisclosuresprovidedforofwhichitbecomesaware;

§ makePHIavailabletoanindividualinaccordancewithHIPAA’saccessrequirements;

§ makePHIavailableforamendmentandincorporateanyamendmentstoPHIinaccordancewithHIPAA;

§ makeavailabletheinformationrequiredtoprovideanaccountingofdisclosures;

§ makeinternalpractices,booksandrecordsrelatingtotheuseanddisclosuresofPHIreceivedfromthePlanavailabletotheHHSSecretaryforthepurposesofdeterminingthePlan’scompliancewithHIPAA;

§ reportbreachesofunsecuredPHIasdescribedinSection6.13;

§ iffeasible,returnordestroyallPHIreceivedfromthePlanthatthePlanSponsorstillmaintainsinanyform,andretainnocopiesofsuchPHIwhennolongerneededforthepurposeforwhichthedisclosurewas made (or if return or destruction is not feasible, limit further uses and disclosures to thosepurposesthatmakethereturnordestructioninfeasible);and

§ ensureadequateseparationbetweenthePlanandCoastRealEstateServicesasrequiredby45C.F.R.Section164.504(f)(2)(iii)anddescribedinthisPlan.

6.8 OrganizedHealthCareArrangementThePlanAdministratormay intendthePlanto formpartofanOrganizedHealthCareArrangementalongwithanyotherbenefitunderacoveredhealthplan(under45C.F.R.Section160.103)providedbyCoastRealEstateServices.

6.9 AccesstoPHIIn accordancewithHIPAA, only the followingemployeesor classesof employeesmaybe given access toPHI:

§ thePrivacyOfficer;and,

§ staffdesignatedbythePrivacyOfficer.

6.10 LimitationsofPHIAccessandDisclosureThe persons described in Section 6.9 may only have access to and use and disclose PHI for PlanadministrationfunctionsthatthePlanSponsorperformsforthePlan.

6.11 NoncomplianceIssuesIf the persons described in Section 6.9 do not comply with this Plan document, the Plan Sponsor shallprovideamechanismforresolvingissuesofnoncompliance,includingdisciplinarysanctions.

6.12 SecurityRulesCoastRealEstateServicesfurtheragreesthat if itcreates,receives,maintains,ortransmitsanyelectronicPHI (other than enrollment/disenrollment information, de-identified information or summary healthinformation, which are not subject to these restrictions) on behalf of the Plan, it will implementadministrative, physical, and technical safeguards that reasonably and appropriately protect theconfidentiality, integrity,andavailabilityof theelectronicprotectedhealth information,and itwillensurethatanyagent(includingsubcontractors)towhomitprovidessuchelectronicPHIshallagreeinwritingtoimplement reasonable and appropriate security measures to protect the information. Coast Real EstateServiceswillreporttothePlananysecurityincidentofwhichitbecomesaware.

CoastRealEstateServiceswillensurethat theprovisionsof thisSectionaresupportedbyreasonableandappropriatesecuritymeasurestotheextentthatthedesigneeshaveaccesstoelectronicPHI.


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6.13 BreachNotificationRulesIntheeventofabreachofunsecuredPHI,thePlanwillnotifyaffectedindividuals,theDepartmentofHealthand Human Services, and/or the media in the form and method described under HIPAA. A breach ispresumed to occur unless a risk analysis is performed by the Plan and the risk analysis shows a “lowprobability”thatthePHIhasbeencompromised.

6.14 HITECHRulesTotheextentthatCoastRealEstateServicestransmitshealthinformationelectronicallyinconnectionwithaCoveredTransactionasdefinedby theHIPAAPrivacyRules, it shalldoso inamannerwhichmeets thecriteria established by the Health Information Technology for Economic and Clinical Health Act of 2009(HITECH)anditsregulations.


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SECTION7– GENERALPROVISIONS

7.1 ExpensesAllcostsandexpensesincurredinadministeringthePlanandotheradministrativeexpensesshallbepaidbyCoastRealEstateServices.

7.2 NonassignabilityItisaconditionofthePlan,andallrightsofeachpersoneligibletoreceivebenefitsunderthePlanshallbesubjectthereto,thatnorightorinterestofanysuchpersoninthePlanshallbeassignableortransferableinwholeorinpart,eitherdirectlyorbyoperationoflaworotherwise,including,butnotbywayoflimitation,execution, levy, garnishment, attachment, pledge, or bankruptcy, but excluding devolution by death ormentalincompetence,andnorightorinterestofanysuchpersoninthePlanshallbeliablefrom,orsubjectto,anyobligationorliabilityofsuchperson,includingclaimsforalimonyorthesupportofanyspouse.

7.3 EmploymentNoncontractualThePlanconfersnorightuponanyEmployeetocontinueinemployment.

7.4 PremiumsandCertainBenefitsSolelyfromGeneralAssetsThe premiums required hereunder and certain self-funded benefits will be paid solely from the generalassetsofCoastRealEstateServices.NothinghereinwillbeconstruedtorequireCoastRealEstateServicesorthePlanAdministratortomaintainanyfundorsegregateanyamountforthebenefitofanyparticipant,andnoparticipantoranyotherpersonshallhaveanyclaimsagainst,rightto,orsecurityorotherinterestin,anyfund,accountorassetofCoastRealEstateServicesfromwhichanypaymentunderthePlanmaybemade.

7.5 LimitationofBenefitsNotwithstandingtheabove,nobenefitsunderthePlanshallbeprovidedforanyPlanYeartoaparticipantwhere such benefit violates the applicable IRS rules by discriminating in favor of highly compensatedindividualsand/orkeyemployees.

7.6 NoGuaranteeofTaxConsequencesNeitherthePlanAdministratornorCoastRealEstateServicesmakesanycommitmentorguaranteethatanyamountspaidtoorforthebenefitofaparticipantunderthePlanwillbeexcludablefromtheparticipant'sgrossincomeforfederalorstatetaxnorthatanyotherfavorabletaxtreatmentwillapplytoorbeavailabletoanyparticipantwithrespecttosuchamounts.Itshallbetheobligationofeachparticipanttodeterminewhether each payment under this Plan is excludable from the participant's gross income for federal andstate tax purposes, and to notify the PlanAdministrator if the participant has reason to believe that anysuchpaymentisnotsoexcludable.

7.7 IndemnificationofCoastRealEstateServicesbyParticipantsIf any participant receives one ormore payments or reimbursements under the Plan that are not for anallowableexpense,suchparticipantshallindemnifyandreimburseCoastRealEstateServicesforanyliabilityitmayincurforfailuretowithholdfederalorstateincometaxorSocialSecuritytaxfromsuchpaymentsorreimbursement. However, such indemnification and reimbursement shall not exceed the amount ofadditional federal and state income tax that the participant would have owed if the payments orreimbursements that had been made to the participant as regular cash compensation, including theparticipant's share of any Social Security tax thatwould have been paid on such compensation, less anyadditionalincomeandSocialSecuritytaxactuallypaidbytheparticipant.


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7.8 NoticesNotices,accountingsandreportsrequiredtobegivenbythePlanAdministratortothirdpartiesotherthanPlanparticipantsmaybegivenbypersonaldeliveryorbymailaddressedtotheparty involvedat the lastaddressofsuchpartyrecordedonthegeneraladdressfilesofthePlanAdministrator.Ifgivenbymail,thedateofmailingshallbedeemedtobethedateofwhichthesamewasgivenorfurnishedtotheaddressee.The PlanAdministrator shall provide all notices to Plan participants in themanner and form required byfederalorstatelaw,includingtheuseofelectronicmeansinconformancewiththefederalrulesgoverningthismethod,ifpermitted.

7.9 GoverningLawThePlanisintendedtoconstituteawelfarebenefitplanwithinthemeaningofSection3(1)ofERISAoranyother federal law.To theextentnotpreemptedbyERISA, thisPlan shallbe interpretedandconstrued inaccordancewiththelawsoftheStateofWashington.

7.10 GenderandNumberWheneverusedinthePlan,wordsinthemasculinegendershallincludemasculineorfemininegender,andunlessthecontextotherwiserequires,wordsinthesingularshallincludetheplural,andwordsinthepluralshallincludethesingular.

INWITNESSWHEREOF,theundersignedauthorizedrepresentativehasexecutedthisamendedandrestated

Plan document this __________day of _______________________, 20____, on behalf of Hoban and

Associates, Inc. d/b/a Coast Real Estate Services to evidence the adoption of this amended and restated

Planassetforthherein.

ForHobanandAssociates,Inc.d/b/aCoastRealEstateServices

By:

Title:

Date:


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APPENDIXAHOBANANDASSOCIATES,INC.d/b/aCOASTREALESTATESERVICES

BENEFITPLAN

InsurancePolicyIssuersandContractAdministrator

IssuerNameandAddress PolicyNo. TypeofBenefit

DeltaDentalofWashington97064thAveNESeattle,WA98115

03816 Dental–PPO

LincolnFinancialGroup150NorthRadnor-ChesterRoadRadnor,PA19087

COASTREAL Life

EmployeeAssistanceProgram

VisionServicePlan(VSP)3333QualityDriveRanchoCordova,CA95670

300298050001 Vision–PPO

ContractAdministrator ContractNo. TypeofBenefit

Integraflex2402W.JeffersonStreetBoise,ID83702

— Section105Plan(HRA)

PHCS/MultiPlan,Inc.115FifthAvenueNewYork,NY10003

WCST Medical–PPO


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APPENDIXBHOBANANDASSOCIATES,INC.d/b/aCOASTREALESTATESERVICES

BENEFITPLAN

ComponentHealthPlansClaimsAppealsContactInformation

Name Phone/FAX/Address(UseAddressandPhoneNumberonIDCardifdifferent)

DeltaDentalofWashington Attn:ClaimsDepartmentDeltaDentalofWashingtonP.O.Box75983Seattle,WA98175Phone:(800)554-1907

LincolnFinancialGroup Attn:MemberServicesComPsych455N.CityfrontPlazaDriveNBCTower,13thFloorChicago,IL60611-5322Phone:(888)628-4824

VisionServicePlan(VSP) Attn:ClaimsDepartmentVSPP.O.Box385018Birmingham,AL35238-5018Phone:(800)877-7195

ClaimsAppeals:Attn:ClaimsUnitVSP3333QualityDriveRanchoCordova,CA95670Phone:(800)877-7195

ContractAdministrator Phone/FAX/Address

Integraflex Attn:HRAClaimsIntegraflex2402W.JeffersonStreetBoise,ID83702Phone;(208)287-0310Fax:(208)287-0311

PHCS/MultiPlan,Inc. Attn:ClaimsAdministrationTheLoomisCompanyP.O.Box7011Wyomissing,PA19640-6011Phone:(800)367-3721Fax:(610)374-6986


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APPENDIXCHOBANANDASSOCIATES,INC.d/b/aCOASTREALESTATESERVICES

BENEFITPLAN

EligibilityandParticipationRequirements

EmployeeClass Line(s)ofCoverage EffectiveDateofEligibility DefinitionofFull-time

RegularFull-TimeEmployees

All Firstdayofthemonthfollowing60daysofemployment

30hoursperweek

VariableHourEmployees

All Firstdayofthemonthcoincidingwithorfollowing13monthsofemployment

Averaging130hourspercalendarmonthduringtheLook-BackMeasurementPeriod

DependentEligibility§ Coverage for dependents, if elected, begins on the date employee coverage begins, unless specified

otherwiseundertheapplicableComponentPlandocument.

§ CoveragealsomaybeavailabletoeligibledomesticpartnersandtheireligibledependentsasdeterminedbytheapplicableComponentPlan.

§ Theterms,“spouse”and“dependent”shallhavethesamemeaningasusedbytheapplicableComponentPlandocument.

EligibilityRulesforVariableHourEmployeesAnemployeewhoisreasonablyexpectedtobeafull-timeemployeeasofhisorherstartdateshallbeofferedcoverageasoftheEffectiveDateofEligibilityspecifiedabove.Anemployeewhoisnotreasonablyexpectedtobeafull-timeemployeeasofhisorherstartdate(VariableHourEmployee),oranemployeewhoisseasonal(inapositionforwhichthecustomaryannualdurationofemploymentissixmonthsorless),willbedeterminedtobe or not to be a full-time employee eligible for benefits under this Plan based on the following rules incompliancewith ACA. To be considered eligible as a full-time employee under ACA rules, the employeemustworkanaverageof30hoursormoreperweekor130hourspercalendarmonth.

DeterminationofFull-TimeStatus.Inordertodeterminethefull-timestatusofanewVariableHourEmployee,CoastRealEstateServiceswillusealook-backmethodtocalculateanemployee’shoursworkedforaperiodoftimespanningaspecifiednumberofmonths(referredtoasthe“InitialMeasurementPeriod”).UponcompletionofaMeasurementPeriod,anemployeewillbeeligibleorineligibleforcoverageforapre-establishedperiodoftimeimmediatelyfollowingtheAdministrativePeriodineffectatthattime(referredtoasthe“StabilityPeriod”).

Look Back Periods Adopted by Coast Real Estate Services. For purposes of the look backmethod, Coast RealEstateServiceshasadoptedthefollowingtimeperiodsforcalculatingfull-timestatus:

§ Initial Measurement and Stability Periods: For newly hired variable hour employees, the MeasurementPeriodwill lasttwelve(12)consecutivemonthsbeginningonthefirstdayofthemonthfollowingdateofhire.Eachemployee’seligibilityforbenefitswillbeassessedduringaone(1)monthAdministrativePeriodimmediately following the Initial Measurement Period. A newly hired variable hour employee who hascompleted his or her Initial Measurement Period will be eligible or ineligible for coverage for a pre-established period of time lasting twelve (12) consecutive months immediately following theAdministrativePeriod.


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§ OngoingMeasurementPeriod:Foremployeeswhohavecompletedtheir InitialMeasurementPeriod,theOngoingMeasurementPeriodwilllasttwelve(12)consecutivemonthsbeginningonNovember1eachyearandendingonOctober31ofthefollowingcalendaryear.Eachemployee’seligibilityforbenefitswillbere-assessedduringatwo(2)monthAdministrativePeriod immediately followingtheOngoingMeasurementPeriod.

§ Ongoing Stability Period: An employee’s eligibility for benefits after a Stability Period ends will be re-determined using theOngoingMeasurement Period in effect at that time. TheOngoing Stability PeriodbeginsonJanuary1eachyearandendsonDecember31ofthesamecalendaryear.

Hours of Service Used to Calculate Full-Time Status. An “hour of service” refers to each hour for which anemployeeispaid,orentitledtopayment,fortheperformanceofdutiesforCoastRealEstateServiceswithintheUnitedStates, includingtimeduringwhichnodutiesareperformedduetovacation,holiday, illness, incapacity(includingdisability),layoff,juryduty,militaryduty,orleaveofabsence.

§ In the case of hourly employees, Coast Real Estate Services will calculate actual hours of service fromrecordsofhoursworkedandnon-workedhoursforwhichpaymentismadeordue(e.g.,vacation,holiday,illness,incapacity,etc.).

§ Forsalariedemployees,CoastRealEstateServiceswillcalculatehoursofserviceusingoneofthefollowingthreemethods:(i)actualcountingofhoursofservice;(ii)usingadays-workedequivalency(i.e.,eighthoursofserviceforeachdayforwhichtheemployeeisentitledtopayforworkedornon-workedtime);or(iii)using a weeks-worked equivalency (i.e., 40 hours of service per week for each week for which theemployeeisentitledtopayforworkedornon-workedtime).

ACArequiresemployerstouseaspecialhours-of-serviceaveragingmethodfortimeawayduetounpaid leaveunderFMLA,USERRA,orjuryduty.

BreaksinServiceAnemployeeparticipatinginthePlanwhoterminatesemploymentmaybereinstatedwithoutundergoinganewwaitingperiodforeligibility if theemployee is rehiredwithin6months fromdateof termination. IfCoastRealEstateServicesdeterminesthataVariableHourEmployeehasbeencontinuouslyemployedafterthebreak,themeasurementandstabilityperiodsthatwouldhaveappliedtotheemployeehadheorshenotexperiencedthebreakinservicewillcontinueuponrehire.

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