EMPLOYEE BENEFITS at a GLANCE ProvidersThe following is a brief summary of benefits provided to Bronson Employees. Additional information is available from Human Resources and the Summary Plan Descriptions or policies. These benefits have increased in quality and quantity over the years and represent a substantialpart of total compensation. Some benefits will be different for regularly scheduled part-time employees.

Benefit Who Pays When Eligible You Receive

Paid Time Off (PTO)* Bronson Based on contract Based on contract Time off for vacation, personal days, holidays, and illness

Medical Plan* Bronson and Employee 1st of month, following Comprehensive coverage options. Two plans available. 60 days of employment Opt out savings.

Dental Plan* Bronson and Employee 1st of month, following Comprehensive dental coverage options available with 60 days of employment orthodontics included. Two plans available.

Vision Insurance* Bronson and Employee 1st of month, following Comprehensive coverage options. Choice of two plans that 60 days of employment include eye exam and frames and lenses, or contacts.

Prescription Plan* Bronson and Employee 1st of month, following Prescription coverage included with health plans. Includes mail 60 days of employment order, network of participating retail pharmacies, and Bronson outpatient pharmacies

Flexible Spending Bronson and Employee 1st of month, following Healthcare: before-tax payroll deductions to use for eligible Accounts* 60 days of employment healthcare expenses. Dependent care: before-tax payroll deductions to use for eligible dependent/elder care expenses. Includes matching contribution from Bronson

Health Savings Account Bronson and Employee 1st of month, following Tax exempt savings account to use with a high deductible medical plan 60 days of employment for current and future medical expenses. Includes Bronson contribution.

Life Insurance* Bronson and/or Employee l Upon Employment l Amount equal to annual salary. s 1st of month, following s Dependent life insurance available for spouse/children, optional 60 days of employment supplemental life insurance for employee up to 5x base pay.

Short Term Disability* Bronson Upon Employment Full base salary coverage for short-term illness up to 26 weeks, (Non-Occupational) after an initial waiting period

Long Term Disability* Bronson Upon Employment 60% of monthly earnings up to $14,000 available for qualified disability after 180-day elimination period

Annual Retirement Bronson Must have 1,000 qualified Annual contribution to 403(b)/401(k) based on vested years of service Savings Plan hours of service, and be in accordance with Plan Provisions. Gradual Vesting of Bronson Contribution employed on December 31 Contribution: 1 year = 60%, 2 years = 80%, 3 years = 100% of the year

Bronson 403(b) Bronson and Employee Upon Employment. You must Bronson will match 50% on the first 6% of qualified pay you Matching Plan be employed on the last day contribute. Gradual Vesting of match: 1 year = 60%, of the quarter and work at 2 years = 80%, 3 years = 100%. least 250 qualified hours per quarter.

Bronson 457(b) Employee Upon Employment Pre-tax deferal plan to IRS limits; must meet minimum TSA Plan base salary criteria for participation (Non-Matching)

Critical Illness Employee 1st of month, following Insurance provides a lump sum benefit upon first diagnosis Insurance 60 days of employment of a critical illness or cancer

Bronson Outpatient Bronson Upon Employment Certain non-prescription items at a discount Pharmacy Discount

Business Travel Bronson Upon Employment Lump sum payable in the event of accidental death or Accident* dismemberment while on Bronson business

Employee Assistance Bronson Upon Employment A confidential assessment and counseling program that assists Program (EAP) employee and their dependents with any type of personal or family problem. Initial visits at no charge to employee

Bronson Athletic Club* Bronson and Employee Upon Employment 50% off initiation fee. Reimbursable monthly dues for eligible employees and if criteria is met.

DEC 2018

Providers Bronson Healthcare Group | Benefits at a Glance

Benefit Who Pays When Eligible You Receive

Accident Insurance Employee 1st of the month, following Accident insurance offered through SunLife 60 days of employment

Wellness Program Bronson 1st of the month, following Wellness dollars that can be used for a variety of services 60 days of employment

Adoption Assistance* Bronson FMLA eligibility required Financial assistance and paid leave for a legal adoption

Paternity Leave* Bronson FMLA eligibility required 2 weeks paid leave at 70% base pay within 12 weeks of birth or adoption

Certification Assistance* Bronson 1st of month following Financial assistance for eligible certification course that is not 90 days of employment a job requirement

Emergency/Back up Bronson and Employee Upon Employment Back up day care at designated center Child Care

Service Awards Bronson Recognition every 5 years Special events and gifts awarded to qualified employees in beginning with 5th anniversary recognition of service

Tuition Assistance* Bronson 1st of month, following Financial support based upon “approved hours” and 90 days of employment course level

KVCC Classes Bronson 1,000+ hours in past 360 days, Maximum assistance of 8 credit hours and may include tuition and PRN status and in good standing fees, books, and supplies

Certification/Advanced Bronson 1st of month, following A one-time bonus to employees who receive a Bronson-recognized Degree Bonus* 90 days of employment certification, registration, licensure or educational degree

Concierge Services Bronson and Employee Upon Employment A wide range of services available to employees, i.e. dry cleaning, mailing, stamps, etc.

Next Generation Bronson Employees with 2 or more Financial assistance for tuition, class fees, and text books Scholarship Program consecutive years of service (determined annually based on budget) (1,000 hours or more per year)

Funeral Leave Bronson Upon Employment Paid time off for 3 scheduled days to attend a funeral for an immediate family member

Jury Duty Leave Bronson Upon Employment Full pay for regular scheduled hours of work missed

Family Medical Leave* Bronson In accordance with federal Time off for serious medical condition of self, parent, child or regulations spouse; birth and adoption

Personal Leave Bronson Varies Time off for medical, birthing/adoption, or education. Details are specific to purpose of leave

Pet Insurance Employee Upon Employment Choice of plans and coverage levels for a variety of animals

Hyatt Legal Plan Employee 1st of month, following Legal plan that covers a wide range of personal legal services 60 days of employment

Identity Theft Employee 1st of month, following Identity theft protection from InfoArmor 60 days of employment

* Eligibility requirement: Assigned to an approved position of 48 hours or more per pay period.

*Effective first of the monthfollowing 60 days of employment

EMPLOYEE CONTRIBUTIONS PER PAY PERIOD

Salary Band: $0 – $37,470.00

Salary Band: $37,470.01 – $74,940.00

Salary Band: $74,940.01 – $124,900.00

Salary Band: $124,900.01 – $250,000.00

Salary Band: $250,000.01 +

Choice of Physicians and Hospitals

Deductible

EMPLOYEE HEALTH/DENTAL/VISION BENEFIT SUMMARIES

1Benefits Summaries Calendar Year 2020

This summary of benefits applies to the year 2020

Bronson Medical Plan

Bronson: Bronson Methodist Hospital; Bronson LakeView Hospital; Bronson Battle Creek

Blue Cross Blue Shield (BCBS) Network:participating providers

Out of Network: hospital and providers not participating in the Network

Employee Only . . . . . . . . . . . . . . . . $35.35

Employee + 1 Child . . . . . . . . . . . . . $70.70

Employee + Spouse . . . . . . . . . . . . . $85.85

Employee + Family . . . . . . . . . . . . $116.15

Employee Only . . . . . . . . . . . . . . . . $38.75

Employee + 1 Child . . . . . . . . . . . . $73.41

Employee + Spouse . . . . . . . . . . . . . $92.03

Employee + Family . . . . . . . . . . . . $122.82

Employee Only . . . . . . . . . . . . . . . . $50.47

Employee + 1 Child . . . . . . . . . . . . $85.49

Employee + Spouse . . . . . . . . . . . . $111.24

Employee + Family . . . . . . . . . . . . $157.59

Employee Only . . . . . . . . . . . . . . . . $60.90

Employee + 1 Child . . . . . . . . . . . . $97.65

Employee + Spouse . . . . . . . . . . . . $123.90

Employee + Family . . . . . . . . . . . . $173.25

Employee Only . . . . . . . . . . . . . . . . $74.90

Employee + 1 Child . . . . . . . . . . . $112.35

Employee + Spouse . . . . . . . . . . . . $139.10

Employee + Family . . . . . . . . . . . . $197.95

No restrictions on choice of providers. Maximum benefit received at a Bronson facility or in network provider/facility.

Bronson $300 individual / $600 family(Deductible waived for preventive services)

BCBS Network$500 individual / $1,000 family(Deductible waived for preventive services)

Out of Network $1,000 individual / $2,000 family

Bronson High Deductible Health PlanBronson: Bronson Methodist Hospital; Bronson LakeView Hospital; Bronson Battle Creek

Blue Cross Blue Shield (BCBS) Network:participating providers

Out of Network: hospital and providers not participating in the Network

Employee Only . . . . . . . . . . . . . . . . $15.15

Employee + 1 Child . . . . . . . . . . . . . $30.30

Employee + Spouse . . . . . . . . . . . . . $45.45

Employee + Family . . . . . . . . . . . . . $60.60

Employee Only . . . . . . . . . . . . . . . . $16.78

Employee + 1 Child . . . . . . . . . . . . . $34.51

Employee + Spouse . . . . . . . . . . . . . $50.06

Employee + Family . . . . . . . . . . . . . $67.63

Employee Only . . . . . . . . . . . . . . . . $28.84

Employee + 1 Child . . . . . . . . . . . . . $44.29

Employee + Spouse . . . . . . . . . . . . . $75.19

Employee + Family . . . . . . . . . . . . . $90.64

Employee Only . . . . . . . . . . . . . . . . $34.65

Employee + 1 Child . . . . . . . . . . . . . $50.40

Employee + Spouse . . . . . . . . . . . . . $80.85

Employee + Family . . . . . . . . . . . . $102.90

Employee Only . . . . . . . . . . . . . . . . $42.80

Employee + 1 Child . . . . . . . . . . . . . $58.85

Employee + Spouse . . . . . . . . . . . . . $90.95

Employee + Family . . . . . . . . . . . . $117.70

No restrictions on choice of providers. Maximum benefit received at a Bronson facility or in network provider/facility.

Bronson$1,400 individual / $2,800 family(Deductible waived for preventive services.All other benefits including prescriptions are subject to the deductible.)

BCBS Network$1,600 individual / $3,200 family(Deductible waived for preventive services.All other benefits including prescriptions are subject to the deductible.)

Out of Network $3,500 individual / $7,000 family

www.mybronsonbenefits.com

Benefits Summaries Calendar Year 20202

Specific Co-pays

Out of Pocket Limit(see Prescription section for Out of Pocket limits)

Hospitalization and Inpatient Surgery:1. Semi-Private Room and Board (includes Intensive

Care Unit and other special care unit charges)2. Physician and Alternative Healthcare Provider

Fees, other than for Inpatient treatment of Mental Health, Alcoholism and Substance Abuse (Reasonable & Customary)

Outpatient Surgery:1. Facility charge2. Physician and Alternative Healthcare Provider

Fees (Reasonable & Customary)

Diagnostic X-Rays and Laboratory Fees:1. Facility charge2. Physician and Alternative Healthcare Provider

Fees (Reasonable & Customary)

Emergency Medical Care — If the Emergency Medical Condition* is life threatening, as determined by the Plan and treatment thereof is out of the patient’s control, Out-of-Network charges incurred within the Network Service Area will be paid at the Bronson/PPO benefit level, provided Plan Rules are followed.1. Physician or Alternative Healthcare Provider

Services (Reasonable & Customary)2. Hospital Emergency Room Services3. Professional Ambulance charges (surface and air)4. Non-emergent Emergency Room

$100 non-emergent emergency room/express care co-pay in addition to regular plan deductibles/co-insurance.

$50 emergent co-pay in addition toregular plan deductions/co-insurance(co-pay waived if admitted).

Office Visits: Bronson $20 Primary Care / $40 SpecialistOffice Visits: BCBS Network $35 Primary Care / $50 Specialist

Bronson $2,500 individual / $5,000 family

BCBS Network $2,500 individual / $5,000 family

Out of Network unlimited

1. Bronson: 85% after deductible BCBS Network: 70% after deductible All Other: 50% after deductible

2. Bronson: 85% after deductible BCBS Network: 70% after deductible All Other: 50% after deductible

1. Bronson: 85% after deductible BCBS Network: 70% after deductible All Other: 50% after deductible

2. Bronson: 85% after deductible BCBS Network: 70% after deductible All Other: 50% after deductible

1. Bronson: 85% after deductible BCBS Network: 70% after deductible All Other: 50% after deductible

2. Bronson: 85% after deductible BCBS Network: 70% after deductible All Other: 50% after deductible

1. Bronson: 85% after deductible BCBS Network: 70% after deductible All Other: 70% after deductible

2. Bronson: 85% after deductible BCBS Network: 70% after deductible All Other: 70% after deductible

3. Bronson: 85% after deductible BCBS Network: 70% after deductible All Other: 70% after deductible

4. Bronson: 50% after deductible BCBS Network: Not covered All Other: Not covered

$100 non-emergent emergency room/express care co-pay in addition to regular plan deductibles/co-insurance.

$50 emergent co-pay in addition toregular plan deductions/co-insurance(co-pay waived if admitted).

Bronson $4,500 individual / $9,000 family (includes deductible and co-pays and prescription costs)

BCBS Network $4,500 individual / $9,000 family (includes deductible and co-pays)

Out of Network unlimited

1. Bronson: 90% after deductible BCBS Network: 70% after deductible All Other: 50% after deductible

2. Bronson: 90% after deductible BCBS Network: 70% after deductible All Other: 50% after deductible

1. Bronson: 90% after deductible BCBS Network: 70% after deductible All Other: 50% after deductible

2. Bronson: 90% after deductible BCBS Network: 70% after deductible All Other: 50% after deductible

1. Bronson: 90% after deductible BCBS Network: 70% after deductible All Other: 50% after deductible

2. Bronson: 90% after deductible BCBS Network: 70% after deductible All Other: 50% after deductible

1. Bronson: 90% after deductible BCBS Network: 70% after deductible All Other: 70% after deductible

2. Bronson: 90% after deductible BCBS Network: 70% after deductible All Other: 70% after deductible

3. Bronson: 90% after deductible BCBS Network: 70% after deductible All Other: 70% after deductible

4. Bronson: 50% after deductible BCBS Network: Not covered All Other: Not covered

Bronson Medical Plan Bronson HDHP

Covered Services

*An Emergency Medical Condition is defined as:• acute symptoms that occur suddenly and unexpectedly• prompt care that must be secured within 24 hours of onset• a condition in which failure to render treatment could result in placing the patient’s permanent

health in jeopardy and/or causing impairment to bodily functions

Benefits Summaries Calendar Year 20203

Rehabilitation Therapy ServicesPhysician referral is not needed for physical therapy up to 21 days or 10 visits, whichever come first.

Treatment of Mental or Nervous Disorders and Substance Abuse

Charges for mammographies(Reasonable & Customary)

Eligible Preventive Care Services1. Facility charge2. Physician or Alternative Healthcare Provider

Fees (Reasonable & Customary)

Charges for voluntary sterilizations (the Plan does not cover sterilization reversals or any complications thereof):1. Facility charge2. Physician and Alternative Healthcare Provider

Fees (Reasonable & Customary)

Infertility/Genetic Counseling(Note: Charges related to infertilitydiagnosis/testing. All other exclusions apply.)1. Facility charge2. Physician and Alternative Healthcare Provider

Fees (Reasonable & Customary)

Pregnancy Related Physician and Alternative Healthcare (Reasonable & Customary). Maternity Care includes pre/post-natal care, and well baby care. Home delivery is not covered under the Plan.

Other Physician and AlternativeHealthcare Provider services performed in the office setting, including:1. Illness and Injury care, dermatology services,

allergy services and antibiotic injections, and other injectibles with an office visit charge

2. Other services without an office visit charge

Home Health CareHome Health Care in lieu of hospitalization (Alternative Healthcare Benefits require precertification with ABS)

Bronson: 85% after deductibleBCBS Network: 70% after deductibleAll Other: 50% after deductible

Inpatient (Obtain Precertification) Bronson: 85% after deductible BCBS Network: 85% after deductible All Other: 50% after deductible

Outpatient Bronson: $20 co-pay BCBS Network: $20 co-pay Out of Network: 50% after deductible

Bronson: 100% (deductible waived)BCBS Network: 70% after deductibleAll Other: 50% after deductible

1. Bronson: 100% BCBS Network: 100% All Other: 50% after deductible

2. Bronson: 100% BCBS Network: 100% All Other: 50% after deductible

1. Bronson: 85% after deductible BCBS Network: 70% after deductible All Other: 50% after deductible

2. Bronson: 85% after deductible BCBS Network: 70% after deductible All Other: 50% after deductible

1. Bronson: 85% after deductible BCBS Network: Not covered All Other: Not covered

2. Bronson: 85% after deductible BCBS Network: 70% after deductible All Other: 50% after deductible

Bronson: 85% after deductibleBCBS Network: 70% after deductibleAll Other: 50% after deductible

1. Bronson: Primary care physician: $20 co-pay Specialist: $40 co-pay BCBS Network: Primary care physician: $35 co-pay Specialist: $50 co-pay Out of Network: 50% after deductible

2. Bronson: 85% after deductible BCBS Network: 70% after deductible Out of Network: 50% after deductible

Bronson: 85% after deductibleBCBS Network: Not coveredAll Other: Not covered

Bronson: 90% after deductibleBCBS Network: 70% after deductibleAll Other: 50% after deductible

Inpatient (Obtain Precertification) Bronson: 90% after deductible BCBS Network: 90% after deductible All Other: 50% after deductible

Outpatient Bronson: 90% after deductible BCBS Network: 90% after deductible All Other: 50% after deductible

Bronson: 100% (deductible waived)BCBS Network: 70% after deductibleAll Other: 50% after deductible

1. Bronson: 100% BCBS Network: 100% All Other: 50% after deductible

2. Bronson: 100% BCBS Network: 100% All Other: 50% after deductible

1.Bronson: 90% after deductible BCBS Network: 70% after deductible All Other: 50% after deductible

2. Bronson: 90% after deductible BCBS Network: 70% after deductible All Other: 50% after deductible

1. Bronson: 90% after deductible BCBS Network: Not covered All Other: Not covered

2. Bronson: 90% after deductible BCBS Network: 70% after deductible All Other: 50% after deductible

Bronson: 90% after deductibleBCBS Network: 70% after deductibleAll Other: 50% after deductible

Bronson:90% after deductibleBCBS Network:70% after deductibleOut of Network: 50% after deductible

Bronson: 90% after deductibleBCBS Network: Not coveredAll Other: Not covered

Bronson Medical Plan Bronson HDHPCovered Services

Benefits Summaries Calendar Year 20204

Alternative Healthcare Benefits (Alternative Healthcare Benefits require precertification with the Nurse Reviewer): Skilled Nursing Facility Care — If provided at a Bronson-approved facility or if

provided in lieu of hospitalization

Hospice(Alternative Healthcare Benefits require precertification with the Nurse Reviewer)

Alternative Healthcare Benefits(Alternative Healthcare Benefits require

precertification with ABS):1. Non-emergency Transportation by Professional Ambulance2. Second Surgical Opinion (Physician and

Alternative Healthcare Provider Fees (Reasonable & Customary)

Durable Medical Equipment (normal wear and damage are not covered under the Plan. Reasonable & Customary). Amounts over $1,000 require precertification

All Other Eligible Expenses (Reasonable & Customary)

Temporomandibular Joint Dysfunction (TMJ)

Transplants*

Bariatric Surgery/Services and Complication (must complete required pre-program)

Motor Vehicle Accident

Bronson: 85% after deductibleBCBS Network: 70% after deductibleAll Other: 50% after deductible

Bronson: 85% after deductibleBCBS Network: 70% after deductibleAll Other: 50% after deductible

Bronson: 85% after deductibleBCBS Network: 70% after deductibleAll Other: 50% after deductible

Bronson: 85% after deductibleBCBS Network: 70% after deductibleAll Other: 50% after deductible

Bronson: 85% after deductibleBCBS Network: 70% after deductibleAll Other: 50% after deductible

Bronson: 85% after deductibleBCBS Network: 70% after deductibleAll Other: 50% after deductible

Bronson: 85% after deductibleBCBS Network: 70% after deductibleAll Other: 50% after deductible

*Obtain precertification

Bronson: 85% after deductibleObtain precertificationBCBS Network: 70% after deductibleObtain precertificationAll Other: Not covered

Plan is considered secondary carrierregardless of PIP coverage

Bronson: 90% after deductibleBCBS Network: 70% after deductibleAll Other: 50% after deductible

Bronson: 90% after deductibleBCBS Network: 70% after deductibleAll Other: 50% after deductible

Bronson: 90% after deductibleBCBS Network: 70% after deductibleAll Other: 50% after deductible

Bronson: 90% after deductibleBCBS Network: 70% after deductibleAll Other: 50% after deductible

Bronson: 90% after deductibleBCBS Network: 70% after deductibleAll Other: 50% after deductible

Bronson: 90% after deductibleBCBS Network: 70% after deductibleAll Other: 50% after deductible

Bronson: 90% after deductibleBCBS Network: 70% after deductibleAll Other: 50% after deductible

*Obtain precertification

Bronson: 90% after deductibleObtain precertificationBCBS Network: 70% after deductibleObtain precertificationAll Other: Not covered

Plan is considered secondary carrierregardless of PIP coverage

Bronson Medical Plan Bronson HDHPCovered Services

Bronson Employees, including PRN, are eligible for certain wellness benefits.Please refer to www.mybronsonbenefits.com for a list of eligible covered services.

• There is a $500 covered dependent maximum and a $1500 family maximum for employees enrolled in the medical plan

• All other employees, including PRN, will have $250 wellness dollars annually for employees only

• All services are reimbursed at 90%

• Unused benefits dollars do not rollover to the next year

Bronson Facilities: Bronson Methodist Hospital; Bronson LakeView Hospital; Bronson Commons; Bronson Battle Creek

Blue Cross Blue Shield Network: Facilities/Providers participating with the Blue Cross Blue Shield Network. Borgess and Borgess-owned providers/facilities are exluded as well as Oaklawn Hospital and Brookside Surgery Center.

All Other: Hospitals and providers outside of Network, including Borgess-owned providers/facilities and Oaklawn Hospital.

Medical exclusions include (but not limited to): custodial care, corrective shoes, cosmetic services, eyeglasses, eye exams and materials, hearing aids, hypnotherapy, personal comfort items, spinal manipulation, and vitamins.

Benefits Summaries Calendar Year 20205

Health Savings AccountEligibilityTo participate in a Health Savings Account, you:• must be covered by the Bronson High Deductible Health Plan• cannot be covered by other health insurance• cannot be enrolled in Medicare• cannot be claimed as a dependent on someone else’s tax return

HSA Contributions: Bronson will contribute $175.00 for single coverage and $350.00 for family coverage on a quarterly basis to your established BenefitWallet health savings account. You may contribute up to the maximum IRS annual limit including the Bronson contribution. All contributions are tax-exempt for qualified medical expenses and employer contribution is excluded from income and employment taxes.

HSA 2019 IRS Contribution Age 55+ Additional Annual Limits Limit Contribution

Single $3,550 $1,000

Family $7,100 $1,000

Dental Benefitswww.deltadentalmi.com

Employee contributions per pay period for full and part-time employees (48-80 hours) (effective first of the month following 60 days of employment)

Deductible

Plan payments for • Preventive services*** • Basic services • Prosthodontic services • Orthodontia

Annual benefits for preventive, basic and prosthodontic services combined

Lifetime benefits for orthodontia

*Covers adult orthodontia **Covers orthodontia up to age 19***Preventive includes sealants / 1st molars up to age 9, 2nd molars up to age 14

Delta Dental DeluxeOPTION 1

Employee – $9.72Employee + 1 – $16.70Family – $24.13

$25 Individual / $75 Family

100%80%80%50%

$1,500

$1,500*

Delta Dental StandardOPTION 2

Employee – $1.86Employee + 1 – $4.43Family – $8.57

$25 Individual / $75 Family

80%50%50%50%

$1,000

$1,500**

Vision Benefitswww.vsp.com

Employee contributions per pay period for full and part-time employees (48-80 hours) (effective first of the month following 60 days of employment)

Co-pay • Well Vision Exams • Prescription Glasses (i.e., frames & lenses) • Contact Lens Exams (fitting & evaluation)

Benefits: • Exam • Corrective Lenses* • Frames

• Contact Lenses

Vision Service PlanHigh / OPTION 1

Employee – $6.17Employee + 1 – $10.20Family – $20.49

$15$15up to $60

Every 12 monthsEvery 12 monthsEvery 12 months, up to

$150 retail$200 allowance after

exam co-pay every 12 months in place of frames and lenses

* Tinted, progressive lenses extra

Vision Service PlanBase / OPTION 2

Employee – $1.81Employee + 1 – $2.99Family – $9.01

$15$15up to $60

Every 12 monthsEvery 12 monthsEvery 24 months, up to

$120 retail$120 allowance after

exam co-pay every 12 months in place of frames and lenses

* Tinted, progressive lenses extra

Benefits Summaries Calendar Year 20206

Prescription Drugswww.express-scripts.com

• Bronson Medical Plan: Annual deductible of $25 per person; annual Out of Pocket – $2,500/$5 ,000.

• High Deductible Health Plan: All prescriptions apply to the deductible. Once deductible is met, prescription schedule of benefits below applies.

Bronson Outpatient Pharmacies (Bronson Kalamazoo, Bronson Mattawan, Bronson Battle Creek):

1. Generic Drugs — 10% co-pay, minimum payment of $5.00 to a maximum of $75 per prescription (30 day supply)

2. Preferred Drugs — 20% co-pay, minimum payment of $10.00 to a maximum of $125 per prescription (30 day supply)

3. Non-Preferred Drugs — 30% co-pay, minimum payment of $30.00

Express Scripts® participating pharmacies, other thanBronson Outpatient Pharmacies:

1. Generic Drugs — 20% co-pay, minimum payment of $10.00 (30 day supply)

2. Preferred Drugs — 30% co-pay, minimum payment of $25.00 (30 day supply)

3. Non-Preferred Drugs — 40% co-pay, minimum payment of $45.00

Express Scripts Rx Service mail order prescriptions (90 day supply):

1. Generic Drugs — 10% co-pay, minimum payment of $15.00

2. Preferred Drugs — 20% co-pay, minimum payment of $30.00

3. Non-Preferred Drugs — 30% co-pay, minimum payment of $70.00

Note: If you elect a preferred or non-preferred brand name drug and there is a generic equivalent available you will pay the difference in cost between the brand name drug and the generic in addition to the appropriate co-pay.

• Please go to www.mybronsonbenefits.com for information regarding diabetes and insulin related medication and co-pays.

• The Patient Protection and Affordable Care Act (PPACA) requires certain categories of drugs and other products be included in preventive care services coverage payable at 100%. Please refer to www.mybronsonbenefits.com for a list of eligible medications.

• Fertility drugs are available at Bronson Outpatient Pharmacies.

• Information about the Express Scripts® formulary can be found at www.express-scripts.com.

• This plan contains certain prior authorization, quantity/dose optimization and step therapy programs. Please refer to the Bronson intranet/mybronsonbenefits for a list of specific medications and/or classes.

Important InformationBronson Utilization Review Services

Covered persons participating in the Bronson Plans are required to call BCBS to certify the following services whether provided at Bronson or any other medical facility:

1. All inpatient admissions (elective admission 7 days prior and emergency or urgent admissions within 48 hours or by the end of the next business day)

2. All outpatient surgery (7 days prior for elective or within 48 hours or by the end of the next business day for emergency surgery)

3. Durable medical equipment exceeding $1,000

4. All non-emergency ambulance transfers (prior to occurrence)

5. Home health care services (prior to occurrence)

6. Skilled Nursing Facility admissions (prior to occurrence)

7. Hospice Services (prior to occurrence)

8. Inpatient or intensive outpatient therapy for treatment of substance abuse or nervous/mental conditions (prior to occurrence)

9. Pre-authorization requirements:

Bronson Employee Authorization Department (BEAD) For those participating in the Bronson health plans, pre-authorizations

for the following services provided within the Bronson system will go through the Bronson Employee Authorization Department (BEAD). In most cases, your doctor’s office will do this for you:

• All inpatient admissions • All inpatient/outpatient surgery (7 days prior for elective, or within 48 hours by the end of the next business day for emergency surgery) • Durable medical equipment exceeding $1,000 • All non-emergency ambulance transfers (prior to occurrence) • Home healthcare services (prior to occurrence) • Skilled nursing facility admission (prior to occurrence) • Hospice services (prior to occurrence)

Call the BEAD at (269) 341-6652 if you have questions regarding the authorization or need to confirm the authorization is complete.

Automated Benefit Services (ABS) Pre-authorizations for any of the above services provided outside of

the Bronson system will continue to go through ABS. This includes any inpatient/intensive outpatient therapy for treatment of substance abuse or nervous/mental condition. In most cases, your doctor’s office will do this for you.

Call ABS at (844) 501-3466 if you have questions regarding your benefits or need to confirm the authorization is complete.

Failure to meet plan requirements will result in reduced benefits or no coverage, in accordance with plan provisions.

• When seeking services from the Blue Cross Blue Shield Network, the precertification requirement may be completed for you. However, it is your responsibility to advise your physician or alternative healthcare provider of this requirement and to verify precertification of services.

• The Bronson Healthcare Group Benefit Plans define dependents as your spouse, dependent children, or adult children (including legally adopted and step-children) up to the end of the month of age 26.

• Your medical benefits coverage is coordinated with other insurance plans which may cover you or your dependents. Coverage levels are based on the Birthday Rule for all Bronson Healthcare Group Plans.

• When a Bronson Facility/Blue Cross Blue Shield Network Provider is utilized, the employee is not responsible for charges over R&C.

• Motor vehicle limitations — this plan shall always be considered the secondary carrier regardless of PIP coverage election with the auto carrier.

• NOTE: The Summary of Benefits is intended to highlight the health care coverage provided. Every effort has been made to provide an accurate description of these Plans. If there is a conflict between this material and the Plan Document, the Plan Document will govern. The Plan Document can be found on the Bronson intranet or in Human Resources.

Bronson does not discriminate on the basis of race, color, nationalorigin, sex, age or disability in its health programs and activities.

Questions?Health Plan coverage: ABS customer service . . . . . . . . . 1-844-501-3466

Prescriptions: Express Scripts . . . . . . . . . . . . . . . . . . . . . 1-800-711-0917

Delta Dental . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-800-462-7283

Vision (VSP) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-800-877-7195

Benefit Wallet . . . . . . . . . . . . . . mybenefitwallet.com • 1-877-HSA-4200

Retirement Plans, 403(b): Fidelity . . . . . . . . . . . . . . . . . 1-800-343-0860

Navia . . . . . . . . . . . . . . . . . . . . . . . customerservice@naviabenefits.com

or 1-800-669-3539

For more information on your Bronson benefits log ontowww.mybronsonbenefits.com.

Oct

ober

201

9

1 of 7

Summary of Benefits and Coverage: What this Plan Covers & What You Pay For Covered Services Coverage Period: 01/01/2018 – 12/31/2018 Bronson Healthcare Group, Inc: HDHP Plan Coverage for: Employee & Family | Plan Type: PPO

The Summary of Benefits and Coverage (SBC) document will help you choose a health plan. The SBC shows you how you and the plan would share the cost for covered health care services. NOTE: Information about the cost of this plan (called the premium) will be provided separately.

This is only a summary. For more information about your coverage, or to get a copy of the complete terms of coverage, visit www.mybronsonbenefits.com or call 1-269-341-6376. For general definitions of common terms, such as allowed amount, balance billing, coinsurance, copayment, deductible, provider, or other underlined terms see the Glossary. You can view the Glossary at www.dol.gov/ebsa/healthreform or call 1-800-211-1534 to request a copy.

Important Questions Answers Why This Matters:

What is the overall deductible?

$1,350 individual / $2,700 family for Bronson Network and BCBMS Network providers, and $3,500 individual / $7,000 family for Non-Network providers. Copays and coinsurance do not count toward the deductible.

Generally, you must pay all of the costs from providers up to the deductible amount before this plan begins to pay. If you have other family members on the plan, the overall family deductible must be met before the plan begins to pay.

Are there services covered before you meet your deductible?

Yes. Preventive care services are covered before you meet your deductible.

This plan covers some items and services even if you haven’t yet met the deductible amount. But a copayment or coinsurance may apply. For example, this plan covers certain preventive services without cost-sharing and before you meet your deductible. See a list of covered preventive services at https://www.healthcare.gov/coverage/preventive-care-benefits/.

Are there other deductibles for specific services?

No. You don’t have to meet deductible for specific services.

What is the out-of-pocket limit for this plan?

Yes. $4,500 individual / $9,000 family for Bronson Network and BCBMS Network providers, and Unlimited individual / Unlimited family for Out-of-Network providers.

The out-of-pocket limit is the most you could pay in a year for covered services. If you have other family members in this plan, they have to meet their own out-of-pocket limits until the overall family out-of-pocket limit has been met.

What is not included in the out-of-pocket limit?

Premiums, balance-billing charges, pre-admission review penalties and health care this plan doesn’t cover.

Even though you pay these expenses, they don’t count toward the out–of–pocket limit.

Will you pay less if you use a network provider?

Yes. See www.abs-tpa.com for a list of network providers.

You pay the least if you use a provider in Bronson Network. You pay more if you use a provider in BCBSM Network. You will pay the most if you use an out-of-network provider, and you might receive a bill from a provider for the difference between the provider’s charge and what your plan pays (balance billing).

Do you need a referral to see a specialist? No. You can see the specialist you choose without a referral.

2 of 7

All copayment and coinsurance costs shown in this chart are after your deductible has been met, if a deductible applies.

Common Medical Event Services You May Need

What You Will Pay

Limitations, Exceptions, & Other Important Information

Bronson Network

Provider (You will pay the

least)

BCBSM Network Provider

Non-Network Provider

(You will pay the most)

If you visit a health care provider’s office or clinic

Primary care visit to treat an injury or illness 10% coinsurance 30% coinsurance 50% coinsurance –––––––––––none–––––––––––

Specialist visit 10% coinsurance 30% coinsurance 50% coinsurance –––––––––––none–––––––––––

Preventive care/screening/ immunization

No charge Deductible does not apply

No charge Deductible does not apply

50% coinsurance You may have to pay for services that aren’t preventive. Ask your provider if the services needed are preventive. Then check what your plan will pay for.

If you have a test

Diagnostic test (x-ray, blood work) 10% coinsurance 30% coinsurance 50% coinsurance –––––––––––none–––––––––––

Imaging (CT/PET scans, MRIs) 10% coinsurance 30% coinsurance 50% coinsurance –––––––––––none–––––––––––

If you need drugs to treat your illness or condition More information about prescription drug coverage is available at www.express-scripts.com

Generic drugs 10% coinsurance ($5 minimum, $75 maximum) (retail and mail order)

20% coinsurance ($10 minimum) (retail) / 10% coinsurance ($15 minimum) (mail order)

20% coinsurance ($10 minimum) (retail) / 10% coinsurance ($15 minimum) (mail order)

Covers up to a 30-day supply (retail prescription); 90-day supply (mail order prescription). Speciality drugs coverage is limited a 30-day supply.

Preferred brand drugs

20% coinsurance ($10 minimum, $125 maximum) (retail and mail order)

30% coinsurance ($25 minimum) (retail) / 20% coinsurance ($30 minimum) (mail order)

30% coinsurance ($25 minimum) (retail) / 20% coinsurance ($30 minimum) (mail order)

Non-preferred brand drugs 30% coinsurance ($30 minimum) (retail and mail order)

40% coinsurance ($45 minimum) (retail) / 30% coinsurance ($70 minimum) (mail order)

40% coinsurance ($45 minimum) (retail) / 30% coinsurance ($70 minimum) (mail order)

3 of 7

Common Medical Event Services You May Need

What You Will Pay

Limitations, Exceptions, & Other Important Information

Bronson Network

Provider (You will pay the

least)

BCBSM Network Provider

Non-Network Provider

(You will pay the most)

Specialty drugs 30% coinsurance ($30 minimum) (retail and mail order)

40% coinsurance ($45 minimum) (retail) / 30% coinsurance ($70 minimum) (mail order)

40% coinsurance ($45 minimum) (retail) / 30% coinsurance ($70 minimum) (mail order)

If you have outpatient surgery

Facility fee (e.g., ambulatory surgery center) 10% coinsurance 30% coinsurance 50% coinsurance

Some procedures require pre-certification. Services that have not been pre-certified will be subject to a reduction in eligible expenses to 50% of the fee schedule amount.

Physician/surgeon fees 10% coinsurance 10% coinsurance 50% coinsurance Some procedures require pre-certification. Services that have not been pre-certified will be subject to a reduction in eligible expenses to 50% of the fee schedule amount.

If you need immediate medical attention

Emergency room care $50 copayment then 10% coinsurance

$50 copayment then 10% coinsurance

$50 copayment then 10% coinsurance

No copayment, deductible, or coinsurance applies to Non-Network if the Network Cost Sharing Maximum has been reached.

Emergency medical transportation 10% coinsurance 10% coinsurance 10% coinsurance –––––––––––none–––––––––––

Urgent care 10% coinsurance 30% coinsurance 50% coinsurance –––––––––––none–––––––––––

If you have a hospital stay

Facility fee (e.g., hospital room) 10% coinsurance 30% coinsurance 50% coinsurance

Prior authorization is required, or benefits will be reduced by 50% of the fee schedule amount.

Physician/surgeon fees 10% coinsurance 10% coinsurance 50% coinsurance –––––––––––none–––––––––––

4 of 7

Common Medical Event Services You May Need

What You Will Pay

Limitations, Exceptions, & Other Important Information

Bronson Network

Provider (You will pay the

least)

BCBSM Network Provider

Non-Network Provider

(You will pay the most)

If you need mental health, behavioral health, or substance abuse services

Outpatient services 10% coinsurance 10% coinsurance 50% coinsurance –––––––––––none–––––––––––

Inpatient services 10% coinsurance 10% coinsurance 50% coinsurance Prior authorization is required, or benefits will be reduced by 50% of the fee schedule amount.

If you are pregnant

Office visits 10% coinsurance 10% coinsurance 50% coinsurance

Cost sharing does not apply for preventive services. Depending on the type of service, a copayment, coinsurance, or deductible may apply. Maternity care may include tests and services described elsewhere in the SBC (i.e. ultrasound). Services excluded for Dependent Daughters.

Childbirth/delivery professional services 10% coinsurance 10% coinsurance 50% coinsurance Services excluded for Dependent Daughters.

Childbirth/delivery facility services 10% coinsurance 10% coinsurance 50% coinsurance

Prior authorization is required for vaginal deliveries requiring more than a 48 hour stay and for cesarean section deliveries requiring more than a 96 hour stay, or benefits will be reduced by 50%. Services excluded for Dependent Daughters.

5 of 7

Common Medical Event Services You May Need

What You Will Pay

Limitations, Exceptions, & Other Important Information

Bronson Network

Provider (You will pay the

least)

BCBSM Network Provider

Non-Network Provider

(You will pay the most)

If you need help recovering or have other special health needs

Home health care 10% coinsurance Not covered Not covered Pre-certification required. Services that have not been pre-certified will be subject to a reduction in eligible expenses to 50% of the fee schedule amount.

Rehabilitation services 10% coinsurance 10% coinsurance 50% coinsurance –––––––––––none–––––––––––

Habilitation services 10% coinsurance 10% coinsurance 50% coinsurance –––––––––––none–––––––––––

Skilled nursing care 10% coinsurance 30% coinsurance 50% coinsurance Pre-certification required. Services that have not been pre-certified will be subject to a reduction in eligible expenses to 50% of the fee schedule amount.

Durable medical equipment 10% coinsurance 10% coinsurance after Bronson Network deductible

50% coinsurance after Bronson Network deductible

Pre-certification required in excess of $1,000. Services that have not been pre-certified will be subject to a reduction in eligible expenses to 50% of the fee schedule amount.

Hospice services 10% coinsurance 10% coinsurance 50% coinsurance Pre-certification required. Services that have not been pre-certified will be subject to a reduction in eligible expenses to 50% of the fee schedule amount.

If your child needs dental or eye care

Children’s eye exam Not covered Not covered Not covered Not covered. Children’s glasses Not covered Not covered Not covered Not covered. Children’s dental check-up Not covered Not covered Not covered Not covered.

6 of 7

Excluded Services & Other Covered Services: Services Your Plan Generally Does NOT Cover (Check your policy or plan document for more information and a list of any other excluded services.) • Acupuncture (if prescribed for rehabilitation

purposes) • Chiropractic care • Cosmetic surgery • Dental care (Adult)

• Hearing aids • Infertility treatment • Long-term care • Non-emergency care when traveling outside the

U.S.

• Private-duty nursing • Routine eye care (Adult) • Routine foot care • Weight loss programs

Other Covered Services (Limitations may apply to these services. This isn’t a complete list. Please see your plan document.)

• Bariatric surgery Your Rights to Continue Coverage: There are agencies that can help if you want to continue your coverage after it ends. For more information on your rights to continue coverage, contact the plan at 1-800-211-1534. You may also contact your state insurance department, the U.S. Department of Labor, Employee Benefits Security Administration at 1-866-444-3272 or www.dol.gov/ebsa/healthreform, or the U.S. Department of Health and Human Services at 1-877-267-2323 x61565 or www.cciio.cms.gov. Other coverage options may be available to you too, including buying individual insurance coverage through the Health Insurance Marketplace. For more information about the Marketplace, visit www.HealthCare.gov or call 1-800-318-2596. Your Grievance and Appeals Rights: There are agencies that can help if you have a complaint against your plan for a denial of a claim. This complaint is called a grievance or appeal. For more information about your rights, look at the explanation of benefits you will receive for that medical claim. Your plan documents also provide complete information to submit a claim, appeal, or a grievance for any reason to your plan. For more information about your rights, this notice, or assistance, contact the plan at 1-800-211-1534. You may also contact your state insurance department, the U.S. Department of Labor, Employee Benefits Security Administration at 1-866-444-3272 or www.dol.gov/ebsa/healthreform, or the U.S. Department of Health and Human Services at 1-877-267-2323 x61565 or www.cciio.cms.gov. Does this plan provide Minimum Essential Coverage? Yes If you don’t have Minimum Essential Coverage for a month, you’ll have to make a payment when you file your tax return unless you qualify for an exemption from the requirement that you have health coverage for that month. Does this plan meet the Minimum Value Standards? Yes If your plan doesn’t meet the Minimum Value Standards, you may be eligible for a premium tax credit to help you pay for a plan through the Marketplace.

––––––––––––––––––––––To see examples of how this plan might cover costs for a sample medical situation, see the next section.––––––––––––––––––––––

7 of 7

Peg is Having a Baby (9 months of in-network pre-natal care and a

hospital delivery)

Mia’s Simple Fracture (in-network emergency room visit and follow

up care)

Managing Joe’s type 2 Diabetes (a year of routine in-network care of a well-

controlled condition)

The plan’s overall deductible $1,350 Specialist coinsurance 10% Hospital (facility) coinsurance 10% Other coinsurance 10% This EXAMPLE event includes services like: Specialist office visits (prenatal care) Childbirth/Delivery Professional Services Childbirth/Delivery Facility Services Diagnostic tests (ultrasounds and blood work) Specialist visit (anesthesia)

Total Example Cost $12,800 In this example, Peg would pay:

Cost Sharing Deductibles $1,350 Copayments $20 Coinsurance $1,263

What isn’t covered Limits or exclusions $60 The total Peg would pay is $2,693

The plan’s overall deductible $1,350 Specialist coinsurance 10% Hospital (facility) coinsurance 10% Other coinsurance 10% This EXAMPLE event includes services like: Primary care physician office visits (including disease education) Diagnostic tests (blood work) Prescription drugs Durable medical equipment (glucose meter)

Total Example Cost $7,400 In this example, Joe would pay:

Cost Sharing Deductibles $1,350 Copayments $455 Coinsurance $904

What isn’t covered Limits or exclusions $55 The total Joe would pay is $2,764

The plan’s overall deductible $1,350 Specialist coinsurance 10% Hospital (facility) coinsurance 10% Other coinsurance 10% This EXAMPLE event includes services like: Emergency room care (including medical supplies) Diagnostic test (x-ray) Durable medical equipment (crutches) Rehabilitation services (physical therapy)

Total Example Cost $1,925 In this example, Mia would pay:

Cost Sharing Deductibles $1350 Copayments $0 Coinsurance $0

What isn’t covered Limits or exclusions $0 The total Mia would pay is $1,350

About these Coverage Examples:

This is not a cost estimator. Treatments shown are just examples of how this plan might cover medical care. Your actual costs will be different depending on the actual care you receive, the prices your providers charge, and many other factors. Focus on the cost sharing amounts (deductibles, copayments and coinsurance) and excluded services under the plan. Use this information to compare the portion of costs you might pay under different health plans. Please note these coverage examples are based on self-only coverage.

Note: These numbers assume the patient does not participate in the plan’s wellness program. If you participate in the plan’s wellness program, you may be able to reduce your costs. For more information about the wellness program, please contact: [insert].

1 of 7

Summary of Benefits and Coverage: What this Plan Covers & What You Pay For Covered Services Coverage Period: 01/01/2018 – 12/31/2018 Bronson Healthcare Group, Inc: 2018 Medical PPO Plan Coverage for: Employee & Family | Plan Type: PPO

The Summary of Benefits and Coverage (SBC) document will help you choose a health plan. The SBC shows you how you and the plan would share the cost for covered health care services. NOTE: Information about the cost of this plan (called the premium) will be provided separately.

This is only a summary. For more information about your coverage, or to get a copy of the complete terms of coverage, visit www.mybronsonbenefits.com or call 1-269-341-6376. For general definitions of common terms, such as allowed amount, balance billing, coinsurance, copayment, deductible, provider, or other

underlined terms see the Glossary. You can view the Glossary at www.dol.gov/ebsa/healthreform or call 1-800-211-1534 to request a copy.

Important Questions Answers Why This Matters:

What is the overall

deductible?

$250 individual / $500 family for Bronson

Network providers, $300 individual / $600 family for BCBSM Network providers and $500 individual / $1,000 family for Non-Network providers. Copays and coinsurance do not count toward

the deductible.

Generally, you must pay all of the costs from providers up to the deductible amount before this plan begins to pay. If you have other family members on the plan, each family member must meet their own individual deductible until the total amount of deductible expenses paid by all family members meets the overall family deductible.

Are there services

covered before you meet your deductible?

Yes. Bronson Network and BCBSM Network Preventive care, Bronson Network and BCBSM Network primary care services are

covered before you meet your deductible.

This plan covers some items and services even if you haven’t yet met the deductible amount. But a copayment or coinsurance may apply. For example, this plan covers

certain preventive services without cost-sharing and before you meet your deductible. See a list of covered preventive services at https://www.healthcare.gov/coverage/preventive-care-benefits/.

Are there other deductibles for specific services?

Yes. $25 for prescription drug coverage There are no other specific deductibles.

You must pay all of the costs for these services up to the specific deductible amount before this plan begins to pay for these services.

What is the out-of-pocket limit for this plan?

Yes. $2,500 individual / $5,000 family for

Bronson Network and BCBSM Network providers. Unlimited individual / Unlimited family for Non-Network providers.

The out-of-pocket limit is the most you could pay in a year for covered services.

If you have other family members in this plan, they have to meet their own out-of-pocket limits until the overall family out-of-pocket limit has been met.

What is not included in

the out-of-pocket limit?

Premiums, balance-billing charges, pre-

admission review penalties and health care this plan doesn’t cover.

Even though you pay these expenses, they don’t count toward the out–of–pocket limit.

Will you pay less if you

use a network provider?

Yes. See www.abs-tpa.com for a list of network providers.

You pay the least if you use a provider in Bronson Network. You pay more if you use

a provider in Network. You will pay the most if you use an out-of-network provider, and you might receive a bill from a provider for the difference between the provider’s charge and what your plan pays (balance billing).

Be aware, your network provider might use an out-of-network provider for some services (such as lab work). Check with your provider before you get services.

2 of 7

Do you need a referral to

see a specialist? No. You can see the specialist you choose without a referral.

All copayment and coinsurance costs shown in this chart are after your deductible has been met, if a deductible applies.

Common

Medical Event Services You May Need

What You Will Pay

Limitations, Exceptions, & Other

Important Information

Bronson

Network Provider

(You will pay the least)

BCBSM Network Provider

Non Network Provider

(You will pay the

most)

If you visit a health

care provider’s office or clinic

Primary care visit to treat an injury or illness

$25/visit

Deductible does not apply

$25/visit

Deductible does not apply

50% coinsurance –––––––––––none–––––––––––

Specialist visit $40/visit Deductible does not apply

$40/visit Deductible does not apply

50% coinsurance –––––––––––none–––––––––––

Preventive care/screening/

immunization No charge No charge 50% coinsurance

You may have to pay for services that aren’t preventive. Ask your provider if the services

needed are preventive. Then check what your plan will pay for.

If you have a test

Diagnostic test (x-ray, blood work)

15% coinsurance

30% coinsurance 50% coinsurance –––––––––––none–––––––––––

Imaging (CT/PET scans, MRIs)

15% coinsurance

30% coinsurance 50% coinsurance –––––––––––none–––––––––––

If you need drugs to

treat your illness or condition More information about prescription drug coverage is available at

www.express-scripts.com

Generic drugs

10% coinsurance ($5 minimum, $75

maximum) (retail and mail order)

20% coinsurance

($10 minimum) (retail) / 10% coinsurance ($15 minimum) (mail order)

20% coinsurance

($10 minimum) (retail) / 10% coinsurance ($15 minimum) (mail order) Covers up to a 30-day supply (retail

prescription); 90-day supply (mail order prescription). Specialty drug coverage limited to a 30-day supply.

Preferred brand drugs

20% coinsurance ($10 minimum, $125 maximum) (retail and mail

order)

30% coinsurance ($25 minimum) (retail) / 20% coinsurance ($30 minimum)

(mail order)

30% coinsurance ($25 minimum) (retail) / 20% coinsurance ($30 minimum)

(mail order)

Non-preferred brand drugs 30% 40% coinsurance 40% coinsurance

3 of 7

Common

Medical Event Services You May Need

What You Will Pay

Limitations, Exceptions, & Other

Important Information

Bronson Network Provider

(You will pay the least)

BCBSM Network

Provider

Non Network Provider

(You will pay the most)

coinsurance ($30 minimum) (retail and mail order)

($45 minimum) (retail) / 30% coinsurance ($70 minimum) (mail order)

($45 minimum) (retail) / 30% coinsurance ($70 minimum) (mail order)

Specialty drugs

30% coinsurance

($30 minimum) (retail and mail order)

40% coinsurance ($45 minimum) (retail) / 30% coinsurance ($70 minimum)

(mail order)

40% coinsurance ($45 minimum) (retail) / 30% coinsurance ($70 minimum)

(mail order)

If you have outpatient surgery

Facility fee (e.g., ambulatory surgery center)

15% coinsurance

30% coinsurance 50% coinsurance

Some procedures require pre-certification. Services that have not been pre-certified will be subject to a reduction in eligible expenses to 50% of the fee schedule amount.

Physician/surgeon fees 15% coinsurance

15% coinsurance 50% coinsurance

Some procedures require pre-certification.

Services that have not been pre-certified will be subject to a reduction in eligible expenses to 50% of the fee schedule amount.

If you need immediate medical attention

Emergency room care $50 copayment then 15% coinsurance

$50 copayment then 15% coinsurance

$50 copayment then 15% coinsurance

No copayment, deductible, or coinsurance applies to Non-Network if the Network Cost Sharing Maximum has been reached.

Emergency medical transportation

15% coinsurance

15% coinsurance 15% coinsurance –––––––––––none–––––––––––

Urgent care 15% coinsurance

30% coinsurance 30% coinsurance –––––––––––none–––––––––––

If you have a hospital stay

Facility fee (e.g., hospital room)

15% coinsurance

30% coinsurance 50% coinsurance Prior authorization is required, or benefits will be reduced by 50% of the fee schedule

amount.

Physician/surgeon fees 15% coinsurance

15% coinsurance 50% coinsurance –––––––––––none–––––––––––

4 of 7

Common

Medical Event Services You May Need

What You Will Pay

Limitations, Exceptions, & Other

Important Information

Bronson Network Provider

(You will pay the least)

BCBSM Network

Provider

Non Network Provider

(You will pay the most)

If you need mental health, behavioral health, or substance abuse services

Outpatient services 15%

coinsurance 15% coinsurance 50% coinsurance –––––––––––none–––––––––––

Inpatient services 15%

coinsurance 15% coinsurance 50% coinsurance

Prior authorization is required, or benefits will be reduced by 50% of the fee schedule amount.

If you are pregnant

Office visits 15% coinsurance

15% coinsurance 50% coinsurance

Cost sharing does not apply for preventive services.

Depending on the type of service, a copayment, coinsurance, or deductible may apply. Maternity care may include tests and

services described elsewhere in the SBC (i.e. ultrasound). Services excluded for Dependent Daughters.

Childbirth/delivery professional services

15% coinsurance

15% coinsurance 50% coinsurance Services excluded for Dependent Daughters.

Childbirth/delivery facility services

15% coinsurance

30% coinsurance 50% coinsurance

Prior authorization is required for vaginal

deliveries requiring more than a 48 hour stay and for cesarean section deliveries requiring more than a 96 hour stay, or benefits will be reduced by 50%.

Services excluded for Dependent Daughters.

If you need help recovering or have

other special health needs

Home health care 15% coinsurance

Not covered Not covered

Pre-certification required, services that have not been pre-certified will be subject to a reduction in eligible expenses to 50% of the fee schedule amount.

Rehabilitation services 15%

coinsurance 15% coinsurance 50% coinsurance –––––––––––none–––––––––––

Habilitation services 15% coinsurance

15% coinsurance 50% coinsurance –––––––––––none–––––––––––

Skilled nursing care 15% coinsurance

30% coinsurance 50% coinsurance Pre-certification required, services that have not been pre-certified will be subject to a

5 of 7

Common

Medical Event Services You May Need

What You Will Pay

Limitations, Exceptions, & Other

Important Information

Bronson Network Provider

(You will pay the least)

BCBSM Network

Provider

Non Network Provider

(You will pay the most)

reduction in eligible expenses to 50% of the fee schedule amount.

Durable medical equipment 15% coinsurance

15% coinsurance 50% coinsurance

Pre-certification required in excess of $1,000. Services that have not been pre-certified will be subject to a reudction in

elgible expenses to 50% of the fee schedule amount.

Hospice services 15% coinsurance

15% coinsurance 50% coinsurance

Pre-certification required, services that have not been pre-certified will be subject to a reduction in eligible expenses to 50% of the

fee schedule amount.

If your child needs dental or eye care

Children’s eye exam Not covered Not covered Not covered.

Children’s glasses Not covered Not covered Not covered.

Children’s dental check-up Not covered Not covered Not covered.

6 of 7

Excluded Services & Other Covered Services:

Services Your Plan Generally Does NOT Cover (Check your policy or plan document for more information and a list of any other excluded services.)

Acupuncture (if prescribed for rehabilitation purposes)

Chiropractic care

Cosmetic surgery

Dental care (Adult)

Hearing aids

Infertility treatment

Long-term care

Non-emergency care when traveling outside the U.S., its protectorates, Canada

Private-duty nursing

Routine eye care (Adult)

Routine foot care

Weight loss programs

Other Covered Services (Limitations may apply to these services. This isn’t a complete list. Please see your plan document.)

Bariatric surgery

Your Rights to Continue Coverage: There are agencies that can help if you want to continue your coverage after it ends. For more information on your rights to continue coverage, contact the plan at 1-800-211-1534. You may also contact your state insurance department, the U.S. Department of Labor, Employee Benefits

Security Administration at 1-866-444-3272 or www.dol.gov/ebsa/healthreform, or the U.S. Department of Health and Human Services at 1-877-267-2323 x61565 or www.cciio.cms.gov. Other coverage options may be available to you too, including buying individual insurance coverage through the Health Insurance Marketplace. For more information about the Marketplace, visit www.HealthCare.gov or call 1-800-318-2596. Your Grievance and Appeals Rights: There are agencies that can help if you have a complaint against your plan for a denial of a claim. This complaint is called a

grievance or appeal. For more information about your rights, look at the explanation of benefits you will receive for that medical claim. Your plan documents also provide complete information to submit a claim, appeal, or a grievance for any reason to your plan. For more information about your rights, this notice, or assistance, contact the plan at 1-800-211-1534. You may also contact your state insurance department, the U.S. Department of Labor, Employee Benefits Security Administration at 1-866-444-3272 or www.dol.gov/ebsa/healthreform, or the U.S. Department of Health and Human Services at 1-877-267-2323 x61565 or

www.cciio.cms.gov. Does this plan provide Minimum Essential Coverage? Yes If you don’t have Minimum Essential Coverage for a month, you’ll have to make a payment when you file your tax return unless you qualify for an exemption from the requirement that you have health coverage for that month.

Does this plan meet the Minimum Value Standards? Yes If your plan doesn’t meet the Minimum Value Standards, you may be eligible for a premium tax credit to help you pay for a plan through the Marketplace.

––––––––––––––––––––––To see examples of how this plan might cover costs for a sample medical situation, see the next section.––––––––––––––––––––––

7 of 7

Peg is Having a Baby (9 months of in-network pre-natal care and a

hospital delivery)

Mia’s Simple Fracture (in-network emergency room visit and follow

up care)

Managing Joe’s type 2 Diabetes (a year of routine in-network care of a well-

controlled condition)

The plan’s overall deductible $250 Specialist copayment $40 Hospital (facility) coinsurance 15%

Other coinsurance 15% This EXAMPLE event includes services like: Specialist office visits (prenatal care)

Childbirth/Delivery Professional Services Childbirth/Delivery Facility Services Diagnostic tests (ultrasounds and blood work) Specialist visit (anesthesia)

Total Example Cost $12,800

In this example, Peg would pay:

Cost Sharing

Deductibles $275

Copayments $50

Coinsurance $1,864

What isn’t covered

Limits or exclusions $60

The total Peg would pay is $2,249

The plan’s overall deductible $250 Specialist copayment $40 Hospital (facility) coinsurance 15%

Other coinsurance 15% This EXAMPLE event includes services like: Primary care physician office visits (including

disease education) Diagnostic tests (blood work) Prescription drugs Durable medical equipment (glucose meter)

Total Example Cost $7,400

In this example, Joe would pay:

Cost Sharing

Deductibles $159

Copayments $500

Coinsurance $346

What isn’t covered

Limits or exclusions $55

The total Joe would pay is $1,060

The plan’s overall deductible $250 Specialist copayment $40 Hospital (facility) coinsurance 15%

Other coinsurance 15% This EXAMPLE event includes services like: Emergency room care (including medical

supplies) Diagnostic test (x-ray) Durable medical equipment (crutches) Rehabilitation services (physical therapy)

Total Example Cost $1,925

In this example, Mia would pay:

Cost Sharing

Deductibles $250

Copayments $170

Coinsurance $245

What isn’t covered

Limits or exclusions $0

The total Mia would pay is $665

About these Coverage Examples:

This is not a cost estimator. Treatments shown are just examples of how this plan might cover medical care. Your actual costs will be

different depending on the actual care you receive, the prices your providers charge, and many other factors. Focus on the cost sharing amounts (deductibles, copayments and coinsurance) and excluded services under the plan. Use this information to compare the portion of costs you might pay under different health plans. Please note these coverage examples are based on self-only coverage.

Note: These numbers assume the patient does not participate in the plan’s wellness program. If you participate in the plan’s wellness program, you may be able to reduce your costs. For more information about the wellness program, please contact: [insert].

Memorandum To: Benefits Eligible Enrollees

From: Human Resources (269) 341-6376 Re: Important Information on Benefits Enrollment Welcome! We are pleased to welcome you to the Bronson family. As a Bronson employee you have become eligible for a wealth of benefit coverage’s. Enclosed in this packet is everything that you will need to make your benefit elections. Please be advised you will need to make your benefit elections within 30 days of your hire date. If you do not make your benefit elections within the 30-day period, you will not be eligible to enroll in any benefits until open enrollment. 401K/403B:

• Employees are eligible to begin contributing to the Bronson 401(k)/403(b) from day one

• Employees will automatically be enrolled in the Bronson 401(k)/403(b) plan with a contribution of 3% beginning the first pay following 60 days of employment.

• Employees will receive information directly to their home from Fidelity regarding how to opt-out of the savings plan. Employees may also visit www.fidelity.com or call 1-800-343-0860 at any time to modify contribution amounts.

Flexible Benefit Plan (FBP):

• Coverage begins the first of the month following 60 days of employment. • Enroll in your benefits through Workday.

*If you experience a qualified status change or certain employment status changes AND provide required documentation to Human Resources within 30 days of the event, you will be allowed to make certain benefit changes that are consistent with the status change.

Required documentation for enrolling a spouse and/or dependents (photocopies or faxes are acceptable):

• Marriage license • Birth certificate(s) for dependent children • Court ordered legal guardianship

• Court approved adoption, photocopy of placement letter from court/adoption agency or photocopy of birth certificate naming the adoptive parents as the parents

Please feel free to call Human Resources at 341-6376 with any questions.

YOUR GUIDE TO GETTING STARTED

Bronson Healthcare Group, Inc.Tax Sheltered Matching Plan

Invest in your retirement—and yourself—today, with help from

the Bronson Healthcare Group, Inc. 403(b) Plan and Fidelity.

Invest some of what you earn today for what you plan toaccomplish tomorrow.

Dear Bronson employee:

It’s a pleasure to let you know that you will be enrolled in the Bronson Healthcare Group, Inc. 403(b)Plan. Take a look and see what a difference the Plan could make in achieving your goals.

If you have not enrolled in the Bronson Healthcare Group, Inc. 403(b) Plan within 30 days of youreligibility date, you will be automatically enrolled in the Bronson Healthcare Group, Inc. 403(b) Planat a contribution rate of 3% of your pretax eligible earnings. Based on your date of birth andassuming a retirement age of 65, you will be invested in a Fidelity Freedom® Fund - Class K, with acorresponding target retirement date. We encourage you to take an active role in the BronsonHealthcare Group, Inc. 403(b) Plan and choose a contribution rate and investment options that areappropriate to you. If you do not wish to contribute to the Bronson Healthcare Group, Inc. 403(b)Plan, you must change your contribution rate to 0% within the first 30 calendar days ofyour eligibility.

Benefit from:

Matching contributions. Your Employer helps your contributions grow through a generousEmployer match—it’s like getting "free" money. That’s why it makes good financial sense to takeadvantage of this great benefit today!

Convenience. Your contributions are automatically deducted regularly from your paycheck.

Tax savings now. Your pretax contributions are deducted from your pay before income taxes aretaken out. This means that you can actually lower the amount of current income taxes you pay eachperiod. It could mean more money in your take-home pay versus saving money in ataxable account.

Tax-deferred savings opportunities. You pay no taxes on any earnings until you withdraw themfrom your account, enabling you to keep more of your money working for you now.

Online beneficiary. With Fidelity’s Online Beneficiary Service, you can designate your beneficiaries,receive instant online confirmation, and check your beneficiary virtually anytime. Please note that ifyou are married, your plan requires you to designate that your spouse receive 100% of your vestedaccount balance. If you are married and you do not designate your spouse as your primarybeneficiary for a portion of your account, your spouse must sign the spousal consent portion of theBeneficiary Designation form in the presence of a notary public.

Catch-up contributions. If you make the maximum contribution to your plan account, and you are50 years of age or older during the calendar year, you can make an additional “catch-up”contribution of $6,000 in 2018.

In addition, if you have 15 or more years of service at Bronson and have contributed less than $5,000a year, on average, to your workplace savings plan, you may be able to make additional "catch-up"contributions to your Bronson 403(b) Plan. This allows you to contribute up to a maximum of $3,000per year, up to a maximum lifetime benefit of $15,000.

To learn more about what your plan offers, see “Frequently asked questions about your plan” laterin this guide.

Participate in your plan and invest in yourself today.

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Frequently asked questions about your plan.Here are answers to questions you may have about the key features, benefits, and rules of your plan.

When can I enroll in the Plan?

If you have not enrolled in the Plan within 30days from your date of hire, you will beautomatically enrolled in the Plan at acontribution rate of 3% of your pretax eligibleearnings. Your contributions will be invested inthe Fidelity Freedom® Fund - Class K. However,we encourage you to take an active role in thePlan and to choose a contribution rate andinvestment options that are appropriate foryou. If you do not wish to contribute to thePlan, you must change your contribution rateto 0% within the first 30 days of yourEmployment. You may change yourcontribution rate at any time by logging on toNetBenefits® at www.netbenefits.com/atwork,or by calling the Fidelity Retirement BenefitsLine at 1-800-343-0860.

How do I enroll in the Plan?

● Logon to www.netbenefits.com/atwork(please note that there is a timeout after tenminutes of inactivity).

● You will need to know your Username, andyou will be asked to establish a Password.

● Follow the prompts for each section atFidelity’s online enrollment site.

● You will be notified once you havecompleted your enrollment.

To confirm your enrollment, please reviewthe summary of your information andconfirm that all information is correct. At thatpoint you will have the ability to revise anyincorrect information. Once all theinformation is confirmed and correct, please

accept the data. You may want to print out acopy of the confirmation for your records.

How much can I contribute?

Through automatic payroll deduction, youmay contribute up to 75% of your eligiblepay on a pretax basis. You can sign up bylogging on to Fidelity NetBenefits® atwww.netbenefits.com/atwork and clicking"Contribution Amount" or by calling theFidelity Retirement Benefits Line at1-800-343-0860.

What is the IRS contribution limit?

The IRS contribution limit for 2018 is$18,500.

When is my enrollment effective?

Immediately. Normally, it takes two payperiods from the date on which we receiveyour paperwork for your deductions tobegin.

Does the Employer contribute to myaccount?

You may be eligible to receive an annualBronson Contribution to your 403(b) SavingsPlan if you work at least 1,000 qualifiedhours in a year and are employed on the lastday of the year. This contribution is based onyour vested years of service:

● 2% of pay if you have less than 10 years ofvested service

● 3.5% of pay if you have 10 through 19 yearsof vested service

● 5% of pay if you have 20 or more years ofvested service

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In addition, your own contributions to thePlan will be matched quarterly by Bronson at50% of the first 6% of pay you contribute, upto 3% of your qualified earnings. You mustbe employed on the last day of the quarterand work at least 250 qualified hours perquarter with a running cumulative total of1,000 hours at the end of the year.

How do I designate my beneficiary?

If you have not already selected yourbeneficiaries, or if you have experienced alife-changing event such as a marriage,divorce, birth of a child, or a death in thefamily, it’s time to consider your beneficiarydesignations. Fidelity’s Online BeneficiariesService, available through FidelityNetBenefits®, offers a straightforward,convenient process that takes just minutes.Simply log on to NetBenefits® atwww.netbenefits.com/atwork and click onthe “Profile” link, then select “Beneficiaries”and follow the online instructions. If you donot have access to the Internet or prefer tocomplete your beneficiary information bypaper form, please call the FidelityRetirement Benefits Line at 1-800-343-0860.

What are my investment options?

To help you meet your investment goals, thePlan offers you a range of options. You canselect a mix of investment options that bestsuits your goals, time horizon, and risktolerance. The many investment optionsavailable through the Plan includeconservative, moderately conservative, andaggressive funds. A complete description ofthe Plan’s investment options and theirperformance, as well as planning tools tohelp you choose an appropriate mix, areavailable online at Fidelity NetBenefits.®

If you wish to invest beyond the the coreinvestment lineup, Bronson offers anexpanded investment lineup. For moreinformation on these expanded investmentoptions please refer to NetBenefits.

What if I don’t make an investmentelection?

We encourage you to take an active role inthe Bronson Healthcare Group, Inc. 403(b)Plan and choose investment options thatbest suit your goals, time horizon, and risktolerance. If you do not select specificinvestment options in the Plan, yourcontributions will be invested in the FidelityFreedom® Fund - Class K with the targetretirement date closest to the year youmight retire, based on your current age andassuming a retirement age of 65, at thedirection of Bronson Healthcare Group, Inc.Please refer to the chart in the InvestmentOptions section for more detail.

If no date of birth or an invalid date of birthis on file at Fidelity your contributions maybe invested in the Fidelity Freedom® IncomeFund - Class K. For more information aboutthe Fidelity Freedom® Fund - Class Koptions, log on towww.netbenefits.com/atwork.

What "catch-up" contribution can I make?

As long as you have reached or will reachage 50 by year end and are making themaximum plan or IRS pretax contribution,you may make an additional "catch-up"contribution each pay period. Goingforward, catch-up contribution limits will besubject to cost of living adjustments(COLAs) in $500 increments.

If you have 15 years or more of workexperience and have contributed less than$5,000 a year, on average, to your retirementsavings plan, you may be able to makeadditional "lifetime catch-up" contributionsto your plan, allowing you to contribute upto a maximum of $3,000 per year, up to amaximum lifetime benefit of $15,000. Pleasenote, in order to receive the maximumbenefit from the age 50 and lifetime catch-up contributions, the "lifetime catch-up"limit for a calendar year ($3,000) must beused before the Age 50+ Catch-up is

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applied. Please consult your tax advisor foradditional information.

When am I vested?

You are always 100% vested in your owncontributions to the Bronson HealthcareGroup, Inc. 403(b) Plan. If you work at least1,000 hours each plan year, the vestingschedule for the company match follows:

Years of ContinuousService

VestedPercentage

Less than 1 0%More than 1 but less than

260%

More than 2 but less than3

80%

3 or more 100%

Can I take a loan from my account?

Although your plan account is intended forthe future, you may borrow from youraccount for any reason.

To learn more about or request a loan, logon to www.netbenefits.com/atwork or callthe Fidelity Retirement Benefits Line at1-800-343-0860.

Can I make withdrawals?

Withdrawals from the Plan are generallypermitted when you terminate youremployment, retire, reach age 59½, becomepermanently disabled, have severe financialhardship, as defined by your plan.

To learn more about or request awithdrawal, log on towww.netbenefits.com/atwork or call theFidelity Retirement Benefits Line at1-800-343-0860.

Can I move money from anotherretirement plan into my account in theBronson Healthcare Group, Inc. 403(b)Plan?

You are permitted to roll over eligible pretaxcontributions from another 401(k) plan,401(a) plan, 403(b) plan or a governmental457(b) retirement plan account or eligible

pretax contributions from conduit individualretirement accounts (IRAs). A conduit IRA isone that contains only money rolled overfrom an employer-sponsored retirementplan that has not been mixed with regularIRA contributions.

Call the Fidelity Retirement Benefits Line at1-800-343-0860 or log on to FidelityNetBenefits® atwww.netbenefits.com/atwork for details.

Be sure to consider all your availableoptions and the applicable fees andfeatures of each before moving yourretirement assets.

How do I access my account?

You can access your account online throughFidelity NetBenefits® atwww.netbenefits.com/atwork or call theFidelity Retirement Benefits Line at1-800-343-0860 to speak with arepresentative or use the automated voiceresponse system, virtually 24 hours, 7 days aweek.

Keep in mind that investing involves risk.The value of your investment willfluctuate over time and you may gain orlose money.

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Investment OptionsHere is a list of investment options for the Bronson Healthcare Group, Inc.403(b) Plan. For up-to-date performance information and other fundspecifics, go to www.netbenefits.com/atwork.

Target Date Funds

Placement of investment options within each risk spectrum is only in relation to the investment options within that specific spectrum. Placement does not reflect risk relative to the investmentoptions shown in the other risk spectrums.

ptions to the left have potentiallymore inflation risk and less investment risk

ptions to the right have potentially less inflation risk and more investment risk

Investment o Investment o

Fidelity Freedom® Income Fund - Class

K

Fidelity Freedom® 2005 Fund - Class K

Fidelity Freedom® 2010 Fund - Class K

Fidelity Freedom® 2015 Fund - Class K

Fidelity Freedom® 2020 Fund - Class K

Fidelity Freedom® 2025 Fund - Class K

Fidelity Freedom® 2030 Fund - Class K

Fidelity Freedom® 2035 Fund - Class K

Fidelity Freedom® 2040 Fund - Class K

Fidelity Freedom® 2045 Fund - Class K

Fidelity Freedom® 2050 Fund - Class K

Fidelity Freedom® 2055 Fund - Class K

Fidelity Freedom® 2060 Fund - Class K

Target date investments are generally designed for investors expecting to retire around the year indicated in each investment‘sname. The investments are managed to gradually become more conservative over time. The investment risks of each target dateinvestment change over time as its asset allocation changes. They are subject to the volatility of the financial markets, includingequity and fixed income investments in the U.S. and abroad and may be subject to risks associated with investing in high yield, smallcap and foreign securities. Principal invested is not guaranteed at any time, including at or after their target dates.

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The chart below lists the assigned fund the Bronson Healthcare Group, Inc. 403(b) Plan believes willbest fit your diversification needs should you not select an investment option.

Your Birth Date* Fund Name Target Retirement Years

Before 1938 Fidelity Freedom® Income Fund - Class K Retired before 2003

January 1, 1938 - December 31, 1942 Fidelity Freedom® 2005 Fund - Class K Target Years 2003 - 2007

January 1, 1943 - December 31, 1947 Fidelity Freedom® 2010 Fund - Class K Target Years 2008 - 2012

January 1, 1948 - December 31, 1952 Fidelity Freedom® 2015 Fund - Class K Target Years 2013 - 2017

January 1, 1953 - December 31, 1957 Fidelity Freedom® 2020 Fund - Class K Target Years 2018 - 2022

January 1, 1958 - December 31, 1962 Fidelity Freedom® 2025 Fund - Class K Target Years 2023 - 2027

January 1, 1963 - December 31, 1967 Fidelity Freedom® 2030 Fund - Class K Target Years 2028 - 2032

January 1, 1968 - December 31, 1972 Fidelity Freedom® 2035 Fund - Class K Target Years 2033 - 2037

January 1, 1973 - December 31, 1977 Fidelity Freedom® 2040 Fund - Class K Target Years 2038 - 2042

January 1, 1978 - December 31, 1982 Fidelity Freedom® 2045 Fund - Class K Target Years 2043 - 2047

January 1, 1983 - December 31, 1987 Fidelity Freedom® 2050 Fund - Class K Target Years 2048 - 2052

January 1, 1988 - December 31, 1992 Fidelity Freedom® 2055 Fund - Class K Target Years 2053 - 2057

January 1, 1993 and later* Fidelity Freedom® 2060 Fund - Class K Target Years 2058 and beyond

*Dates selected by Plan Sponsor

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Core Investment Options

ft have potentially more inflation risk and less investment risk less inflation risk and more investment risk

CCONSEERVVATIIVE AGGRESSIVE

Investment options to the le Investment options to the right have potentially

SHORT-TERMINVESTMENT BOND STOCKS

Stable Value Bond Domestic Equities International/Global

Principal ® Guaranteed InterestBalance Contract

Diversified

PIMCO Total ReturnFund Institutional Class

Large Value

American BeaconLarge Cap Value FundInstitutional Class

Mid Value

Fidelity® Low-PricedStock Fund - Class K

Small Value

Columbia Small CapValue Fund IIInstitutional Class

Large Blend

Fidelity® 500 IndexFund - Premium Class

Large Growth

Fidelity® Contrafund®

- Class K

Diversified

Fidelity® DiversifiedInternational Fund -Class K

Fidelity® InternationalIndex Fund - PremiumClass

This spectrum, with the exception of the Domestic Equity category, is based on Fidelity’s analysis of the characteristics of thegeneral investment categories of the investment options and not on the actual security holdings, which can change frequently.Investment options in the Domestic Equity category are based on the options’ Morningstar categories as of 02/28/2018.Morningstar categories are based on a fund’s style as measured by its underlying portfolio holdings over the past three years andmay change at any time. These style calculations do not represent the investment options’ objectives and do not predict theinvestment options’ future styles. Investment options are listed in alphabetical order within each investment category. Riskassociated with the investment options can vary significantly within each particular investment category, and the relative risk ofcategories may change under certain economic conditions. For a more complete discussion of risk associated with the mutual fundoptions, please read the prospectuses before making your investment decision. The spectrum does not represent actual or impliedperformance.

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tions Extended Investment Options

ft have potentially more inflation risk and less investment risk less inflation risk and more investment risk

CCONSEERVVATIIVE AGGRESSIVE

Investment options to the le Investment options to the right have potentially

BOND STOCKS AND BONDS STOCKS

Bond Balanced/Hybrid Domestic Equities Specialty

Government

Fidelity® GovernmentIncome Fund

Diversified

Fidelity® U.S. Bond IndexFund - Premium Class

Fidelity® Puritan® Fund -Class K

Large Blend

Fidelity® Growth & IncomePortfolio - Class K

Mid Blend

Fidelity® Extended MarketIndex Fund - Premium Class

Small Blend

Fidelity® Small CapDiscovery Fund

Large Growth

Fidelity® Blue Chip GrowthFund - Class K

Fidelity® Growth CompanyFund - Class K

Fidelity® Real EstateInvestment Portfolio

This spectrum, with the exception of the Domestic Equity category, is based on Fidelity’s analysis of the characteristics of thegeneral investment categories of the investment options and not on the actual security holdings, which can change frequently.Investment options in the Domestic Equity category are based on the options’ Morningstar categories as of 02/28/2018.Morningstar categories are based on a fund’s style as measured by its underlying portfolio holdings over the past three years andmay change at any time. These style calculations do not represent the investment options’ objectives and do not predict theinvestment options’ future styles. Investment options are listed in alphabetical order within each investment category. Riskassociated with the investment options can vary significantly within each particular investment category, and the relative risk ofcategories may change under certain economic conditions. For a more complete discussion of risk associated with the mutual fundoptions, please read the prospectuses before making your investment decision. The spectrum does not represent actual or impliedperformance.

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Fidelity BrokerageLink®

Fidelity BrokerageLink® combines the convenience of your workplace retirement plan with the additional flexibility of a brokerage account. It gives you expanded investment choices to manage your retirement contributions.

e plan fiduciary neither evaluates nor monitors the investments available

you select are suitable for your situation, including your goals, time horizon, and risk tolerance. ee the fact sheet and commission schedule for applicablefees and risks.

Th

S

BrokerageLink® includes investments beyond those in your plan’s lineup

through BrokerageLink. It is your responsibility to ensure that the investments

.

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This information is intended to be educational and is not tailored to the investment needs of any specific investor.

This document provides only a summary of the main features of the Bronson Healthcare Group, Inc. 403(b) Plan and the PlanDocument will govern in the event of discrepancies.

The Plan is intended to be a participant-directed plan as described in Section 404(c) of ERISA, which means that fiduciaries of thePlan are ordinarily relieved of liability for any losses that are the direct and necessary result of investment instructions given by aparticipant or beneficiary.

© 2010 - 2018 FMR LLC. All rights reserved.

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New Health Insurance Marketplace Coverage Options and Your Health Coverage

PART A: General Information :

What is the Health Insurance Marketplace?

Can I Save Money on my Health Insurance Premiums in the Marketplace?

Does Employer Health Coverage Affect Eligibility for Premium Savings through the Marketplace?

How Can I Get More Information?

Form Approved OMB No. 1210-0149

5 31 2020

PART B: Information About Health Coverage Offered by Your Employer

3. Employer name 4. Employer Identification Number (EIN)

5. Employer address 6. Employer phone number

7. City 8. State 9. ZIP code

10. Who can we contact about employee health coverage at this job?

11. Phone number (if different from above) 12. Email address

13. Is the employee currently eligible for coverage offered by this employer, or will the employee be eligible inthe next 3 months?

Yes (Continue)13a. If the employee is not eligible today, including as a result of a waiting or probationary period, when is the

employee eligible for coverage? (mm/dd/yyyy) (Continue)No (STOP and return this form to employee)

14. Does the employer offer a health plan that meets the minimum value standard*?Yes (Go to question 15) No (STOP and return form to employee)

15. For the lowest-cost plan that meets the minimum value standard* offered only to the employee (don't includefamily plans): If the employer has wellness programs, provide the premium that the employee would pay if he/ shereceived the maximum discount for any tobacco cessation programs, and didn't receive any other discounts based onwellness programs.a. How much would the employee have to pay in premiums for this plan? $b. How often? Weekly Every 2 weeks Twice a month Monthly Quarterly Yearly

16. What change will the employer make for the new plan year?Employer won't offer health coverageEmployer will start offering health coverage to employees or change the premium for the lowest-cost plan available only to the employee that meets the minimum value standard.* (Premium should reflect thediscount for wellness programs. See question 15.)

a. How much would the employee have to pay in premiums for this plan? $b. How often? Weekly Every 2 weeks Twice a month Monthly Quarterly Yearly

Bronson Healthcare Group, Inc. Welfare Benefit Plan

Notice of Privacy Practices January 2017

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

This notice is being provided to you pursuant to the federal law known as HIPAA and an amendment to that law known as HITECH.

If you have any questions about this notice, please contact: Privacy Office Bronson Healthcare Group, Inc. Christine Sangalli 601 John Street, Kalamazoo, MI 49007 (269) 341-6000

Who Will Follow This Notice: This notice describes the medical information practices of all of the group health plans (collectively, the “Plan”) maintained by Bronson Healthcare Group, Inc. (the “Plan Sponsor”) and that of any third party that assists in the administration of Plan claims. The Plan has been amended to incorporate the requirements of this notice.

Our Pledge Regarding Your Protected Health Information: We understand that medical information about you and your health is personal. We are required by law to protect medical information about you. This notice applies to the medical records and information we maintain concerning the Plan. Your health care provider may have different policies or notices regarding the use and disclosure of your medical information created in the health provider’s facility. This notice, which is required by law, will tell you about the ways in which we may use and disclose medical information about you (known as “protected health information” under federal law). It also describes our obligations and your rights regarding the use and disclosure of protected health information.

HOW WE MAY USE AND DISCLOSE HEALTH INFORMATION ABOUT YOU: The following categories describe different ways that we use and disclose protected health information. For each category of uses or disclosures we will explain what we mean and present some examples. Not every use or disclosure in a category will be listed. However, all of the ways we are permitted to use and disclose information will fall within one of the categories.

For Treatment: We may use or disclose your protected health information to facilitate medical treatment or services by providers. We may disclose medical information about you to providers, including doctors, nurses, or other hospital personnel who are involved in taking care of you.

For Payment: We may use and disclose your protected health information to determine eligibility for Plan benefits, to facilitate payment for the treatment and services you receive from health care providers, or to determine benefit payment under the Plan. For example, we may tell your health care provider about your medical history to determine whether a particular treatment is experimental, investigational, or medically necessary or to determine whether the Plan will cover the treatment. We may also share your protected health information with a utilization review or precertification service provider. Likewise, we may share your protected health information with another entity to assist with the adjudication or subrogation of health claims or to another health plan to coordinate benefit payments.

For Health Care Operations: We may use and disclose your protected health information for Plan operations purposes. These uses and disclosures are necessary to run the Plan. For example, we may use your protected

2

health information in connection with: conducting quality assessment and improvement activities; underwriting, premium rating, and other activities relating to Plan coverage; submitting claims for stop-loss (or excess loss) coverage; conducting or arranging for medical review, legal services, audit services, and fraud and abuse detection programs; business planning and development such as cost management; and business management and general Plan administrative activities.

To Business Associates and Subcontractors: We may contract with individuals and entities known as Business Associates to perform various functions or provide certain services. In order to perform these functions or provide these services, Business Associates may receive, create, maintain, use and/or disclose your protected health information, but only after they sign an agreement with us requiring them to implement appropriate safeguards regarding your protected health information. For example, we may disclose your protected health information to a Business Associate to administer claims or to provide support services, but only after the Business Associate enters into a Business Associate Agreement with us. Similarly, a Business Associate may hire a Subcontractor to assist in performing functions or providing services in connection with the Plan. If a Subcontractor is hired, the Business Associate may not disclose your protected health information to the Subcontractor until after the Subcontractor enters into a Subcontractor Agreement with the Business Associate.

As Required by Law: We will disclose your protected health information when required to do so by federal, state or local law.

To Avert a Serious Threat to Health or Safety: We may use and disclose your protected health information when necessary to prevent a serious threat to your health and safety or the health and safety of the public or another person. Any disclosure, however, would only be to someone able to help prevent the threat. For example, we may disclose your protected health information in a proceeding regarding the licensure of a physician.

Disclosure to Health Plan Sponsor: Information may be disclosed to another health plan maintained by Plan Sponsor for purposes of facilitating claims payments under that plan. In addition, your protected health information may be disclosed to Plan Sponsor and its personnel for purposes of administering benefits under the Plan or as otherwise permitted by law and Plan Sponsor’s HIPAA privacy policies and procedures.

Special Situations

Organ and Tissue Donation: If you are an organ donor, we may release your protected health information to organizations that handle organ procurement or organ, eye or tissue transplantation or to an organ donation bank, as necessary to facilitate organ or tissue donation and transplantation.

Military and Veterans: If you are a member of the armed forces, we may release your protected health information as required by military command authorities. We may also release protected health information about foreign military personnel to the appropriate foreign military authority.

Workers’ Compensation: We may release your protected health information for workers’ compensation or similar programs. These programs provide benefits for work-related injuries or illnesses.

Public Health Risks: We may disclose your protected health information for public health activities, such as to prevent or control disease, injury or disability, report births and deaths, or notify a person who may have been exposed to a disease or may be at risk for contracting or spreading a disease or condition.

Health Oversight Activities: We may disclose your protected health information to a health oversight agency for activities authorized by law. These oversight activities include, for example, audits, investigations, inspections, and licensure. These activities are necessary for the government to monitor the health care system, government programs, and compliance with civil rights laws.

Law Enforcement: We may release protected health information if asked to do so by a law enforcement official in certain situations, such as: in response to a court order, subpoena, warrant, or summons; to identify or locate a

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suspect, fugitive, material witness, or missing person; about the victim of a crime if, under certain limited circumstance, we are unable to obtain the person’s agreement; or about criminal conduct.

Coroners and Medical Examiners: We may release protected health information to a coroner or medical examiner. This may be necessary, for example, to identify a deceased person or determine the cause of death.

Your Rights Regarding Your Protected Health Information

You have the following rights regarding your protected health information which we maintain:

Right to Access: You have the right to request access to the portion of your protected health information containing your enrollment, payment and other records used to make decisions about your Plan benefits. This includes the right to inspect the information as well as the right to a copy of the information. You may request that the information be sent to a third party. You must submit a request for access in writing to the Privacy Officer. If you request a copy of the information, we may charge a reasonable fee for the costs of copying, mailing or other supplies associated with your request (such as a thumb drive in the case of a request for electronic information – see next paragraph). We may deny your request to inspect and copy in certain circumstances. If you are denied access to medical information, you may request that the denial be reviewed.

If the Plan maintains your protected health information electronically in a designated record set, the Plan will provide you with access to the information in the electronic form and format you request if readily producible or, if not, in a readable electronic form and format as agreed to by the Plan and you.

Right to Amend: If you feel that protected health information we have about you is incorrect or incomplete, you may make a written request to ask us to amend the information. The request should state the reason for the amendment and the specific information being amended. The amendment must be submitted to the Privacy Officer; must be contained on one page of paper legibly handwritten or typed in at least 10 point font.

We may deny your request for an amendment if it is not in writing or does not include a reason to support the request. In addition, we may deny your request if you ask us to amend information that: is not part of the medical information kept by or for the Plan; was not created by us, unless the person or entity that created the information is no longer available to make the amendment; is not part of the information which you would be permitted to inspect and copy; or is accurate and complete.

Right to an accounting of disclosures: You have the right to request an accounting of certain disclosures of your protected health information. The accounting will not include disclosures to carry out treatment, payment and health care operations, disclosures to you about your own protected health information, disclosures pursuant to an individual authorization or other disclosures as set forth in Plan Sponsor’s HIPAA privacy policies and procedures. To request this list or accounting of disclosures, you must submit your request in writing to the Privacy Officer. Your request must state a time period which may not be longer than six years. Your request should indicate in what form you want the list (for example, paper or electronic). The first list you request within a 12 month period will be free. For additional lists, we may charge you for the reasonable costs of providing the list. We will notify you of the cost involved and you may choose to withdraw or modify your request at that time before any costs are incurred.

Effective at the time prescribed by federal regulations, you may also request an accounting of uses and disclosures of your protected health information maintained as an electronic health record in the event the Plan maintains such records.

Right to Request Restrictions: You have the right to request a restriction or limitation regarding your protected health information we use or disclose for treatment, payment or health care operations. You also have the right to request a limit on your protected health information we disclose to someone who is involved in your care or the payment for your care, like a family member or friend. For example, you could ask that we not use or disclose information about a surgery you had.

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We are not required to agree to your request.

To request restrictions, you must make your request in writing to the Privacy Officer. In your request, you must tell us: (1) What information you want to limit; (2) Whether you want to limit our use, disclosure or both; and (3) To whom you want the limits to apply, for example, disclosures to your spouse.

Right to Request Confidential Communications: You have the right to request that we communicate with you about medical matters in a certain way or at a certain location. For example, you can ask that we only contact you at work or by mail.

To request confidential communications, you must make your request in writing to the Privacy Officer. We will not ask you the reason for your request. We will accommodate all reasonable requests. Your request must specify how or where you wish to be contacted.

Right to a Paper Copy of this Notice: If you received this notice electronically, you have the right to a paper copy of this notice. You may ask us to give you a paper copy of this notice at any time. To obtain a paper copy of this notice, contact the Privacy Officer.

Genetic Information If we use or disclose protected health information for underwriting purposes with respect to the Plan, we will not (except in the case of any long term care benefits) use or disclose protected health information that is your genetic information for such purposes. Breach Notification Requirements In the event unsecured protected health information about you is “breached,” unless we determine that there is a low probability that the protected health information has been compromised, we will notify you of the situation. We will also inform HHS and take any other steps required by law. WRITTEN REQUESTS AND COMPLAINTS All written requests, or appeals, or if you are concerned your privacy rights may have been violated or you disagree with a decision we make about your medical information, you may contact our privacy office. Privacy Office Bronson Healthcare Group Christine Sangalli 601 John Street Kalamazoo, MI 49007 (269)341-6000 COPIES OF NOTICE AND CHANGES We reserve the right to change this notice. We reserve the right to make the revised or changed notice effective for protected health information we already have about you as well as any information we receive in the future. We will notify you in the event of a change. Other Uses of Your Protected Health Information

Other uses and disclosures of your protected health information not covered by this notice or applicable laws will be made only with your written permission. If you provide us permission to use or disclose your protected health information, you may revoke that permission, in writing, at any time. If you revoke your permission, we will no longer use or disclose your protected health information for the reasons covered by your written authorization. You understand that we are unable to take back any disclosures we have already made with your permission.