Benefits Plan Overview

Pre-Tax Benefits

 Flexible Spending Accounts*

• Medical Reimbursement Maximum $2,750/year
• Dependent Care Reimbursement Maximum $5,000/year

 Cancer Benefits: Colonial Life

 Accident Benefits: Colonial Life

 Medical Bridge Benefits: Colonial Life

 Dental Insurance: IMS

Vision Insurance: Superior

*You will need to re-sign for the Spending Accounts if you want them to continue next year.

IF YOU DO NOT RE-SIGN, YOUR CONTRIBUTION WILL STOP EFFECTIVE AUGUST 31, 2021.

Post-Tax Benefits

 Disability Benefits: Colonial Life

 Critical Illness Benefits: Colonial Life

 Identity Theft Shield & Life Events Legal Plan: Legal Shield

 Life Insurance

• Term Life Insurance: Colonial Life
• Whole Life Insurance: Colonial Life
• Group Term Life Insurance: Colonial Life

Please note other insurance products will remain in effect unless you see a representative to change them.

ENROLLMENT PERIOD: MARCH 1, 2021 – JUNE 3, 2021

EFFECTIVE DATES:

SEPTEMBER 1, 2021 – AUGUST 31, 2022 (FSA, COLONIAL, GTL & LEGAL PLAN)

OCTOBER 1, 2021 – SEPTEMBER 30, 2022 (DENTAL & VISION)

QUALIFICATIONS:

• You must work 30 hours or more per week.

IMPORTANT FACTS:

• The plan year for Colonial Insurance products, Spending Accounts, Colonial Group Term Life and Legal Shield Identity Theft Shield & Life Events Legal Plan lasts from September 1, 2021 through August 31, 2022. The plan year for IMS Dental and Superior Vision lasts from October 1, 2021 through September 30, 2022. Please Note: Dental benefits are based on the Calendar Year, running from January 1st through December 31st. Dental benefits and deductibles will reset every January 1st.

• Deductions for Colonial Insurance products, Spending Accounts, IMS Dental, Colonial Group Term Life, Superior Vision and Legal Shield Identity Theft Shield & Life Events Legal Plan will begin September 2021.

• If signing up for any coverage on your spouse and/or children, please have their dates of birth and social security numbers available when meeting with the Benefits Representative.

• If you will be receiving a new debit card, whether you are a new participant or to replace your expired card, please be aware that it may take up to 30 days following your plan effective date for your card to arrive. Your card will be delivered by mail in a plain white envelope. During this time you may use manual claim forms for eligible expenses. Please note that your debit card is good through the expiration date printed on the card.

• Elections made during this enrollment period CANNOT BE CHANGED AFTER THE ENROLLMENT PERIOD unless there is a family status change as defined by the Internal Revenue Code. Examples of a family status change are: marriage, divorce, death of a spouse or child, birth or adoption of a child, termination or commencement of a spouse’s employment, or the transition of spouse’s employment from full-time to part-time, or vice-versa.

• Once a family status change has occurred, an employee has 30 days to notify the North Carolina Service Center at 1-888-662-7500 to request a change in elections.

• Flexible Spending Account expenses must be incurred during the Plan Year in order to be eligible for reimbursement.

• An employee has 90 days after the plan year ends to submit claims for spending account expenses that were incurred during the plan year. Please note that if employment terminates during the plan year, that employee’s plan year ends the day employment ends. The employee has 90 days after the termination date to submit claims.

• With Dependent Care Flexible Spending Accounts, the maximum reimbursement you can request is equal to the current account balance in your Dependent Care account. You cannot be reimbursed more than has actually been deducted from your pay.

• As a married couple, one spouse cannot be enrolled in an FSA at the same time the other is contributing to an HSA.

• The Colonial Cancer plan and the Health Screening Rider on the Colonial Accident and Colonial Medical Bridge plan have a 30-day waiting period for new enrollees. Coverage, therefore, will not begin until October 1, 2021.

• Additionally, some policies may include a pre-existing condition clause. Please read your policy carefully for full details.

• Please be aware there are certain coverages that may be subject to federal and state tax when premium is paid by pretax deduction or employee contribution.

• An employee taking a leave of absence, other than under the Family & Medical Leave Act, may not be eligible to re-enter the Flexible Benefits Program until the next plan year. Please contact your Benefit Administrator for more information.