2023

EMPLOYEE BENEFITS ENROLLMENT GUIDE

Hallmark Aviation Services - SFO

TABLE OF

CONTENTS 3 4 5 6 7 8 9 10 11 12 2

WHAT’S NEW WHO IS ELIGIBLE? WHEN TO ENROLL CHANGING YOUR BENEFITS THINGS TO CONSIDER KEY TERMS TO KNOW MEDICAL INSURANCE

PEDIATRIC DENTAL AND VISION INSURANCE

DENTAL AND VISION INSURANCE BASIC LIFE AND AD&D VOLUNTARY LIFE AND AD&D VOLUNTARY LONG TERM DISABILITY VOLUNTARY SHORT TERM DISABILITY ACCIDENT INSURANCE

CRITICAL ILLNESS INSURANCE

HOSPITAL INDEMNITY INSURANCE

CARRIER CONTACT INFORMATION

Hallmark Aviation Services is proud to offer a comprehensive benefits program. We are committed to offering affordable, high quality benefit options for our valued employees. This guide will provide you with information on the options available for you for 2023, as well as how to enroll in the plans and make changes after enrolling. There are also additional resources and contact information for each of the insurance carriers.

WHAT’S NEW: VOLUNTARY BENEFITS FOR 2023 In addition to core benefits like medical, dental, and vision coverage, we have new Voluntary Benefits for 2023. These are additional coverages you can purchase to enhance protections for you and your family. We offer these new Voluntary Benefits from MetLife: • Short Term Disability (STD): Sure, medical insurance pays for medical costs, but how will you pay for everyday bills if you are out of work? STD is partial income replacement to help. • Accident Insurance: An accident can result in costs that medical insurance may not cover. This plan pays you benefits for covered accidents that you can use however you need. • Critical Illness Insurance: The diagnosis of a serious illness—such as cancer, heart disease, or stroke—can devastate your finances. Critical Illness pays you a lump-sum benefit to help. • Hospital Indemnity: This coverage pays you a benefit for covered hospitalizations, above and beyond what your medical plan may pay, directly to you to use as you see fit.

WHO IS ELIGIBLE? Hourly employees are eligible for benefits on the first of the month following 30 days of employment. Salaried employees are eligible for benefits on the first of the month following 60 days of employment. Your benefits allow you to cover your eligible dependents, which include: • Your legal spouse or registered domestic partner • Your children to age 26—regardless of student status or tax-dependent status—step child, legally adopted child, a child placed for adoption, or a child for whom you are the legal guardian.

WHEN TO ENROLL Before you enroll for coverage, take some time to fully understand how each plan works. You can sign up for benefits or change your benefits at the following times: • First of the month following 30 days of employment for hourly employees and first of the month following 60 days of employment for salaried employees • During the annual open enrollment period • Within 30 days of a Qualifying Life Event (QLE)

CHANGING YOUR BENEFITS Due to IRS regulations, once you have made your elections for the plan year, you cannot change your benefits until the next annual open enrollment period. The only exception is if you experience a Qualifying Life Event (QLE). Election changes must be consistent with your life event.

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Qualifying Life Events (QLE) include, but are not limited to: • Marriage, divorce, or legal separation • Birth or adoption of a child • Death of your spouse or covered child • Change in your employment status • Spouse or dependent’s loss of coverage • Qualified Medical Child Support Order • Change in residence, work location, or work status that effects your eligibility for coverage To request a benefits change after open enrollment, you must provide proof within 30 days of the QLE. Please notify Human Resources.

THINGS TO CONSIDER Are you able to budget for a deductible and out-of-pocket medical expenses? Do you prefer to pay more for medical insurance out of your paycheck, but less when you need care? Do you prefer the predictability of having a copay or paying a coinsurance for medical services? For any questions and more information on Open Enrollment or your benefits, call Mehak Hussain at 1-310-215-7223.

KEY TERMS TO KNOW

$

%

Deductible The amount you must pay each year for covered services before the plan will begin to pay.

Coinsurance Your share of costs for a covered medical service, usually after you meet the deductible.

Copay A fixed dollar amount that you pay for certain covered medical services.

Out-of-Pocket Maximum Includes copays, deductibles, and coinsurance. Once you pay this amount, the plan will pay 100% of covered medical services for the remainder of the calendar or plan year.

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MEDICAL INSURANCE MEDICAL BENEFITS CALENDAR YEAR DEDUCTIBLE CALENDAR YEAR OUT-OF-POCKET MAX

SFO UMR - EPO None $1,000 Individual/$3,000 Family

PRIMARY CARE OFFICE VISIT

$30 copay

PREVENTIVE CARE

No Charge

EMERGENCY ROOM

$250 copay

URGENT CARE

$30 copay

ADVANCED DIAGNOSTIC

$100 copay

HOSPITAL INPATIENT OUTPATIENT SURGERY

$500 copay up to $1,500 $250 copay

PRESCRIPTION RX DEDUCTIBLE

None

RETAIL RX 30 DAY SUPPLY GENERIC PREFERRED BRAND NON-PREFERRED

$15 copay $30 copay $50 copay

MAIL RX 31-90 DAY SUPPLY GENERIC PREFERRED BRAND NON-PREFERRED

$25 copay $100 copay $150 copay

SPECIALTY DRUGS

20% up to $150

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PEDIATRIC DENTAL AND VISION INSURANCE (UMR) DENTAL BENEFITS

UMR DENTAL* YOUR PAYMENT (MUST USE AN IN-NETWORK PROVIDER)

CALENDAR YEAR DEDUCTIBLE

None

DIAGNOSTIC AND PREVENTIVE SERVICES ORAL EXAMS X-RAYS ROUTINE CLEANINGS TOPICAL FLOURIDE SEALANTS

$0

BASIC SERVICES RESTORATIVE PROCEDURES PERIODONTAL MAINTENANCE

20%

TYPE C MAJOR SERVICES ENDODONTICS CROWNS BRIDGES DENTURES

50%

ORTHODONTICS MEDICALLY NECESSARY

50%

VISION BENEFITS FREQUENCY EYE EXAMINATION LENSES FRAMES (OR) CONTACTS

UMR - VISION* Once every 12 months Once every 12 months Once every 24 months Once every 12 months

YOUR PAYMENT

(PPO BENEFIT - OFFERS YOU THE FREEDOM TO RECEIVE CARE FROM ANY PROVIDER)

COMPREHENSIVE EXAM FRAMES COLLECTION FRAMES NON-COLLECTION

$0

$0 All charges above $150

LENSES SINGLE BIFOCAL TRIFOCAL

$0

CONTACT LENSES CONVENTIONAL (IN LIEU OF LENSES) ELECTIVE/NON ELECTIVE

$0

*Pediatric Benefits are available through the end of the month in which the Member turns 19 years old.

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DENTAL AND VISION INSURANCE LINCOLN DENTAL DENTAL BENEFITS CALENDAR YEAR DEDUCTIBLE CALENDAR YEAR BENEFIT MAXIMUM TYPE A PREVENTIVE SERVICES ORAL EXAMS X-RAYS ROUTINE CLEANINGS TOPICAL FLOURIDE SEALANTS TYPE B BASIC SERVICES SPACE MAINTAINERS FILLINGS SIMPLE EXTRACTIONS ORAL SURGERY TYPE C MAJOR SERVICES ENDODONTICS CROWNS BRIDGES DENTURES ORTHODONTIA VISION BENEFITS

DPPO - LOW IN-NETWORK

FRAMES LENSES SINGLE BIFOCAL TRIFOCAL CONTACT LENSES CONVENTIONAL (IN LIEU OF LENSES)

HMO IN-NETWORK

$25 Individual/$75 Family $50 Individual/$150 Family

None

$1,250

$2,000

See schedule of benefits

100%; deductible waived

100%; deductible waived

See schedule of benefits

80%; after deductible

90%; after deductible

See schedule of benefits

50%; after deductible

60%; after deductible

See schedule of benefits

Not covered

60% Lifetime Max $1,500

$1,895 Adolescent & Adult

EYEMED - VISION (INSIGHT NETWORK) IN-NETWORK

FREQUENCY EYE EXAMINATION LENSES FRAMES (OR) CONTACTS EXAM

DPPO - HIGH IN-NETWORK

OUT-OF-NETWORK

Once every 12 months Once every 12 months Once every 24 months Once every 12 months $1,250

Plan pays up to $40 allowance

Plan pays up to $130 allowance then 20% off remaining balance

Plan pays up to $91 allowance

$25 copay $25 copay $25 copay

Plan pays up to $30 allowance Plan pays up to $50 allowance Plan pays up to $70 allowance

Plan pays up to $130 allowance then 15% off remaining balance

Plan pays up to $130 allowance

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LIFE/AD&D AND DISABILITY INSURANCE LIFE/AD&D BENEFITS

LINCOLN FINANCIAL

BASIC LIFE/AD&D EMPLOYEE VOLUNTARY LIFE/AD&D EMPLOYEE GUARANTEED ISSUE SPOUSE VOLUNTARY LIFE/AD&D SPOUSE GUARANTEED ISSUE CHILD VOLUNTARY LIFE/AD&D

1x your base annual earnings up to $100,000 5x base annual earnings up to $500,000 max Up to $200,000 max newly hired $250,000 max Up to $50,000 max newly hired $10,000 max (1 day to age 26 guaranteed coverage amount)

VOLUNTARY BENEFITS

LINCOLN FINANCIAL

VOLUNTARY LONG TERM DISABILITY

Benefit Increments 66.67% of basic covered pay. Maximum monthly amount $7,000. Benefit begins after 180-day waiting period. Benefit Duration to age 65 or retirement benefit date.

NEW FOR 2023! VOLUNTARY SHORT TERM DISABILITY Benefit eligible employees may choose to elect Short Term Disability Insurance through MetLife. The plan covers 20% of your income while you are unable to work if you suffer a non-work related illness or injury. Benefits begin after 14 days for a maximum of 26 weeks. Full-time employees working at least 30 hours per week are eligible, provided you are actively at work. • Benefit Amount is $50 - $1,000 per week in $25 increments up to 20% of your weekly base covered pay. • Maximum weekly amount is $1,000. • Benefits begin after 14-day waiting period for sickness or injury. • Benefit Duration is a maximum of 26 weeks.

BASIC LIFE AND AD&D All employees working over 30 hours per week are provided with group Life and Accidental Death and Dismemberment Insurance through Lincoln Financial in the amount of 1x your base annual earnings to a maximum of $100,000. This benefit is paid on your behalf by Hallmark Aviation Services.

VOLUNTARY LIFE AND AD&D Benefit eligible employees may choose to elect additional life and AD&D coverage through Lincoln Financial. If you are currently enrolled, you may increase your coverage amount for yourself or your dependents during open enrollment. Please note that proof of good health may be required and is always required for dependents. NOTE FOR 2023: During this Open Enrollment for 2023, employees who previously declined Voluntary Life coverages will be able to enroll themselves and spouse without providing Evidence of Insurability.

VOLUNTARY LONG TERM DISABILITY Benefit eligible employees may choose to elect Long Term Disability Insurance through Lincoln Financial. This plan is designed to cover a portion (66.67%) of your income when you are unable to work in the event that you suffer a non-work related illness or injury. Benefits begin after a 180-day waiting period for a duration of up to age 65 with a maximum monthly benefit of $7,000.

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NEW FOR 2023! ACCIDENT INSURANCE Accidents can have a huge financial impact. You may have medical coverage, but what about other expenses? Accident insurance helps you pay for uncovered medical expenses and everyday expenses when you are injured in a covered accident. With MetLife Accident Insurance, you have a choice of a Low Plan and High Plan. Each provides payments in addition to other insurance you may receive. They differ in the levels of coverage, so you can elect the plan that meets your needs. Benefit amounts are based on a schedule depending upon the injury. There is also an Organized Sports Injury Benefit Rider which increases the amount payable for certain benefits by 25% for injuries from an accident that occurs while participating in an organized sport. BENEFIT TYPE FRACTURE BENEFIT* CONCUSSION BENEFIT COMA BENEFIT AMBULANCE BENEFIT EMERGENCY CARE BENEFIT THERAPY SERVICES BENEFIT (INCLUDES PHYSICAL THERAPY) TRANSPORTATION BENEFIT ADMISSION BENEFIT ICU SUPPLEMENTAL ADMISSION BENEFIT CONFINEMENT BENEFIT ACCIDENTAL DEATH BENEFIT

LOW PLAN BENEFITS

HIGH PLAN BENEFITS

$100 – $8,000 depending on the fracture and type of repair

$200 – $10,000 depending on the fracture and type of repair

$250

$500

$7,500

$10,000

Ground: $300 Air: $1,000

Ground: $400 Air: $1,250

$75 – $250 depending on location of care

$100 – $300 depending on location of care

$35

$50

$300

$400

$1,000 for the day of admission

$2,000 for the day of admission

$1,000 for the day of admission

$1,500 for the day of admission

$150 per day

$250 per day

$25,000 $75,000 for accidental death on common carrier

$50,000 $150,000 for accidental death on common carrier

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NEW FOR 2023! CRITICAL ILLNESS INSURANCE Critical Illness Insurance from MetLife is designed to come to the rescue of budget-conscious families by helping to pay the costs associated with the initial occurrence of a serious illness such as a heart attack, stroke, cancer, or other covered critical condition. You can choose a benefit amount of $10,000, $20,000, or $30,000 and cover your spouse/domestic partner and dependent children for 50% of your benefit amount. Payments are in a lump sum upon the first diagnosis of a covered condition, regardless of any other insurance you may have, paid directly to you or your designated recipient to use however you wish. Additional benefits include: • Recurrence Benefit for a subsequent verified diagnosis of a covered condition. • Total Benefit Amount of 5x your elected benefit for multiple payments for covered occurrence. You can receive a maximum of $50,000, $100,000, or $150,000. • Health Screening Benefit of $50 per calendar year for taking one of the eligible screening/ prevention measures. BENEFIT TYPE EMPLOYEE

SPOUSE/DOMESTIC PARTNER2

DEPENDENT CHILD(REN)3

LOW PLAN BENEFITS

HIGH PLAN BENEFITS

Coverage is guaranteed provided you are actively at work.1 Coverage is guaranteed provided the employee is actively at work and the spouse/domestic partner is 50% of the Employee’s Initial Benefit not subject to a medical restriction as set forth on the enrollment form and in the Certificate.1 Coverage is guaranteed provided the employee is actively at work and the dependent is not subject 50% of the Employee’s Initial Benefit to a medical restriction as set forth on the enrollment form and in the Certificate.1 $10,000, $20,000, or $30,000

Coverage is guaranteed provided (1) the employee is performing all of the usual and customary duties of your job at the employer's place of business or at an alternate place approved by your employer, and (2) dependents are not subject to medical restrictions as set forth on the enrollment form and in the Certificate. Some states require the insured to have medical coverage. MetLife will not pay a benefit for a Covered Condition that is diagnosed prior to the coverage effective date. 2 Coverage for Domestic Partners, civil union partners, and reciprocal beneficiaries varies by state. Please contact MetLife for more information. 3 Dependent Child coverage varies by state. Please contact MetLife for more information. 1

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NEW FOR 2023! HOSPITAL INDEMNITY INSURANCE The cost of a hospital stay can be overwhelming, and those costs seem to grow every year. Medical coverage alone might not be enough, and a hospital stay can set you back financially. Hospital Indemnity Insurance can help to ease the financial impact by providing a lump-sum payment directly to you for hospital-related costs. With MetLife, you can choose between a Low Plan and a High Plan. Both provide a lump-sum cash payment for covered events, regardless of any other insurance you have, to use as you need. SUBCATEGORY

ADMISSION BENEFIT

CONFINEMENT BENEFIT

CONFINEMENT BENEFIT FOR NEWBORN NURSERY CARE

BENEFIT LIMITS (APPLIES TO SUBCATEGORY)

BENEFIT

LOW PLAN

HIGH PLAN

Admission

$1,500

$2,500

4 time(s) per calendar year¹

ICU Supplemental Admission (Benefit paid concurrently with the Admission benefit when a Covered Person is admitted to ICU)

$500

$1,000

15 days per calendar year. ICU Supplemental Confinement will pay an additional benefit for 15 of those days

Confinement4

$150

$200

ICU Supplemental Confinement (Benefit paid concurrently with the Confinement benefit when a Covered Person is admitted to ICU)

$100

$200

Confinement Benefit for Newborn Nursery Care5

$25

$50

2 day(s) per confinement

If a covered person is readmitted within 90 days for the same or related sickness/injury for which we paid an Admission Benefit, an additional Admission Benefit is not payable. 4 If the Admission Benefit is payable for a Confinement, the Confinement Benefit will begin to be payable the day after Admission. 5 Payable for the period of newborn confinement for a newborn child who is not sick or injured. 1

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CARRIER CONTACT INFORMATION UMR EPO

Lincoln Life/AD&D/Disability

Optum Rx

S&K Financial and Insurance, Inc.

Lincoln Dental HMO

Lincoln Employee Assistance Program

Member Services Phone: 1-800-826-9781 Website: www.umr.com

Member Services Phone: 1-800-356-3477 Website: www.optumrx.com

Member Services Phone: 1-888-877-7828 Website: www.ldc.lfg.com

Lincoln Dental PPO Member Services Phone: 1-800-423-2765 Website: www.lfg.com

EYEMED Vision

Member Services Phone: 1-800-423-2765 Website: www.lfg.com

Benefit Resources Phone: 1-213-627-5304 Please send your service inquiries to: [email protected]

Employee Services Phone: 1-888-628-4824 Website: www.GuidanceResources.com Username: LFGsupport Password: LFGsupport1

MetLife Accident, Critical Illness, Hospital Indemnity, Voluntary Short Term Disability Member Services Phone: 1-800-638-5433 Website: www.metlife.com

Member Services Phone: 1-866-723-0513 Website: www.eyemed.com

The information in this Benefits Summary is presented for illustrative purposes and is based on information provided by the employer. The text contained in this Summary was taken from various summary plan descriptions and benefit information. While every effort was taken to accurately report your benefits, discrepancies or errors are always possible. In case of discrepancy between the Benefits Summary and the actual plan documents, the actual plan documents will prevail. All information is confidential, pursuant to the Health Insurance Portability and Accountability Act of 1996. If you have any questions about this summary, contact Human Resources.

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Hallmark Aviation Services- SFO