Page 3 - 2019 Sharks Benefits V6.1

Table of Contents

Benefit Plan Eligibility .................................................................................. 1

Benefit Plan Contributions .......................................................................... 3

Medical Plan Options .................................................................................. 4

Medical Plan Comparison ........................................................................ 5-6

Dental Plan Options .................................................................................. 7-8

Vision Plan .................................................................................................. 9

Flexible Spending Accounts ......................................................... 10

Life/AD&D and Voluntary Life ............................................................... 14-23

Long Term Disability .................................................................................. 23

Long Term Care ......................................................................................... 24

Employee EAP Plan .................................................................................... 25

401(k) Plan ........................................................................................... 26-27

Insurance Contact Information ............................................................ 28-29

PPACA New Hire Notices ...................................................................... 30-31

HIPAA Notification..................................................................................... 32

COBRA Initial Notification ..................................................................... 33-37

WHCRA Annual Notice .............................................................................. 38

This description of employee benefits only summarizes the provisions of a formal benefit Plan document and does
not attempt to cover all of the details contained in the Plan document. The operation of the Plan, including events
making you eligible or ineligible for benefits, the amount of benefits to which you (or your beneficiaries) may be
entitled, and actions you (or your beneficiaries) must take to request and support a claim for benefits will be
governed solely by the terms of the official Plan document. To the extent that any of the information contained
herein or any information you receive orally is inconsistent
with the official Plan document, the provisions set forth in the Plan document will govern in all cases. As a
participant in our benefit plans, you have the rights to:

• examine, without charge, at our office 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 and available at the Public
Disclosure Room of the Employee Benefits Security Administration; and obtain, upon written request,
copies of documents governing the operation of the Plan, including insurance contracts and collective
bargaining agreements, and copies of the latest annual report (Form 5500 Series) and updated summary
plan description.