Benefits Guide

CITY OF EAST RIDGE TENNESSEE EST. 1921 OFFICIAL EMPLOYEE BENEFITS Employee Benefits Guide Everything you need to make confident benefit decisions @ Plan Year: July 1, 2026 - June 30, 2027 ®@ Open Enrollment: May 26 - June 9, 2026 Gateway to Tennessee e is subject to the full terms, ontract. Presented by 2026-2027 BENEFITS What's Inside How to Enroll Medical Benefits Health Reimbursement Employee Navigator Cigna HRA OAP — Gold & Silver City-funded HRA details myCigna & Virtual Care Dental & Vision Life & AD&D App, MDLIVE 24/7 Guardian — both plans. Lincoln Financial — City-paid Short & Long-Term Disability Voluntary Life Supplemental Benefits STD Voluntary - LTD City-paid Employee-paid options Accident & Critical lines Value-Added Services Important Contacts Annual Notices EAP, TravelConnect & more Al carrier info & links Federally required disclosures Open Enrollment: May 26 - June 9, 2026. Complete all elections at employeenavigator.com — Company ID: CityOfEastRidge. Coverage effective July 1, 2026. Questions? Contact HR or Oakbridge Insurance. f EastRidge How to Enroll — Employee Navigator Open Enrollment: May 26 ~ June 9, 2026 - employeenavigator.com - Company ID: e Register / Log In Accept Terms Click Login > Register. Company ID: CityOfEastRidge. Accept Terms of Use & Privacy Policy. Click Accept > Returning users log in with existing credentials. Let's Begin > Sign Document - Finish > Start > Get Started. Personal Info Dependents Verify your personal information for accuracy. Click ‘Add or update dependents. All changes must be made Save & Continue on each page. here. Click Save & Continue. Medical Dental & Vision Select who is covered. All enrolling dependents must Repeat Step 5 for Dental then Vision. show a green checkmark. To decline, click "Don't want this benefit?" Basic Life & AD&D Beneficiaries City-paid —no cost to you. Select dependent Click Add a Beneficiary. Enter relationship, name, and coverage level from the dropdown. Save & Continue. allocation %. Total must equal 100% Voluntary Life Disability & Supplemental Select benefit amount via slider. Increases require EO! Confirm LTD (City-paid), elect STD if desired, enroll in —click Open Link. Policy #: 760836. EO! not required Accident and/or Critical Iliness. for Voluntary AD&D. Cn) ‘Sign& Submit— Required Enrollment is NOT processed without your electronic signature. Apply your signature on the final screen. Medical Benefits — Cigna HRA OAP ‘Two plan options « No referral required « City funds an HRA to offset your deductible - Cigna Open Access Plus Lower cost-sharing in exchange for a slightly higher premium. Best for employees who anticipate regular medical care. BI-WEEKLY EMPLOYEE PREMIUMS Employee Only Employee +1 Family $43.84 $112.52 $163.61 |pay period I pay period I pay period | ‘Spousal Surcharge: $23.08 bi-weekly surcharge applies if spouse has access to other employer-sponsored coverage. Benef In-Network Out-of-Network Annual Deductible $5,000 Ind / $10,000 Fam $10,000 / $20,000 City HRA Contribution Up to $4,200 / $8,400 N/A Your Deductible Share $800 Individual Employee responsible Out-of-Pocket Max $6,000 / $12,000 $12,000 / $24,000 Preventive Care No Charge 30% coinsurance MDLIVE Virtual Care No Charge N/A Primary Care Visit 10% after deductible 30% after deductible Specialist Visit 10% after deductible 30% after deductible Emergency Room 10% after deductible 10% after deductible Urgent Care 10% after deductible 30% after deductible Lab / X-ray 10% after deductible 30% after deductible Imaging (CT/MRI) 10% after deductible 30% after deductible Hospital - Inpatient 10% after deductible 30% after deductible Hospital - Outpatient Surgery 10% after deductible 30% after deductible Mental Health 10% after deductible 30% after deductible Rehab (PT/OT/ST) 10% after deductible 30% after deductible City of East Ridge MEDICAL BENEFITS — CIGNA HRA OAP (CONTINUED) Option 2 — Silver Plan Lower premiums offset by a larger City-funded HRA. Good choice if you want to minimize monthly payroll deductions. BI-WEEKLY EMPLOYEE PREMIUMS Employee Only Employee +1 Family $19.75 $64.28 $93.48 / pay period I pay period J pay period | Spousal Surcharge: $23.08 bi-weekly surcharge appliesif spouse has access to other employer-sponsored coverage. Benefit In-Network Out-of-Network Annual Deductible $7,000 Ind / $14,000 Fam $10,000 / $20,000 City HRA Contribution Up to $5,000 / $10,000 NIA Your Deductible Share $2,000 Individual Employee responsible Out-of-Pocket Max $8,000 / $16,000 $16,000 / $32,000 Preventive Care No Charge 30% coinsurance MDLIVE Virtual Care No Charge NIA Primary Care Visit 20% after deductible 30% after deductible Specialist Visit 20% after deductible 30% after deductible Emergency Room 20% after deductible 30% after deductible Urgent Care 20% after deductible 30% after deductible Lab/ X-ray 20% after deductible 30% after deductible Imaging (CT/MRI) 20% after deductible 30% after deductible Hospital - Inpatient 20% after deductible 30% after deductible Hospital- Outpatient Surgery 20% after deductible 30% after deductible Mental Health 20% after deductible 30% after deductible Rehab (PT/OT/ST) 20% after deductible 30% after deductible Pre-authorization required for certain services. OON providers may balance-bill. For Rx, see the Cigna Healthcare Advantage 4-Tier Drug List on the City website. Full SBC: www.cigna.com or 1-866-494-2111, City of East Ridge Health Reimbursement Arrangement (HRA) City-funded - Administered by Cigna - No employee contribution required Important: After your deductible is met, submit your receipt and E08 to HR for reimbursement in $50 increments up to $1,000. The City funds an HRA for every enrolled employee. You pay nothing into it. The HRA works on a per-claim basis — each eligible claim is reviewed and reimbursed separately. Only IRS-qualified medical expenses are reimbursable. Op! old HRA Total Annual Deductible $5,000 Ind / $10,000 Fam Total Annual Deductible $7,000 Ind / $14,000 Fam You Pay (Deductible) $800 Individual You Pay (Deductible) $2,000 Individual City HRA Covers $4,200 / $8,400 City HRA Covers $5,000 / $10,000 Your Share per Claim 16% Your Share per Claim 29% City Share per Claim 84% City Share per Claim 1% Post-Deductible Extra $50 increments up to $1,000 Post-Deductible Extra ‘$50 increments up to $1,000 Gold Plan Example Silver Plan Example You incur a $1,000 eligible medical expense: You incur a $1,000 eligible medical expense: > You pay > You pay $160 $290 (16%) > City HRA pays (29%) > City HRA pays $840 $710 (84%) (1%) After your $800 employee deductible is met, submit your After your $2,000 employee deductible is met, submit your receipt and EOB to HR for reimbursement in $50 increments receipt and EOB to HR for reimbursement in $50 increments up to $1,000. up to $1,000. HRA questions? Call the number on the back of your Cigna ID card. City of East Ridge | | myCigna App & Virtual Care (MDLIVE) Free on iOS & Android - 24/7 access « No charge on either plan - No deductible applied Q ul ~ Digital ID Card Deductible @ HRA Tracker Find Care View and share your Cigna ID card Real-time balances for deductible, out-of- Search in-network doctors, specialists, instantly — no physical card needed pocket max, and HRA, urgent care, hospitals, and pharmacies. *® = (2) Prescriptions Virtual Care 24/7 Health Advocate Compare drug costs, find the most Launch an MDLIVE visit directly from the Live chat 24/7 with a Cigna health affordable pharmacy, manage app — no separate login needed. advocate for coverage questions. medications. MDLIVE VIRTUAL CARE — SERVICES AVAILABLE Service Area Con Cost Urgent / Primary Cold & flu, sinus infections, allergies, ear infections, UTIs, rashes, headaches, and No Care more Charge Behavioral Health Anxiety, depression, stress, grief, PTSD, sleep disorders, addiction support, ongoing No therapy Charge Dermatology Acne, eczema, psoriasis, rosacea, hair loss, skin lesions (photo-based consultation No available) Charge Nutrition Counseling _ Dietary guidance, weight management, chronic disease nutrition, personalized No dietitian plans Charge Wellness Screening Annual wellness check-in — counts toward Accident plan Weliness benefit ($50) No Charge ‘Access: myCigna app > Virtual Care | my.cigna.com | Phone: 1-855-667-9722 | Member Services: 1-866-494-2111. Register at my.cigna.com or search myCignain the App Store / Google Play. City of East Ridge Dental & Vision — Guardian Effective July 1, 2026 - Pre-tax payroll deduction - guardiananytime.com - 1-800-541-7846 DENTAL BENEFITS Coverage Class In-Network Out-of-Network Class | — Preventive Exams, cleanings, xrays, fluoride, sealants 100% — no deductible Reimbursed at UCR Class Il — Basic Restorative Fillings, simple extractions, root canals 90% after deductible Reimbursed at UCR Class Il — Major Restorat Crowns, dentures, bridges 60% after deductible Reimbursed at UCR Orthodontia 50% — $1,500 lifetime max (dependent childrenttoiagaia9)d at UCR Annual Maximum $1,500 per person per calendar year Calendar Year Deductible $50 Individual / $150 Family (waived for Class !) Reimbursed at UCR Exam & Cleaning Frequency ainarcalanaanyedt Full Mouth X-rays Every 3-5 years Employee Only Employee + 1 Family pay period / pay period / pay period VISION BENEFITS Benefit In-Network Out-of-Network Copays Exam: $10 | Materials: $25* Comprehensive Eye Exam 100% after copay Up to plan allowance Single, Bifocal & Trifocal Lenses 100% after copay Up to plan allowance Frames $120 frame allowance toward your choice Up to plan allowance Contact Lenses (elective) Contact lens allowance in lieu of glasses Up to plan allowance Contact Lens Fitting Covered with contact purchase = Laser Vision Discounts available through Guardian NA Frequency — Exam & Lenses once per calendar year Frequency — Frames Once every two calendar years Employee Only Employee + 1 Family / pay period / pay period / pay period Find a provider: guardiananytime.com ~ Find a Dentist / Find a Vision Provider. Davis Vision providers available nationwide. Contact Guardian for current frame and contact lens allowance amounts. * Materials copay waived for elective contact lenses. City of East Ridge Basic Life @ AD&D — City-Paid Lincoln Financial - No cost to eligible full-time employees » 1-800-423-2765 Coverage Benefit Employee Life & AD&D $20,000 each Spouse Life Coverage $5,000 Dependent Children (14 days - 6 months) $100 Dependent Children (6 months—under 26) $2,000 Cost to Employee Evidence of Insurability Not required — fully guaranteed issue Conversion Option Yes, with restrictions — see certificate of benefits, Value-Added Services Included LifeKeys® (counseling, legal & financial) & TravelConnect® (emergency travel) Designate your beneficiary in Employee Navigator. Update after any major life event — marriage, divorce, birth, or death in the family. Short & Long-Term Disability Lincoln Financial - STD is employee-paid (voluntary) - LTD is City-paid at no cost Long-Term Disability Weekly Benefit 60% of earnings Monthly Benefit 60% of earnings Maximum Weekly Benefit $750 / week Maximum Monthly Benefit $5,000 / month Maximum Duration 25 weeks Elimination Period 180 days Elimination Period — Accident 14 days x , 3-mo lookback / 12-mo Pre-existing Conditions exclusion Elimination Period — Illness 14 days Premium Waiver While Rate (per $10 weekly benefit) $0.536 : Yes Disabled Cost to Employee so City of East Ridge SHORT & LONG-TERM DISABILITY (CONTINUED) LTD MAXIMUM BENEFIT PERIOD BY AGE AT DISABILITY ‘Age at Disability Max Benefit Period Age at Disability Max Benefit Period Under 60 To Age 65 (or SSNRA) 65 24 months 60 60 months, 66 21 months. 6 48 months, 67 18 months 62 42 months, 68 15 months 63 36 months 69 and over 12 months 64 30 months, STD VOLUNTARY RATE EXAMPLES Weekly Earnings Weekly Benefit (60%) Monthly Rate Bi-Weekly Rate $500 / week $300 / week $16.08 $7.42 $750 / week $450 / week $24.12 $1113 $1,000/ week $600 / week $32.16 $14.84 $1,250/ week $750 / week (max) $40.20 $18.55 Rate: $0.536 per $10 of weekly benefit. Maximum weekly benefit is $750. Bi jeekly = monthly x 12 + 26. STD covers up to 25 weeks. LTD begins after the 180-day elimination period — seamless long-term income protection. File claims ear! 800-423-2765. EastRidge Voluntary Life @ AD@D Lincoln Financial - Employee-paid - Policy #760836 - Pre-tax payroll deductions Feature Employee Spouse Dependent Children Coverage Increments $10,000 $5,000 Fixed amounts Maximum Coverage Lesser of 7x salary or 100% of EE; max Day 1-6 mo: $1,000 / 6 mo-26 yrs: $500,000 $500,000 $20,000 Guarantee Issue (New $150,000 $50,000 Guaranteed issue Hire) AD&D Included Yes — equals life benefit Yes—equals life benefit N/A Benefit Reduction 35% at 70; 15% more at75 35% at 70; 15% more at —_ Ends at age 26 75 Portability Yes Yes (basedonEE age) N/A RATE TABLE — PER $1,000 OF COVERAGE ‘Age Band Life Rate/$1,000 EE AD&D/S1,000 ‘Spouse AD&D/$1,000 Example: $50K Life+AD&D/mo Under 30, $0.26 $0.020 $0.026 $7.30 30-34 $0126 $0.020 $0.026 $7.30 35-39 $0156 $0.020 $0.026 $8.80 40-44 $0.230 $0.020 $0.026 $12.50 45-49 $0.399 $0.020 $0.026 $20.95 50-54 $0.607 $0.020 $0.026 $31.35 55-59 $0.769 $0.020 $0.026 $39.45 60-64 $1ig2 $0.020 $0.026 $60.60 65-69 $2.206 $0.020 $0.026 $111.30 70+ $3.623 $0,020 $0.026 $182.15 Dependent Children (flat rate) $3.64/mo for $20k How to Calculate Your Monthly Cost Example: age 45, electing $100,000 Voluntary Life + AD&D Life: $0.399 + 1,000 x $100,000 = $39.90/mo + AD&D: $0.020 1,000 x $100,000 = $2.00/mo $41.90/mo total EOI required for elections above Guarantee Issue ($150,000 EE / $50,000 spouse). Employees and Spouses may increase their Voluntary Life amount by up to two increments per year without EOI, up to Maximum Coverage. Complete EOI electronically in Employee Navigator for amounts above Gl. The amount currently elected must be re-elected each year to remain enrolled. City of East Ridge Supplemental Benefits — Cigna Employee-paid - Accident Insurance & Critical IlIness - Effective July 1, 2026 ACCIDENT INSURANCE — PER PAY PERIOD RATES Employee Only FE + spauee FE + chila(ren) $3.69 $6.54 $8.66 [pay period | pay period | pay period cE + Femly $11.51 Accident Ben Amount Accident Benefi Amount Emergency Care (V/accident) $200 Hospital Admission (I/accident) $1,000 Physician / Urgent Care visit, $100 Hospital Stay (up to 365 days) $200/day Diagnostic Exam (X-ray or Lab) $75 Intensive Care Unit Stay $400/day Ground / Water Ambulance $400 Skull/Hip/Thigh — Non-Surgical $4,000 Air Ambulance (I/accident) $1,600 Skull/Hip/Thigh — Surgical $8,000 Accidental Death $50,000 Upper Arm/Shoulder — Surgical $2,000 Auto Accidental Death $50,000 Common Carrier Accidental Death $100,000 Sight Both Eyes / Both Hands $30,000 One Hand+Foot / Both Ears $15,000 | Wellness / Health Screening (1/yr) $50 Finger or Toe $2,000 CRITICAL ILLNESS INSURANCE Pays a lump-sum directly to you upon diagnosis of a covered condition (heart attack, stroke, cancer, major organ failure, and more). Use it for anything. Benefits paid in addition to other insurance. No pre-existing condition exclusion. Guarantee Issue for new hires: $30,000. Benefit Levels $10,000 / $20,000 / $30,000 Guarantee Issue (New $30,000 — no health questions required Spouse Benefit 50% of employee's elected benefit Dependent Children 50% of employee's elected benefit (birth to age 26) Portability Coverage continues to age 100 upon termination EOI Required For elections above $30,000 Gl or after initial enrollment Accident Insurance is an accident-only policy. It does NOT constitute comprehensive health insurance and does not satisfy ACA Minimum Essential Coverage. City of East Ridge SUPPLEMENTAL BENEFITS — CRITICAL ILLNESS RATES (CONTINUEI CRITICAL ILLNESS MONTHLY RATES — $10,000 BENEFIT LEVEL ‘Age Band Employee Only EE + Spouse EE + Child(ren) 0-24 $3.83 $7.43 $5.18 25-29 $4.31 $7.98 $5.66 $9.33 30-34 $5.13 $9.03 $6.48 $10.38 35-39 $6.85 $11.53 $8.20 $12.88 40-44 $8.91 $14.68 $10.26 $16.03 45-49 $12.95 $20.84 $14.30 $22.19 50-54 $17.66 $28.20 $19.01 $29.55, 55-59 $25.85 $40.55 $27.20 $41.90 60-64 $33.40 $51.95 $34.75 $53.30 65-69 $43.94 $68.93 $45.29 $70.28 70-74 $5751 $91.16 $58.86 $92.51 75-79 $75.15 $118.96 $76.51 $120.31 80-84 $89.08 $141.41 $90.43 $142.76 85+ $96.58 $152.83 $97.93 $154.18 CRITICAL ILLNESS MONTHLY RATES — $20,000 BENEFIT LEVEL Age Band Employee Only EE + Spouse EE + Child(ren) 0-24 $7.66 $14.86 $10.36 25-29 $8.62 $15.96 $11.32 30-34 $10.26 $18.06 $12.96 35-39 $13.70 $23.06 $16.40 40-44 $17.82 $29.36 $20.52 45-49 $25.90 $41.68 $28.60 50-54 $35.32 $56.40 $38.02 55-59 $51.70 $8130 $54.40 60-64 $66.80 $103.90 $69.50 $106.60 65-69 $87.88 $137.86 $90.58 $140.56 70-74 $115.02 $182.32 $117.72 $185.02 75-79 $150.30 $237.92 $153.02 $240.62 80-84 $178.16 $282.82 $180.86 $285.52 85+ $193.16 $305.66 $195.86 $308.36 Rates are monthly, uni-tobacco, age-banded. $30,000 benefit level available — contact HR or Oakbridge Insurance for rates. City of East Ridge Value-Added Service Included with Lincoln Financial benefits No additional cost Available whether or not you file a clain E al home price co Pre-planning arrangemen Reduces emotional an financial burde ur fami for famili gating 18 Topics: Family, Parenting, Addictions, Legal, Financial, 1-888-628-4824 Keys® Services TravelConnect® upport — counseling, g Emergenc uation to nearest facility torney consultations, planning Repatriationof remains if you pass away while trav ances, iment help. Identi ination requirements aster or political unrest 1-888-628-4824 Active 100+ miles from home - 24/7/365 all EAP and LifeKeys services at GuidanceResources.com or down he GuidanceNow app. of EastRidge Important Contacts & Resources For enrollment questions, contact City of East Ridge HR. For claims or coverage details, contact Oakbridge Insurance. Carrier / Resource Plan / Service Phone Web: Cigna Medical, HRA, Virtual Care 1-866-494-2111 www.cigna.com myCigna / MDLIVE App, Virtual Care, Claims 1-855-667-9722 my.cigna.com Guardian Dental & Vision 1-800-541-7846 guardiananytime.com Lincoln Financial Life, STD, LTD, Voluntary Life 1-800-423-2765 lincolnfinancial.com EmployeeConnect EAP Counseling, Legal, Financial 1-888-628-4824 guidanceresources.com Online Enrollment — Company ID: Employee Navigator employeenavigator.com CityOfEastRidge Broker / Benefits Advisor — Jason Oakbridge Insurance 706-419-3964 jbryant@oakbridgeinsurance.com Bryant City of East Ridge HR Eligibility, Payroll, HR Questions. (423) 867-7711 eastridgetn.gov Medicare Part D creditable coverage questions 1-800-633-4227 medicare.gov TennCare / CoverKids Tennessee Medicaid & CHIP assistance 1-800-525-6401 tn.govitenncare DOL / EBSA ERISA & benefits compliance questions 1-866-444-3272 dol,goviebsa Questions about enrollment or eligibility? Contact City of East Ridge HR. For claims or coverage details, contact Oakbridge Insurance, City of East Ridge Annual Notices Federally required disclosures — please read and retain this guide 1, HIPAA Special Enrollment Notice If you are dectining enrollment for yourself or your dependents because of other health insurance coverage, you may be able to enroll in this, plan if you or your dependents lose eligibility for that other coverage, or if the employer stops contributing toward your or your dependents" other coverage. You must request enrollment within 30 days after your other coverage ends or after the employer stops contributing toward the other coverage. In addition, if you have a new dependent as a result of marriage, birth, adoption, or placement for adoption, you may be able to enroll yourself and your dependents. However, you must request enrollment within 30 days after the marriage, birth, adoption, or placement for adoption. To request special enrollment or obtain more information, contact Human Resources. 2. Women’s Health and Cancer Rights Act (WHCRA) of 1998 If you have had or are going to have a mastectomy, you may be entitled to certain benefits under the Women's Health and Cancer Rights Act of 1998 (WHCRA). For mastectomies performed under this plan, coverage will be provided — in consultation with the attending physician and the patient — for: + All stages of reconstruction of the breast on which the mastectomy was performed; + Surgery and reconstruction of the other breast to produce a symmetrical appearance; + Prostheses; and + Treatment of physical complications of the mastectomy, including lymphedema. These benefits will be provided subject to the same deductibles and coinsurance applicable to other medical and surgical benefits provided under this plan. Written notice of the availability of such benefits has been delivered to each participant upon enrollment and annually thereafter. Questions? Contact HR or Cigna at 1-866-494-2101, 3. Newborns’ and Mothers’ Health Protection Act Group health plans and health insurance issuers generally may not, under federal law, restrict benefits for any hospital length of stay in connection with childbirth for the mother or newborn child to less than 48 hours following a vaginal delivery, or less than 96 hours following a cesarean section. However, federal law generally does not prohibit the mother's or newborn's attending provider, after consulting with the mother, from discharging the mother or her newborn earlier than these periods. In any case, plans and issuers may not, under federal law, require that a provider obtain authorization from the plan or the issuer for prescribing a length of stay not in excess of the above periods, ANN! L NOTICES (CONTINUED) 4. Notice of Privacy Practices (HIPAA) Your health plan is required by law to maintain the privacy of your protected health information (PHI) and to provide you with notice of its legal duties and privacy practices with respect to PHI. Your insurer may use and disclose PHI for treatment, payment, and health care operations purposes without your authorization. You have the right to: request restrictions on certain uses and disclosures of your PHI; receive confidential communications of PHI; inspect and copy your PHI; amend your PHI; receive an accounting of disclosures of your PHI; and receive a paper copy of the Notice of Privacy Practices. Contact your carrier or HR fora full Notice of Privacy Practices. Cigna: 1-866-494-2111 | wwvi.cigna.com 5. Nolice of Creditable Coverage — Met are Part D. Important Notice from the City of East Ridge About Your Prescription Drug Coverage and Medicare. Please read this notice carefully and keep it where you can find it. This notice has information about your current prescription drug coverage with the City of East Ridge and about your options under Medicare's prescription drug coverage. The City of East Ridge has determined that the prescription drug coverage offered by the Cigna health plan is, on average for all plan Participants, expected to pay out as much as standard Medicare prescription drug coverage pays and is therefore considered Creditable Coverage. Because your existing coverage is Creditable Coverage, you can keep this coverage and not pay a higher premium (a penalty) if you later decide to join a Medicare drug plan —as long as you do not go 63 or more consecutive days without creditable prescription drug coverage after your group health plan coverage ends. For more information about Medicare prescription drug plans: visit www.medicare. gov; call 1-800-MEDICARE (1-800-633-4227), TTY: 1- 877-486-2048; or contact the State Health Insurance Assistance Program (SHIP) for your state. For questions about this notice or your current prescription drug coverage, contact Human Resources, 6. 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 Medicaid or CHIP. If you or your dependents are NOT currently enrolled in Medicaid or CHIP and you think you or a child might be eligible for either of these programs, contact your State Medicaid or CHIP office or dial 1-877-KIDS NOW or visit www.insurekidsnow.gov to find out how to apply. 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. Tennessee — TennCare: 1-800-525-6401 | www.tn.govitenncare Tennessee CHIP (CoverKids): 1-800-525-6401 | www.tn.govitenncare For questions or more information, contact the U.S. Department of Labor, Employee Benefits Security Administration: 1-866-444-EBSA (3272) | www.dol.goviebsa/healthreform ANN! L NOTICES (CONTINUED) 7. Genetic Information Nondiserimination Act (GINA) The Genetic Information Nondiscrimination Act of 2008 (GINA) prohibits employers and other entities covered by GINA Title Il from requesting or requiring genetic information of employees or their family members. In order to comply with this law, we are asking that you not provide any genetic information when responding to any request for medical information. "Genetic information," as defined by GINA, includes an individual's family medical history, the results of an individual's or family member's genetic tests, the fact that an individual or an individual's family member sought or received genetic services, and genetic information of a fetus carried by an individual or an individual's family member or an embryo lawfully held by an individual or family member receiving assistive reproductive services. Under GINA, its illegal for health insurance issuers to: (1) adjust premium or contribution amounts for a group on the basis of genetic information; (2) request, require, or purchase genetic information for underwriting purposes; or (3) use genetic information to determine eligibility, set premiums, or otherwise discriminate. 8. Employee Rights Under ERISA As a participant in this plan, you are entitled to certain rights and protections under the Employee Retirement Income Security Act of 1974 (ERISA). ERISA provides that all plan participants shall be entitled to: + Examine, without charge, at the Plan Administrator's office and at other specified locations, all documents governing the plan, including insurance contracts and collective bargaining agreements, and a copy of the latest annual report (Form 5500 Series) filed by the plan with the U.S. Department of Labor. + Obtain, upon written request to the Plan Administrator, copies of documents governing the operation of the plan. The administrator may make a reasonable charge for the copies. + Receive a summary of the plan's annual financial report. The Plan Administrator is required by law to furnish each participant with a copy of this summary annual report. Prudent actions by plan fiduciaries. In addition to creating rights for plan participants, ERISA imposes duties upon the people who are responsible for the operation of the employee benefit plan. The people who operate your plan, called "fiduciaries" of the plan, have a duty to do so prudently and in the interest of you and other plan participants and beneficiaries. No one, including your employer or any other person, may fire you or otherwise discriminate against you in any way to prevent you from obtaining a welfare benefit or exercising your rights under ERISA. Enforce your rights. If your claim for a benefit is denied or ignored, in whole or in part, you have a right to know why this was done, to obtain copies of documents relating to the decision without charge, and to appeal any denial, all within certain time schedules. If it should happen that planfiduciaries misuse the plan's money, or if you are discriminated against for asserting your rights, you may seek assistance from the U.S. Department of Labor, or you may file suit in a federal court. Assistance: 1-866-444-EBSA (3272) | www.dol.govjebsa 9. Grandfathered Plan Status The City of East Ridge health plan believes this plan is not a grandfathered health plan under the Patient Protection and Affordable Care Act (ACA). Being a non-grandfathered plan means this plan must comply with certain consumer protections in the ACA — for example, the plan must cover certain preventive care services without cost-sharing. Questions regarding which protections apply to this plan: 1-866-444- 3272 | www.dol.govlebsa/heaithreform 10, Mental Health Parity and Addiction Equity Act (MHPAEA) This plan complies with the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA). The financial requirements (such as deductibles and copayments) and treatment limitations (such as visit limits) applicable to mental health or substance use disorder (MH/SUD) benefits may not be more restrictive than the predominant requirements or limitations applied to substantially all medical and surgical benefits covered by the plan. In general, the rules under MHPAEA also provide that separate cost- sharing requirements or treatment limitations that apply only to MH/SUD benefits are not permitted, For information on MH/SUD benefits available under this plan, or for questions about MHPAEA, contact Cigna at 1-866-494-2111, For confidential support, counseling, and EAP referrals, contact EmployeeConnect at 1-888-628-4824 or visit GuidanceResources.com — available 24/7/365. City of East Ridge