2015 Employee Benefits Guide

2015 Employee Benefits Guide November 2014

Table of Contents Your MaineHealth Employee Benefits... 1 Eligibility and Enrollment... 2 Medical Plans: Overview... 4 Tobacco Testing... 5 Medical Plans: A Closer Look... 6 Employee Health Improvement Works on Wellness (WOW!)... 12 Employee Assistance Program... 14 Dental Plan... 15 Vision Plan... 16 Health Savings Account... 17 Flexible Spending Accounts... 18 Life and Accidental Death & Dismemberment (AD&D) Insurance... 21 Critical Illness Insurance... 24 Accident Insurance... 25 Disability Coverage... 25 Perks Connect MaineHealth Employee Discount Program... 26 HearPO... 26 Pet Insurance through VPI... 26 Worldwide Emergency Travel Assistance Services... 27 529 College Savings Plans... 28 Harold Alfond Challenge... 28 Benefits Plan Documents and Forms... 28 Benefit Plan Contacts... 29 Enrolling Online: The MaineHealth Benefits Portal... 32 Step-by-Step Enrollment Instructions... 33 Reminder: Health Care Reform... 40 Legal Notices... 41 Your Employee Benefits Guide has been prepared to help you make benefit enrollment decisions for yourself and your family. The information included in this Guide is effective as of November 2014. The information provides only highlights of the core benefits program provided by MaineHealth, and is not intended to be a complete plan description. Information in this booklet does not supersede or change any of the terms and conditions of any Plan document, insurance policy, contract, or other legal agreement; the wording in the official documents will govern. This Guide is not a contract of employment between any employee and their employer.

Your MaineHealth Employee Benefits As a member of the MaineHealth family, your employer offers a great benefits package along with tools and resources designed to help you make the best choices to care for you and your family s health and wellbeing. This 2015 Employee Benefits Guide includes an overview of many of your benefits programs along with online enrollment instructions. Please read this Guide carefully to learn about your benefit offerings and how to enroll. Have Questions? If you have any questions about what s in this Guide, please call the HR Solution Center at 207-661-4000. The chart below shows a snapshot of your benefit programs, including contribution requirements, enrollment deadlines and coverage start dates. Your MaineHealth Employee Benefits Benefit You Contribute Your Employer Contributes When You Enroll When You are Eligible for Coverage to Begin Health Insurance Yes Yes Dental Insurance Yes Yes Vision Insurance Yes No Flexible Spending Accounts (FSAs) Healthcare Dependent Care Voluntary Life Insurance Yes Yes Transit FSA Yes No Health Savings Account (HSA) Yes No No Yes, if you enroll in the Healthy Saver Plan You must enroll within the first 31 days of employment otherwise you will have to wait to enroll until the next annual Open Enrollment or until you have a qualified life event or status change. You can contribute to this account within the first 31 days of employment or at any time after that. You can open your HSA during your enrollment process or any time after that. First day of the month on or after your first day of benefit eligibility Basic Life and AD&D Insurance No Yes; employer pays full cost Short-term Disability Coverage No Yes; employer pays full cost Your employer takes care of this for you.you don t need to take any action to enroll. First day of the month on or after six months of employment Long-term Disability Coverage No Yes; employer pays full cost First day of the month on or after six months of employment Critical Illness Insurance Yes No Accident Insurance Yes No You must enroll within the first 31 days of employment otherwise you will have to wait to enroll until the next annual Open Enrollment. First day of the month on or after your first day of benefit eligibility You will also be able to take advantage of several other benefit programs, including the Employee Works on Wellness (WOW!) program, Employee Assistance Program, Worldwide Emergency Travel Assistance Services and the Perks Connect Employee Discount Program. Your eligibility begins the first day of the month on or after your first day of work. 1

Eligibility and Enrollment Who is Eligible? To be eligible for coverage under these MaineHealth benefit plans you must be regularly scheduled to work at least 20 hours per week in a single position at a MaineHealth member organization which participates in these MaineHealth benefit plans. If you meet the above rule and work in additional regularly scheduled positions at the same MaineHealth member organization, the hours from all those positions will be combined, up to a maximum of 40 hours for benefit purposes. If you have a regularly scheduled position at more than one MaineHealth member organization which participates in these MaineHealth benefit plans, only the hours from the first organization at which you were hired to work 20 hours or more will be considered in determining your eligibility and the level of benefit that you receive. If you do not meet the above rules for benefit eligibility, you may still qualify for medical coverage under the Affordable Care Act (ACA). MaineHealth will measure your actual hours worked over a 12 month measurement period to determine the average number of hours worked. If it is determined that you worked an average of 30+ hours per week during the measurement period, you will be offered medical insurance and will be eligible for coverage for 12 months, which is referred to as the Stability Period. You will be measured each year to determine eligibility for medical insurance coverage. For more information on the ACA, see page 41 of this Guide. Who Can You Cover? Under the MaineHealth benefit programs, you may cover yourself and your eligible dependents. An eligible dependent is a: Legal spouse Domestic partner Child to age 26 Any unmarried child who is medically certified as disabled and dependent on the parent. A child is defined as a: Biological child Stepchild Domestic partner s child Legally adopted child Legal ward Legally placed foster child up to age 26, who lives with you A child for whom you or your spouse has received a court order requiring you to provide benefit(s). Please refer to the Summary Plan Description for the full definition of an eligible dependent. Contributions and Taxes Your medical, dental, vision, Health Savings Account and Flexible Spending Account contributions are made with pre-tax dollars. The IRS requires that the cost for medical, dental and vision coverage for your domestic partner and your domestic partner s children be deducted from your paycheck after taxes. The IRS also taxes employer contributions (called imputed income) for domestic partner coverage. 2

Qualifying Life Events or Status Changes If something in your life changes, you may qualify for different benefits. For example, if you get married during the year, you may switch your health coverage level to include new family members or you may elect voluntary life insurance coverage for your spouse. See the box on this page for a list of qualified life events and status changes. Each qualified life event or status change allows you to make unique changes. When you enter your life event in the Benefits Portal, you will see the plans you are allowed to change. If you have a qualifying life event or status change, you must change your coverage within 31 days from your event. Otherwise, you will have to wait until the next annual Open Enrollment. The changes you make will be effective from the date of the change. Important Notice About Dependent Eligibility If you want to cover dependents on one of your benefit plans, you will have to show that they are eligible. This is called the Dependent Eligibility Audit. You will need to do this for all newly enrolled dependents. You may have to provide documents such as: Marriage certificate Domestic partner documents Birth certificates If this applies to you, you will receive audit materials in the mail after you enroll. Qualified Life Events and Status Changes Change in marital status: You get married You enter a domestic partner relationship You get a divorce Your spouse dies Change in dependent status: Birth of a child Death of a child Adopt a child Placement of foster child Change in employment status for you or your dependents: Dependent leaving a job and losing coverage Dependent starting a new job and gaining coverage Starting or coming back from an unpaid leave of absence A change in employment status that affects your eligibility 3

Medical Plans: Overview MaineHealth sponsors two medical plans: the Healthy Saver Plan and the Healthy HMO Plan. Both plans are offered through Anthem Blue Cross and Blue Shield of Maine, cover preventive services at 100% and offer you a tax-advantaged savings opportunity. No matter which plan you choose, you will have high-quality medical coverage and access to a broad network of healthcare providers and facilities. Both plans meet the guidelines under the Health Care Reform law. Healthy Saver Plan Preventive services check-ups, immunizations and routine screenings covered at 100% in-network, meaning you pay nothing Consumer-driven health plan (CDHP) design; compared to HMO, you ll pay less out of each paycheck and pay the full cost when you receive services until you meet your deductible Includes a tax-advantaged Health Savings Account (HSA) with a MaineHealth contribution WOW! Rewards deposited to HSA Lower payroll deductions Higher upfront annual deductible Can receive care from physicians and facilities in either the Preferred Network, the Participating Network or out-of-network Must select a Primary Care Physician (PCP) during Open Enrollment, but do not need PCP referrals to see specialists or other providers Healthy HMO Plan Preventive services check-ups, immunizations and routine screenings covered at 100% in-network, meaning you pay nothing Lowest annual upfront deductible Receive care from physicians and facilities from either the Preferred Network (providers who work with the MaineHealth family) or the Participating Network (providers who are part of the statewide Anthem HMO Maine Network) No coverage for out-of-network services, unless authorized by Anthem and unavailable in-network Must select a Primary Care Physician during Open Enrollment; PCP referral required to see specialists or other providers Our Commitment to Wellness At MaineHealth, we are committed to creating a healthy community. We want our employees to engage in their personal health. That s why we connect our wellness program to our medical plan offerings. Employees who take action to manage their health have a choice of medical plans. Employees who demonstrate that they are living tobacco free pay less for medical insurance. Here s how it works. Each year, if you are a benefits-eligible employee who is enrolled in the medical plan, you must: Complete the WOW! Rewards process, the details of which will be communicated during the year. You must complete the process to be eligible to have medical plan choice and to avoid paying an additional fee for medical coverage the following year. Test negative for tobacco use to avoid paying a $1,200 annual tobacco fee ($46.16 per paycheck) in addition to your regular contribution to the cost of health insurance. Important Information About Your First Year of Employment As a new hire in your first year of employment: You are eligible to enroll in either the Healthy Saver Plan or the Healthy HMO Plan this year. You will be required to participate in WOW! Rewards to continue to have a choice of medical plans. You must test tobacco free within 60 days of enrolling in the MaineHealth medical plan to avoid paying the tobacco fee. Spouses and/or domestic partners enrolled in a MaineHealth medical plan must participate in WOW! Rewards to avoid an additional fee for their medical coverage for the following year. 4

Tobacco Testing After you enroll in a MaineHealth medical plan, you must test negative for tobacco within 60 days to avoid paying the tobacco fee of $1,200 per year ($46.16 per biweekly paycheck). You can get the tobacco test done for free at one of the participating MaineHealth NorDx facilities. See www.mainehealth.org/wow for a list of testing locations. If you test positive or if you do not take the tobacco test, the tobacco fee will be deducted from your paycheck beginning with the first payroll following 60 days from your enrollment. If you do not test negative for tobacco within 60 days of your enrollment in the MaineHealth medical plan, you will pay $46.16 more biweekly for MaineHealth medical insurance in 2015, no matter which medical plan you choose. If you do not test negative, you will pay the tobacco fee for the remainder of the year. You will have the chance to screen again during the next WOW! Rewards participation period and have the fee removed the following January. Our goal is to help you live tobacco free. See pages 12 and 31 for information about resources to help you quit. Tobacco Testing Steps Follow these steps to complete your tobacco test within 60 days of your enrollment in the medical plan: 1. Enroll in a MaineHealth medical plan within the timeframe allowed. 2. Wait 10-14 days. 3. Go to www.mainehealth.org/wow to print your tobacco screening form and confirm the participating NorDx locations. 4. Complete the form and take it to a participating NorDx screening location to complete your tobacco test. You will be notified only if your results are positive. If you do not enroll in a MaineHealth medical plan, you do not need to test for tobacco use. 5

Medical Plans: A Closer Look Healthy Saver Plan Healthy HMO Plan How Plan Pays Benefits Preferred Network Participating or Out-of-Network Preferred Network Participating Network Office Visit Charges Subject to deductible Apply to the out-of-pocket maximum: Copays: $15 PCP / $40 Specialist Apply to the out-of-pocket maximum: Copays: $30 PCP / $60 Specialist Calendar Year Deductible $1,500 Employee Only Contract $3,000 Employee + Dependent(s) Contract $200 Individual $400 Family $400 Individual $800 Family Aggregate Combined across networks Applies to all services including pharmacy Accumulative No cross-tier accumulation Accumulative No cross-tier accumulation Your Coinsurance (The amount you have to pay after Calendar Year Deductible is met) 0% 30% 10% 30% Out-of-Network Coverage Prescription Drug Coverage <30 day supply >30 day supply Available Copays apply after deductible is met:* Tier 1 Tier 2 Tier 3 $10 $30 $45 $20 $60 $90 (Apply to out-of-pocket maximum) No coverage for out-of-network services, unless authorized by Anthem and unavailable in-network Copays apply until the calendar year prescription copayment maximum is met: Tier 1 Tier 2 Tier 3 $10 $30 $45 $20 $60 $90 (Do not apply to medical out-of-pocket maximum) NEW: Prescription drug copay out-of-pocket maximum is $1,500 individual/$3,000 family Calendar Year Out-of-Pocket Maximum $3,000 Employee Only Contract $6,000 Employee + Dependent(s) Contract $1,700 Individual $3,400 Family $3,400 Individual $6,800 Family Pre-Tax Savings Opportunity Annual MaineHealth Contribution Employee Contributions 2015 Contribution Limit WOW! Rewards Deposited Pre-Tax Yes; Health Savings Account $250 Employee Only Contract $500 Employee + Dependent(s) Contract Elect payroll deductions to HSA at enrollment; can change at any time in 2015 After-tax lump sum contributions at any time, which may be deducted when you file your tax return $3,350 Employee Only Contract** $6,650 Employee + Dependent(s) Contract** Employees age 55+ may contribute an additional $1,000** Yes Yes; Healthcare Flexible Spending Account None Elect payroll deductions to FSA at enrollment; cannot change in 2015 unless qualifying event or family status change $2,550 No Account Balance Rollover to Next Year Yes NEW! Yes, up to $500 * For certain preventive medications, copays apply before the deductible is met. ** The annual HSA contribution limit includes employee plus employer contributions. MaineHealth s contribution to your HSA and any WOW! Rewards deposited to your HSA will apply to the annual IRS HSA contribution limit and reduce the amount that you can contribute on an individual basis. 2015 Rates You will receive the biweekly employee contribution rates for the MaineHealth medical plans from your Human Resources contact. You can also find them on www.mainehealth.bswift.com. 6

Provider Networks Both of our medical plans offer access to quality healthcare providers, hospitals and other healthcare facilities. Depending on the medical plan you choose and your specific healthcare needs, you may choose to get care from a Preferred, Participating, in-network or out-of-network provider or facility. Generally, the plan will pay more of the cost of care when you use a provider or facility within the MaineHealth family. Here s an overview of each network. Preferred and Participating Networks The Participating level of coverage is our standard level of coverage. Richer benefits are available in the Preferred Network because services are performed within the MaineHealth family or by providers who have a strategic relationship with MaineHealth. Although you may not always have a choice as to which physicians provide services, physicians do have the ability to become Preferred providers of MaineHealth by joining our Physician Hospital Organization (PHO). The providers listed in the Participating level of coverage have made a business decision not to do so. Employees should not assume that their Preferred providers will always use Preferred facilities. If your Preferred provider uses a Participating facility, it is your responsibility to pay the facility charges at the Participating level. Preferred Hospitals within the Preferred Network include: Franklin Memorial Hospital Lincoln Health (Miles and St. Andrews campuses) Maine Medical Center MaineGeneral Medical Centers Memorial Hospital (New Hampshire) Mid Coast Hospital New England Rehabilitation Hospital Pen Bay Medical Center St. Mary s Regional Medical Center Southern Maine Health Care (Biddeford and Sanford Medical Centers) Spring Harbor Hospital Stephens Memorial Hospital Waldo County General Hospital Other facilities within the Preferred Network* include: Independent Labs Free Standing Imaging and Surgical Facilities Home Health Providers Coastal Women s Health Care Lab NorDx Lab work performed at a Preferred facility or provider will pay at the Preferred benefit level Central Maine Orthopaedics PA Eye Care & Surgery Center Generations Surgery Center Insight Premier Health InterMed Imaging/Radiology Maine Centers for HealthCare Maine Eye Center Maine Medical Partners Neurosurgery & Spine Associates Maine Molecular Imaging LLC Marshwood Imaging Center OA Centers for Orthopedics Orthopedic Surgery Center Portland Endoscopy Center SMHC Diagnostic Services (Biddeford, Kennebunk, Saco, Sanford and Waterboro) Western Ave Day Surgery Center Wolf Ambulatory Surgery Unit Androscoggin Home Care & Hospice Community Health and Nursing Service Cove s Edge D/B/A Miles and St. Andrews Home Health and Hospice Healthreach Homecare HomeHealth Visiting Nurses Hospice of Southern Maine Kno-Wal-Lin Home Care & Hospice New England Life Care (Home Infusion Therapy) Waldo County Home Healthcare Services * For a list of providers that participate in the Preferred Network, go to www.anthem.com/mainehealth 7

Participating Participating Network providers in the Healthy Saver Plan are part of the Anthem PPO network. Participating Network providers in the Healthy HMO Plan are part of the Anthem HMO Maine network. Participating Network hospitals are hospitals (other than those listed previously in the Preferred Network) that are part of the Anthem HMO Maine network or Anthem PPO network. In-Network (for Healthy Saver Plan) In-network providers and hospitals are those that are part of the Anthem Maine statewide PPO network and the BlueCard national network. Out-of-Network (for Healthy Saver Plan) Out-of-network providers, hospitals and facilities are all those outside of the MaineHealth family and Anthem network. Away from Home Care (for Healthy HMO Plan) The Away from Home Care program grants a temporary courtesy enrollment in a Host HMO that enables members who are living away from home, for example, a child going to college, to receive a comprehensive range of benefits, including routine and preventive services. There is no additional premium charge for participating in this program. Participating members receive the Host HMO s benefit plan and follow the referral and authorization guidelines of the Host HMO while within that area. This may differ from the Home HMO benefits and guidelines. The program is only available in select areas in the United States. It is not available outside the United Sates. For questions regarding coverage areas please contact Anthem. Prescription Drug Benefit Both medical plans provide three-tiered coverage for prescription drugs. Tier 1: Generic Tier 2: Formulary (Brand Name) In the Healthy HMO Plan, you pay the copays (shown above) for prescriptions. The deductible does not apply. Copays do not count toward meeting your medical out-of-pocket maximum but do apply towards a separate prescription drug out-of-pocket maximum. With the Healthy Saver Plan, you pay the full cost of prescription medicines until you meet your annual deductible, then you pay copays until you meet the annual out-of-pocket maximum. For certain preventive medicines, you pay only a copay even before you meet Tier 3: Non-formulary (Speciality Drugs) 30-day supply $10 $30 $45 >30-day supply $20 $60 $90 For more information about your prescription drug coverage, the formulary and how to access the mail-order program, contact Anthem at www.anthem.com/mainehealth. your deductible. Once your out-of-pocket maximum is met, there are no copays for the rest of the year. You can find the list of preventive medicines in the Library on the Employee Benefits Portal at www.mainehealth.bswift.com. It s important to note that the on-site hospital pharmacies at Maine Medical Center, Pen Bay Healthcare and Southern Maine Health Care are available to fulfill your prescription needs. Mandatory Generic Program MaineHealth encourages the use of less costly generic prescription drugs when they are available. If you choose a brand-name drug when a generic drug is available, you must pay the difference in cost between the generic drug and the brand-name drug in addition to your copay. If you are unable to take a generic medication, your doctor should contact Anthem for review. For more information about your prescription drug coverage and the formulary, contact Anthem. Mail-order Anthem s mail-order program provides the benefit of home delivery and saves you both time and money on prescriptions you take regularly. 8

Step Therapy Step therapy provides safe, effective treatment while helping keep costs low by ensuring you try a first line or less expensive choice before a more expensive brand-name drug can be dispensed. Specialty Pharmacies A specialty pharmacy provides support and drugs for people with complex, long-term health conditions. Specialty drugs come in different forms like pills or liquids, or they may be injected, infused or inhaled. These drugs often need special storage and handling and may be administered by a doctor or nurse. The MaineHealth medical plan requires employees to use one of our specialty pharmacies, Maine Medical Center (coming in 2015), Accredo or Apothecary by Design, when purchasing specialty drugs. For more information regarding the use of the specialty pharmacies, please contact Anthem. Paying for Services With the Healthy Saver Plan At Your Provider s Office Remember to always show your medical plan ID when you receive services. For medical expenses at an in-network provider you do not pay at the time of your visit. Your provider will send the bill to Anthem so that Anthem can apply the charges to your deductible and out-of-pocket maximum, as applicable. Anthem will then send you an Explanation of Benefits (EOB). The EOB will describe your claim, what the provider charged, what Anthem will pay and what you should expect to pay. If you owe a balance, you should receive a bill directly from the provider. Once you meet the annual out-of pocket maximum, MaineHealth pays 100% of the costs for covered services and you will not be charged for the remainder of the year. Note: If you use an out-of-network doctor or hospital, you should pay at the time services are received and submit a claim form to Anthem. At the Pharmacy Remember to always show your medical plan ID when you receive services. You will pay for prescription drugs at the point of sale. Anthem will track your deductible and out-of-pocket amounts at the time of the transaction and immediately provide the information to your pharmacist so he or she can tell you how much you need to pay. Once you meet the annual out-of pocket maximum, the Plan pays 100% of the costs for covered prescription drugs and you will not be charged for the remainder of the calendar year. Using Your HSA Use your HSA like a checking account with a debit card attached. You can use your HSA debit card to pay a provider bill, to pay for a prescription at the pharmacy or to place an online pharmacy order. When you use your HSA debit card, the money will be automatically withdrawn from your HSA. If you pay with cash or a personal debit or credit card, you can reimburse yourself from your HSA later through HealthEquity s website. You are responsible for maintaining the documents associated with paying your claims. Paying for Services with the Healthy HMO Medical Plan At Your Provider s Office Remember to always show your medical plan ID when you receive services. Medical services are only covered when provided by a Preferred or Participating provider. You will pay copays for PCP and Specialist office visits until you meet your annual out-of-pocket maximum. Once you meet your deductible you will pay co-insurance on any additional covered services you receive. Once you meet the annual medical out-of-pocket maximum, MaineHealth pays 100% of the medical costs for covered services and you will not be charged for the remainder of the year. 9

At the Pharmacy Remember to always show your medical plan ID when you receive services. For covered prescriptions you will pay copays at the time of purchase until you meet your prescription out-of-pocket maximum. Once you meet your prescription out-of-pocket maximum, MaineHealth pays 100% of the cost and you will not be charged for covered prescriptions for the remainder of the calendar year. These copays do not apply towards your medical out-of-pocket maximum. Using your Healthcare FSA If you elect to contribute to a Healthcare Flexible Spending Account (FSA) you can use your Healthcare FSA to pay a provider bill, prescription copays and other eligible health care expenses. There are two ways to use your FSA: 1. When you use your FSA debit card, the money will be automatically withdrawn from your Healthcare FSA. 2. If you pay with cash or a personal debit or credit card you can submit a claim with your receipts to EBPA for reimbursement. You should save receipts from purchases made with your Healthcare FSA debit card because you may be asked to prove these purchases were eligible health expenses. For more information on how a Healthcare FSA works go to page 18. Deciding Which Plan Is Best for You As you review your medical plan options, think about cost, cash flow, and your current and future healthcare needs. Keep in mind that preventive care is covered at 100% under both plans when you stay in-network. Here are some questions to get you started. How would you prefer to pay for your healthcare? Would you rather pay less from each paycheck and save the difference to pay for an office visit or prescription? Or would you rather pay more per paycheck and then, if you go to the doctor, know you ll just need to pay a copay? Do you have the cash flow to pay for services as you use them? With the Healthy Saver Plan, you do need to have the money to pay the full cost of medical expenses upfront until you reach the deductible. Are you comfortable with the role of healthcare consumer? Since you re paying the full cost of services until you reach your deductible in the Healthy Saver Plan, if you can find ways to save on healthcare services, the savings go right into your wallet. Do you need or want access to care from healthcare providers outside the Preferred or Participating Networks? The Healthy Saver Plan covers out-of-network services, but the Healthy HMO does not, unless authorized by Anthem and not available in-network. Do you want to start saving a nest egg for future healthcare expenses? If you d like to begin putting aside funds for future healthcare expenses, you may want to enroll in the Healthy Saver Plan which offers the HSA. 10

Mental Health and Substance Abuse Care You can use your mental health or substance abuse benefits without a referral from your primary care provider. To get care, call the Behavioral Health Care Program (BHCP) at 1-800-538-9698. The BHCP will approve eight counseling sessions and help you find an in-network provider. If you need more than eight sessions, your provider must request them from the BHCP. Under the Healthy HMO, non-authorized services will not be covered unless provided by your PCP. Under the Healthy Saver Plan, services authorized by BHCP will be covered at the highest level. If you do not get an authorization from BHCP, then any covered services will be paid at the lower level. Plan deductibles and copays apply. For more specific details about coverage, please go to www.anthem.com/mainehealth to view the plan documents. IN AN EMERGENCY: If you have an emergency and need to go to the emergency room, call the BHCP at 1-800-538-9698 for approval within 48 hours of getting emergency care. Compare Plans with the bestfit Plan Advisor Tool As you consider your 2015 medical plan options, take advantage of the bestfit Plan Advisor tool on the MaineHealth Employee Benefits Portal. To use the tool: 1. Once you get to the enrollment screen for medical coverage, choose Help Me Decide. 2. Choose a health status for yourself and covered dependents. 3. Enter the care you will use and your coverage level. 4. You will see a graphic comparing the out-of-pocket costs you are likely to have for each plan. Use the bestfit Plan Advisor Tool to compare estimated 2015 out-of-pocket costs under the MaineHealth medical plans. 11

Employee Health Improvement Works on Wellness (WOW!) Your health is a priority to MaineHealth. Achieving health and remaining healthy is an active process that s why MaineHealth s Works On Wellness (WOW!) offers many programs to help you maintain and improve your health. WOW! has resources and programs to help you in your daily efforts to keep you and your family healthy. You can get started right away and participate throughout the year. Below is an overview of just a few of the programs available. For more information and to use interactive tools, visit our website at www.mainehealth.org/wow. WOW! Healthy Paybacks You can get $50 rebates for attending Weight Watchers meetings, and $50 rebates for other eligible programs such as health education classes, community supported agricultural shares, healthy food purchases and much more! There are two six-month eligibility periods: April to September and October to March. For more details on WOW! Healthy Paybacks, visit www.mainehealth.org/wow. Cash for Your Cart Good health pays off! You have more energy You take fewer or no medications You are at lower risk for developing a chronic health condition like diabetes or heart disease Cash for Your Cart is another way to earn rewards for making healthy choices under the Healthy Paybacks program. You can earn your $50 rebates by buying healthy foods at the grocery store. It s easy! All food items are scored from 0 to 100 based on nutritional value. If you have a grocery cart score of 60 or higher for at least 2 shopping trips in a month you will earn $10 per month up to $50 (for the six month eligibility period). You can also earn additional savings on offers featured on the Cash for Your Cart site. Go to www.mainehealth.org/cashforyourcart to learn more about how to register and get started. Tobacco Treatment MaineHealth is committed to creating a tobacco-free community. When you are ready to quit, MaineHealth offers resources to help. Resources available to all MaineHealth employees: see tobacco treatment specialists at on-site facilities, where available, at no cost. Call MaineHealth Central Scheduling at 855-300-8702 (toll-free) to find a free tobacco cessation class or treatment group near you. You can also go to www.mainehealth.org/wow and click on Tobacco Treatment for more information about resources to help you quit. Resources available to Maine residents: call the Maine Tobacco HelpLine, available 24/7 at 1-800-207-1230 (free to all Maine residents) or visit www.tobaccofreemaine.org. Resources available to New Hampshire residents: call the New Hampshire Tobacco HelpLine at 1-800-784-8669 (free to all NH residents) or visit www.trytostopnh.org. WOW! Rewards Participating in the WOW! Rewards program provides benefits-eligible employees a choice in medical plan options plus the opportunity to earn cash rewards for meeting health targets. Participation requirements for employees and covered spouses/domestic partners will be communicated on an annual basis. 12

Care Management The Care Management program is designed to help you become as healthy as possible and to connect to resources and information to help you manage your health. Care Management can be provided to you as part of the healthcare team, or through your MaineHealth health insurance administered by Anthem. The Care Manager will provide you education and information specific to your health condition and any other identified needs. Care Managers can meet with you over the phone when it is convenient for you, or with you at the doctor s office or at home. The Care Management program is free to you. If you are interested, ask your Primary Care Physician for a referral or call the MMC PHO Care Management Department at 207-482-7064. You can also call the Anthem Customer Service Department at the number listed on the back of your ID card to request a Care Manager. Future Moms Expecting a baby? If so, and if you are enrolled in a health plan through MaineHealth, you can enroll in Anthem s Future Moms program. By signing up, you gain access to a toll-free 24/ 7 registered nurse line, a childhood immunization schedule, a best-selling book that details what you can expect for you and your baby during your pregnancy, nutritional counseling, breastfeeding advice, postpartum support and much more. To enroll, contact Anthem at 888-347-8360. Once you enroll, you can receive a $50 Babies R Us gift card through the WOW! Healthy Paybacks program. For more information, visit www.mainehealth.org/wow and click on Healthy Pregnancy & Newborns. Health Coaching A health coach is your personal trainer outside the gym. You can call a Health Coach for help with a chronic issue such as diabetes, breathing problems or a heart condition, or if you simply want reliable information on general health topics. To learn more about this service, go to www.mainehealth.org/wow and click on the Ask a Health Coach section. Learning Resource Center The MaineHealth Learning Resource Center is a place to find health information you can trust. Visit www.mainehealthlearningcenter.org for tools, tips and information on: How to be savvy about finding trustworthy health information. Common health concerns, like heart health, diabetes, cancer, mental health and more. Healthy living at all ages. Finding quality healthcare and being a prepared patient. Using resources like our online library and health educators. 13

Employee Assistance Program The Employee Assistance Program (EAP), LifeBalance offers counseling, online screening tools, self-help tools and information on a wide range of issues. This confidential counselling can help you and your family members deal with life s challenges. LifeBalance can help you with: Stress Anxiety Depression Family or parenting issues Marital or relationship issues Adjusting to change Self-improvement Child and elder care Legal issues Grief Work/life balance Financial concerns Your contact with EAP services is completely confidential. No information will be released about your call or the nature of your call, without your written permission. In addition, you can find helpful information at LifeBalance s website, including LifeArticles, books, booklets, audiotapes, CDs and language translation services. Call 877-259-3785, available 24 hours a day. For more information, visit www.lifebalance.net User ID: mainehealth Password: lifebalance Life changes Life challenges LifeBalance 14

Dental Plan Good oral health is an important part of your general health. Delta Dental manages our dental program and offers a network of Participating dentists. The dentists that participant in the PPO Network or the Premier Network will submit a claim to Delta on your behalf. The dentist typically cannot require payment from you at the time of service, with the exception of non-covered services and coinsurance amounts. By choosing a dentist from the PPO Network you will have fewer out-of-pocket expenses. When looking for a Participating Dentist on the Delta website, select Premier Plan or PPO type. Plan Overview Dental Services Annual Deductible Annual Maximum Diagnostic and Preventive Services Oral exams and dental cleanings (2 in any period of 12 months) X-Rays Fluoride Treatments (One every 12 months up to age 19) Space maintainers (Up to age 15) Sealants (Up to age 14) Basic Services Fillings and Extractions Endodontics Periodontics Root Canals Oral Surgery Major Services Crowns Dentures Bridgework Inlays and Onlays Implants Orthodontia (Dependent Children to Age 19) Subject to a lifetime maximum of $1,250 Plan Pays $50 per person up to a maximum of $100 per family $1,500 per covered person 100% (annual deductible waived) 80% 50% 50% (annual deductible waived) 2015 Rates 2015 Dental Plan Biweekly Rates Coverage Level Pre-tax After-tax Total Employee Only $8.91 $0.00 $8.91 Employee and Spouse/Family $24.50 $0.00 $24.50 Employee and Domestic Partner $8.91 $15.59 $24.50 Employee, Domestic Partner and Domestic Partner s Child(ren) Employee, Domestic Partner and Employee s Child(ren) $8.91 $15.59 $24.50 $24.50 $0.00 $24.50 15

Vision Plan Our Vision Plan is managed by Anthem Blue View Vision. With this plan, you can get your vision care from an in-network or out-of-network provider. As you can see below, you will receive a higher level of coverage if you go to an in-network provider. You can find an in-network provider at www.anthem.com/mainehealth. Plan Overview Vision Services In-network Benefits Out-of-network Benefits Annual deductible None None Routine eye exam (Once every calendar year) $15 copay $85 allowance Eyeglass frames (Once every other calendar year) $150 allowance then 20% off remaining balance $64 allowance Eyeglass lenses (Once every calendar year) Single lenses Bifocal lenses Trifocal lenses Lenticular lenses $25 copay $25 copay $25 copay $25 copay $36 allowance $54 allowance $69 allowance $88 allowance Contact Lenses* (elective conventional) (Once every calendar year) $130 allowance then 15% off remaining balance $105 allowance *Contact lenses are in lieu of eyeglass lenses. 2015 Rates 2015 Vision Plan Biweekly Rates Coverage Level Pre-tax After-tax Total Employee Only $2.24 $0.00 $2.24 Employee and Spouse $3.80 $0.00 $3.80 Employee and Child(ren) $4.03 $0.00 $4.03 Family $6.05 $0.00 $6.05 Employee and Domestic Partner $2.24 $1.56 $3.80 Employee, Domestic Partner and Domestic Partner s Child(ren) Employee, Domestic Partner and Employee s Child(ren) $2.24 $3.81 $6.05 $4.03 $2.02 $6.05 16

Health Savings Account An HSA is an interest-earning, tax-advantaged account. It s a valuable financial tool that helps you make the most of the dollars you spend on current and future healthcare expenses for yourself or your tax dependents. Building Your HSA Your HSA may be funded in four ways: 1. MaineHealth contributions. Healthy Saver Plan participants will receive a start-up HSA contribution $250 for Employee Only coverage and $500 for Employee + Dependent(s) coverage. 2. Your contributions. You can contribute to your HSA, either through pre-tax payroll deductions or as a lump sum deposit during the year. For 2015, the total combined limit for your and MaineHealth s contributions is $3,350 for Employee Only coverage or $6,650 for Employee + Dependent(s) coverage. And if you will be age 55+ by Dec. 31, 2015, you can contribute $1,000 more in 2015. The maximum contribution amount may change if you change your level of coverage during the year due to a qualified life event. When deciding how much to contribute to your HSA, it is your responsibility to make sure you do not go over your personal annual maximum contribution allowed by the IRS. You need to take into account any employer contributions including annual start-up contributions, WOW! Rewards contributions, WOW! Healthy Payback contributions, and also any deposits or contributions you decide to make directly to your account outside of the payroll process. All money deposited into your HSA counts toward your annual maximum allowed contribution. 3. Interest and investment earnings. Like a traditional bank account, your HSA balance will earn interest over time. And once your account reaches a minimum amount, you can invest it among a variety of options. 4. WOW! Rewards. If you enroll in the Healthy Saver Plan, any future WOW! Rewards earned will be deposited directly into your HSA to avoid paying taxes and make your dollars go further. 5. WOW! Healthy Paybacks. If you participate in the Healthy Paybacks Program, you can elect to have your rebates deposited into your HSA. Rollovers The funds in your HSA roll over and continue to grow from year to year. You can continue to make the full HSA contribution each year, provided all eligibility requirements are met. Because an HSA is intended to serve, at least in part, as a long-term savings vehicle, you can save funds over a long period of time. There is no time limit for claiming a reimbursement from your account as long as you incur the expense after the HSA was set up. HSA Eligibility You are NOT eligible to open or contribute to an HSA if: Using Your HSA When you open your HSA, you will receive an HSA debit card from HealthEquity. You can use your debit card to pay for qualified healthcare expenses at retail locations, over the phone or on the Internet, just like any other debit card. You are covered under any other medical plan, unless it s also a CDHP You are participating in a Healthcare FSA, either yours or your spouse s You are claimed as a dependent on another person s tax return You are enrolled in Medicare (when you start receiving Social Security benefits, you are automatically enrolled in Medicare Part A unless you actively decline this coverage. If your spouse is enrolled in Medicare but you are not, you can contribute to the HSA and use it to pay for qualified medical expenses for you, your spouse and your tax dependents). If you are not eligible to contribute to an HSA, you may be eligible to contribute to a Healthcare Flexible Spending Account (FSA) instead. For more information, go to www.healthequity.com/mainehealth or call HealthEquity at 877-302-7070. 17

Flexible Spending Accounts You must re-enroll in the Healthcare and Dependent Flexible Spending Accounts (FSAs), administered by EBPA, allow you Care FSAs each year during to pay certain out-of-pocket healthcare, dependent care and transit annual Open Enrollment. expenses with pre-tax dollars. When you enroll, you elect the amount you want to contribute from each paycheck. Your contributions are not taxed when they are deducted from your pay or when the money is reimbursed to you. This means these dollars are essentially tax-free! 2015 Flexible Spending Accounts Annual Pre-tax Deferral Maximums Healthcare Flexible Spending Account... $2,550 Dependent Care Flexible Spending Account... $5,000* Transit Flexible Spending Account... $1,560 Healthcare FSA You can use the money you contribute to your Healthcare FSA to pay for certain expenses that are not fully covered by your medical, dental or vision plans. This includes services for you and eligible dependents. Please note that the IRS does not consider domestic partners or children you do not claim on your tax return to be eligible dependents for purposes of the Healthcare FSA. Eligible Healthcare Expenses You can be reimbursed for any eligible medical, vision and dental expenses that are medically necessary, but are not covered by your insurance, such as: Medical and dental deductibles or copayments Vision care expenses including eye exams, prescription eyeglasses, contact lenses, and contact lens solutions Hearing exams and hearing aids For a list of eligible expenses go to www.ebpabenefits.com Expenses reimbursed through the Healthcare FSA cannot be claimed as a deduction on your federal or state income tax return. Dependent Care FSA You can use the money you contribute to the Dependent Care FSA to pay for childcare and other dependent services. This allows you (and your spouse, if you are married) to work while your dependent is cared for. You can contribute to the Dependent Care FSA if: You are a single parent with primary responsibility for child care You and your spouse both work You work and your spouse is a full-time student for at least five months of the year You work and your spouse is physically or mentally incapable of self-care Changes to the use it or lose it rule for the Healthcare FSA! You may carry over a maximum amount of $500 from year to year in the Healthcare FSA, effective January 1, 2015. * Highly compensated individuals are limited to a maximum contribution of $2,000 in 2015. 18

The following limitations may apply to some married participants: If your spouse contributes to a Dependent Care FSA with his or her employer, the combined maximum for both of you is $5,000 for any calendar year. Your contribution to your Dependent Care FSA cannot be more than your spouse s earned income. If you and your spouse file separate income tax returns, the maximum you may contribute is $2,500 for the calendar year. Eligible Dependent Care Expenses Dependent care provided in your home, as long as the caretaker cannot be claimed as a dependent on your federal income tax return and is not one of your children under age 19. Dependent care provided outside of your home, including: Licensed nursery schools Summer day camps Legally-approved day care centers for children and disabled adults After school programs Who is Eligible? Dependents who: Live with you Rely on you for financial support Are claimed as a dependent on your federal income tax return Are either a child under the age of 13, or a spouse or other dependent adult who is physically or mentally unable to care for himself or herself Dependent Care Tax Credit The federal dependent care tax credit can be applied up to $3,000 in expenses for one child and $6,000 in expenses for two or more children. The non-refundable amount is determined by multiplying your child care expenses (up to the allowable limit) by a certain percentage, based on adjusted gross income. For example, those making $15,000 can receive a credit equal to 35% of expenses for a maximum tax break of $1,050 for a single child or $2,100 for two or more kids. The credit percentage falls to 20% for families earning $43,000 or more. If you plan to take the tax credit, you cannot use the Dependent Care FSA for that portion of your expenses. You may want to speak with a financial planner or tax adviser to help you decide whether you should enroll in the Dependent Care FSA or take the federal dependent care tax credit, based on your needs. For more information, go to www.ebpabenefits.com or www.mainehealth.bswift.com. Transit FSA You may contribute up to $130 per month to this account to use for the cost of mass transit to get to and from work. This includes traveling by: Bus Rail Ferry Van pools You can be reimbursed for fares and tickets. You can also use your Benefits Debit Card to pay for fares if the provider will accept it. You can carry over unused balances from one year to the next. And, you can enroll, change, or suspend contribution amounts at any time. If you leave employment with MaineHealth, you will forfeit any unused balance in your Transit FSA. 19

How You Save Money with Tax-Advantaged Accounts Here is an example of how you can save on taxes by participating in a tax-advantaged savings account such as the FSA or the Health Savings Account described on page 17. This example assumes you earn $36,000 per year and contribute $2,550 to the Healthcare FSA and $5,000 to the Dependent Care FSA. Description With Spending Accounts Without Spending Accounts Annual salary $36,000 $36,000 Pre-tax contribution to Dependent Care FSA $5,000 $0 Pre-tax contribution to Healthcare FSA $2,550 $0 Taxable income $28,450 $36,000 Federal tax withholding* $4,268 $5,400 Social Security (FICA) withholding* $2,176 $2,754 Healthcare and dependent care costs $0 $7,550 Take-home pay $22,006 $20,296 Annual tax savings $1,710 N/A *Assumes a federal tax rate of 15% and a FICA tax rate of 7.65%. This is only an estimate. Please consult your tax advisor. What You Should Know About FSAs Because of the tax advantage offered by these accounts, the IRS imposes strict rules and limitations on how you may use them. The account(s) can be used only for expenses billed during the current plan year of January 1 through December 31. You have until March 31 of the following year to submit claims for expenses you incurred during the previous calendar year. For the Healthcare and Dependent Care FSAs, once you make your elections for a calendar year, you cannot change them until the next annual enrollment. You cannot increase, decrease, or cancel your contributions during the year, unless you have a qualified life event or status change (as described on page 3). You can change your contribution to the Transit FSA at any time during the year. There is no limit on the amount you can carry over from year to year in the Transit FSA. If you have any unused money in your Healthcare FSA at the end of the year, you may carry over up to $500 to the next year. Any amount over $500 is forfeited. If you have any unused money in your Dependent Care FSA at the end of the year, it will be forfeited. This is referred to as the use it or lose it rule, so plan carefully! If you enroll in the Healthy Saver Plan and are eligible for an HSA, you may not participate in a Healthcare FSA. You can open a Health Savings Account to pay for health expenses with tax-free dollars. 20

Life and Accidental Death & Dismemberment (AD&D) Insurance Basic Life and AD&D Insurance MaineHealth s life insurance program is provided to help you ensure that your family is financially secure in the event of your death. As an eligible employee, you will be enrolled in employer-paid basic life and accidental death and dismemberment insurance equal to one times or two times your annual salary (see certificates of coverage). In the event of an accidental death or dismemberment, you or your beneficiaries may receive an additional amount up to the total of your life insurance coverage. Voluntary Life Insurance You can elect a greater level of financial protection by purchasing voluntary life insurance. If you elect voluntary life insurance coverage for yourself, you may also purchase coverage for your spouse or domestic partner and dependent children. For You You may purchase voluntary life insurance for yourself in amounts of $10,000 up to five times your annual salary to a maximum of $500,000. You are guaranteed a coverage amount of $200,000 if you enroll when you are first eligible and have not waived coverage before. Employee Voluntary Life Insurance 2015 Biweekly Rates Your Age as of 12/31/2015 Biweekly Cost per $10,000 of Coverage Non-Tobacco User Tobacco User 0-29 $0.172 $0.309 30-34 $0.207 $0.342 35-39 $0.282 $0.501 40-44 $0.466 $0.828 45-49 $0.748 $1.375 50-54 $1.280 $2.307 55-59 $2.010 $4.024 60-64 $2.322 $4.175 65-69 $3.893 $7.008 70-74 $7.007 $12.878 75+ $10.486 $19.330 21

For Your Spouse or Domestic Partner You can purchase coverage in increments of $5,000. Coverage must be equal or less than the coverage you get for yourself. The maximum coverage amount is $500,000. Spouse/Domestic Partner Voluntary Life Insurance 2015 Biweekly Rates Your Spouse/Domestic Partner s Age as of 12/31/2015 Biweekly Cost per $5,000 of Coverage 0-29 $0.185 30-34 $0.216 35-39 $0.325 40-44 $0.563 45-49 $0.924 50-54 $1.487 55-59 $2.050 60-64 $2.916 65-69 $4.346 70-74 $7.262 75+ $17.691 For Your Dependent Children up to Age 26 You can purchase coverage in increments of $2,000. You can purchase coverage up to $10,000 per child, no matter how many children you cover. Child Voluntary Life Insurance 2015 Biweekly Rates Coverage Amount Biweekly Rate $2,000 $0.090 $4,000 $0.180 $6,000 $0.270 $8,000 $0.360 $10,000 $0.450 If you have a salary reduction due to a change in rate of pay or scheduled hours, your voluntary life insurance election will be adjusted so that it does not exceed five times your new annual salary. Any spouse or domestic partner voluntary life insurance amounts will be adjusted as well. 22

Evidence of Insurability Evidence of Insurability is medical information you may need to provide about the condition of your health before you can be approved for certain levels of life insurance coverage. You will need to complete an evidence of insurability form if: You want to be covered for more than $200,000 for yourself You want your spouse or domestic partner to have coverage greater than $100,000 You did not purchase voluntary insurance for yourself, spouse or child and want to enroll during annual Open Enrollment or due to a life event. What You Should Know About Your MaineHealth Life Insurance If you are an employee whose spouse is also employed under the MaineHealth family: You may not elect voluntary life insurance for your spouse. Your spouse must elect this coverage as the employee. Only one of the parents may carry the coverage for your dependent children. If you enroll a totally disabled dependent, coverage will be delayed until the dependent is no longer totally disabled. The effective date of coverage will be delayed if you are not in active employment on the original effective date. You may drop or decrease coverage for yourself or dependents at any time during the plan year. You can only add or increase coverage during annual Open Enrollment or if you have a qualified life event or status change (see page 3). Life Planning Financial & Legal Resources Support When You Need It Most Dealing with the death of a family member is difficult enough even before worrying about the personal, legal and financial decisions that need to be made. That s why MaineHealth s group life insurance through Unum includes Life Planning Financial & Legal Resources. This service provides financial and legal guidance and emotional support for beneficiaries as well as employees and spouses who are terminally ill. Counselors offer customized, objective, personal advice to each covered person. Regardless of their recommendations, the consultants don t receive any commission. In the event of a life insurance claim, beneficiaries will be contacted about this service. 23

Critical Illness Insurance Critical illness insurance can pay a lump sum benefit at the diagnosis of a covered illness. You may purchase critical illness insurance for yourself in amounts of $10,000 or $20,000 and for your spouse/domestic partner of $5,000 or $10,000. You are guaranteed coverage if you enroll when you are first eligible and have not waived coverage before. Critical illness insurance is a level premium product, which means you will always pay the rate for the age you are when you first buy the coverage. There are no rate increases due to aging. This is your opportunity to elect critical illness insurance up to the maximum of $20,000 without being subject to a review of your medical history. If you waive coverage (for yourself and your dependents), when you are first eligible and you wish to elect coverage during a future annual Open Enrollment, you will be subject to Evidence of Insurability and you may or may not be approved for coverage based on your medical history. Critical Illness Insurance 2015 Biweekly Rates Employee Non-tobacco User Issue Age Benefit Amt. <25 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70> $10,000 $3.19 $3.42 $4.53 $5.73 $7.71 $10.16 $13.02 $16.85 $21.23 $23.77 $41.73 $20,000 $5.26 $5.73 $7.94 $10.34 $14.31 $19.20 $24.93 $32.59 $41.36 $46.43 $82.34 Employee Tobacco User Issue Age Benefit Amt. <25 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70> $10,000 $4.06 $4.66 $6.51 $9.00 $12.69 $17.13 $22.48 $28.34 $33.74 $35.13 $55.89 $20,000 $7.02 $8.22 $11.91 $16.89 $24.28 $33.14 $43.85 $55.57 $66.37 $69.14 $110.68 Spouse Non-Tobacco User Issue Age Benefit Amt. <25 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 $5,000 $2.15 $2.26 $2.82 $3.42 $4.41 $5.63 $7.06 $8.98 $11.17 $10,000 $3.19 $3.42 $4.53 $5.73 $7.71 $10.16 $13.02 $16.85 $21.23 Spouse Tobacco User Issue Age Benefit Amt. <25 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 $5,000 $2.59 $2.89 $3.81 $5.06 $6.90 $9.12 $11.79 $14.73 $17.43 $10,000 $4.06 $4.66 $6.51 $9.00 $12.69 $17.13 $22.48 $28.34 $33.74 24

Accident Insurance Accident insurance can provide benefits for covered accidents that occur on and off the job. Coverage provides a lump-sum benefit based on the type of injury (or covered incident) or the type of treatment you need. You may elect coverage for yourself, your spouse/domestic partner and children. Biweekly rates for accident insurance are: Employee: $7.52 Employee and Spouse/Domestic Partner: $12.16 Employee and Child(ren): $14.04 Family: $18.68 Disability Coverage If you cannot work due to your own injury or illness, MaineHealth provides short-term disability (STD) and long-term disability (LTD) coverage at no cost to you. Coverage is effective as of the first day of the month on or after six months of continuous active employment in a benefits eligible position. See Summary Plan Description or Certificate of Coverage for more details. Short-term Disability Our short-term disability program replaces up to 60% of your lost income based on your lost hours if you are unable to work, or can only work on a partial basis, because of a disability that is not work-related. This includes the birth of a child. Disability benefits are approved by Unum based on information supplied by your medical provider. The STD benefit begins after 14 calendar days of non-work-related disability. Days 1 through 3 will be paid at 100% of your pre-disability wages with Paid Time Off (PTO) or Earned Time, if available. Days 4 through 14 will be paid at up to 100% of your pre-disability wages using your Frozen Sick Time or PTO/Earned Time, if available, unless you have requested to save up to one week of PTO/Earned Time. Once approved, the STD benefit is paid to you in your regular biweekly paycheck. Your STD benefit will be supplemented with your accumulated Frozen Sick Time (if applicable) or PTO/Earned Time, unless you have requested to save up to one week of PTO/Earned time. The benefit is payable for up to 24 weeks. At that point, Unum will review your claim to determine whether you are eligible to receive long-term disability benefits. Long-term Disability Our long-term disability program replaces up to 60% of your lost income if you are unable to work, or can only work on a partial basis due to a disability. The maximum amount you can receive each month is $10,000. LTD benefits begin after either 180 days or the end of STD benefits whichever is later. You will get the LTD benefit in a monthly check from Unum. If you are disabled before age 60, you may be able to receive payment until you turn 65. If you are disabled after age 60, please see the Summary Plan Description for details. Your LTD benefit may be reduced by payments from Workers Compensation, Social Security Disability and other sources of disability income. If you are disabled by a pre-existing condition in the first year you are covered under the LTD program, no benefit will be payable. If you need to open an STD claim, please call 877-352-8818, Monday through Friday, 8 a.m. to 8 p.m. 25

Perks Connect MaineHealth Employee Discount Program MaineHealth has partnered with Perks Connect to offer this Employee Discount Program. Members receive offers and access to discounts through direct relationships with local merchants and national retailers and vendors. Discounts are available for: Auto care Beauty Cellular services Florists Gyms and fitness centers Lodging Restaurants Uniforms Getting started is easy. Go to www.member.perksconnect.com and click Register Now to get started. Use the group code: MH14. HearPO HearPO gives discounts on hearing testing, diagnostics and supplies. Benefits to all MaineHealth employees and family members include: Help finding a hearing care provider near you. 40% off hearing tests and diagnostics. Hearing aid low price guarantee, risk free 60 day trial and 3 year warranty. Up to 2-year supply of free hearing aid batteries. For more information call 1-888-669-2168. Pet Insurance through VPI MaineHealth employees are eligible for up to a 5% discount on pet insurance from Veterinary Pet Insurance (VPI). You may elect coverage for surgeries, diagnostic tests, hospitalization, medications and vaccinations. If you elect coverage you will pay VPI directly, not through payroll deductions. To get a quote or learn more, call 1-877-PETS-VPI or visit www.petsvpi.com and let them know you are a MaineHealth employee. 26

Worldwide Emergency Travel Assistance Services Worldwide Emergency Travel Assistance Services protects you in the event of a medical emergency when you are traveling. This program is administered by Unum, and can help you whether you are traveling for business or pleasure, in a foreign land or just 100 miles from home. The benefits include: Guaranteed hospital admission (upon validation of your medical insurance) Emergency medical evacuation Return travel to your home when medically authorized Multilingual services Legal referrals Return of remains if death occurs during travel. For more information, visit www.unum.com/travelassistance. 27

529 College Savings Plans A 529 Plan is an educational savings plan meant to help families set aside money for future college costs. Earnings are not subject to federal tax or (in general) state tax when used for the qualified expenses of the designated beneficiary, such as tuition, fees, books, and room and board. NexGen College Investing Plan: Call 877-463-9843 for more information. College America offered through the American Funds Virginia 529 College Savings Plan: Call 800-421-4120 and tell the operator that you are employed by MaineHealth and would like more details about enrolling in the plan. MaineHealth has a direct employer relationship with the American Funds Virginia College Savings Plan which permits MaineHealth employees to purchase Class E shares. Class E shares do not have front end or back end loads or sales charges and have generally lower fees. Be sure you obtain the lower cost benefits of the Class E shares. MaineHealth does not offer payroll deductions for 529 contributions. Harold Alfond College Challenge The Harold Alfond College Challenge is a statewide scholarship program that gives a $500 grant to every Maine resident baby to start an account with Maine s college savings program, which is called the NextGen College Investing Plan (NextGen). The Harold Alfond College Challenge Grant (Alfond Grant) is intended to help Maine families plan for education beyond high school. The account must be opened by the child s first birthday. For more information and terms and conditions go to www.500forbaby.org. Benefits Plan Documents and Forms To access the MaineHealth benefits plan documents and benefits forms, go to www.mainehealth.bswift.com and go to the Library tab. The MaineHealth Benefits portal is available 24/7 and provides access to all plan documents and certificates of coverage for all MaineHealth benefits plans. For information about other benefits such as Paid Time Off, Tuition Assistance and Retirement Plans, please contact your MaineHealth member organization s HR department. 28

Benefit Plan Contacts HR Solution Center 207-661-4000 hrsolutions@mainehealth.org Health Insurance Anthem Blue Cross Blue Shield 888-224-4896 for questions about the Healthy Saver Plan www.anthem.com/mainehealth 800-527-7706 for questions about the Healthy HMO Hospital Admission 800-392-1016 Preauthorization required Mental Health/ Substance Abuse (Both MaineHealth medical plans) 800-538-9698 Preauthorization required For Urgent Care Outside of Maine 800-810-BLUE Prescription Drug Benefit Anthem 888-224-4896 for questions about the Healthy Saver Plan www.anthem.com/mainehealth 800-527-7706 for questions about the Healthy HMO Mail Order Prescriptions 800-962-8192 www.anthem.com/mainehealth Prior Authorization 800-662-0210 www.anthem.com/mainehealth Specialty Drugs: Accredo Apothecary by Design Maine Medical Center* 800-870-6419 207-774-5220 207-662-2626* www.anthem.com/mainehealth * Coming in 2015. 29

Dependent Verification Center Aon Hewitt 800-725-5810 www.yourdependentverification.com/plan-smart-info Employee Health Improvement Works on Wellness WOW! WOW! Rewards Program WOW! Healthy Paybacks Tobacco Treatment Health Information & Resources (WOW Health Coach, Care Management & More) KidsHealth WebMD Health Manager LifeBalance Healthy Pregnancy & Newborns 866-WOW-6090 www.mainehealth.org/wow Employee Assistance Program EAP Program LifeBalance 877-259-3785 www.lifebalance.net ID: mainehealth Password: lifebalance Dental Insurance Northeast Delta Dental 800-832-5700 www.nedelta.com Vision Insurance Anthem Blue View Vision 866-723-0515 www.anthem.com/mainehealth 30

Flexible Spending Accounts EBPA 888-678-3457 www.ebpabenefits.com Health Savings Account HealthEquity 877-302-7070 www.healthequity.com/mainehealth Tobacco Treatment MaineHealth Central Scheduling 855-300-8702 Maine Tobacco Helpline 800-207-1230 www.tobaccofreemaine.org New Hampshire Tobacco Helpline 800-784-8669 www.trytostopnh.org Health Information MaineHealth Learning Resource Center 866-609-5183 www.mainehealth.org/lrc Other Benefits Perks Connect Group Code: MH14 www.member.perksconnect.com 529 College Savings Plan NextGen College Investing Plan CollegeAmerica, offered by Virginia 529 877-463-9843 800-421-4120 31

Enrolling Online: The MaineHealth Benefits Portal All benefits-eligible MaineHealth employees will enroll in 2015 benefits online using the MaineHealth Benefits Portal ( the Portal ). The Portal provides easy and convenient access to a variety of resources during your new hire enrollment, the annual Open Enrollment period, and on an ongoing basis all year long. Access the Portal to: Enroll in your benefits Get documents and forms such as Summary Plan Descriptions, benefits summaries, rates and vendor information Access helpful tools Link directly to benefits plan websites and resources Make any benefits changes for life events during the year, such as a marriage or birth of a baby Your new hire enrollment must be completed within 31 days of your date of hire using the MaineHealth Benefits Portal at www.mainehealth.bswift.com. The Portal supports the following browsers: Microsoft Internet Explorer, versions 9.0 and up Mozilla Firefox, version 2.0.0.4 and up Safari, version 4.0.1 and up Chrome, version 19.0.1.084.52m and up You must have the following settings enabled: cookies, JavaScripts and Style Sheets. Important Notice Regarding Dependent Eligibility If you want to cover dependents on your health plan, you will have to demonstrate that they are eligible. This is called the Dependent Eligibility Audit. You will need to do this for all newly enrolled dependents.you may have to provide documents such as: Marriage certificate Domestic partner documents Birth certificates If this applies to you, you will receive audit materials in the mail after you enroll. 32

Step-by-Step Enrollment Instructions Follow the steps below to enroll in your 2015 MaineHealth benefits through the MaineHealth Benefits Portal. Step 1: Log In to www.mainehealth.bswift.com You ll need to enter your username and password to access the Portal. All usernames and passwords have been set to the following: Username: Enter the first two letters of your first name + the first four letters of your last name + the last four numbers of your Social Security number on the Portal landing page (as shown below). Password: Enter the last four digits of your Social Security number. Your Username will remain the same as long as you work for MaineHealth, even if you transfer among organizations or have a name change. Enter your username and password and click Log In. Do NOT use the Back button in your Internet browser. This will log you out of the site. To navigate through the site, use the navigation bar located on the left-hand side of the screen. Please note: Your enrollment process is not complete unless you Review and Agree to your elections and receive an on-screen confirmation statement. Step 2: Review the Home Page From the Home Page, click on ENROLL NOW. Enrollment is broken down into the following three steps or tabs. You will follow each step through each tab to make changes or confirm your information on file and choose your benefits for the new plan year. 1. Enter Your Information 2. Select Your Benefits 3. Confirm Step 3: Verify Your Personal Information Please check that all your personal information including your tobacco user status is correct. If you need to make any changes, you can do so directly on the site. However, if you need to make a change to your first name, last name, DOB, gender, home address or work email, please contact the HR Solution Center. Verify that all information is accurate. When done, check I agree at the bottom of the page and click Continue. Please Note: Any field that has an asterisk next to it is required. 33

Step 4: Add Your Family Information Please be sure to add all dependents in the Family Information section before proceeding to the next section. To do this, click on the Add dependents link. When all your family information is accurate, check I agree and click Continue. Step 5: Answer Key Questions Answer questions about whether you are receiving Social Security benefits or whether your spouse is employed by and eligible for benefits from MaineHealth. Click Continue. Step 6: Make Your Medical, HSA, Dental and Vision Plan Elections To start your enrollment, on the Select Your Benefits tab click on the Get Started button. If you are currently enrolled in a benefit plan the list on the left of the screen will have a green check mark. To review or change your election, simply click on the name of the plan. 34

From here, you can compare costs across all available plans by choosing your desired tier in the Compare Costs drop-down menu, compare plan details side by side by clicking on Help Me Decide and review details of a specific plan by clicking on the plan name link. Upon making your plan selection, you will be able to waive or cover eligible dependents by checking the box next to each dependent s name. If you wish to add a new dependent at this time, click on the Add Dependent button to be directed to the Family tab to add the dependent. If you are satisfied with your selection, click Save & Continue. Please Note: During the enrollment process, plans that are incomplete, or with no selection, are blue and show no cost. Complete plans are green with checkmarks indicating that you have elected or waived the plan and will show your biweekly cost. Following the plan selection, you may see the Primary Care Information page, depending on the medical plan you choose. You will have to enter the required information and can search for your PCP s ID by clicking on Provider Website. The PCP ID is 10 digits and starts with 680Z. Entering an incorrect ID will delay the receipt of your medical ID cards. If you have trouble finding your provider ID, please call the HR Solution Center at 207-661-4000 for assistance. If you have elected to enroll in the Healthy Saver Plan and are eligible for an HSA, you will be automatically enrolled with a zero contribution election. This is so MaineHealth can deposit your startup contribution. If you wish, you may enter an additional contribution of your own to your HSA up to your annual limit. 35

Step 7: Elect Voluntary Life Insurance Coverage These enrollments differ from the medical, dental and vision plans. When choosing these benefits, you will not need to select dependents to be covered, but you will need to choose whether you would like to enroll in the plan and enter a coverage amount. When you are satisfied with your election, click Next. Step 8: Enter Beneficiary Information Enter your life insurance beneficiary assignments to total 100%. When done, click Continue. If you would like to add another beneficiary, click on Add Beneficiary to be directed to the Beneficiary Maintenance page. 36

Step 9: Elect Contributions to FSAs Healthcare and Dependent Care To elect the FSA plans and make a contribution, select the radio button next to the plan name and enter your contribution amount in the box provided. When you are satisfied with your election, click Next. When you are satisfied with all your benefits plan elections, click on the Continue button at the bottom of the page. If you have exceeded the guaranteed issue for any of your selected life plans, you will receive a pop-up reminder at this point. 37

Step 10: Review and Agree to Your Elections You will now be on the final review page. Review all your benefit elections and covered dependents. Once you ve completed your enrollment, check the I agree to the changes I ve made and I m done with my enrollment box at the bottom of the page and then click the Save My Enrollment! button at the bottom of this page. Please Note: If you are enrolling in the Unum Life Insurance plans and are subject to evidence of insurability (EOI), once you click on Save My Enrollment, you will be automatically linked to Unum s website to complete an online EOI form and submit it directly to Unum. Dependent Eligibility Verification MaineHealth routinely conducts an eligibility audit on all employees with dependents enrolled in the benefit plan. The audit requires employees to provide documentation verifying their dependents status. If you are enrolling new dependents under the health plan, you will be required to provide proof of your dependents eligibility. Our Dependent Verification Center will mail a packet to your home shortly after enrollment with specific details on the documents needed from you. 38

Step 11: Receive Your Confirmation You will be able to change your elections as many times as you like until your enrollment period ends. If you would like to make a change after receiving your confirmation, you will need to start the enrollment process from the beginning. Your changed elections will not be saved until you receive a new confirmation. After you agree to your elections, you will receive an on-screen confirmation. We highly recommend that you send yourself an email confirmation of your elections. To do so, click on the Email icon on the New Elections page after making your election. If you don t have an email address in the system, please print out the confirmation page before you leave the site by clicking on the Printer icon. Questions If you have any benefits-related questions that cannot be answered on this website or if you are having trouble signing on to the Portal, please call the HR Solution Center at 207-661-4000. If you forget your password, click on Forgot Password on the Log In page of the Portal. Please Note: Although the online benefits enrollment site is a secure site, and your information is encrypted during transit, it is important that you log off when you have completed your session. Click the Log Out icon in the upper right-hand corner of the enrollment site to log off. For security purposes, the system will automatically log you out if you are idle for more than 30 minutes. 39

Reminder: Health Care Reform Two key provisions of the Health Care Reform law became effective on January 1, 2014: the Individual Mandate and the introduction of the Health Insurance Marketplace. Individual Mandate Under the Individual Mandate provision, you must have health insurance or pay a federal tax penalty. You can get your insurance through MaineHealth if you are eligible, a spouse s or domestic partner s plan, a parent s plan (if you are under age 26), the government, or through a state Insurance Marketplace. If you are eligible for and enroll in a MaineHealth medical plan, you will meet the Individual Mandate requirement. Want to Know More? To learn more about the Health Insurance Marketplace and Health Care Reform, access www.healthcare.gov or call 800-318-2596. You can also access www.enroll207.com or call 877-626-1684 for more information. Health Insurance Marketplace The Health Insurance Marketplace, or public exchange, is a place that people can buy health insurance. A Marketplace is available in each state. All Americans can purchase health insurance through a Marketplace, but if you are a benefits-eligible employee, the MaineHealth medical plans are likely to be the more cost-effective option. The legally required Marketplace Notice on pages 41-43 offers more information about the Marketplace and the availability of tax credits. 40

Legal Notices New Health Insurance Marketplace Coverage Options and Your Health Coverage PART A: General Information When key parts of the health care law take effect in 2014, there will be a new way to buy health insurance: the Health Insurance Marketplace. To assist you as you evaluate options for you and your family, this notice provides some basic information about the new Marketplace and employment-based health coverage offered by your employer. What is the Health Insurance Marketplace? The Marketplace is designed to help you find health insurance that meets your needs and fits your budget. The Marketplace offers one-stop shopping to find and compare private health insurance options. You may also be eligible for a new kind of tax credit that lowers your monthly premium right away. Open enrollment for health insurance coverage through the Marketplace began in October 2013 for coverage starting as early as January 1, 2014. Can I Save Money on my Health Insurance Premiums in the Marketplace? You may qualify to save money and lower your monthly premium, but only if your employer does not offer coverage, or offers coverage that doesn t meet certain standards. The savings on your premium that you re eligible for depends on your household income. Does Employer Health Coverage Affect Eligibility for Premium Savings through the Marketplace? Yes. If you have an offer of health coverage from your employer that meets certain standards, you will not be eligible for a tax credit through the Marketplace and may wish to enroll in your employer s health plan. However, you may be eligible for a tax credit that lowers your monthly premium, or a reduction in certain cost-sharing if your employer does not offer coverage to you at all or does not offer coverage that meets certain standards. If the cost of a plan from your employer that would cover you (and not any other members of your family) is more than 9.5% of your household income for the year, or if the coverage your employer provides does not meet the minimum value standard set by the Affordable Care Act, you may be eligible for a tax credit. 1 Note: If you purchase a health plan through the Marketplace instead of accepting health coverage offered by your employer, then you may lose the employer contribution (if any) to the employer-offered coverage. Also, this employer contribution as well as your employee contribution to employer-offered coverage is often excluded from income for Federal and State income tax purposes. Your payments for coverage through the Marketplace are made on an after-tax basis. How Can I Get More Information? For more information about your coverage offered by your employer, please check your summary plan description or contact The MaineHealth HR Solution Center at 229 Vaughan Street, Portland, Maine 04102 or 207-661-4000. The Marketplace can help you evaluate your coverage options, including your eligibility for coverage through the Marketplace and its cost. Please visit HealthCare.gov for more information, including an online application for health insurance coverage and contact information for a Health Insurance Marketplace in your area. 1 An employer-sponsored health plan meets the minimum value standard if the plan s share of the total allowed benefit costs covered by the plan is no less than 60 percent of such costs. 41

PART B: Information About Health Coverage Offered by Your Employer This section contains information about any health coverage offered by your employer. If you decide to complete an application for coverage in the Marketplace, you will be asked to provide this information. This information is numbered to correspond to the Marketplace application. 3. Employer name: MaineHealth 5. Employer address: 110 Free Street 4. Employer Identification Number (EIN): 01-0431680 6. Employer phone number: 207-661-7001 7. City: Portland 8. State Maine 9. ZIP code: 04101 10. Who can we contact about employee health coverage at this job? The MaineHealth HR Solution Center 11. Phone number (if different from above): 207-661-4000 12. Email address: hrsolutions@mainehealth.org Here is some basic information about health coverage offered by this employer: As your employer, we offer a health plan to: All employees. Some employees. Eligible employees are: To be eligible for coverage under the MaineHealth Health Plan you must be regularly scheduled to work at least 20 hours per week in a single position at a MaineHealth member organization which participates in this MaineHealth Health Plan. However: For purposes of complying with the Affordable Care Act (ACA) MaineHealth will measure your actual hours worked over a 12 month measurement period to determine the average number of hours worked. If it is determined that you worked an average of 30+ hours per week during the measurement period, you will be offered health insurance and will be eligible for coverage for 12 months, which is referred to as the Stability Period. Your hours will be measured each year to determine eligibility for health insurance coverage. For more information on the ACA, see page 41 of this guide. With respect to dependents: We do offer coverage. Eligible dependents are: Legal spouse; Domestic partner; Children under age 26 this includes your biological children, stepchildren, domestic partners children and legally adopted children. Also includes legal wards and legally placed foster children- up to age 26, who live with you; Children of any age, who are unmarried, principally dependent on you for support, and incapable of self-sustaining employment because of physical or mental disability; Children who are unmarried and become eligible for medical coverage under the terms of a Qualified Medical Child Support Order (QMCSO). We do not offer coverage. 42

If checked, this coverage meets the minimum value standard, and the cost of this coverage to you is intended to be affordable, based on employee wages. ** Even if your employer intends your coverage to be affordable, you may still be eligible for a premium discount through the Marketplace. The Marketplace will use your household income, along with other factors, to determine whether you may be eligible for a premium discount. If, for example, your wages vary from week to week (perhaps you are an hourly employee or you work on a commission basis), if you are newly employed mid-year, or if you have other income losses, you may still qualify for a premium discount. If you decide to shop for coverage in the Marketplace, HealthCare.gov will guide you through the process. Employer information you ll need when you visit HealthCare.gov to find out if you can get a tax credit to lower your monthly premiums can be requested by contacting the MaineHealth HR Solution Center at 207-661-4000. 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). (Continued on next page) 43

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, 2014. Contact your State for more information on eligibility ALABAMA Medicaid Website... http://www.medicaid.alabama.gov Phone... 1-855-692-5447 ALASKA Medicaid Website...http://health.hss.state.ak.us/dpa/programs/medicaid/ Phone (Outside of Anchorage)... 1-888-318-8890 Phone (Anchorage)... 1-907-269-6529 ARIZONA CHIP Website...http://www.azahcccs.gov/applicants Phone (Outside of Maricopa County)... 1-877-764-5437 Phone (Maricopa County)... 1-602-417-5437 COLORADO Medicaid Medicaid Website... http://www.colorado.gov/ Medicaid Phone (In state)... 1-800-866-3513 Medicaid Phone (Out of state)... 1-800-221-3943 FLORIDA Medicaid Website... http://www.flmedicaidtplrecovery.com/ Phone... 1-877-357-3268 GEORGIA Medicaid Website...http://dch.georgia.gov/ Click on Programs, then Medicaid, then Health Insurance Premium Payment (HIPP) Phone...1-800-869-1150 IDAHO Medicaid Medicaid Website...http://healthandwelfare.idaho.gov/ Medical/Medicaid/PremiumAssistance/ tabid/1510/default.aspx Medicaid Phone... 1-800-926-2588 INDIANA Medicaid Website... http://www.in.gov/fssa Phone... 1-800-889-9949 IOWA Medicaid Website... www.dhs.state.ia.us/hipp/ Phone... 1-888-346-9562 KANSAS Medicaid Website... http://www.kdheks.gov/hcf/ Phone... 1-800-792-4884 KENTUCKY Medicaid Website... http://chfs.ky.gov/dms/default.htm Phone... 1-800-635-2570 LOUISIANA Medicaid Website... http://www.lahipp.dhh.louisiana.gov Phone... 1-888-695-2447 MAINE Medicaid Website...http://www.maine.gov/dhhs/ofi/ public-assistance/index.html Phone... 1-800-977-6740 TTY... 1-800-977-6741 MASSACHUSETTS Medicaid and CHIP Website...http://www.mass.gov/MassHealth Phone...1-800-462-1120 MINNESOTA Medicaid Website... http://www.dhs.state.mn.us/ Click on Health Care, then Medical Assistance Phone... 1-800-657-3629 MISSOURI Medicaid Website... http://www.dss.mo.gov/mhd/participants/ pages/hipp.htm Phone... 1-573-751-2005 MONTANA Medicaid Website...http://medicaidprovider.hhs.mt.gov/ clientpages/clientindex.shtml Phone... 1-800-694-3084 NEBRASKA Medicaid Website... www.accessnebraska.ne.gov Phone... 1-855-632-7633 NEVADA Medicaid Medicaid Website... http://dwss.nv.gov/ Medicaid Phone... 1-800-992-0900 NEW HAMPSHIRE Medicaid Website... http://www.dhhs.nh.gov/oii/documents/hippapp.pdf Phone... 1-603-271-5218 NEW JERSEY Medicaid and CHIP Medicaid Website...http://www.state.nj.us/humanservices/ dmahs/clients/medicaid/ Medicaid Phone... 1-609-631-2392 CHIP Website... http://www.njfamilycare.org/index.html CHIP Phone... 1-800-701-0710 NEW YORK Medicaid Website... http://www.nyhealth.gov/health_care/medicaid/ Phone... 1-800-541-2831 NORTH CAROLINA Medicaid Website... http://www.ncdhhs.gov/dma Phone... 1-919-855-4100 NORTH DAKOTA Medicaid Website...http://www.nd.gov/dhs/services/medicalserv/ medicaid/ Phone... 1-800-755-2604 OREGON Medicaid Website...http://www.oregonhealthykids.gov http://www.hijossaludablesoregon.gov Phone... 1-800-699-9075 OKLAHOMA Medicaid and CHIP Website... http://www.insureoklahoma.org Phone... 1-888-365-3742 PENNSYLVANIA Medicaid Website...http://www.dpw.state.pa.us/hipp Phone... 1-800-692-7462 RHODE ISLAND Medicaid Website...www.ohhs.ri.gov Phone... 1-401-462-5300 SOUTH CAROLINA Medicaid Website...http://www.scdhhs.gov Phone... 1-888-549-0820 44

SOUTH DAKOTA Medicaid Website...http://dss.sd.gov Phone... 1-888-828-0059 TEXAS Medicaid Website...http://www.gethipptexas.com/ Phone... 1-800-440-0493 UTAH Medicaid and CHIP Website... http://health.utah.gov/upp Phone... 1-866-435-7414 VERMONT Medicaid Website... http://www.greenmountaincare.org/ Phone... 1-800-250-8427 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 WASHINGTON Medicaid Website...http://www.hca.wa.gov/medicaid/premiumpymt/ pages/index.aspx Phone... 1-800-562-3022 ext. 15473 WEST VIRGINIA Medicaid Website...www.dhhr.wv.gov/bms/ Phone... 1-877-598-5820, HMS Third Party Liability WISCONSIN Medicaid Website...http://www.badgercareplus.org/ pubs/p-10095.htm Phone... 1-800-362-3002 WYOMING Medicaid Website...http://health.wyo.gov/healthcarefin/ equalitycare Phone... 1-307-777-7531 To see if any other States have added a premium assistance program since July 31, 2014, or for more information on special enrollment rights, you can contact either: U.S. Department of Labor Employee Benefits Security Administration www.dol.gov/ebsa 1-866-444-EBSA (3272) U.S. Department of Health and Human Services Centers for Medicare & Medicaid Services www.cms.hhs.gov 1-877-267-2323, Menu Option 4, Ext. 61565 Women s Health and Cancer Rights Act of 1998 Requires Coverage for Reconstructive Surgery After Mastectomies The Women s Health and Cancer Rights Act of 1998 requires health plans that provide medical and surgical benefits for mastectomies to also provide benefits for the following, as requested by the patient in consultation with her physician: 1. Reconstruction of the breast on which the mastectomy has been performed; 2. Surgery and reconstruction of the other breast to produce a symmetrical appearance; 3. Prostheses; 4. Treatment of physical complications of all stages of the mastectomy, including lymphedemas. You and your covered dependents will receive these benefits if needed. Benefits are subject to the same deductibles, copayments, coinsurance or limitations that may apply to other covered services under your plan. Please contact your healthcare contract administrator if you have any questions or concerns. The telephone number is located on the back of your health plan ID card. 45

Pen Bay Healthcare 2015 Health Plan Biweekly Payroll Deduction Rates Rates are based on 26 payroll deductions per year. FULL TIME (35-40 hours) Employee Biweekly Payroll Deduction Under $30,000 - $100,000 - $150,000 - $200,000 2015 Healthy Saver CDHP Nonsmoker* $30,000 $99,999 $149,999 $199,999 and Over Employee Only $30.21 $36.09 $50.50 $64.92 $79.33 Employee + Child(ren) $71.36 $80.48 $99.25 $118.02 $136.79 Employee + Spouse $114.17 $128.37 $156.27 $184.16 $212.06 Employee + Family $114.17 $128.37 $156.27 $184.16 $212.06 Under $30,000 - $100,000 - $150,000 - $200,000 2015 Healthy HMO Nonsmoker* $30,000 $99,999 $149,999 $199,999 and Over Employee Only $52.52 $58.67 $73.74 $88.83 $103.90 Employee + Child(ren) $100.79 $110.01 $129.75 $149.49 $169.23 Employee + Spouse $161.26 $176.01 $205.22 $234.44 $263.65 Employee + Family $161.26 $176.01 $205.22 $234.44 $263.65 PART TIME (20-34.99 hours) Employee Biweekly Payroll Deduction All 2015 Healthy Saver CDHP Nonsmoker* Employees Employee Only $91.00 Employee + Child(ren) $188.00 Employee + Spouse $235.00 Employee + Family $274.00 All 2015 Healthy HMO Nonsmoker* Employees Employee Only $116.10 Employee + Child(ren) $222.80 Employee + Spouse $287.65 Employee + Family $328.44 * 46.16 biweekly will be added as a Tobacco Fee for employees enrolled in a health plan who do not test negative for tobacco.

2015 Employee Benefits Guide