2017 BENEFITS ENROLLMENT GUIDE

TABLE OF CONTENTS
Table of Contents ................................................................................................................................................................................. 2
welcome ................................................................................................................................................................................................ 4
Time to Enroll ........................................................................................................................................................................................ 5
Enrollment Checklist ............................................................................................................................................................................. 6
General: ................................................................................................................................................................................................. 7
If You Do Not Enroll .............................................................................................................................................................................. 8
Eligibility ................................................................................................................................................................................................ 9
Part-Time Employees ........................................................................................................................................................................... 9
Your Dependents ................................................................................................................................................................................10
Benefits overview ...............................................................................................................................................................................11
What’s In Store for 2017 ....................................................................................................................................................................13
2017 Benefit options ..........................................................................................................................................................................14
Choose Well, Live Well .......................................................................................................................................................................16
Medical Insurance .............................................................17
Medical Insurance ..............................................................................................18
Medical Insurance (cont’d) ................................................................................................................................................................19
medical Insurance (cont’d).................................................................................................................................................................20
Medical Plan Examples* .....................................................................................................................................................................21
Prescription Drugs .............................................................................................................................................................................25
Health Savings Account (HSA) .....................................................................................................................................26
Flexible Spending Accounts ......................................................................................................27
Dental Insurance .................................................................................................................................................................................28
Vision Insurance ..........................................................................29
Disability Plans ....................................................................................................................................................................................30
Life/AD&D Insurance ..........................................................................................................................................................................31
Colonial Voluntary Benefits ................................................................................................................................................................33
Group Critical Care .............................................................................................................................................................................34
Group Medical Bridge.........................................................................................................................................................................36
Additional Information .......................................................................................................................................................................40
Required Notices ................................................................................................................................................................................41
FLSA / Exchange Notice ......................................................................................................................................................................46
Medicaid / Chip Contact Information ................................................................................................................................................49
Definitions ...........................................................................................................................................................................................53
Contact Information ...........................................................................................................................................................................55
WELCOME

Welcome to Little Bird’s 2017 Benefits Guide – your point of reference for benefits information and the
wellness resources available to you for the 2017 calendar year. We want you to understand and feel
secure about your health and financial well-being, and confident that your benefits will support you
through various life circumstances. That’s why Little Bird is excited to share the benefit offerings for next
year and we urge you to share this information with your family. Please take the time to educate
yourself so you can make the elections that will best provide for you and your dependents’ needs.

Our commitment to you is to:

 Provide you with competitive benefits
coverage options
 Offer lower-paid employees health care
coverage at a reduced cost
 Offer programs, tools and resources to help
you balance professional priorities,
personal obligations and leisure time
 Encourage you and your families through
Company-sponsored offerings to
proactively make better choices to live
healthier lifestyles
 Help you prepare for life challenges
through increased coverage options and
plans based on your individual
circumstances
 Provide opportunities to positively impact
your communities through Company-
sponsored programs and events
TIME TO ENROLL
Little Bird is committed to providing a robust and competitive benefits program and educational tools to
help support you and your family. We are proud to continue this tradition in 2017!

We encourage you to get the most from your benefits by becoming familiar with all the offerings
available and by using the tools and resources provided to help you and your family live healthier and
happier lives. Be proactive, Choose Well, Live Well.

Open/New Hire Enrollment is the time to make important decisions about your health and welfare
benefits, while taking a fresh look at your entire benefits package. This guide is a great place to start!

Add Your Dependents

During New Hire Enrollment, we are going to ask you to add who you would like to cover under the
Little Bird Benefits Program. For those new dependents you are covering, you will be asked to provide
documentation to confirm their eligibility. To learn more, see page 10.
ENROLLMENT CHECKLIST

Use this checklist to help you through the enrollment process. Little Bird’s new hire enrollment annual period
lasts for 30 days starting from your hire date. Changes made during this period are effective on the first of the
month following the hire date.

Take the time to educate yourself on all of the benefit options available to you. Little Bird provides a variety of
tools and resources to help with your benefits decisions. Access these tools online through the Little Bird Nest at
www.littlebird.hr (click on “Login” in upper right hand corner). You will be asked to confirm your address and
personal information before you’re able to select “Manage Benefits”.

□ Attend a New Hire Benefits webinar to hear Little Bird explain the details of each plan and give you an
overview of all benefit programs.

□ Review this 2017 Benefits Guide carefully as you consider your plan choices.

□ Decide if you want to enroll in a Flexible Spending Account (Healthcare and/or Dependent Care) or a
Limited Healthcare FSA (for HSA Plan participants). Remember: you must actively enroll each year.

□ HSA Plan members: decide how much you want to contribute to your Health Savings Account.

During Enrollment:

□ Select your beneficiary(ies). New Hire enrollment is the best time to add your beneficiary(ies). Please
check back periodically to make sure this information is up to date.

□ Have questions about the various benefit plans, contact The Little Bird Benefits Concierge today at 877-
227-9994 or mybenefits@littlebird.hr. The Benefits Concierge is available Monday to Friday, from 9am to
6pm to answer all your benefits-related inquiries and help with enrollment.
□ Complete your elections by the deadline! If you do not make elections or waive, you will automatically be
enrolled in the EPO 4000 medical plan under employee-only coverage for 2017.
□ After completing your enrollment online, save or print a copy of your confirmation, review it for accuracy,
and retain it for your records. Little Bird will not mail confirmations to you so this is your only record of
your enrollment.
After Enrollment:

Verify your 2017 benefits elections, by visiting the Little Bird Nest at www.littlebird.hr (click “login”). If you notice
any errors, notify the Little Bird Benefits Concierge team immediately at 1-877-227-9994 or email
mybenefits@littlebird.hr

Medical coverage: If you elect coverage, you will receive an ID card in the mail that you should use for all medical
and prescription services.

Your ID card contains important information about you, your employer group, and the benefits to which you are
entitled. Always carry your ID card with you, present it when receiving health care services or supplies, and make
sure your provider always has a current copy of your ID card.

Dental Coverage: If you elect coverage, you will not receive an ID card. You can request a Dental ID card by
registering on mycigna.com on or after January 1, 2017. Note, you will have one user ID for all medical, dental and
vision plans so feel free to use your medical card when visiting a dentist.

Vision coverage: If you elect coverage, you will receive a separate ID card. Be sure to have your Vision ID card
ready to present at the provider’s office.

Changing benefit elections after the Open Enrollment Period

You have a variety of benefits to choose from. Be sure to consider all options before making your final decisions.
Remember that once you make your elections, most will remain in effect for 2017 unless you experience a
Qualified Life event. Examples of life events include:

Life Events
Change in marital status (marriage, death of spouse, divorce, legal separation)
Change in number of dependents (birth, death, adoption, eligibility status, child support order)
Change in benefits status for you or your spouse due to new employment, termination, leave of absence, full-
time to part-time or vice versa.
Special enrollment rights under HIPAA
Medicare coverage
Lose medical coverage

GENERAL:

The 2017 plan year is the calendar year — January 1 through December 31.
 Our Healthcare plans are pre-tax, which means that you save money, and you can only make future
changes to your elections during Open Enrollment or if you have a Qualifying Life Event.

IF YOU DO NOT ENROLL

Open/New Hire Enrollment is the only time when you can change your health and welfare benefits,
including adding and removing dependents. To make changes at another time, you must experience a
qualifying life event and make changes within 31 days of the event. If you do not enroll during your new
hire enrollment period (30 days from date of hire), your 2017 health and welfare benefit plan elections
will be as follows:

Benefit 2017 Benefit

Medical If you do not make elections or waive , you will be
Dental automatically enrolled in the EPO 4000 medical plan
Vision under “employee only” coverage for 2017.
Voluntary Life Insurance
Accident, Critical Illness
Group Legal
Health Care, Dependent Care Flexible Spending and You will not be enrolled in these plans if you do not
Health Savings Accounts elect them during your enrollment period.
Short & Long Term Disability You will have employer-paid coverage in 2017.
Basic Life and AD&D Insurance

Don’t forget to make sure your dependents are listed under each plan you wish them to be covered by
in 2017. For example, if your newborn was covered under Medical in 2016 and you want your child
covered under Dental for 2017, you will have to add them to your Dental coverage during enrollment.
 ELIGIBILITY

Full-time staff-members are eligible for the Little Bird HR benefits program. You are considered full-time
if you are scheduled to work 30 or more hours per week.

Eligible full-time employees may participate in the:

➢ Medical Plan
➢ Dental Plan
➢ Vision Plan
➢ Flexible Spending Accounts
➢ Health Savings Accounts
➢ Voluntary Life Insurance
➢ Accident Insurance
➢ Group Legal Plan
➢ Commuter Benefits
➢ Identity Theft Insurance

Full-time eligible employees are

automatically enrolled in the employer paid
benefits listed below:

➢ Short-Term Disability Program

➢ Long-Term Disability Plan
➢ Basic Life and AD&D Plans

PART-TIME EMPLOYEES
Part-time employees who are not regularly
scheduled to work at least 30 hours per
week are not eligible to participate in the
Little Bird Benefits Program.

YOUR DEPENDENTS

If you are a benefits-eligible employee, you may also enroll your eligible dependents.
Your eligible dependents include:
➢ Your spouse (provided you are not legally separated or divorced). For the purposes of the Plan,
your spouse is your legal partner in marriage, and from whom you are not legally divorced; and
➢ Your child(ren) or those of your spouse, until the end of the month in which they reach age 26

Dependent Verification
We will continue to conduct a dependent verification for any newly added dependents. As part of the
verification, employees who are covering new dependents will be required to provide proof of
dependency. These documents must be emailed to mybenefits@littlebird.hr witihin 30 days of adding a
new dependent. A list of acceptable documentation can be found below. If you are unable to verify
your dependent by the deadline, your dependent will be ineligible for coverage for 2017.

Verification of Eligibility
Remember, in order to cover new dependents under any benefits, you must email supporting
dependency document to mybenefits@littbird.hr.

Legal spouse Copy of marriage certificate.

Biological child to age 26
Step-child to age 26
Adopted child to age 26
Copy of birth certificate or copy of prior year federal tax
return showing dependent claimed on taxes.
Copy of birth certificate and copy of marriage certificate
showing your spouse as the biological parent.
Copy of official papers showing placement of child in
your home;
or a copy of final adoption papers.
It is also important that you make sure to list your dependents’ personal information correctly, including dates of birth and
Social Security numbers. Social Security numbers are required. If you are unsure if your dependent meets the eligibility
requirements, please contact the Little Bird Benefits Concierge at 877-227-9994.

BENEFITS OVERVIEW

The information in this guide can help you decide which benefits to enroll in by providing an overview of
the benefits. This booklet also contains information on how to enroll in each benefit plan. Using your
Benefit Bucks, you will either elect or waive medical coverage. The remaining Benefit Bucks can be used
to purchase other benefits that may fit your needs.

Below are the Core Benefits, along with the Additional Benefits that are available:

Core Benefits Additional Benefits

Medical Voluntary Life and AD&D Insurance

Dental Accident Insurance

Vision Critical Illness Insurance

Basic Life/AD&D Medical Bridge (Hospital Indemnity) Insurance

Short Term Disability Employee Assistance Program

Long Term Disability Flexible Spending Accounts

New York State Mandated Disability (if applicable) Health Savings Account

Commuter Benefits (Parking & Transit)

Paycheck Direct

MetLaw Legal Protection Services

ID Watchdog – ID Theft Protection

WHAT’S IN STORE FOR 2017

Little Bird evaluates our benefits each year so that we can continue to offer you a comprehensive and
competitive benefits package. For 2017, Little Bird is pleased to share that Cigna will be the new carrier
for medical, dental and vision coverage.

We are also excited to announce the arrival of three new offerings for 2017:

Accident Protection Insurance: Accident insurance provides coverage for injuries based on a schedule
of benefits. If applicable, multiple claims can be submitted for different treatments received from
the same covered accident. The benefits do not coordinate with existing medical insurance so they
can be used toward deductibles, copays, prescriptions and/or anything that the insured sees fit.

Critical Care Insurance: Provides a lump sum benefit paid upon the first diagnosis of a covered critical
illness or event. Benefits are paid directly to the insured and can be used in any way they like
including toward deductibles, copays or any other medical expenses. Employees must have major
medical coverage in order to enroll in Critical Illness.

• Non-tobacco premiums for a $5,000 or $10,000 policy are shown below

• Colonial premiums are based on the employee’s current age and tobacco status; premiums will
not increase as the employee changes age bands

Medical Bridge (Hospital Indemnity) Insurance: provides cash benefits when an insured is hospitalized
due to a covered illness or injury. The benefits do not coordinate with existing medical insurance so
they can be used toward deductibles, copays, prescriptions and/or anything that the insured sees fit.

For more information about how to take advantage of these exciting programs, review the guide.
2017 BENEFIT OPTIONS

Medical

Cigna - Open Access Plus Network

Through the Medical Plan options, Little Bird offers benefits designed to help keep you and your family healthy
and support you in times of financial hardship of in the face of serious illness or injury. Little Bird offers seven
medical plans so you can select the coverage that’s right for you.

All plan offerings are under Cigna’s Open Access Plan network. This means that whichever medical plan you
choose:

● You can visit an in-network specialist without a referral.

● You don’t need to select a primary care physician. You will pay less when using in-network providers
(doctors and facilities that contract with Cigna’s Open Access Plus network). Out-of-network providers
(doctors and facilities that do not contract with Cigna Open Access Plus network) will always cost you
more than in-network providers, as you will be responsible for any charges above what are considered
“reasonable and customary” (R&C). For more details on the Medical Plan options, see the Plan
Comparison Charts on pages 17-19 of this guide. To find a medical network provider, visit
www.cigna.com.
● If you do go out of network and submit for reimbursement, out of network claims are adjusted based on
the reimbursement level.
 Medical Plans 2017 Open Access Plus Network
EPO 4000
EPO 2000
In network benefits only
EPO 1000
EPO 0
H.S.A 3000
In & Out of network benefits H.S.A 2000
PPO 1000

Frequently Asked Questions In-Network Out-of-Network

Can I go to any doctor and receive
Yes Yes
plan benefits?
Yes. You will pay less when
Do I pay less if I see certain doctors?
you use in network doctors.
No. You can always go directly to a specialist.
Do I need a referral to see a specialist? However, you will receive out-of-network benefits
if the specialist is not in the network.
Can I use mail-order for prescription drugs
Yes for Certain Drugs In-Network Benefit Only
I use regularly?
CHOOSE WELL, LIVE WELL
Remember: in-network preventive care services are available at no cost to you.

Preventive services include a routine checkup for yourself and your eligible dependents, and much
more:

➢ Well-child care, including immunizations

➢ Annual Adult screenings and immunizations, including for blood pressure, diabetes and
cardiovascular disease
➢ Health services for women, including well-woman exams, routine mammograms, HPV DNA
testing, and breastfeeding and postpartum counseling
➢ Birth control devices for women, including Tier 1 contraceptives
➢ Adult counseling on tobacco use and alcohol use, as well as counseling on nutrition, physical
activity and depression
Use the resources available to you to proactively make better choices to live a healthier life. For more
information on preventive care, visit Cigna online at http://www.cigna.com/health-and-well-
being/preventive-care.

Remember: Certain services can be used for preventive or diagnostic reasons. Diagnostic services are
subject to the applicable copay or deductible and coinsurance amounts.
MEDICAL INSURANCE

The medical plans cover a wide range of services, from preventive and routine care, to hospitalization
and surgery. The medical plans include a prescription drug benefit, which covers prescriptions at
participating pharmacies and mail-order maintenance drugs.

Cigna

All plans you enroll in will be using one network, the Open Access Plus Network. Out of network care is
covered on certain plans, but you will pay more for your care. Most out of network costs are subject to
an annual deductible and then cost-share will apply.

What does all of this mean?

Below are some definitions that can help you understand the plans a little bit more. For more definitions, visit
pages 52 of this guide.

Deductible: Total dollar amount, based on the allowed amount which you must pay out of pocket
for covered medical expenses each calendar year before the plan starts to pay for most services.
The deductible does not apply to network preventive care and any services where you pay
a copayment rather than coinsurance.

Coinsurance: A percentage of the medical costs, based on the allowed amount, that you must pay for certain
services after you meet your annual deductible.

Out-of-Pocket Maximum: The maximum amount a Plan member must pay towards covered medical expenses in a
calendar year for both network and non-network services. Once you meet this out-of-pocket maximum, the Plan
pays the entire coinsurance amount for covered services for the remainder of the calendar year. Deductibles and
copays go toward the annual out-of-pocket maximum.

Copayment: A set dollar amount you pay for network doctor office visits, emergency room services and
prescription drugs.
MEDICAL INSURANCE

* Annual Deductible and Out-of-pocket Maximums reset every January 1st. This is not a complete list of
covered services. For more details please log in to your Little Bird Nest account via www.littlebird.hr and
view the Library in the Manage Benefits window.

Health Savings Account Plan Options

PLAN DESIGN HSA 3000 HSA 2000

In-Network Deductible
$3,000/$6,000 $2,000/$4,000
(Indv/Family)

In-Network Coinsurance 80% 90%

Out of Pocket Max $6,000 /$12,000 $4,000/$6,550

PCP/Spec Copay Ded + Coins Ded + Coins

Hospital In-Patient Ded + Coins Ded + Coins

Out-Patient Copay Ded + Coins Ded + Coins

Emergency Room Copay Ded + Coins Ded + Coins

Urgent Care Ded + Coins Ded + Coins

Retail – RX $15/$40/$70 $15/$40/$70
Out-of-Network Deductible $9,000/$18,000 $4,000/$8,000

Out-of-Network Coinsurance 50% 70%

Out-of-Network OOP Max $18,000/$36,000 $8,000/$16,000

Coverage Tier Monthly Cost Monthly Cost
Employee Only $384.39 $478.79
Employee + Spouse $807.22 $1,005.47
Employee + Child(ren) $730.33 $909.71
Family $1,153.16 $1,436.39
MEDICAL INSURANCE (CONT’D)

Exclusive Provider Organization (EPO) Plan Options

PLAN DESIGN EPO 4000 EPO 2000 EPO 1000 EPO 0

In-Network Deductible
$4,000/8,000 $2,000/$4,000 $1,000/$2,000 $0
(Indv/Family)

In-Network Coinsurance 80% 80% 80% 100%

Out of Pocket Max $7,150/$14,300 $4,000/$8,000 $3,000/$6,000 $3,000/$6,000

PCP/Spec Copay $30/$50 $25/$50 $30 / $60 $25/$50

$500 per admission,
Hospital In-Patient Ded + Coins Ded + Coins then 80% 100% Coins
coinsurance
$250 per facility
Out-Patient Copay Ded + Coins Ded + Coins visit, then 80% 100% Coins
coinsurance
$200 per visit $200 per visit $150 per visit $150 per visit
Emergency Room Copay (waived if (waived if (waived if (waived if
admitted) admitted) admitted) admitted)
Urgent Care $75 $75 $75 $50
Retail – RX $15/$40/$70 $15/$40/$70 $15/$40/$70 $15/$40/$70

Out-of-Network Deductible n/a n/a n/a n/a

Out-of-Network
n/a n/a n/a n/a
Coinsurance
Out-of-Network OOP Max n/a n/a n/a n/a
Coverage Tier Monthly Cost Monthly Cost Monthly Cost Monthly Cost
Employee Only $417.57 $463.38 $488.77 $585.44
Employee + Spouse $876.91 $973.10 $1,026.43 $1,229.42

Employee + Child(ren) $793.41 $880.43 $928.68 $1,112.32

Family $1,252.75 $1,390.16 $1,466.33 $1,756.31
MEDICAL INSURANCE (CONT’D)

Preferred Provider Organization (PPO) Plan Options

PLAN DESIGN PPO 1000

In-Network Deductible
$1,000/$2,000
(Indv/Family)

In-Network Coinsurance 80%

Out of Pocket Max $3,000/$6,000

PCP/Spec Copay $25/ $50

Hospital In-Patient Ded + Coins

Out-Patient Copay Ded + Coins

$250 per visit

Emergency Room Copay
(waived if admitted)
Urgent Care $75
Retail – RX $15/$40/$70

Out-of-Network Deductible $4,000/$8,000

Out-of-Network
60%
Coinsurance

Out-of-Network OOP Max $12,000/$24,000

Coverage Tier Monthly Cost

Employee Only $538.23
Employee + Spouse $1,130.27

Employee + Child(ren) $1,022.64

Family $1,614.68
MEDICAL PLAN EXAMPLES*

Which Plan Is Right for Me?

Little Bird offers several Medical Plan options for 2017-some offer the flexibility of in-and out-of-
network care. The following examples can help you choose which Medical Plan option may be right for
you. Review them to see which best matches your situation. Then conduct your own comparison using
the Ask Emma feature in the Little Bird Nest, which can provide an estimate of your total health care
costs for 2017. For the purpose of these examples, “Ded”= Deductible and “Coins”= coinsurance.

* These examples show how this plan might cover medical care in given situations. Use these examples to see, in general, how much
financial protection a sample patient might get if they are covered under different plans. Don't use these examples to estimate your actual
costs under this plan. The actual care you receive will be different from these examples, and the cost of that care will also be different. See
the next page for important information about these examples. Note: These numbers assume enrollment in individual-only coverage.
 Meet Brad, he:

● Earns $45,000 a year ● Values low per-paycheck contributions

● Is single and doesn’t have any children ● Plans to seek preventive care
● Doesn’t anticipate any major health care in 2017 ● Always uses in-network providers

Given Brad’s situation, let’s see how each medical plan option could work for him*.
Medical Plan H.S.A 3000 H.S.A 2000 EPO 4000 EPO 2000 EPO 1000 EPO 0 PPO 1000
Service Brad pays….
(APE) Annual physical APE= $0 APE= $0 APE= $0 APE= $0 APE= $0 APE= $0 APE= $0
exam (in-network) +
one additional visit to Additional Additional Additional Additional Additional Additional Additional
his primary care visit= $30 visit= $25 visit= $30 visit= $25 visit= $25
visit= (Ded + visit= (Ded +
physician
Coins for Coins for
PCP visit) PCP visit)
$57 $57

Two in-network (Specialist (Specialist $50 each $50 each $60 each $50 each $50 each
specialist visits visit= $144 visit= $144 visit= $100 visit= $100 visit= $120 visit= $100 visit= $100
each) each)
Ded + coins= Ded + coins=
$288 $288

Two generic drug (Generic RX= (Generic RX= $15 each $15 each $15 each $15 each $15 each
prescriptions $16 each) $16 each) RX= $30 RX= $30 RX= $30 RX= $30 RX= $30
Ded + coins= Ded + coins=
$32 $32

Total Cost $377 $377 $160 $155 $160 $155 $155

 Meet Lisa, she:
● Earns $57,000 a year ● Values in -network care providers for her daughter’s
care
● Is married to Brian and they have one daughter, ● Plans to seek preventive care
Amanda, who is asthmatic and needs medical care ● Provides medical coverage for her family
from specialists
Given Lisa’s situation, let’s see how each medical plan option could work for her and her family.*

Medical Plan H.S.A 3000 H.S.A 2000 EPO 4000 EPO 2000 EPO 1000 EPO 0 PPO 1000
Service Lisa pays….
Lisa’s annual physical $0 $0 $0 $0 $0 $0 $0
exam (in-network)

Bryan’s annual physical $0 $0 $0 $0 $0 $0 $0

exam (in-network)

Amanda’s annual physical $0 $0 $0 $0 $0 $0 $0

exam (in-network)

Amanda’s 30 specialist (in-network (in-network ($50 per ($50 per ($60 per ($50 per ($50 per
office visits for asthma $200 per visit) $200 per visit) visit) visit) visit) visit)
symptoms Ded= $6,000 visit) Ded= $1,500 $1,500 $1,800 $1,500 $1,500
$4,000+ (10%
coins)= $200
Amanda’s ER visit for an 20% coins= 10% coins= Ded= Ded= Ded= $0 Ded=
asthma attack, resulting $3,600 $1,800 $8,000 + $4,000 + $2,000 + $2,000+
in a hospital admission (20% coins) (20% coins) $500 (20% coins)
and a five-night stay $2,000 $2,800 Hospital In- $3,200
(hospital bill of $18,000*) patient
copay+(20%
coins)
$3,300
Total Cost $9,600 $6,000 $11,500 $8,300 $7,600 $1,500 $6,700
Out-of-pocket max $12,000 $8,000 $14,300 $8,000 $6,000 $6,000 $6,000
Total owed by Lisa $9,600 $6,000 $11,500 $8,000 $6,000 $1,500 $6,000
 Meet Jessica, she:
● Earns $62,000 a year ● Values in-and-out-of-network care providers
for care
● Is married to Randy and they just welcomed ● Provides medical coverage for her family
their new healthy baby boy, Eric
● Jessica and Randy had a healthy birth with no
complications.

Given Jessica’s situation, let’s see how each medical plan option could work for her and her family.*

Medical Plan H.S.A 3000 H.S.A 2000 EPO 4000 EPO 2000 EPO 1000 EPO 0 PPO 1000
Service Jessica pays….
In-network Delivery (in-network (in- (in- (in- (in- $0 (in-
and hospital Ded)= network network network network network
admission and a four $6,000 Ded)= Ded)= Ded)= Ded)= Ded)=
night stay (hospital + $4,000+ $8,000+ $4,000+ $2,000+ $2,000+
bill of $35,000) (20% (10% (20% (20% hospital (20%
coins)= coins)= coins)= coins)= in-patient coins)=
$5,800 $3,100 $5,400 $6,200 co-pay $6,600
$500
+(20%
coins)=
$6,500
Total Cost $11,800 $7,100 $13,400 $6,200 $9,000 $0 $8,600

Out-of-pocket max $12,000 $8,000 $14,300 $8,000 $6,000 $6,000 $6,000

Total owed by Lisa $11,800 $7,100 $13,400 $6,200 $6,000 $0 $6,000
PRESCRIPTION DRUGS

When you enroll in one of our Medical Plans, you automatically receive prescription drug
coverage administered by Cigna.

Your prescription drug costs are based on three different tiers of prescription drugs:

Tier 1 – This is your lowest-cost option and typically includes generic drugs and the lowest-cost brand-name
drugs.

Tier 2 – This mid-range cost option includes most preferred brand-name drugs.

Tier 3 – This is your highest-cost option and includes drugs that are usually the newest and most expensive, and
are considered non-preferred brand-name drugs. If your doctor prescribes you a Tier 3 drug, ask your doctor if
there is a lower-cost alternative in Tier 1 or Tier 2 that would provide the same treatment benefits.

Follow these simple steps to learn if your prescription drug is covered by Cigna, and how your prescription drugs
may be priced with Cigna:

i. Go to Cigna.com/druglist
Use the drop down menu to select the Standard 3 Tier drug list

Present your Cigna Medical ID card at a pharmacy that participates in the Cigna Open Access Plus network for up
to a 31-day supply. Or you can save money on maintenance medications by using the mail-order program and
receive a 90-day supply of medication for the cost of a 75-day supply – delivered right to your door. Either way,
you will pay a copayment for your medication. Receive fast answers from Cigna pharmacists 24/7 800.285.4812
(after January 1, 2017). You may also send your prescription and applicable copayment to Cigna Pharmacy.
HEALTH SAVINGS ACCOUNT (HSA)

A Health Savings Account (HSA) allows you to put money aside to pay for current and future qualified
medical expenses using pre-tax dollars. An HSA can only be elected if an HSA Medical Plan has also been
selected. Your HSA provides a triple tax advantage; contributions are tax deductible, invested balances
grow tax free, and all withdrawals for qualified expenses are tax free.

Eligibility Requirements:

● Must be enrolled in a High Deductible (HSA) Health Plan

● Must not be enrolled in Medicare
● Must not be covered by other medical insurance(s)
● Must not be claimed as a dependent on someone else’s’ taxes
● Must not have received VA medical benefits at any time in the past three months
● Spouse is not contributing to/participating in a general-purpose FSA through his / her employer

Maximum tax-deductible contribution to an HSA for 2017:

● $3,400 for an individual medical insurance plan

● $6,750 for employee plus one and family medical insurance plan
● Catch-up provision for anyone over the age of 55 is $1,000

Debit Card

HSA Bank is our 2017 HSA administrator. Following enrollment, an HSA debit card will be mailed to all
new participants. Your HSA card can be used to pay for qualified medical expenses billed from an
insurance company, a physician’s office or a pharmacy. A list of qualified medical expenses can be found
at http://www.irs.gov/publications/p502/index.html.
FLEXIBLE SPENDING ACCOUNTS

We continue to offer health care and dependent care flexible spending accounts (FSAs), administered by
Discovery Benefits, which allow you to pay for eligible health and dependent care expenses with pretax dollars.

Health Care FSA

You may elect to defer from $100 to $2,600 annually into a health care FSA. The $2,600 limit applies individually;
a married couple may contribute a maximum of $5,000. You may not enroll in a Health Care FSA if you currently
contribute to a H.S.A.

Limited-Purpose FSA

A Limited Purpose FSA (LPFSA) is a flexible spending account that you may enroll in when you have a health
savings account (HSA). You can use an LPFSA to pay for eligible out-of-pocket dental and vision expenses.
Such expenses include:
• Dental and orthodontic care; like fillings, X-rays and braces
• Vision care, including eyeglasses, contact lenses and LASIK surgery
You may elect to defer from $100 to $2,600 annually into a LPFSA. The $2,600 limit applies individually; a married
couple may contribute a maximum of $5,000. Limited-Purpose FSAs are available to individuals that open and
contribute to a H.S.A.

Dependent Care FSA

You may elect to defer from $100 to $5,000 annually into a dependent care FSA per household. If you are a
highly compensated employee (HCE), defined by the IRS as an employee with annual compensation greater than
$120,000, your election will be capped at $2,500 and may be reduced during the year, if necessary, to ensure that
the plan passes federally-required discrimination testing.
Please note that for expenses to qualify for reimbursement, both you and your spouse (if applicable) must be working, looking for work or attending school full-
time during the period for which you are requesting reimbursement.
DENTAL INSURANCE

Our dental plans encourage early detection of dental problems by paying the most toward diagnostic
and preventive services, such as routine check-ups and cleanings.

Cigna

For 2017, Little Bird is offering dental coverage through Cigna. Little Bird is offering three PPO plans and
one DMO plan. If you elect the PPO Plan, you can go to any dentist in the Premier and PPO networks.
Preventive and Orthodontic Care (if applicable) are exempt from the deductible. If you elect the DMO
plan, you will have to select a primary care dentist in the Cigna network.
DHMO DPPO 1000 DPPO 1250 DPPO 2000
Managed Cigna DPPO Out-of- Cigna DPPO Out-of- Cigna DPPO Out-of -
Care Advantage Network Advantage Network Advantage Network
Class 1–
Schedule of
Preventive & 100% 100% 100% 100% 100% 100%
Fees
Diagnostic
Class 2 – Basic Schedule of
80% 50% 90% 60% 100% 80%
Restorative Fees
Class 3 – Major Schedule of
50% 50% 50% 25% 60% 50%
Restorative Fees
Individual n/a $100 $100 $100 $100 $50 $50
Family n/a $300 $300 $300 $300 $150 $150
Calendar Year
Unlimited
Maximum
$1,000 $1,000 $1,250 $1,250 $2,000 $2,000
(applies to class
1 services)
Orthodontia Schedule of Not
Not Covered 50% 50% 50% 50%
(Adult & child) Fees Covered
Ortho Life Schedule of Not
Not Covered $2,000 $2,000 $2,000 $2,000
Maximum Fees Covered
Coverage Tier Monthly Cost Monthly Cost Monthly Cost Monthly Cost
Employee Only $20.27 $16.90 $26.45 $44.98
Employee +
$37.53 $33.80 $52.91 $89.97
Spouse
Employee +
$41.89 $42.42 $66.39 $112.90
Child(ren)
Family $62.90 $62.13 $97.08 $165.08
VISION INSURANCE

Participation in the Cigna vision plan is also available to all benefit-eligible employees. We encourage
you to use a doctor in the network. The plan helps you pay for a wide range of vision-related services
and products as shown below.

Plan Design Vision 10 Vision 0

Exam/Materials Frequency Frequency

Eye Exam Every calendar year Every calendar year

Lenses Every calendar year Every calendar year

Frames Every calendar year Every calendar year

Plan Benefits In-Network Out-of-Network In-Network Out-of-Network

Up to $60 Up to $60
Eye Exam $10 Covered in Full
reimbursement reimbursement
Up to $40 Up to $40
Single Lenses $25 Covered in Full
reimbursement reimbursement
Up to $65 Up to $65
Bifocal Lenses $25 Covered in Full
reimbursement reimbursement
Up to $144 Up to $144
Contacts Lenses $180 allowance $180 allowance
reimbursement reimbursement
$150 allowance
Up to $83 $180 allowance + 20% Up to $100
Frames after $25 copay +
reimbursement off reimbursement
20% off
Coverage Tier Monthly Cost Monthly Cost
Employee Only $7.60 $9.09
Employee +
Spouse $15.21 $18.18
Employee +
Child(ren) $15.36 $18.37
Family $24.51 $29.31
DISABILITY PLANS

Little Bird offers Short Term Disability (STD) and Long Term Disability (LTD) through Cigna Life & Disability.
These disability coverage(s) are paid 100% by your employer and work in conjunction with one another
to provide continuous income replacement in the event of a serious illness or injury requiring a leave of
absence.

STD Benefit Highlights

This policy will pay you a weekly benefit if you are unable to work due to a serious illness or injury.
There is a waiting period between when you become ill and when your benefits will begin. This
coverage is at no cost to you.

STD Coverage Type STD Benefits

● Covers accidents and illnesses for up to 26 weeks.

● Benefits are 60% of your weekly earnings, up to $1,500 per
Short-Term Disability (STD) week.
● Payments to you begin on the 8th day following as accidents or
day of sickness.

LTD Benefit Highlights

This policy will pay you a monthly benefit if you are unable to work due to a serious illness or injury.
There is a waiting period between when you become ill and when your benefits will begin. This coverage
is at no cost to you.

LTD Coverage Type LTD Benefits

● Income replacement begins after 180 days of sickness
or disability
● Offers a 60% income replacement of monthly earnings, up to
Long-Term Disability (LTD)
$7,500 per month.
● Benefits end at recovery or at Social Security Normal
Retirement Age
LIFE/AD&D INSURANCE

Your family depends on your income for a comfortable lifestyle and for the resources necessary to make their
dreams – such as a college education – a reality. Like anyone, you don’t like to think of the scenario where you’re
no longer there for your family. However, you do need to ensure their lives and dreams can continue if the worst
should occur.

Basic Life & Accidental Death & Dismemberment Insurance

Cigna’s Life Insurance plan pays benefits to your beneficiary(ies) if you die or are seriously injured. The Basic Life
Insurance is paid 100% by your employer.

Basic Life 1x your salary, up to $500,000

Basic Accidental Death
Matches Basic Life coverage
& Dismemberment

Voluntary Life& Voluntary Accidental Death & Dismemberment (AD&D)

You have the freedom to select adequate levels of life insurance coverage to protect the well-being of your
family. Little Bird offers Voluntary Life and Voluntary Accidental Death & Dismemberment through Cigna. If you
elect coverage, these premiums are 100% paid for by you.

Voluntary Employee Life/AD&D Insurance

For yourself: Increments of $10,000 to a maximum of $500,000, not to exceed 5 times your base annual earnings.
There is a guarantee issue of $200,000.

Voluntary Dependent Life/AD&D Insurance

● For your spouse: Increments of $5,000 to a maximum of $250,000, not to exceed 50% of employee’s
elected amount. There is a guarantee issue of $25,000.
● For your eligible children: Increments of $5,000 to a maximum of $10,000 (per child), not to exceed 50%
of the employee’s elected amount. There is a guarantee issue of $10,000.
Beneficiary(ies)

Your employer pays for you to have Basic Life Insurance and AD&D coverage. For this reason, you will be required
to review and update your beneficiary(ies) during the enrollment period. Primary beneficiary is the first in line to
receive your death benefit. If the primary beneficiary(ies) dies before you do, a secondary beneficiary(ies) is the
next in line to receive the benefit.

Be sure to update your beneficiary(ies) during enrollment.

Voluntary Life Insurance

Age-Bands (Employee & Spouse Rates) Monthly Rate Per $1,000

Under 25 $.039
25-29 $.039
30-34 $.046
35-39 $.06
40-44 $.089
45-49 $.141
50-54 $.219
55-59 $.335
60-64 $.465
65-69 $.793
70-74 $1.498
Over 74 $1.498
Child Rates $.21

Proof of Good Health (Evidence of Insurability)

You may apply for any amount of Life insurance coverage up to the guaranteed issue limit of $200,000 for
yourself and up to $25,000 for your spouse without providing proof of good health. If you apply for coverage for
yourself or your dependents more than, or choose coverage above these amounts, you will be required to
provide evidence of insurability and be approved in order to qualify for coverage. Proof of good health does not
apply to Accidental Death and Dismemberment Coverage.
COLONIAL VOLUNTARY BENEFITS

You do everything to keep your family safe, but accidents and illness do happen. Little Bird HR is pleased to offer
Group Accident, Group Critical Care Insurance and Group Medical Bridge coverage for the 2017 plan year.

Group Accident Insurance

Group Accident insurance is an indemnity plan that provides you and your family with hospital, physician,
accidental death and catastrophic accident benefits in the event of a covered accident. These benefits can help
with the out-of-pocket medical and non-medical expenses associated with an accident. This is a limited policy.
Please refer to the Summary Plan Description for more details, any exclusions and policy limitations.

Group Accident Insurance Schedule of Benefits

Accident Emergency Room Benefit $125

Initial Accident Physician Office Visit / Urgent Care $125

Ambulance (Ground / Air) $200 / $1,500

Initial Hospital Confinement $1,000

Hospital Confinement (per day) NY Residents: $165 (per day up to 365 days)
All Other: $200 (per day up to 365 days)
Accident Follow-up Visit (per visit) $50 (maximum 3 visits)

Physical Therapy (per visit) $25 (maximum 10 visits)

Fractures (Closed / Open) $150 up to $7,500

Ankle /Foot / Wrist $450 / $900
Leg $1,125 / $2,250
Upper Arm $525 / $1,050
Accidental Death Benefit
$25,000 / $25,000 / $5,000
Employee / Spouse / Child
Accidental Death Common Carrier 4x Accidental Death Benefit

Tier New York All Other States

Employee $13.92 $14.93
Employee + Spouse $21.00 $24.24
Employee + Child(ren) $24.31 $28.16
Employee + Family $31.39 $37.77
GROUP CRITICAL CARE

Group Critical Care insurance helps you and your family maintains financial security during the lengthy, expensive
recovery period of a serious medical event such as cancer, heart attack or stroke. It provides a lump sum benefit
to help with the out-of–pocket medical and/or non-medical expenses of a specified critical illness and/or cancer.
Rates are based on the amount of coverage you elect, your age and smoker status. This is a limited policy. Please
refer to the Summary Plan Description for more details, any exclusions and policy limitations.

Group Critical Care Schedule of Benefits

Invasive Cancer 100%

Carcinoma In Situ 25%

Other Cancer $500 – flat amount

Heart Attack 100%

Heart Failure 100%

Stroke 100%

Coronary Artery Disease / Bypass 25%

End Stage Renal (Kidney) Failure 100%

Major Organ Failure / Transplant 100%

NY Residents: Not Covered

Blindness
All Other: 100%
Occupational HIV, Occupational NY Residents: Not Covered
Infectious Hepatitis B, C or D All Other: 100%
 New York (Non Tobacco)

$5,000 coverage $10,000 coverage

Employee + Employee + Employee + Employee + Employee + Employee +

Ages Employee Employee
Spouse Child(ren) Family Spouse Child(ren) Family

16-29 $6.21 $8.19 $6.46 $8.49 $7.51 $10.14 $8.01 $10.74

30-39 $7.86 $10.69 $8.11 $10.89 $10.81 $15.14 $11.31 $15.54
40-49 $11.41 $15.99 $11.66 $16.24 $17.91 $25.75 $18.41 $26.24
50-59 $17.76 $25.84 $17.96 $26.19 $30.62 $45.44 $31.02 $46.15
60-74 $27.06 $39.94 $27.56 $41.19 $49.22 $73.64 $50.22 $76.15

New York (Non Tobacco)

$15,000 coverage $20,000 coverage

Employee + Employee + Employee + Employee + Employee + Employee +

Ages Employee Employee
Spouse Child(ren) Family Spouse Child(ren) Family

16-29 $8.81 $12.10 $9.57 $13.00 $10.11 $14.05 $11.12 $15.25

30-39 $13.77 $19.60 $14.51 $20.20 $16.72 $24.05 $17.71 $24.85
40-49 $24.41 $35.50 $25.17 $36.24 $30.91 $45.25 $31.92 $46.24
50-59 $43.47 $65.04 $44.07 $66.10 $56.32 $84.64 $57.12 $86.05
60-74 $71.37 $107.34 $72.87 $111.10 $93.52 $141.05 $95.52 $146.05

All Other States (Non Tobacco)

$5,000 coverage $10,000 coverage

Employee + Employee + Employee + Employee + Employee + Employee +

Ages Employee Employee
Spouse Child(ren) Family Spouse Child(ren) Family

16-29 $4.60 $7.00 $4.85 $7.25 $6.30 $9.50 $6.80 $10.00

30-39 $6.40 $9.75 $6.65 $10.00 $9.90 $15.00 $10.40 $15.50
40-49 $10.60 $16.05 $10.90 $16.30 $18.30 $27.60 $18.90 $28.10
50-59 $17.25 $26.45 $17.55 $26.75 $31.60 $48.40 $32.20 $49.00
60-74 $26.55 $40.55 $26.85 $40.90 $50.20 $76.60 $50.80 $77.30

All Other States (Non Tobacco)

$15,000 $20,000

Employee + Employee + Employee + Employee + Employee + Employee +

Ages Employee Employee
Spouse Child(ren) Family Spouse Child(ren) Family

16-29 $8.00 $12.00 $8.75 $12.75 $9.70 $14.50 $10.70 $15.50

30-39 $13.40 $20.25 $14.15 $21.00 $16.90 $25.50 $17.90 $26.50
40-49 $26.00 $39.15 $26.90 $39.90 $33.70 $50.70 $34.90 $51.70
50-59 $45.95 $70.35 $46.85 $71.25 $60.30 $92.30 $61.50 $93.50
60-74 $73.85 $112.65 $74.75 $113.70 $97.50 $148.70 $98.70 $150.10
 GROUP MEDICAL BRIDGE

Group Medical Bridge provides additional out-of-pocket protection for services including hospital confinement.
The benefits help offset the larger financial exposures of their health insurance plan including deductibles and co-
insurance. This is a limited policy. Please refer to the Summary Plan Description for more details, any exclusions
and policy limitations.

Group Medical Bridge Schedule of Benefits

Hospital Admission $1,000

NY Residents: $165 – 60 days

maximum
Daily Hospital Confinement (Non ICU)
All Other: Not Included

Health Screening $50

Included – birth must not occur

during the first 9 months after
the effective date (applies to
Pregnancy Coverage
hospital admission and daily
hospital confinement benefits)

New York All Other States

17 – 49 50 – 59 60 - 64 65 - 99 17 – 49 50 – 59 60 - 64 65 - 99
Employee $17.88 $26.06 $36.88 $52.82 $11.94 $14.77 $19.85 $27.11
Employee + Spouse $31.65 $51.41 $76.28 $108.84 $20.81 $28.41 $40.15 $55.08
Employee + Child(ren) $24.15 $32.33 $43.15 $59.09 $16.07 $18.91 $23.98 $31.24
Employee + Family $37.92 $57.68 $82.55 $115.11 $24.94 $32.55 $44.28 $59.21
Additional Benefits

In addition to comprehensive medical, dental, vision, life, and disability options Little Bird is pleased to
offer you these additional benefits:

Talkspace

Sometimes a personal or professional issue can affect your work, health and general
well-being. In these times, you may need an experienced professional to help you manage life’s challenges. Little
Bird HR is pleased to offer you Talkspace: access to professional, personal, and confidential online therapy at no
cost to you.

Talkspace is here to help support you when dealing with issues such as emotional well-being, family and
relationships, legal and financial issues, healthy lifestyles,
or work / life transitions.

Some highlights of the Talkspace include:

 Getting matched with a personal licensed counselor who will be there to contact 24/7
 100% anonymous service
 Contact professionals through unlimited text, audio and video messaging

Commuter Benefit Plan

Through Discovery Benefits, we offer a Commuter Benefit Plan (CBP). This is a tax free account for workplace
commuting expenses (including mass transit and parking expenses / excluding taxis, tolls and fuel). This means
money is deducted through convenient paycheck deductions before taxes are taken out. Since you do not pay tax
on this money, you are saving money automatically. You can contribute up to $255 a month for transit (bus or
train) for things such as passes, tokens, fare card, voucher, or similar items. You can also contribute up to $255 a
month for qualified parking expenses for things like parking at a location for commuter vehicle or vanpool, mass
transit facilities, a garage near work, and parking meters.

Want to contribute more than the maximum allowed?

You can do so by contributing on a post-tax basis. This means any contributions over the monthly pre-tax limit (as
stated above) will be deducted from your paycheck after taxes.

You can join or leave the Commuter Benefit Plan at any time via the Little Bird Nest.
Legal Protection

MetLaw offers comprehensive assistance for a wide range of legal services. Covered services include debt
collection defense, identity theft, wills, mortgages, deeds, and much more. By purchasing this benefit, you have
access to a network of more than 13,000 participating plan attorneys.1 This benefit is paid 100% by you.

Monthly Cost
Rate Per Person $22.50

ID Theft Protection

ID Watchdog is an identity monitoring service which closely tracks any changes to your credit, financial
transactions, personal information and more.

Identity Resolution and Restoration services are performed by Certified ID Theft Risk Management Specialists who
serve as your dedicated case manager to provide you with a 100% guaranteed identity resolution. This includes
$1M in reimbursement insurance.

Monthly Cost IDW Platinum IDW B

Employee Rate: $12.95 $7.95
Family Rate: $22.95 $13.95

Perks and Discounts

Abenity provides access to over 289,000 local and national discounts at work, at home, or on the go! Save on
thousands of hotels, restaurants, movie tickets, retailers, florists, car dealers, theme parks, national attractions,
concerts, and events.

To take advantage of these discounts, at no cost to you, visit Littlebird.abenity.com/login and be sure to register
using the Registration Code: LittleBird

1
If services are provided by a non-plan attorney, the participant is responsible for paying the difference between the reimbursement amount and th
e attorney’s charge for the services.
Paycheck Direct

Paycheck Direct is an employee purchasing program. This program helps you buy the big-ticket items that you
want and need today, then make low, convenient payments over 12 months. When you shop Paycheck Direct,
you can choose from thousands of name-brand products, including TVS, computers, major appliances, furniture
and so much more. Buy as often as you like up to your purchase limit.

Who is Eligible for Paycheck Direct?

You must be 18 years or older, earning at least $18,000 per calendar year, considered full-time, and have worked
at your current employer for at least 12 consecutive months.

Use the chart below to determine your Paycheck Direct purchase limit. The minimum order is $150 (before
shipping and taxes). Shop now at www.mypaycheckdirect.com/littlebirdhr.

Minimum Salary Maximum Salary Purchase Limit

$18,000 $25,000 $500
$25,001 $25,000 $750
$35,001 $50,000 $1,000
$50,001 $65,000 $1,500
$65,001 $74,999 $2,000
$75,000+ N/A $2,500
ADDITIONAL INFORMATION
Affordable Care Act (ACA) - Frequently Asked Questions
Employees Eligible for the Company-Sponsored Medical Plan

Q. What is the Affordable Care Act?

A. The Patient Protection and Affordable Care Act, commonly called the Affordable Care Act (ACA)
is a United States federal statute signed into law by President Obama in March 2010.

The ACA includes subsidies, health insurance exchanges, and mandates, including an individual mandate that,
with certain exceptions, requires all individuals beginning January 1, 2014 to have health insurance or pay a
penalty. The law includes subsidies to help individuals with low incomes comply with the mandate. Coverage
through the health insurance exchange is guaranteed; even if you have a pre-existing medical condition, your cost
for coverage will be the same as all other applicants of the same age living in the same geographic location.

Q. Who is required to have health insurance?

A. As of January 1, 2014, all Americans – with some exceptions – are required to have medical insurance coverage
or incur a penalty. Qualified health insurance plans that meet the ACA requirements may include:

● Government-sponsored plans, such as:

● Medicare or Medicaid
● Children’s Health Insurance Program (CHIP)
● TRICARE
● Veterans health care programs
● Employer-based or sponsored health care plans - the Colonial Medical Bridge (Hospital Indemnity)
Insurance is NOT considered qualified health insurance
● Individual private coverage
Q. Will the Company continue to offer medical coverage in 2017?
A. Yes, we will continue to offer medical coverage to eligible employees and their eligible family members in 2017.

Q. What is the health insurance exchange?

A. The health insurance exchange, sometimes called the Exchange or Marketplace, is a resource where individuals
can learn about private health coverage options, compare private health insurance plans, and enroll in private
health insurance coverage. The health insurance exchange also provides information on programs that help
individuals with low to moderate incomes, and resources to pay for private health insurance coverage.

You can get help online at www.healthcare.gov, or call 1-800-318-2596, 24 hours a day, 7 days a week
REQUIRED NOTICES

Newborns’ and Mothers’ Health Protection Act

Under federal law, health care plans may not restrict any hospital length of stay in connection with childbirth for the
mother or newborn child to less than 48 hours following a normal 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 and with the mother’s consent, from discharging the mother or her newborn earlier than
48 hours (or 96 hours as applicable).

Continued Coverage Under COBRA

Under the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA), you and your covered dependents
may be able to continue your medical and dental coverage if you lose your health care coverage as the result of
certain qualifying events. Contact the Little Bird Benefits Concierge for more information.

Women’s Health and Cancer Rights Act Enrollment Notice

The following is language that group health plans may use as a guide when crafting the WHCRA enrollment notice:

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 individuals receiving mastectomy-related benefits, coverage
will be provided in a manner determined
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.

If you would like more information on WHCRA benefits, call the Little Bird Benefits Concierge.

Women’s Health and Cancer Rights Act Annual Notice

The following is language that group health plans may use as a guide when crafting the WHCRA annual notice:

Do you know that your plan, as required by the Women’s Health and Cancer Rights Act of 1998, provides benefits
for mastectomy-related services including all stages of reconstruction and surgery to achieve symmetry between
the breasts, prostheses, and complications resulting from a mastectomy, including lymphedema? Call the Little Bird
Benefits Concierge for more information.
HIPAA Regulations Help to Protect Your Privacy

The privacy provisions of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) help to ensure that
your health care-related information stays private. New employees will receive a Privacy Practice Notice which
outlines the ways in which the medical plan may use and disclose protected health information (PHI). The notice
also describes your rights. For more information, contact the Little Bird Benefits Concierge.

Notice of Availability of Reasonable Alternative Standard

Your health plan is committed to helping you achieve your best health. Rewards for participating in a wellness
program are available to all employees. If you think you might
be unable to meet a standard for a reward under this wellness program, you might qualify
for an opportunity to earn the same reward by different means. Contact the Little Bird HR team and we will work
with you (and if you wish, with your doctor) to find a wellness program with the same reward that is right or you in
light of your health status.

Notice to Employees Regarding Employer Contributions to HSAs

This notice explains how you may be eligible to receive contributions from employer if you
are covered by a High Deductible Health Plan (HDHP). Your employer may provide contributions to the Health
Savings Account (HSA) of each employee who is considered an eligible employee.

Important Notice from Little Bird HR 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 Little Bird HR and about your options under Medicare’s prescription drug
coverage. This information can help you decide whether or not you want to join a Medicare drug plan. If you are
considering joining, you should compare your current coverage, including which drugs are covered at what cost,
with the coverage and costs of the plans offering Medicare prescription drug coverage in your area. Information
about where you can get help to make decisions about your prescription drug coverage is at the end of this
notice.

There are two important things you need to know about your current coverage and Medicare’s prescription drug
coverage:

1. Medicare prescription drug coverage became available in 2006 to everyone with Medicare. You can get
this coverage if you join a Medicare Prescription Drug Plan or join a Medicare Advantage Plan (like an
HMO or PPO) that offers prescription drug coverage. All Medicare drug plans provide at least a standard
level of coverage set by Medicare. Some plans may also offer more coverage for a higher monthly
premium.

2. Little Bird has determined that the prescription drug coverage offered by the Little Bird HR 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.

When Can You Join a Medicare Drug Plan?

You can join a Medicare drug plan when you first become eligible for Medicare and each year from October 15th
to December 7th.

However, if you lose your current creditable prescription drug coverage, through no fault of your own, you will also
be eligible for a two (2) month Special Enrollment Period (SEP) to join
a Medicare drug plan.

What Happens to Your Current Coverage if You Decide to Join a Medicare Drug Plan?

If you decide to join a Medicare drug plan, your current Little Bird coverage may be affected. If you do decide to
join a Medicare drug plan and drop your current Little Bird coverage, be aware that you and your dependents
may not be able to get this coverage back.

When Will You Pay a Higher Premium (Penalty) to Join a Medicare Drug Plan?

You should also know that if you drop or lose your current coverage with Little Bird HR and don’t join a Medicare
drug plan within 63 continuous days after your current coverage ends, you may pay a higher premium (a penalty)
to join a Medicare drug plan later.

If you go 63 continuous days or longer without creditable prescription drug coverage, your monthly premium may
go up by at least 1% of the Medicare base beneficiary premium per month for every month that you did not have
that coverage. For example, if you go nineteen months without creditable coverage, your premium may
consistently be at least 19% higher than the Medicare base beneficiary premium. You may have to pay this higher
premium
(a penalty) as long as you have Medicare prescription drug coverage. In addition, you may have to wait until the
following October to join.

For More Information About This Notice or Your Current

Prescription Drug Coverage…

Contact the Little Bird Benefit Concierge team. NOTE: You’ll get this notice each year. You will also get it before
the next period you can join a Medicare drug plan, and if this coverage through Little Bird HR changes. You also
may request a copy of this notice at any time.
For More Information About Your Options Under Medicare
Prescription Drug Coverage…

More detailed information about Medicare plans that offer prescription drug coverage is in
the “Medicare & You” handbook. You’ll get a copy of the handbook in the mail every year
from Medicare. You may also be contacted directly by Medicare drug plans.

For more information about Medicare prescription drug coverage:

● Visit www.medicare.gov
● Call your State Health Insurance Assistance Program (see the inside back cover
of your copy of the “Medicare & You” handbook for their telephone number) for personalized help
● Call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048.
If you have limited income and resources, extra help paying for Medicare prescription drug coverage is available.
For information about this extra help, visit Social Security on the web
at www.socialsecurity.gov, or call them at 1-800-772-1213 (TTY 1-800-325-0778).

Remember: Keep this Creditable Coverage notice. If you decide to join one of the Medicare drug plans, you may
be required to provide a copy of this notice when you join to show whether or not you have maintained creditable
coverage and, therefore, whether or not you are required to pay a higher premium (a penalty).

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).

HIPAA Notice of Special Enrollment Rights

If you are declining enrollment for yourself or your dependents (including your spouse) because of other health
insurance or group health plan coverage, you may be able to enroll yourself and your dependents in this plan if
you or your dependents lose eligibility for that
other coverage (or if the employer stops contributing towards your or your dependents’ other coverage).
However, you must request enrollment within 30 days after your or your dependents’ other coverage ends (or after
the employer stops contributing toward the other coverage).

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.

If you decline enrollment for yourself or for an eligible dependent (including your spouse) while Medicaid coverage
or coverage under a state children’s health insurance program is in effect, you may be able to enroll yourself and
your dependents in this plan if you or your dependents lose eligibility for that other coverage. However, you must
request enrollment within 60 days after your or your dependents’ coverage ends under Medicaid or a state
children’s health insurance program.

If you or your dependents (including your spouse) become eligible for a state premium assistance subsidy from
Medicaid or through a state children’s health insurance program with respect to coverage under this plan, you
may be able to enroll yourself and your dependents in this plan. However, you must request enrollment within 60
days after your or your dependents’ determination of eligibility for such assistance.

To request special enrollment or obtain more information, contact the Little Bird Benefit Concierge team at 877-227-
9994 or email mybenefits@littlebird.hr for assistance.
FLSA / EXCHANGE NOTICE
MEDICAID / CHIP CONTACT INFORMATION

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 January 31, 2016. Contact your State for more
information on eligibility:

State Plan Phone / Website

Website: www.myalhipp.com
Alabama Medicaid
Phone: 1-855-692-5447

Website: http://myakhipp.com/
Alaska Medicaid
Phone: 1-866-251-4861

Website: http://myarhipp.com/
Arkansas Medicaid
Phone: 1-855-692-7447

Website: http://www.colorado.gov/hcpf
Colorado Medicaid
Customer Contact Center: 1-800-221-3943

Website: https://www.flmedicaidtplrecovery.com/hipp/
Florida Medicaid
Phone: 1-877-357-3268

Website: http://dch.georgia.gov/medicaid
Click on Programs, then Medicaid, then Health
Georgia Medicaid
Insurance Premium Payment (HIPP)
Phone: 404-656-4507

Healthy Indiana Plan for Low Income Adults:

Website: http://www.hip.in.gov
Phone: 1-877-438-4479
Indiana Medicaid
All Other Medicaid:
Website: http://www.indianamedical.com
Phone: 1-800-403-0864

Website: www.dhs.state.ia.us/hipp/
Iowa Medicaid
Phone: 1-888-346-9562

Website: http://www.kdheks.gov/hcf/
Kansas Medicaid
Phone: 1-785-296-3512

Website: http://chfs.ky.gov/dms/default.htm
Kentucky Medicaid
Phone: 1-800-635-2570

Website: http://dhh.louisiana.gov/index.cfm/subhome/1/n/331
Louisiana Medicaid
Phone: 1-888-695-2447

Website: http://www.maine.gov/dhhs/ofi/public-
assistance/index.html
Maine Medicaid
Phone: 1-800-442-6003
TTY: Maine relay 711
 Website: http://www.mass.gov/MassHealth
Massachusetts Medicaid / CHIP
Phone: 1-800-462-1120

Website: http://mn.gov/dhs/ma/
Minnesota Medicaid
Phone: 1-800-657-3739

Website:
Missouri Medicaid http://www.dss.mo.gov/mhd/participants/pages/hipp.htm
Phone: 573-751-2005

State Plan Phone / Website

Website:
Montana Medicaid http://dphhs.mt.gov/MontanaHealthcarePrograms/HIPP
Phone: 1-800-694-3084

Website:
http://dhhs.ne.gov/Children_Family_Services/AccessNebraska/
Nebraska Medicaid
Pages/accessnebraska_index.aspx
Phone: 1-855-632-7633

Website: http://dwss.nv.gov/
Nevada Medicaid
Phone: 1-800-992-0900

Website: http://www.dhhs.nh.gov/oii/documents/hippapp.pdf
New Hampshire Medicaid
Phone: 603-271-5218

Medicaid Website: http://www.state.nj.us/humanservices/

dmahs/clients/medicaid/
New Jersey Medicaid / CHIP Medicaid Phone: 609-631-2392
CHIP Website: http://www.njfamilycare.org/index.html
CHIP Phone: 1-800-701-0710

Website: http://www.nyhealth.gov/health_care/medicaid/
New York Medicaid
Phone: 1-800-541-2831

Website: http://www.ncdhhs.gov/dma
North Carolina Medicaid
Phone: 919-855-4100

Website:
North Dakota Medicaid http://www.nd.gov/dhs/services/medicalserv/medicaid/
Phone: 1-844-854-4825

Website: http://www.insureoklahoma.org
Oklahoma Medicaid / CHIP
Phone: 1-888-365-3742

Website: http://healthcare.oregon.gov/Pages/index.aspx
Oregon Medicaid / CHIP http://www.oregonhealthcare.gov/index-es.html
Phone: 1-800-699-9075
 Website: http://www.dhs.pa.gov/hipp
Pennsylvania Medicaid
Phone: 1-800-692-7462

Website: www.eohhs.ri.gov
Rhode Island Medicaid
Phone: 401-462-5300

Website: http://www.scdhhs.gov
South Carolina Medicaid
Phone: 1-888-549-0820

Website: http://dss.sd.gov
South Dakota Medicaid
Phone: 1-888-828-0059

Website: https://www.gethipptexas.com/
Texas Medicaid
Phone: 1-800-440-0493

Medicaid Website: http://health.utah.gov/medicaid

Utah Medicaid / CHIP CHIP Website: http://health.utah.gov/chip
Phone: 1-877-543-7669

State Plan Phone / Website

Website: http://www.greenmountaincare.org/
Vermont Medicaid
Phone: 1-800-250-8427

Medicaid Website:
http://www.coverva.org/programs_premium_assistance.cfm
Medicaid Phone: 1-800-432-5924
Virginia Medicaid / CHIP
CHIP Website:
http://www.coverva.org/programs_premium_assistance.cfm
CHIP Phone: 1-855-242-8282

Website: http://www.hca.wa.gov/free-or-low-cost-health-
Washington Medicaid care/program-administration/premium-payment-program
Phone: 1-800-562-3022 ext. 15473

Website:
www.dhhr.wv.gov/bms//Medicaid%20Expansion/Pages/defaul
West Virginia Medicaid
t.aspx
Phone: 1-877-598-5820, HMS Third Party Liability

Website:
https://www.dhs.wisconsin.gov/publications/p1/
Wisconsin Medicaid / CHIP
p10095.pdf
Phone: 1-800-362-3002

Website: https://wyequalitycare.acs-inc.com/
Wyoming Medicaid
Phone: 307-777-7531
To see if any other states have added a premium assistance program since January 31, 2015,
or for more information on special enrollment rights, contact either:

U.S. Department of Labor Employee U.S. Department of Health and Human Services
Benefits Security Administration Centers for Medicare & Medicaid Services
www.dol.gov/ebsa www.cms.hhs.gov
1-866-444-EBSA (3272) 1-877-267-2323, Menu Option 4, Ext. 61565
DEFINITIONS

Affordable Care Act (ACA): The Patient Protection and Affordable Care Act, commonly called the
Affordable Care Act (ACA) is a United States federal statute signed into law by President Obama in
March 2010. The law puts in place comprehensive health insurance reforms.

Annual Maximum: Total dollar amount a plan pays during a calendar year toward the covered
expenses of each person enrolled.

Out-of-Pocket Maximum: The maximum amount a Plan member must pay towards covered medical
expenses in a calendar year for both network and non-network services. Once you meet this out-of-
pocket maximum, the Plan pays the entire coinsurance amount for covered services for the remainder
of the calendar year. Deductibles and copays go toward the annual out-of-pocket maximum.

Coinsurance: A percentage of the medical costs, based on the allowed amount, that you must pay for
certain services after you meet your annual deductible.

Conversion: an employee changes or “converts” her / his Group Life coverage to an

Individual Life Insurance policy without having to answer any medical questions. Conversion
is for an Associate who is leaving her / his job, reducing hours, or has reached the age
when coverage may be reduced or eliminated, and still wants to maintain the protection that life
insurance provides.

Copayment: A set dollar amount you pay for network doctor office visits, emergency room services and
prescription drugs.

Deductible: Total dollar amount, based on the allowed amount, that you must pay out of pocket
for covered medical expenses each calendar year before the plan starts to pay for most services.
The deductible does not apply to network preventive care and any services where you pay
a copayment rather than coinsurance. Some of your dental options also have an annual deductible,
generally for basic and major dental care services.

Brand Formulary Drugs: The brand formulary is an approved, recommended list of

brand-name medications. Drugs on this list are available to you at a lower cost than drugs
that do not appear on this preferred list.

Generic Drugs: These drugs are usually most cost-effective. Generic drugs are chemically identical to
their brand-name counterparts. Purchasing generic drugs allows you to pay a
lower out-of-pocket cost than if you purchase formulary or non-formulary brand name drugs.

Maintenance Drugs: Prescriptions commonly used to treat conditions that are considered chronic or
long-term. These conditions usually require regular, daily use of medicines. Examples of maintenance
drugs are those used to treat high blood pressure, heart disease, asthma and diabetes.
Non-Formulary Drugs: These drugs are not on the recommended formulary list. These
drugs are usually more expensive than drugs found on the formulary. You may purchase brand-name
medications that do not appear on the recommended list, but at a significantly higher out-of pocket
cost.

PDP Fee: PDP Fee refers to the fees that participating PDP dentists have agreed to accept as payment
in full, subject to any copayments, deductibles, cost sharing and benefits maximums.

Portability: an Associate carries or “ports” her/his current Group Life coverage after employment ends,
without having to answer any medical questions. Portability is for an Associate who is leaving her / his
job and still wants to maintain the protection that life
insurance provides.

Pre-tax Plan: A plan for active employees that is paid for with pre-tax money. The IRS allows for certain
expenses to be paid for with tax-free dollars. The state takes premiums out of your check before taxes
are calculated, increasing your spendable income and reducing the amount you owe in income taxes.
Consequently, the IRS has tax laws that require you to stay in the plans you select for a full plan year
(January through December). You can only make changes during Open Enrollment or if you have a
qualifying life event.

Primary Care Physician (PCP): The health care professional who monitors your health
needs and coordinates your overall medical care, including referrals for tests or specialists.

Provider: Any type of health care professional or facility that provides services under
your plan.

Network: A group of health care providers, including dentists, physicians, hospitals and other health
care providers, that agrees to accept pre-determined rates when serving members.

Qualifying Life Event: an occurrence that qualifies the Subscriber to make an insurance coverage
change outside of the Open Enrollment

Reasonable and Customary Charge (R&C): R&C fee refers to the Reasonable and Customary (R&C)
charge, which is based on the lowest of (1) the dentist’s actual charge, (2) the dentist’s usual charge for
the same or similar services, or (3) the charge of most dentist’s in the same geographic area for the
same or similar services as determined by Cigna.

Specialty Drugs: prescription medications that require special handling, administration or monitoring.
These drugs may be used to treat complex, chronic and often costly conditions.
 CONTACT INFORMATION

Contact Information Email Address / Website Telephone Number Claims Address / Other
Little Bird
Benefits Concierge mybenefits@littlebird.hr 1-877-227-9994
Carriers

P.O. Box 188037

Cigna Dental http://www.cigna.com/ 1-800-244-6224
Chattanooga, TN 37422

P.O. Box 182223

Cigna Medical http://www.cigna.com/ 1-800-244-6224
Chattanooga, TN 37422

P.O Box 385018

Cigna Vision http://www.cigna.com/ 1-877-478-7557
Birmingham, AL 35238

Discovery Benefits
th
Discovery Benefits www.discoverybenefits.com 1-866-451-3399 4321 20 Avenue S
Fargo, ND 58103

Individual vouchers provided via

Talkspace http://get.talkspace.com/littlebird/ 516-847-5432 email

Indicate you are a member of

Cigna Identity Protection N/A 1-888-226-4567 Cigna Identity Theft Program and
Group #57

Create a Login for more

Cigna Will Preparation www.cignawillcenter.com 1-800-901-7534
information!

Colonial Voluntary Benefits

NY : www.colonial-paulrevere.com P.O. Box 100195
Group Accident 1-800-325-4368 Columbia, SC 29202
Group Critical Care All Other States: www.coloniallife.com
Group Medical Bridge
 ID Watchdog
ID Watchdog www.idwatchdog.com 1-866-513-1518 P.O Box 297
Denver, CO 80201-0297

MetLaw via Hyatt Legal Plans

www.legalplans.com 1-800-821-6400 N /A
(Group Legal)
 Little Bird HR, Inc.
234 5th Ave Suite #412
New York, New York 10001
www.littlebird.hr