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2020 Benefit Summary

LIFE Senior Services | 2

Table of Contents

Benefits Overview ................................................................................................ 3

Medical Benefits .................................................................................................... 4

Teladoc.................................................................................................................. 6

Dental Benefits ...................................................................................................... 7

Vision Benefits ....................................................................................................... 8

Flexible Spending Account (FSA) ......................................................................... 9

STD Benefits ....................................................................................................... 10

LTD Benefits........................................................................................................ 11

Life and Accidental Death & Dismemberment Insurance ................................... 12

Voluntary Life and AD&D Insurance ................................................................... 13

Universal Life Insurance ..................................................................................... 14

Accident Insurance ............................................................................................. 16

Critical Illness Insurance .................................................................................... 17

Legal Plan .......................................................................................................... 19

Identity Protection Plan ...................................................................................... 20

Employee Contributions for Benefits .................................................................. 21

Contact Information ............................................................................................ 25

Legal Notices ...................................................................................................... 26

This document is an outline of the coverage proposed by the carrier(s), based on information provided by your company. It does not include all of the terms, coverage, exclusions, limitations, and conditions of the actual contract language. The policies and contracts themselves must be read for those details. Policy forms for your reference will be made available upon request.

The intent of this document is to provide you with general information regarding the status of, and/or potential concerns related to, your current employee benefits environment. It does not necessarily fully address all of your specific issues. It should not be construed as, nor is it intended to provide, legal advice. Questions regarding specific issues should be addressed by your general counsel or an attorney who specializes in this practice area.


Benefits Overview

Life Senior Services is proud to offer a comprehensive benefits package to eligible, full-time employees who work 30 hours per week and have 30 days of service. The complete benefits package is briefly summarized in this booklet.

You share the costs of some benefits, and Life Senior Services provides other benefits at no cost to you. In addition, there are voluntary benefits with reasonable group rates that you can purchase through payroll deductions.

Benefits Offered

Medical Teladoc New 2020

Dental Vision New 2020

Flexible Spending Account (FSA)

Voluntary STD LTD Life/AD&D Voluntary Life and AD&D

Universal Life New 2020

Accident New 2020

Critical Illness New 2020

Legal New 2020

Identity Protection New 2020

Eligibility

You and your dependents are eligible for LIFE Senior Services benefits on the first of the month following 30 days of employment.

Eligible dependents are your spouse, children under age 26, disabled dependents of any age, or LIFE Senior Services eligible dependents.

Elections made now will remain until the next open enrollment unless you or your family members experience a qualifying event. If you experience a qualifying event, you must contact HR within 30 days.

If you work 20 or more hours per week , you are considered Part-Time and you are eligible to enroll in the following benefits: Universal Life, Accident, Critical Illness, Legal and Identity Protection as well as the Flexible Spending Account (FSA) for both medical and dependent care accounts.

If you work 30 or more hours per week, you are considered Full-Time and you are eligible to enroll in all benefits.


Medical Benefits Administered by CommunityCare

Comprehensive and preventive healthcare coverage is important in protecting you and your family from the financial risks of unexpected illness and injury. A little prevention usually goes a long way—especially in healthcare. Routine exams and regular preventive care provide an inexpensive review of your health. Small problems can potentially develop into large expenses. By identifying the problems early, often they can be treated at little cost.

Comprehensive healthcare also provides peace of mind. In case of an illness or injury, you and your family are covered with an excellent medical plan through LIFE Senior Services.

LIFE Senior Services offers you a choice of three (3) HMO medical plans. With the HMO, you must select a primary care physician. An HMO plan does not offer out –of –network benefits unless in an emergency.

Value Plan Premier Plan In-Network In-Network

Annual Deductible $3,500 single / $7,000 family $2,000 single / $4,000 family

Annual Out-of-Pocket Maximum(includes deductible) $6,000 single / $12,000 family $5,500 single / $11,00 family

Coinsurance 20% 20%

Doctor’s Office Primary Care Office Visit $20 copay $25 copay

Specialist Office Visit $50 copay $50 copay

Preventive CareNo Charge No Charge

Diagnostic Test (x-ray/Lab) 20% 20%

Imaging (CT/PET/MRI) $750 copay 20% after deductible

Prescription Drugs Retail—Generic Drug(30-day supply)

$15 copay $15 copay

Retail—Preferred Brand Drug(30-day supply)

$40 copay $40 copay

Retail—Non-Preferred Drug(30-day supply)

$70 copay $70 copay

Retail—Specialty drug(30-day supply)

$160 copay $160 copay

Mail Order—Generic Drug(90-day supply) $30 copay $30 copay

Mail Order—Preferred Brand Drug(90-day supply) $80 copay $80 copay

Mail Order—Non-Preferred Drug(90-day supply) $140 copay $140 copay


Value Plan Premier Plan In-Network In-Network

Hospital Services

Emergency Room 20% after deductible 20% after deductible

Urgent Care $50 copay $50 copay

Inpatient Hospital 20% after deductible 20% after deductible

Outpatient Surgery 20% after deductible 20% after deductible

Mental Health/Substance Abuse Services

Inpatient 20% after deductible 20% after deductible

Outpatient Services $20 copay $25 copay

Other Services

Maternity Inpatient Services 20% after deductible 20% after deductible

Outpatient Rehabilitation Services (visit limits apply) 20% after deductible 20% after deductible


Telehealth Services Administered by Teladoc

Provides convenient care at a lower cost by giving members and their dependents an on-demand or scheduled visit with a U.S. board-certified doctor via phone or video, 24/7. Members can get resolution to episodic healthcare issues, including cold and flu, allergies, bronchitis, and so much more.

Our platform enables members to connect to our network of healthcare professionals within minutes, anytime, anywhere, 24/7.

So many reasonsto use Teladoc®!Teladoc gives you affordable, 24/7/365 access to quality medical care through the convenience of phone or video consults.

WHEN SHOULD I USE TELADOC?

• When you need care now• If your doctor is unavailable• If you’re considering the ER or

urgent care center for a non-emergency issue

• On vacation, on a business trip, oraway from home

• For short-term prescription refills

SHARE WITH YOUR PCP

With your consent, Teladoc is happy to provide information about your Teladoc consult to your primary care physician.

Talk to a doctor anytime!

Teladoc.com

1-800-Teladoc


Dental Benefits Administered by Standard using Ameritas Classic PPO Network

Good oral care enhances overall physical health, appearance and mental well-being. Problems with the teeth and gums are common and easily treated health problems. Keep your teeth healthy and your smile bright with the LIFE Senior Services dental benefit plan.

Services In-Network and Out-of-Network PPO Annual Deductible $100 per person; $300 family limit

Annual Benefit Maximum $1,000

Preventive Dental Services (cleanings, exams, x-rays) 100%; no deductible

Basic Dental Services (fillings, endodontics, periodontics, extractions) 80%

Major Dental Services (crowns, onlays, bridges, dentures, repairs) 50%

Orthodontia Services (children under 19) —12 month waiting period from date enrolled in plan 50% to $1,000 lifetime maximum

Voluntary Vision Insurance Administered by Standard with the VSP Network

Regular eye examinations can not only determine your need for corrective eyewear but also may detect general health problems in their earliest stages. Protection for the eyes should be a major concern to everyone.

Locate a VSP provider at: standard.com/services

Service In-Network(any VSP provider)

Eye Exam —once every 12 months $10 copay; covered in full

Lenses — once every 12 monthsSingle Vision Lenses $25 copay; covered in full

Lined Bifocal Lenses $25 copay; covered in fullLined Trifocal Lenses $25 copay; covered in fullLenticular Lenses $25 copay; covered in fullFrames —once every 24 months $130 allowance + 20% off

amount above allowance

Contact Lenses —once every 12 months if you elect contacts instead of lenses/frames

$130 allowance

Fit & follow up exam Up to $60

Not everyone’s personal situation is the same; your family needs may be different from the needs of your coworkers.

In recognition of these differences, we offer voluntary benefits, which you can purchase at group rates.

No need for an ID card. To take advantage of your Standard/VSP vision benefit, simply contact a VSP provider and let them know you have VSP coverage—they handle the paperwork for you. You may contact the VSP call center at 800-877-7195.


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Healthcare Flexible Spending Account

You’re paying enough for healthcare. Don’t pay taxes on it, too.

The medical, dental and vision care expenses that aren’t covered by insurance—what you pay out of your own pocket—don’t have to take such a big bite out of your budget. Use a WageWorks® Flexible Spending Account (FSA) to cover these expenses and save using pre-tax dollars.

It’s like a 30% off sale on eligible healthcare expenses.1

• Save up to 30% on things like glasses,braces and other necessities1

• Access the full amount of your annualelection on day one of your plan year

• Pick from several convenient, no-hasslepayment and reimbursement options

How does it feel to savee hundreds of dollars every year?It’s up to you. Simply decide how much to contribute to your Healthcare FSA, and funds are withdrawn from your paycheck before taxes. So you’re not paying taxes on your full income. And that feels pretty good.

If you’ve ever used an app,, you can do this. Checking your balances and managing your account is as simple as using your smartphone. Just download the EZ Receipts® mobile app by WageWorks to access your account from anywhere.

Medical Spending Account -

Dependent Care Spending Account - Save up to $5,000 per year on a pre-tax basis for qualified child care expenses.

You can spend your pre-tax medical and/or dependent care dollars through March 15th of each year. You must submit your medical and/or dependent care receipts for reimbursement no later than April 1st of each year.



This coverage replaces a portion of our income whenyou can’t work becauseof a qualifying disability.

Even if you’re healthy now, its important to protect yourself and the people who count on your income. This insurance can help you pay the bills when you’re unable to work.

Group Short Term Disability Insurance Administered by Standard

What Your Benefit Provides

This is the benefit you’d receive if you were to suffer a qualifying disability. Eligible earnings are your weekly insured predisablity earnings, as defined by the group policy. Your benefit amount will be reduced by deductible income.

60% of your eligible earnings, up to a maximum benefit of $2,500 per week. Plan minimum $15 per week.

Benefit Waiting Period

If you suffer a qualifying disability, your benefit waiting period is the length of time you must be continuously disabled before you can begin receiving your weekly benefit.

0 days for accidental injury7 days for disease, pregnancy or mental disorder

Late Enrollment Penalty

The late enrollment penalty applies if you do not apply for this coverage within 31 days of becoming eligible.

If you do not apply for coverage within 31 days of becoming eligible, your benefit waiting period for any qualifying disability caused by disease, pregnancy or mental disorder occurring during the fist 12 months of coverage will be 60 days.

How Long Your Benefits Last

This is the maximum length of time you could be eligible to receive a weekly disability benefit.

180 days

How Much Your Coverage Cost

Your employer is paying for a portion of the premium. The rate is $1.30 per $10 of weekly benefit of which you pay 30% of the cost. Your rate is shown in the calculator below.


Group Long Term Disability insurance from Standard helps provide financial protection for insured members by promising to pay a monthly benefit in the event of a covered disability.

The cost of this benefit is paid by Life Senior Services

What is your biggest asset? (Hint: It's YOU!). Think of disability insurance as insurance for a portion of your paycheck. Long Term Disability insurance helps provide financial protection by paying a monthly benefit in the event of a disability.

Monthly Benefit

This benefit provides 60% of the first $16,667 of monthly pre-disablity earnings, reduced by deductible income (e.g., work earnings, workers’ compensation, state disability, etc.)

Maximum Monthly Benefit

$10,000

Minimum Monthly Benefit

$100 or 10% of the Long Term Disability benefit before reduction by deductible income.

Benefit Waiting Period

180 days

Maximum Benefit Period

If you become disabled before age 62, Long Term Disability benefits may continue during disability until age 65 or to the Social Security Normal Retirement Age (SSNRA) or 3 years 6 months, whichever is longest. If you become disabled at age 62 or older, the benefit duration is determined by the age when disability begins. See below:

Age Maximum Benefit Period

62 To SSNRA, or 3 years 6 months, whichever is longer 63 To SSNRA, or 3 years, whichever is longer 64 To SSNRA, or 2 years 6 months, whichever is longer 65 2 years 66 1 year 9 months 67 1 year 6 months

Group Long Term Disability Insurance Administered by Standard

LIFE Senior Services| 12

Basic Life/AD&D Insurance Administered by Standard

Your Benefits

Class 1 Directors and above

$100,000

Basic Life insurance from Standard helps provide financial protection for insured members by promising to pay a benefit in the event of a members death. Basic AD&D will provide an additional amount if your death is the result of an accident.

The cost of this benefit is paid by Life Senior Services.

$100,000

$50,000$50,000

Basic Life Coverage: AD&D Coverage:

Class 2 All Others

Basic Life Coverage: AD&D Coverage:

Age Reduction

Basic Life and AD&D insurance coverage amount reduces to 65% at age 70 and to 50% at age 75.

Voluntary Life/AD&D Insurance Administered by Standard

How Much Can I Apply For?

Your combined Basic Life and additional Life amounts cannot exceed a maximum of 8x your annual earnings. The coverage amount for your spouse cannot exceed 50% of your amount. The coverage amount for your children can-non exceed 100% of your amount.

For You: $10,000-$500,000 in increments of $10,000

For Your Spouse: $5,000-$250,000 in increments of $5,000

For Your Child(ren) $2,000-$10,000 in increments of $2,000

What is the Guarantee Issue Maximum?

Depending on your eligibly, this is the maximum amount of coverage you may apply for during initial enrollment without answering health questions.

For You: Up to $150,000

For Your Spouse: Up to $25,000

For your Child(ren): Up to $10,000


Voluntary Life/AD&D Insurance Continued Administered by Standard

How Much Your Coverage Costs

Use the formula below to calculate your premium. If you are buying coverage for your spouse, you will use the same formula that you used for yourself, but use your age and your spouse’s rate.

If you buy coverage for your dependent children your monthly rate is the same no matter how many children you’re covering.

Age (as of January 1)

Your Rate (Per $1,000

of total coverage)

Your Spouses Rate (Per $1,000

of total coverage)

<30 $0.08 $0.08

30‐34 $0.10 $0.10

35‐39 $0.11 $0.11

40‐44 $0.18 $0.18

45‐49 $0.26 $0.26

50‐54 $0.41 $0.41

55‐59 $0.60 $0.60

60‐64 $0.81 $0.81

65‐69 $1.29 $1.29

70‐74 $2.08 $2.08

75+ $5.20 $5.20

Child(ren) $.23


Universal Life Insurance with Long Term Care BenefitsAdministered by Transamerica Life Insurance Company

As the events in your life change, so do the your needs for life insurance. A universal life policy has the flexibility to adjust to your needs. You decide what level of insurance is right for you and your family's needs. This policy will have the ability to build cash value with a guaranteed tax-deferred interest rate of 3%. This policy is fully portable/convertible, allowing you to keep this policy after retirement or taking another job, as long as you pay the premium.

ENJOY OUR HASSLE-FREE APPLICATION AND CLAIMS PROCESS.Apply by answering a few simple questions. No physicals or blood work required.3 Our easy-to-navigate website allows you to update your information, keep track of your policies, apply for loans, submit claims and more from your PC or mobile device.

USE YOUR BENEFITS WHEN YOU NEED THEM MOST.Life is unpredictable. Universal life offers help that goes beyond traditional life insurance to meet challenging situations. If you need to borrow against the cash value, you can pay it back when times get better.

If you’re diagnosed with a terminal illness, you can use a portion of the policy’s death benefit to make a difficult time easier. If you’re laid off, monthly deductions are waived for up to six months so you maintain your policy.

TAKE OUR PORTABLE, FLEXIBLE POLICY WITH YOU.We let you keep your insurance when changing jobs and adjust premiums, death benefit and cash value amounts to meet changing personal financial situations like getting married, having a child, buying a house, seeing your child through graduation or retiring.

ELIGIBILITYYou can insure your eligible spouse, children and grandchildren with their own policies or purchase protection for your children through a child level term life insurance rider. The chart below gives the ages at which you and family members may apply, but all universal life policies can be maintained up to age 100.

You may purchase up to $100,000 for yourself, $15,000 for your spouse and $25,000 on your children without answer medical questions.


Universal Life Insurance continued with Long Term Care Benefits continued Administered by Transamerica Life Insurance Company

DETAILS

LIVING BENEFIT RIDER

• Provides an accelerated death benefit for chronic conditions if someone needs assistance with at least2 out of the 6 Activities of Daily Living (ADLs).

• Guaranteed issue of up to $100,000 with the LBR available based on group size and demographics.

• After a 90-day waiting period, provides a 4%/month benefit (4% of the policy value) up to 25 months.

• The LBR does not require the insured to be institutionalized for a benefit to be paid. Care could be at home,in assisted living, at a nursing home, or hospital.

• No long term care licensed caregiver requirement. Benefit can be paid to a family member or facility forcare.

• No long term care licensing requirement for the agent to offer our LBR and extension of LBR.

• The 4% benefit is an indemnity cash benefit regardless of the cost of care.

EXTENSION OF BENEFITS RIDER*

• Pays an additional 4% monthly benefit (4% of the policy value) for up to an additional 25 months(starting in month 26). With the LBR and extension, the insured can receive up to 50 months of payouts.

• As soon as the first monthly benefit is paid under the Extension of Benefits Rider, we will also issue a paid-upcertificate for 25% of the death benefit that was in force on the date the first Living Benefit Rider payment wasmade on the policy. This paid-up insurance will have no cash or loan values. We will not provide this paid-uplife insurance benefit if you elect to receive a one-time lump sum benefit under the Accelerated Death Benefitfor Chronic Condition Rider.

• The insured has potential access to up to 225% of the life insurance face amount with the LBR,extension, and 25% restoration of the policy value.


Accident Insurance Administered by Standard

Having an accident doesn’t just hurt you — it can also damage your finances. Your medical insurance will cover some of the expenses, but you’ll be left to cover the bills for your copays and deductible. Those can add up fast, especially if you're unable to work while you recover. That’s where Accident insurance comes in: It helps protect your bank account from the out-of-pocket expenses that can come with an injury — whether you're coping with a broken arm or recovering from a serious car accident.

Here’s how it works:

In the even of a covered accident, your Accident insurance will pay a benefit directly to you. You can use this money wherever you need it most — whether that’s to help with your deductible, copays and other medical bills, or your daily expenses while you recover.

Emergency Care Benefits Fractures

Ambulance ‐‐ Air $1,500

Ankle, arm, collarbone, elbow, foot, hand, lower jaw, shoulder, wrist, kneecap, sternum $650‐$1,300

Ambulance‐Ground $600 Bones of face, coccyx, nose, verte‐brae $750‐$1,500

Emergency Room Visit $200 Rib $500‐$1,000

Urgent Care Visit $60 Finger, toe $200‐$400

Ini al Care Visit (not payable if urgent care/er benefit is payable) $60 Hip $3,000‐$6,000

Emergency Dental Care ‐‐ Crown $350 Leg (hip to knee) $3,000‐$6,000

Emergency Dental Care ‐‐ Extrac on $150

Leg (knee to ankle), pelvis, vertebral column $1,700‐$3,400

Outpa ent X‐ray $60 Skull (depressed) $5,250‐$10,500

Major Diagnos c(MRI, CT Scan, EEG) $300 Skull (non‐depressed) $2,000‐$4,000

Transfusion Blood, Plasma or platelets $600 Chip Fracture

25% of the associated fracture above (non‐surgical)

Specific Injury Benefits Disloca ons

Burns $500‐$12,500 Ankle, collarbone, elbow, foot, hand, lower jaw, shoulder, wrist $1,000‐$2,000

Coma $15,000 Knee (not including kneecap) $1,000‐$2,000

Concussion $200 Collarbone $500‐$1,000

Eye Injury $300 Hip $3,500‐$7,000

Lacera ons $100‐$800 Par al Disloca on 25% of the associated disloca on

above


Chances are good that a family member, friend or colleague of your has endured a critical illness, You may have even seen that person struggle to pay the bills. Think of Critical Illness insurance as financial peace of mind, so you don't have to choose between paying the medical bills or your car payment.

Critical Illness Insurance Administered by Standard

Critical Illness can make a big difference in your ability to pay out-of-pocket expenses associated with a serious illness. It pays a lump-sum benefit directly to you upon diagnosis of a covered illness, regardless of your treatment costs or what’s covered by your medical insurance. Elect coverage in an amount of your choosing: $10,000 or $20,000


Critical Illness Insurance continued Administered by Standard

With Critical Illness insurance you can:

Update your coverage as needed. As your life circumstances change, increase or decrease yourcoverage

Take it with you. If you leave your job, you can take your coverage with your.

Pick and choose how to spend your benefit. Spend your lump-sum benefit however you want.

Protect your loved ones. Cover your spouse up to $10,000, as long as it’s not more than your benefit amount. Your kids are automatically covered at 25% of the amount elected for yourself for the same critical illnesses that you are. Kids are also covered for 21 additional childhood diseases, including cystic fibrosis, down syndrome, muscular dystrophy, spina bifida, and cerebral palsy.

Receive a benefit for taking care of your health. Your and your covered loved ones receive a healthmaintenance screening benefit of $50 once per calendar year when visiting the doctor for a coveredwellness exam.

Receive additional benefits. If you are diagnosed with a covered illness again after a treatment-freeperiod of 12 months, you will receive 100% of the original benefit amount. If you are diagnosed with adifferent and subsequent covered illness at least 90 days after the diagnoses of the first critical illness, youwill receive and additional critical illness insurance benefit.

Coverage for: Coverage Amount:

You Flat amount of $10,000 or $20,000

Your Spouse Flat amount of $5,000 or $10,000, not to exceed 50% of the employee election

Your child(ren) through age 25 Automa cally covered at 25% of employee coverage amount

Coverage Age Band Rates Per Month

<30 30‐39 40‐49 50‐59 60‐70 71‐79

$5,000 $2.10 $3.10 $6.40 $13.10 $25.20 $50.80

$10,000 $4.20 $6.20 $12.80 $26.20 $54.40 $101.60

$20,000 $8.40 $12.40 $25.60 $52.40 $100.80 $203.20

Annual health screening benefit $50 per insured per calendar year.


Legal Administered by LegalZoom

Live your best life.By giving you easy access to a suite of financial and legal resources, LifePlan by LegalZoom helps you take care of tomorrow, so you can live your best life today — all for the cost of a few trips to the local coffee shop.

For only $14.99 a month, you get:

How a year with LifePlan stacks up:

Identity Protection Administered by InfoArmor

The most comprehensive identity protection plan available

NEW!Allstate Digital Footprint™

All the incredible things you can do online require something from you — data. A “digital footprint” is a collection of all the data you’ve left behind that might expose your identity. Our new tool offers a simple way for you to see and secure your information, and help stop identity theft before it starts.

Run your personalized Allstate Digital Footprint and see your digital exposure

Check your identity health score

View, manage, and clear alerts in real time

Monitor your credit scores and reports for any changes or errors

Receive alerts for cash withdrawals, balance transfers, and large purchases from any linked bank account

Monitor linked social media accounts for questionable content and signs of account takeover

Reduce solicitation attempts by opting out of credit card offers, telemarketing calls, commercial mail and email, and unrequested coupons

Protect your account with biometric authentication security in iOS and Android

Get reimbursed for stolen 401(k) & HSA funds; we’ll also advance fraudulent tax returns †

How it works

Enroll in PrivacyArmor PlusYou’re protected from your effective date. Our auto-on credit monitoring alerts, and support require no additional setup.

We’ll do the heavy liftingIn the event of identity theft or fraud, Privacy Advocates® are available 24/7. They won’t stop until you’re in the clear.

Get to know us Explore additional features in our easy-to-use portal. The more we monitor, the safer you can be.

We’ve got your backOur $1 million identity theft insurance policy covers out-of-pocket costs associated with identity restoration.†

We’re on the jobOur human operatives see more — like when your personal information is sold on the dark web. If you’ve been compromised, we alert you.



Employee Contributions for Benefits

Benefit Plan Cost Summary Per Paycheck (unless otherwse stated)

CommunityCare Medcial Op ons*

Value Plan Premier Plan

$3,500 deduc ble; 20% coinsurance;

$20 PCP; $50 Specialist; $50 Urgent Care

$0 Teladoc

$2,000 deduc ble; 20% coinsurance;

$25 PCP; $50 Specialist; $50 Urgent Care

$0 Teladoc

$ 64.55 $ 99.18 Employee Only

Employee + Spouse $394.08 $436.26 $273.94

$303.26 Employee + Child (ren)

Family $531.97 $588.91

* You may qualify for a lower cost op on based on your household income. Please contact EllenArmstrong at 918‐619‐4749 to find out if you qualify.

The Standard Dental Plan

Employee Only $5.32

Employee + Spouse $11.29

Employee + Child(ren) $14.98

Family $18.74

The Standard Balanced Care Vision Plan

VSP Network

Employee Only $3.72

Employee + Spouse $7.21

Employee + Child(ren) $6.78

Family $10.27


Employee Contributions for Benefits continued

The Standard Basic Life

Class 1: Directors and above $100,000Class 2: All Others $50,000

Employee Only Employer Paid

The Standard Short Term Disability

60% to a maximum of $2,500 monthly

Employee Only $0.39 per $10 of weekly benefit*

*LSS is paying 70% of this rate. The rate shown here has been reduced by your employer's contribu on.


Employee Contributions for Benefits continued The Standard Voluntary Term Life Insurance

Increments of $10K up to $150K without medical underwri ng. Includes AD&D.

Age Monthly Rate per $1,000

Employee Costs 0 ‐ 29 $0.08 30 ‐ 34 $0.10 35 ‐ 39 $0.11 40 ‐ 44 $0.18 45 ‐ 49 $0.26 50 ‐ 54 $0.41 55 ‐ 59 $0.60 60 ‐ 64 $0.81 65 ‐ 69 $1.29 70 ‐ 74 $2.08 75 ‐ 99 $5.20

The "Guarantee Issue" maximum for employee coverage is $150,000. This means you do not have to answer medical ques ons if you do not exceed this amount of requested coverage.

The above rates are the same for spousal coverage. You may purchase spousal coverage in increments of $5,000 to a maximum of $25,000 without medical underwri ng.

Coverage for your children is available in increments of $2,000 up to $10,000 at a rate of $.23 per $1,000. The rate includes all children in the family.

___________ ÷ ____1000____ = __________ x _________ = __________ _____________

Enter the amount of coverage you are

reques ng

Enter the rate from the rate table

This amount is an es mate of how much you would pay each month

To get an es mate of your per

paycheck premium, mul ply the month‐

ly premium by 26

TransAmerica Permanent Life Insurance with Long Term Care

You may purchase this coverage in increments of $10,000 up to $100,000 without having to answer medical ques ons. You may purchase $15,000 for your spouse and $25,000 for kids without answering medical ques ons. See below for sample non‐ smoker rates per paycheck:

Age Sample Rates for $50,000 face amount:

35 $13.78

45 $22.03

55 $39.15


Employee Contributions for Benefits continued

The Standard ‐ Accident Plan

Benefits are payable directly to you regardless of other coverage you may have.

Employee Only $5.28 Employee + Spouse $8.28

Employee + Child(ren) $9.99 Family $15.60

The Standard ‐ Cri cal Illness Plan

Benefits are payable directly to you regardless of other coverage you may have.

Age: $5,000 Benefit Level $10,000 Benefit Level $20,000 Benefit Level

<30 $0.97 $1.94 $3.88 30 ‐ 39 $1.43 $2.86 $5.72 40 ‐ 49 $2.95 $5.91 $11.82 50 ‐ 59 $6.05 $12.09 $24.18 60 ‐ 70 $11.63 $23.26 $46.52 71 ‐ 79 $23.45 $46.89 $93.78

LegalZoom

Financial Advice, Legal Advice, A orney‐Assisted Estate Plan, Tax and Insurance Advice

Employee (includes Family) $6.92

InfoArmor

Comprehensive Identy Monitoring, Best‐In‐Class Remedia on, Rapid Alerts

Employee Only $4.59

Employee + Family $8.28

The rates below include coverage for children. Child coverage represents 25% of the employee election.

The $5,000 benefit level below is for spousal coverage only.

You may elect either a $10,000 or $20,000 level. Coverage for your spouse can not exceed 50% of your elected benefit level.


Contact Information

If you have specific questions about a benefit plan, please contact the administrator listed below, or your local human resources department.

Benefit Administrator Phone Website/Email Medical CommunityCare 918.594.5295 ccok.com

Telehealth TELADOC 800.835.2362 teladoc.com

Dental Standard 800.547.9515 standard.com/services

Human Resources LIFE Senior Services 918.664.9000 lifeseniorservices.org

Voluntary Vision Standard 800.547.9515 standard.com/services

Short Term Disability Standard 888.937.4783 standard.com

Long Term Disability Standard 888.937.4783 standard.com

Basic Life/ADD Standard 888.937.4783 standard.com

Voluntary Life/ADD Standard 888.937.4783 standard.com

Universal Life Transamerica 888.763.7474 transamericabenefits.com

Accident Standard 866.851.2439 standard.com

Critical Illness Standard 866.851.2439 standard.com

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Employee General Notices

Initial Notice of Your HIPAA Special Enrollment Rights

Our records show that you are eligible to participate in the LIFE Senior Services group health plan (to actually participate, you must complete an enrollment form and pay part of the premium through payroll deduction). A federal law called HIPAA requires that we notify you about an important provision in the plan - your right to enroll in the plan under its “special enrollment provision” if you acquire a new dependent, or if you decline coverage under this plan for yourself or an eligible dependent while other coverage is in effect and later lose that other coverage for certain qualifying reasons.

If you are declining enrollment for yourself or your dependents (including your spouse) because of other health insurance or group health plan coverage, you may be able to enroll yourself and your dependents in this plan if you or your dependents lose eligibility for that other coverage (or if the employer stops contributing toward your or your dependents’ other coverage). However, you must request enrollment within 30 days after your or your dependents’ other coverage ends (or after the employer stops contributing toward the other coverage).

In addition, if you have a new dependent as a result of marriage, birth, adoption, or placement for adoption, you may be able to enroll yourself and your dependents. However, you must request enrollment within 30 days after the marriage, birth, adoption, or placement for adoption.

To request special enrollment or to obtain more information about the plan’s special enrollment provisions, contact your Human Resources Department.

HIPPA Notice of Privacy Practices Reminder

LIFE Senior Services is committed to the privacy of your health information. The administrators of the LIFE Senior Services health plan (the “Plan”) use strict privacy standards to protect your health information from unauthorized use or disclosure. The plan’s policies protecting your privacy rights and your rights under the law are described in the plan’s Notice of Privacy Practices. You may receive a copy of the Notice of Privacy Practices by contacting Human Resources.

Newborns’ and Mothers’ Health Protection Act (NMHPA)

Group health plans and health insurance issuers generally may not, under Federal law, restrict benefits for any hospital length of stay in connection with childbirth for the mother or newborn child to less than 48 hours following a vaginal delivery, or less than 96 hours following a cesarean section. However, Federal law generally does not prohibit the mother’s or newborn’s attending provider, after consulting with the mother, from discharging the mother or her newborn earlier than 48 hours (or 96 hours as applicable). In any case, plans and issuers may not, under Federal law, require that a provider obtain authorization from the plan or the insurance issuer for prescribing a length of stay not in excess of 48 hours (or 96 hours).

Women’s Health and Cancer Rights Act (WHCRA)

If you have had or are going to have a mastectomy, you may be entitled to certain benefits under the Women’s Health and Cancer Rights Act of 1998 (WHCRA). For individuals receiving mastectomy-related benefits, coverage will be provided in a manner determined in consultation with the attending physician and the patient, for:

All stages of reconstruction of the breast on which the mastectomy was performed; Surgery and reconstruction of the other breast to produce a symmetrical appearance; Prostheses; and Treatment of physical complications of the mastectomy, including lymphedema.

These benefits will be provided subject to the same deductibles and coinsurance applicable to other medical and surgical benefits provided under this plan. Under WHCRA, mastectomy benefits may be subject to annual deductibles and coinsurance consistent with those established for other benefits under the plan or coverage.

26 | LIFE Senior Services

Premium Assistance Under Medicaid and the Children’s Health Insurance Program (CHIP)

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

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

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

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

If you live in one of the following states, you may be eligible for assistance paying your employer health plan premiums. The following list of states is current as of July 31, 2018. Contact your State for more information on eligibility –

ALABAMA – Medicaid FLORIDA – Medicaid

Website: http://myalhipp.com/ Phone: 1-855-692-5447

Website: http://flmedicaidtplrecovery.com/hipp/ Phone: 1-877-357-3268

ALASKA – Medicaid GEORGIA – Medicaid The AK Health Insurance Premium Payment Program Website: http://myakhipp.com/ Phone: 1-866-251-4861 Email: [email protected] Medicaid Eligibility: http://dhss.alaska.gov/dpa/Pages/medicaid/default.aspx

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

ARKANSAS – Medicaid INDIANA – Medicaid

Website: http://myarhipp.com/ Phone: 1-855-MyARHIPP (855-692-7447)

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

COLORADO – Health First Colorado (Colorado’s Medicaid Program) &

Child Health Plan Plus (CHP+) IOWA – Medicaid

Health First Colorado Website: https://www.healthfirstcolorado.com/ Health First Colorado Member Contact Center: 1-800-221-3943/ State Relay 711CHP+: Colorado.gov/HCPF/Child-Health-Plan-PlusCHP+ Customer Service: 1-800-359-1991/State Relay 711

Website: http://dhs.iowa.gov/ime/members/medicaid-a-to-z/hipp Phone: 1-888-346-9562

KANSAS – Medicaid NEW HAMPSHIRE - Medicaid

Website: http://www.kdheks.gov/hcf/ Phone: 1-785-296-3512

Website: https://www.dhhs.nh.gov/ombp/nhhpp/ Phone: 603-271-5218 Hotline: NH Medicaid Service Center at 1-888-901-4999

KENTUCKY – Medicaid NEW JERSEY – Medicaid and CHIP Website: http://chfs.ky.gov/dms/default.htm Phone: 1-800-635-2570

Medicaid Website: http://www.state.nj.us/humanservices/ dmahs/clients/medicaid/ Medicaid Phone: 609-631-2392 CHIP Website: http://www.njfamilycare.org/index.html CHIP Phone: 1-800-701-0710

LOUISIANA – Medicaid NEW YORK – Medicaid Website: http://dhh.louisiana.gov/index.cfm/subhome/1/n/331 Phone: 1-888-695-2447

Website: https://www.health.ny.gov/health_care/medicaid/ Phone: 1-800-541-2831

MAINE – Medicaid NORTH CAROLINA – Medicaid Website: http://www.maine.gov/dhhs/ofi/public-assistance/index.html Phone: 1-800-442-6003 TTY: Maine relay 711

Website: https://dma.ncdhhs.gov/ Phone: 919-855-4100

MASSACHUSETTS – Medicaid and CHIP NORTH DAKOTA – Medicaid Website: http://www.mass.gov/eohhs/gov/departments/masshealth/ Phone: 1-800-862-4840

Website: http://www.nd.gov/dhs/services/medicalserv/medicaid/ Phone: 1-844-854-4825

MINNESOTA – Medicaid OKLAHOMA – Medicaid and CHIP Website: http://mn.gov/dhs/people-we-serve/seniors/health-care/health-care-programs/programs-and-services/medical-assistance.jsp Phone: 1-800-657-3739

Website: http://www.insureoklahoma.org Phone: 1-888-365-3742

MISSOURI – Medicaid OREGON – Medicaid Website: https://www.dss.mo.gov/mhd/participants/pages/hipp.htm Phone: 573-751-2005

Website: http://healthcare.oregon.gov/Pages/index.aspx http://www.oregonhealthcare.gov/index-es.html Phone: 1-800-699-9075

MONTANA – Medicaid PENNSYLVANIA – Medicaid Website: http://dphhs.mt.gov/MontanaHealthcarePrograms/HIPP Phone: 1-800-694-3084

Website: http://www.dhs.pa.gov/provider/medicalassistance/healthinsurancepremiumpaymenthippprogram/index.htm Phone: 1-800-692-7462

NEBRASKA – Medicaid RHODE ISLAND – Medicaid Website: http://www.ACCESSNebraska.ne.gov Phone: (855) 632-7633 Lincoln: (402) 473-7000 Omaha: (402) 595-1178

Website: http://www.eohhs.ri.gov/ Phone: 855-697-4347

NEVADA – Medicaid SOUTH CAROLINA – Medicaid

Medicaid Website: https://dhcfp.nv.gov Medicaid Phone: 1-800-992-0900

Website: https://www.scdhhs.gov Phone: 1-888-549-0820

SOUTH DAKOTA - Medicaid WASHINGTON – Medicaid

To see if any other states have added a premium assistance program since July 31, 2018, or for more information on special enrollment rights, contact either:

U.S. Department of Labor U.S. Department of Health and Human Services Employee Benefits Security Administration Centers for Medicare & Medicaid Services www.dol.gov/agencies/ebsa www.cms.hhs.gov 1-866-444-EBSA (3272) 1-877-267-2323, Menu Option 4, Ext. 61565

Paperwork Reduction Act Statement

According to the Paperwork Reduction Act of 1995 (Pub. L. 104-13) (PRA), no persons are required to respond to a collection of information unless such collection displays a valid Office of Management and Budget (OMB) control number. The Department notes that a Federal agency cannot conduct or sponsor a collection of information unless it is approved by OMB under the PRA, and displays a currently valid OMB control number, and the public is not required to respond to a collection of information unless it displays a currently valid OMB control number. See 44 U.S.C. 3507. Also, notwithstanding any other provisions of law, no person shall be subject to penalty for failing to comply with a collection of information if the collection of information does not display a currently valid OMB control number. See 44 U.S.C. 3512.

The public reporting burden for this collection of information is estimated to average approximately seven minutes per respondent. Interested parties are encouraged to send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the U.S. Department of Labor, Employee Benefits Security Administration, Office of Policy and Research, Attention: PRA Clearance Officer, 200 Constitution Avenue, N.W., Room N-5718, Washington, DC 20210 or email [email protected] and reference the OMB Control Number 1210-0137.

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

Website: http://dss.sd.gov Phone: 1-888-828-0059

Website: http://www.hca.wa.gov/free-or-low-cost-health-care/program-administration/premium-payment-program Phone: 1-800-562-3022 ext. 15473

TEXAS – Medicaid WEST VIRGINIA – Medicaid Website: http://gethipptexas.com/ Phone: 1-800-440-0493

Website: http://mywvhipp.com/ Toll-free phone: 1-855-MyWVHIPP (1-855-699-8447)

UTAH – Medicaid and CHIP WISCONSIN – Medicaid and CHIP Medicaid Website: https://medicaid.utah.gov/ CHIP Website: http://health.utah.gov/chip Phone: 1-877-543-7669

Website: https://www.dhs.wisconsin.gov/publications/p1/p10095.pdf Phone: 1-800-362-3002

VERMONT – Medicaid WYOMING - Medicaid

Website: http://www.greenmountaincare.org/ Phone: 1-800-250-8427

Website: https://wyequalitycare.acs-inc.com/ Phone: 307-777-7531

VIRGINIA – Medicaid and CHIP Medicaid Website: http://www.coverva.org/programs_premium_assistance.cfm Medicaid Phone: 1-800-432-5924 CHIP Website: http://www.coverva.org/programs_premium_assistance.cfm CHIP Phone: 1-855-242-8282

Important Notice from LIFE Senior Services About Your Prescription Drug Coverage and Medicare

Please read this notice carefully and keep it where you can find it. This notice has information about your current prescription drug coverage with the LIFE Senior Services group health plan and about your options under Medicare’s prescription drug coverage. This information can help you decide whether or not you want to join a Medicare drug plan. If you are considering joining, you should compare your current coverage, including which drugs are covered at what cost, with the coverage and costs of the plans offering Medicare prescription drug coverage in your area. Information about where you can get help to make decisions about your prescription drug coverage is at the end of this notice.

There are two important things you need to know about your current coverage and Medicare’s prescription drug coverage:

1. Medicare prescription drug coverage became available in 2006 to everyone with Medicare. You can get thiscoverage if you join a Medicare Prescription Drug Plan or join a Medicare Advantage Plan (like an HMO orPPO) that offers prescription drug coverage. All Medicare drug plans provide at least a standard level ofcoverage set by Medicare. Some plans may also offer more coverage for a higher monthly premium.

2. Mertz Manufacturing, Inc .has determined that the prescription drug coverage offered by the LIFE SeniorServices group health plan is, on average for all plan participants, expected to pay out as much as standardMedicare prescription drug coverage pays and is therefore considered Creditable Coverage. Because yourexisting coverage is Creditable Coverage, you can keep this coverage and not pay a higher premium (apenalty) if you later decide to join a Medicare drug plan.

When Can You Join a Medicare Drug Plan?

You can join a Medicare drug plan when you first become eligible for Medicare and each year from October 15th to December 7th.

However, if you lose your current creditable prescription drug coverage, through no fault of your own, you will also be eligible for a two (2) month Special Enrollment Period (SEP) to join a Medicare drug plan.

What Happens to Your Current Coverage if You Decide to Join a Medicare Drug Plan?

If you decide to join a Medicare drug plan, your current LIFE Senior Services medical coverage will not be affected. You can keep this coverage if you elect part D. This plan will not coordinate with Part D coverage. If you do decide to join a Medicare drug plan and drop your current LIFE Senior Services medical coverage, be aware that you and your dependents will be able to get this coverage back during the annual open enrollment period.

When Will You Pay a Higher Premium (Penalty) to Join a Medicare Drug Plan?

You should also know that if you drop or lose your current coverage with LIFE Senior Services and don’t join a Medicare drug plan within 63 continuous days after your current coverage ends, you may pay a higher premium (a penalty) to join a Medicare drug plan later. If you go 63 continuous days or longer without creditable prescription drug coverage, your monthly premium may go up by at least 1% of the Medicare base beneficiary premium per month for every month that you did not have that coverage. For example, if you go nineteen months without creditable coverage, your premium may consistently be at least 19% higher than the Medicare base beneficiary premium. You may have to pay this higher premium (a penalty) as long as you have Medicare prescription drug coverage. In addition, you may have to wait until the following October to join.

For More Information About This Notice or Your Current Prescription Drug Coverage…

Contact the person listed below for further information. NOTE: You’ll get this notice each year. You will also get it before the next period you can join a Medicare drug plan, and if this coverage through LIFE Senior Services changes. You also may request a copy of this notice at any time.

For More Information About Your Options Under Medicare Prescription Drug Coverage…

More detailed information about Medicare plans that offer prescription drug coverage is in the “Medicare & You” handbook. You’ll get a copy of the handbook in the mail every year from Medicare. You may also be contacted directly by Medicare drug plans.

For more information about Medicare prescription drug coverage:

Visit www.medicare.gov Call your State Health Insurance Assistance Program (see the inside back cover of your copy of the

“Medicare & You” handbook for their telephone number) for personalized help Call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048.

If you have limited income and resources, extra help paying for Medicare prescription drug coverage is available. For information about this extra help, visit Social Security on the web at www.socialsecurity.gov, or call them at 1-800-772-1213 (TTY 1-800-325-0778).

Remember: Keep this Creditable Coverage notice. If you decide to join one of the Medicare drug plans, you may be required to provide a copy of this notice when you join to show whether or not you have maintained creditable coverage and, therefore, whether or not you are required to pay a higher premium (a penalty).

Date: Name of Entity/Sender: Contact: Address: Phone Number:

01/01/2020 LIFE Senior Services Human Resources 5330 E. 31st St, Tulsa, OK 74135 918-664-9000

General Notice of COBRA Continuation Coverage Rights

You’re getting this notice because you recently gained coverage under a group health plan. This notice has important information about your right to COBRA continuation coverage, which is a temporary extension of coverage under the Plan. This notice explains COBRA continuation coverage, when it may become available to you and your family, and what you need to do to protect your right to get it. When you become eligible for COBRA, you may also become eligible for other coverage options that may cost less than COBRA continuation coverage. The right to COBRA continuation coverage was created by a federal law, the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA). COBRA continuation coverage can become available to you and other members of your family when group health coverage would otherwise end. For more information about your rights and obligations under the Plan and under federal law, you should review the Plan’s Summary Plan Description or contact the Plan Administrator. You may have other options available to you when you lose group health coverage. For example, you may be eligible to buy an individual plan through the Health Insurance Marketplace. By enrolling in coverage through the Marketplace, you may qualify for lower costs on your monthly premiums and lower out-of-pocket costs. Additionally, you may qualify for a 30-day special enrollment period for another group health plan for which you are eligible (such as a spouse’s plan), even if that plan generally doesn’t accept late enrollees.

What is COBRA continuation coverage? COBRA continuation coverage is a continuation of Plan coverage when it would otherwise end because of a Life event. This is also called a “qualifying event.” Specific qualifying events are listed later in this notice. After a qualifying event, COBRA continuation coverage must be offered to each person who is a “qualified beneficiary.” You, your spouse, and your dependent children could become qualified beneficiaries if coverage under the Plan is lost because of the qualifying event. Under the Plan, qualified beneficiaries who elect COBRA continuation coverage must pay for COBRA continuation coverage. If you’re an employee, you’ll become a qualified beneficiary if you lose your coverage under the Plan because of the following qualifying events:

Your hours of employment are reduced, or Your employment ends for any reason other than your gross misconduct.

If you’re the spouse of an employee, you’ll become a qualified beneficiary if you lose your coverage under the Plan because of the following qualifying events:

Your spouse dies; Your spouse’s hours of employment are reduced; Your spouse’s employment ends for any reason other than his or her gross misconduct; Your spouse becomes entitled to Medicare benefits (under Part A, Part B, or both); or You become divorced or legally separated from your spouse.

Your dependent children will become qualified beneficiaries if they lose coverage under the Plan because of the following qualifying events:

The parent-employee dies; The parent-employee’s hours of employment are reduced; The parent-employee’s employment ends for any reason other than his or her gross misconduct; The parent-employee becomes entitled to Medicare benefits (Part A, Part B, or both); The parents become divorced or legally separated; or The child stops being eligible for coverage under the Plan as a “dependent child.”

When is COBRA continuation coverage available? The Plan will offer COBRA continuation coverage to qualified beneficiaries only after the Plan Administrator has been notified that a qualifying event has occurred. The employer must notify the Plan Administrator of the following qualifying events:

The end of employment or reduction of hours of employment; Death of the employee; The employee’s becoming entitled to Medicare benefits (under Part A, Part B, or both).

For all other qualifying events (divorce or legal separation of the employee and spouse or a dependent child’s losing eligibility for coverage as a dependent child), you must notify the Plan Administrator within 60 days after the qualifying event occurs.

How is COBRA continuation coverage provided?

Once the Plan Administrator receives notice that a qualifying event has occurred, COBRA continuation coverage will be offered to each of the qualified beneficiaries. Each qualified beneficiary will have an independent right to elect COBRA continuation coverage. Covered employees may elect COBRA continuation coverage on behalf of their spouses, and parents may elect COBRA continuation coverage on behalf of their children.

COBRA continuation coverage is a temporary continuation of coverage that generally lasts for 18 months due to employment termination or reduction of hours of work. Certain qualifying events, or a second qualifying event during the initial period of coverage, may permit a beneficiary to receive a maximum of 36 months of coverage.

There are also ways in which this 18-month period of COBRA continuation coverage can be extended:

Disability extension of 18-month period of COBRA continuation coverage

If you or anyone in your family covered under the Plan is determined by Social Security to be disabled and you notify the Plan Administrator in a timely fashion, you and your entire family may be entitled to get up to an additional 11 months of COBRA continuation coverage, for a maximum of 29 months. The disability would have to have started at some time before the 60th day of COBRA continuation coverage and must last at least until the end of the 18-month period of COBRA continuation coverage.

If your family experiences another qualifying event during the 18 months of COBRA continuation coverage, the spouse and dependent children in your family can get up to 18 additional months of COBRA continuation coverage, for a maximum of 36 months, if the Plan is properly notified about the second qualifying event. This extension may be available to the spouse and any dependent children getting COBRA continuation coverage if the employee or former employee dies; becomes entitled to Medicare benefits (under Part A, Part B, or both); gets divorced or legally separated; or if the dependent child stops being eligible under the Plan as a dependent child. This extension is only available if the second qualifying event would have caused the spouse or dependent child to lose coverage under the Plan had the first qualifying event not occurred.

Are there other coverage options besides COBRA Continuation Coverage?

Yes. Instead of enrolling in COBRA continuation coverage, there may be other coverage options for you and your family through the Health Insurance Marketplace, Medicaid, or other group health plan coverage options (such as a spouse’s plan) through what is called a “special enrollment period.” Some of these options may cost less than COBRA continuation coverage. You can learn more about many of these options at www.healthcare.gov.

If you have questions

Questions concerning your Plan or your COBRA continuation coverage rights should be addressed to the contact or contacts identified below. For more information about your rights under the Employee Retirement Income Security Act (ERISA), including COBRA, the Patient Protection and Affordable Care Act, and other laws affecting group health plans, contact the nearest Regional or District Office of the U.S. Department of Labor’s Employee Benefits Security Administration (EBSA) in your area or visit www.dol.gov/ebsa. (Addresses and phone numbers of Regional and District EBSA Offices are available through EBSA’s website.) For more information about the Marketplace, visit www.HealthCare.gov.

Keep your Plan informed of address changes

To protect your family’s rights, let the Plan Administrator know about any changes in the addresses of family members. You should also keep a copy, for your records, of any notices you send to the Plan Administrator.

Plan contact information:

LIFE Senior Services, 5330 E. 31st St, Tulsa, OK 74135

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