EMPLOYEE

BENEFITS
GUIDE
2022
UPDATED
US Acute Care Solutions is proud to offer a market-leading suite of benefits to you and your
family. Each year, we seek feedback from all of our clinicians and non-clinicians to learn what
is important to you and identify any new benefits that may be of interest. We then research
our competitors and the overall market to ensure we are providing you with a comprehensive
suite of benefits.

The following pages reflect our 2022 benefit offerings, and you should read this guide
thoroughly to make the best selections for you and your family.

You must make your benefit elections within 30 days of your eligibility date or you will only
have company paid benefits for the current plan year.

The HR Team is ready to assist you with any questions you might have via email
AskHR@usacs.com or 833-447-8326.

Here’s to your good health,

USACS Total Rewards Team

 TABLE OF CONTENTS
4 Preparing For Benefit Enrollment
5 Eligibility & Enrollment
We all work together to make 7 Tobacco Use/Cessation
US Acute Care Solutions a
success, and our teamwork 8 Medical Benefits
extends to your benefits. 10 Health Savings Account
Your health and well-being
are important to us, so we 12 Pharmacy Benefits
provide benefit options to 13 Using OptumRx
make your and your family’s
lives better. Together, let’s 14 Out-of-Pocket Costs
invest in you. Review this 18 Virtual Medicine – TELADOC
guide for details on your
2022 benefits from A to Z. 19 Teladoc Behavioral Health
If you have questions, the 20 401(k)/Retirement Benefits
Human Resources Team is
here to help. 22 Dental Benefits
23 Vision Benefits
Info on the Go! 24 Flexible Spending Accounts
Scan with Your 26 HSA vs. FSA
Smartphone to 27 Life and AD&D Insurance
Access Enrollment
Materials Online 29 Voluntary Insurance Rates
Anytime. 30 Short and Long Term Disability
31 Paid Parental Leave
32 Wellbeing/Mental Health
34 Supplemental Health Benefits
36 Additional Benefits
40 Glossary
42 Required Notices
44 Important Contacts

Be sure to check out the following benefits available to you:

Pages 27-30 for Life & Disability Benefits Page 36 for Identity Theft Protection details
Pages 20-21 for 401(k) details Page 42 for important information
concerning Medicare Part D coverage.

In this Guide, we use the term company to refer to US Acute Care Solutions. This Guide is intended to describe the eligibility requirements, enrollment procedures and coverage effective
dates for the benefits offered by the company. It is not a legal plan document and does not imply a guarantee of employment or a continuation of benefits. While this Guide is a tool to
answer most of your questions, full details of the plans are contained in the Summary Plan Descriptions (SPDs), which govern each plan’s operation. Whenever an interpretation of a plan
benefit is necessary, the actual plan documents will be used.
 PREPARING FOR BENEFIT ENROLLMENT
As a committed partner in your health, US Acute Care Solutions absorbs a significant
amount of your benefit costs. Your contributions for medical, dental and vision benefits
are deducted on a pre-tax basis, lessening your tax liability. Please note that employee
contributions vary depending on level of coverage.

You may select any combination of medical, dental and/or vision plan coverage. For example, you could select medical
coverage for you and your entire family, but select dental and vision coverage only for yourself. The only requirement
is that you, as an eligible employee of US Acute Care Solutions, must elect coverage for yourself in order to elect any
dependent coverage.

Enrollment Check List

 pdate your personal

U Consider your HSA or FSA
information An HSA or FSA can help cover healthcare
costs including dental and vision services and
If you’ve experienced a qualifying life event
prescriptions. Adding one of these accounts
in the last year, you may need to change your
to your benefits can help with your long-term
elections or update your details.
financial goals.

Gather Dependent Check to see if your

Information pharmacy is in-network
Obtain required documentation if you are
Going in-network often saves you money.
adding dependents to coverage. You will need
Check for any plan changes to make sure your
Social Security numbers, birth certificates, and/
favorite pharmacy is still your best bet and is
or marriage licenses.
covered in-network.

Double-check covered and

restricted medications
If you make any changes to your plan, consider
how it affects your prescription coverage.

 eview available plans’

R
deductibles
Take a look at your options – if you foresee a
lot of medical needs this year, you might want
a lower deductible. If not, you could switch to a
higher deductible and enjoy lower premiums.

4
 ELIGIBILITY & ENROLLMENT
US Acute Care Solutions offers a variety of benefits to support you and your family’s
needs. Choose options that cover what’s important to your unique lifestyle.

Eligibility
If you are a full-time employee of US Acute Care
Solutions who is classified as a clinical employee of the
Company working at least 108 hours per month, or a
non-clinical employee of the Company working at least
25 hours per week, you are eligible to participate in the
medical, dental, vision, life and disability plans and
additional benefits.
How to Enroll
Enrollment will be in Workday. Access your benefits
enrollment task through your Workday inbox during your
benefits enrollment period. Mobile access is also available
on the Workday app.
When Does Coverage Begin?
Your elections are effective the first day of your
employment (or the effective date of your status change
from part time to full time). You won’t be able to change
your benefits until the next enrollment period unless you
experience a qualifying life event.
As part of our effort to maintain compliance and to
provide excellent benefit programs to our valued
clinicians/non-clinicians, US Acute Care Solutions requires
that you only enroll dependents who are eligible for
coverage in a USACS sponsored health plan.
Some common mistakes made in claiming dependents for
insurance coverage that may not be eligible include:
» ex-wives and ex-husbands
» former stepchildren
» nieces and nephews
» grandchildren
» employee’s parents
» adult children
If you realize based on the above list that you are
covering an ineligible dependent, you may voluntarily
remove that dependent from your insurance with no
questions asked.

Eligible Dependents
Dependents eligible for coverage in the US Acute Care
Solutions benefits plans include:
» Your legal spouse or domestic partner*
» Children up to age 26 (includes birth children, *Please note, if you cover a domestic partner, your premiums will be paid on an after-
tax basis. Based on IRS guidelines, you will be required to pay taxes on the value of the
stepchildren, legally adopted children, children benefits paid for by the company for your domestic partner coverage.
placed for adoption, foster children and children for
whom legal guardianship has been awarded to you
or your spouse)
» Dependent children 26 or more years old,
unmarried and primarily supported by you and Thoughts & Tips: You CANNOT change
incapable of self-sustaining employment by reason your benefit selections during the plan year
of mental or physical disability which arose while the unless you have a qualifying life event, such
child was covered as a dependent under this plan
(periodic certification may be required)
as marriage and/or the birth or adoption of
a child.

5
 Enroll Now. You’ve Got One Shot!
What are Qualifying Life Events?

Most people know you can change your benefits when you start a new job or during Open Enrollment. But did you
know that changes in your life may permit you to update your coverage at other points in the year? Qualifying Life
Events (QLEs) determined by the IRS could allow you to enroll in health insurance or change your elections outside of
the annual time.

Common
qualifying
events include:
A change in your employment status from full time to
part time, or part time to full time, resulting in a gain
or loss of eligibility
A change in your legal Entitlement to
marital status (marriage, Medicare or Medicaid
divorce or legal separation)

A change in the number of Eligibility for coverage

your dependents (for example, through the Marketplace
through birth or adoption,
or if a child is no longer an
eligible dependent)
Changes in your address
A change in your spouse’s or location that may
employment status affect the coverage for
(resulting in a loss or gain which you are eligible
of coverage)

Some
lesser-known
qualifying
events are:

Changes that make you no longer

Turning 26 and losing coverage
eligible for Medicaid or the Children’s
through a parent’s plan
Health Insurance Program (CHIP)

Death in the family (leading to change

in dependents or loss of coverage)

When a Qualifying Life Event occurs, you have 30 days to request changes to your coverage. Keep in mind your
change in coverage must be consistent with your change in status.

Questions regarding specific life events and your ability to request changes should be directed to US Acute Care
Solutions’ Human Resources Team. Don’t miss out on a chance to update your benefits!

6
 TOBACCO USE/CESSATION

Tobacco User Surcharge

US Acute Care Solutions has a tobacco user surcharge
to help control employee medical premium costs. This
surcharge applies to any employee and/or spouse
enrolled in the medical plan who has utilized tobacco/
nicotine within the past six months. This includes
cigarettes, chewing tobacco, e-cigarettes, vaping, cigars,
etc. You can find the surcharge rates in the Medical Plan
Summary section of this guide.

US Acute Care Solutions wants to help move you forward toward a healthier life via
UBreathe, a program offered through Marquee Health. This tobacco cessation program is
offered to all employees and spouses enrolled in the medical plan who are interested in
quitting tobacco.

Tobacco Cessation
It’s okay to be a quitter! Here’s a chance to improve your health and save money. USACS offers a Tobacco Cessation
Program. Employees who use tobacco/nicotine but wish to avoid the surcharge are invited to complete the UBreathe
Tobacco Cessation program, provided confidentially by Marquee Health. In order to avoid the tobacco surcharge,
employees must enroll and complete 6 sessions with a Marquee Health Educator within 4 months of their hire date.
The UBreathe program includes unlimited access to your dedicated Marquee Health educator, but only 6 sessions
are required to earn the incentive. To enroll in UBreathe, call a Health Coach (toll-free) at 800-882-2109 or email
coaching@mywellportal.com.

7
 MEDICAL BENEFITS
US Acute Care Solutions provides four medical plan options, including two High
Deductible Health Plans (HDHP), to meet your individual and family needs. USACS’
medical plans are administered by Contigo Health using the Anthem BCBS PPO network.
All plans pay 100% of the cost for in-network preventive care, including annual physicals
and COVID-19 testing.

BRONZE SILVER GOLD PLATINUM

HDHP with HSA HDHP with HSA
OUT-OF- OUT-OF- OUT-OF- OUT-OF-
IN-NETWORK IN-NETWORK IN-NETWORK IN-NETWORK
NETWORK NETWORK NETWORK NETWORK

DEDUCTIBLE
(INDIVIDUAL/ $3,500/ $5,000/ $2,800/ $5,600/ $2,000/ $4,000/ $1,750/ $3,500/
FAMILY) $7,000 $10,000 $5,600 $11,200 $4,000 $8,000 $3,500 $7,000

OUT-OF-POCKET MAXIMUM
(INDIVIDUAL/ $5,000/ $8,000/ $4,500/ $9,000/ $5,000/ $8,000/ $4,000/ $8,000/
FAMILY) $10,000 $16,000 $9,000 $18,000 $10,000 $16,000 $8,000 $16,000
COINSURANCE
80%* 60%* 75%* 50%* 70%* 50%* 70%* 50%*
PAYS
OFFICE VISITS
PREVENTIVE CARE 100% Not covered 100% Not covered 100% Not covered 100% Not covered

PRIMARY CARE 80%* 60%* 75%* 50%* 70%* 50%* $50 copay 50%*

SPECIALISTS 80%* 60%* 75%* 50%* 70%* 50%* $75 copay 50%*

OTHER SERVICES
DIAGNOSTIC
TESTING &
80%* 60%* 75%* 50%* 70%* 50%* 70%* 50%*
IMAGING
(FREE-STANDING)
INPATIENT
80%* 60%* 75%* 50%* 70%* 50%* 70%* 50%*
HOSPITAL
URGENT CARE 80%* 60%* 75%* 50%* 70%* 50%* 70%* 50%*
EMERGENCY
80%* 80%* 75%* 75%* 70%* 70%* 70%* 70%*
ROOM
*Plan pays after deductible

The individual deductible amount must be met by each member enrolled under your medical coverage. If you have
several covered dependents, all charges used to apply toward a “per individual” deductible amount will also be applied
toward the “per family” deductible amount. When the family deductible amount is reached, no further individual
deductibles will have to be met for the remainder of that plan year. No member may contribute more than the individual
deductible amount to the “per family” deductible amount. The same typically applies for the out-of-pocket maximum.

8
Medical Premiums
Premium contributions for medical are deducted from your paycheck on a pre-tax basis. Your level of coverage
determines your monthly contributions.

BRONZE SILVER GOLD PLATINUM

MONTHLY CONTRIBUTIONS
EMPLOYEE ONLY1 $0.00 $62.50 $125.00 $178.00
EMPLOYEE + SPOUSE 1, 2 $75.00 $250.00 $525.00 $805.00

EMPLOYEE + CHILD(REN ) 1 $50.00 $200.00 $431.25 $650.00

EMPLOYEE + FAMILY 1, 2 $125.00 $306.25 $656.25 $1,008.00

1
There will be an additional $50/month surcharge added to the monthly premiums for clinicians/non-clinicians
and/or spouses who have utilized tobacco/nicotine within the past six months. The surcharge is not included in the
rates above.
2
There will be an additional $100/month surcharge added to Employee + Spouse and Employee + Family tiers for
clinicians/non-clinicians who have spouses that have access to medical coverage from their employer and still
elect coverage from USACS. The surcharge is not included in the rates above.

How to Find a Provider

Visit www.anthem.com for a current list of Anthem BCBS
PPO network providers.

NOTE: You will need the group ID prefix (EMB) listed

on the front of your medical insurance card to simplify
your search.

Thoughts & Tips: Most preventive care

offered by an in-network physician is covered
at 100%.

9
 HEALTH SAVINGS ACCOUNT
Need funds to help cover out-of-pocket healthcare expenses? Consider a Health Savings
Account (HSA). An HSA is a personal healthcare bank account used to pay for
qualified medical expenses and funded by you. HSA contributions and withdrawals
for qualified healthcare expenses are tax-free. You must be enrolled in an HDHP to
participate.

Your HSA can be used for qualified expenses for you,
your spouse and/or tax dependent(s), even if they are not
covered by your plan. If you are not currently enrolled
in an HDHP but you have unused HSA funds from a
previous account, those funds can still be used for
qualified expenses.
HSA Bank will issue you a debit card, giving you direct
access to your account balance. Use your debit card
to pay for qualified medical expenses, with no need to
submit receipts for reimbursement. You must have a
balance in your HSA account to use the card.
Eligible expenses include doctors’ visits, eye exams,
prescription expenses, laser eye surgery and more. Check
out IRS Publication 502 on www.irs.gov for a complete list
of eligible expenses.
Eligibility
You are eligible to contribute to an HSA if:
» You are enrolled in an HSA-eligible High Deductible
Health Plan.
» You are not covered by your spouse’s non-HDHP
health plan.
» Your spouse does not have a healthcare Flexible
Spending Account or Health Reimbursement
Account.
» You are not eligible to be claimed as a dependent
on someone else’s tax return.
» You are not enrolled in Medicare or TRICARE.
» You have not received Department of Veterans
Affairs medical benefits in the past 90 days for non-
service-related care. (Service-related care will not be
taken into consideration.)

Your Money. Your Account.

Tax-free Interest
Your HSA is a personal bank account that you own and
administer. It’s up to you how much you contribute,
when to use the money for medical services, and when
Voluntary Contributions
to reimburse yourself. You can save and roll over HSA
funds to the next year if you don’t spend them all in
the calendar year. You can even let funds accumulate
year-over-year to use in retirement. HSA funds are

HSA
also portable if you change jobs. There are no vesting
requirements or forfeiture provisions. When your HSA
balance reaches $1,000, you will also have access to
investment options.

Tax-free Payments
(for qualified medical expenses)

10
How to Enroll
To enroll in the company-sponsored HSA, you must elect
an HDHP and designate the amount to contribute on a
pre-tax basis. US Acute Care Solutions will establish an
HSA account in your name and send in your contribution
once bank account information has been provided
and verified.
Plan. Spend. Save.
Contributions to an HSA can be made through payroll
deduction on a pre-tax basis when you open an account
with HSA Bank. The money in this account (including
interest and investment earnings) grows tax free.
When the funds are used for qualified medical expenses,
they are spent tax-free.
Per IRS regulations, if HSA funds are used for purposes
other than qualified medical expenses and you are
younger than age 65, you must pay federal income tax on
the amount withdrawn, plus a 20% penalty tax.
Thoughts & Tips: It’s up to you how much to contribute to your HSA. Buying a new house
or sending a kid to college? You can contribute less this year. Paid off your student loans or got
a new job? Stash the annual max in your account.
HSA Funding Limits
The IRS places an annual limit on the maximum amount
that can be contributed to HSAs. For 2022, contributions
are limited to the following:
HSA FUNDING LIMITS
EMPLOYEE $3,650
FAMILY $7,300
CATCH ‑UP CONTRIBUTION
(AGES 55+)
$1,000
HSA contributions in excess of the IRS annual
contribution limits ($3,650 for individual coverage
and $7,300 for family coverage for 2022) are not tax
deductible and are generally subject to a 6% excise tax.
If you’ve contributed too much to your HSA this year, you
have two options:
» Remove the excess contributions and the net
income attributable to the excess contribution
before you file your federal income tax return
(including extensions). You’ll pay income taxes on
the excess removed from your HSA.
» Leave the excess contributions in your HSA and pay
6% excise tax on excess contributions. Next year
consider contributing less than the annual limit to
your HSA to make up for the excess contribution
during the previous year.
The US Acute Care Solutions HSA is established with HSA
Bank. You may be able to roll over funds from another
HSA. For more information, visit www.hsabank.com.
11
 PHARMACY BENEFITS
Our prescription drug benefits are provided through the broad OptumRx network of over 67,000 pharmacies. The
OptumRx network includes CVS, Walgreens, Walmart, Sam’s Club, Kroger, and more. If you have questions, call
OptumRx at 844-785-1599 or visit www.optumrx.com.

BRONZE SILVER GOLD PLATINUM

IN-NETWORK IN-NETWORK IN-NETWORK IN-NETWORK

PREVENTIVE DRUGS
100% COVERED**

RETAIL RX***
GENERIC 80%* 75%* $16 copay $16 copay

PREFERRED 80%* 75%* $50 copay $50 copay

NON-PREFERRED 80%* 75%* $80 copay $80 copay

MAIL ORDER RX***

GENERIC 80%* 75%* $40 copay $40 copay

PREFERRED 80%* 75%* $125 copay $125 copay

NON-PREFERRED 80%* 75%* $200 copay $200 copay

*Plan pays after deductible

**Must have a prescription for medication, even if sold over the counter
***Out-of-network medications are not covered

Maintenance Medication
You will be required to fill maintenance medications with
a 90-day prescription. Maintenance medications are
those you take on a regular basis (high blood pressure,
diabetes, birth control, etc). These medications can
be filled through a retail pharmacy or home delivery.
You will have one 30-day grace fill available for any
new prescription. After the grace fill, you must fill your
prescription with a 90-day supply or you will pay the full
cost of your medications.

12
 USING OPTUMRX
Network Retail Pharmacies
Show your medical insurance card at any OptumRx
network retail pharmacy. Sign into your account,
call customer service or use the app to find
network pharmacies.
Home Delivery
Order up to a 90-day supply of the medication you take
regularly for less. There’s no charge for standard shipping
to U.S. addresses. You can set up home delivery online
at www.optumrx.com, use the app or call OptumRx at
844-785-1599. If you call, make sure you have your
doctor’s contact information, the name and strength of
your medications, and payment information handy.
OptumRx App
Making your online pharmacy experience as easy as
possible. You can:
» Access your ID card
» Search drug prices at multiple pharmacies
» Locate a network pharmacy
» Manage medication reminders
» Transfer a prescription to home delivery
» Track your home delivery order
» Refill a home delivery prescription
Download the app today at the app store for your
smartphone carrier.
Is My Drug on the Formulary?
A formulary is a list of generic and brand name drugs
that are approved by the Food and Drug Administration
(FDA) and are covered under your prescription drug plan.
If your drug isn’t on a carrier’s formulary, you’ll pay more
for it. The formulary is the same for all four medical plan
options at USACS.
How Much Will My Drug Cost?
The cost of your prescription depends on how your
medication is classified—either Generic, Preferred or
Non-Preferred. Generics will cost less than Preferred
and Non-Preferred drugs. You can also find this
information at www.optumrx.com.
Is My Drug Considered “Preventive”
(Covered 100%)?
The Affordable Care Act requires that certain preventive
care drugs are covered at 100% when you fill them in
network. This applies across all plan options. Review the
preventive drug list at www.optumrx.com for details.
13
 OUT-OF-POCKET COSTS
Deductible Copay
The amount you must pay for covered services before The fixed amount you pay for healthcare
your insurance starts paying its portion. services at the time you receive them.

UP TO
DEDUCTIBLE

YOU PAY
100%

Know before you go:

Paying for services

Coinsurance Out-of-
Your percentage of Pocket
the cost of a covered Maximum
service. If your office The most you will pay
visit is $100 and your during the plan year
coinsurance is 20% (and before your insurance
you’ve met your deductible begins to pay 100% of the
but not your out-of-pocket allowed amount.
maximum), your payment
would be $20.

% UP TO THE
YOU PAY OUT-OF-POCKET
MAXIMUM
%
PLAN PAYS
PLAN PAYS
100%
AFTER THROUGH
OUT-OF-POCKET END OF
MAXIMUM IS REACHED PLAN YEAR

AFTER
DEDUCTIBLE
IS REACHED

14
 HOW TO PICK A PLAN
It’s important that you choose a medical plan that offers the right coverage at the right cost for you. Keep in mind that
you pay for the monthly cost on a before-tax basis.

Pay Now or Pay Later?

How much you pay out of your paycheck is one thing. You also have to consider what you’ll pay throughout the year
when you need care. You determine which coverage level gives you the best value on your total healthcare costs.

Pay LESS now and MORE when you need care
The Bronze HDHP and Silver HDHP medical options cost
less per paycheck, but the deductibles are higher. Make
sure you know how the deductible works, and that the
deductible amount is something you can afford in the
event you need a lot of healthcare. Keep in mind that you
can enroll in an HSA to set aside pre-tax money to cover
medical costs prior to meeting your deductible.
Pay MORE now and LESS when you need care
The Platinum PPO Plan option generally costs more but
the deducible is lower. Keep in mind that if you don’t
expect to have a lot of healthcare needs, you could be
spending money for benefits you don’t use.

15
 PREVENTIVE CARE

The US Acute Care Solutions health plans cover a set of preventive services
— at no cost to you!

Screening tests and routine checkups are considered preventive, which means they’re often paid at 100%. Keep up to
date with your primary care physician to save time and money and keep yourself healthier in the long run. Under the
U.S. Patient Protection and Affordable Care Act (PPACA), some common covered services include:

Screenings for blood Pediatric screenings for

Wellness visits,
pressure, cancer, hearing, vision, obesity
physicals and standard
cholesterol, depression, and developmental
immunizations
obesity and diabetes disorders

Anemia screenings, breastfeeding

Iron supplements (for children ages
support and pumps for pregnant
6 to 12 months at risk for anemia)
and nursing women

Take advantage of these covered services. However, remember that diagnostic care to identify health risks is covered
according to plan benefits, even if done during a preventive care visit. This means if your doctor finds a new condition
or potential risk during your appointment, the services may be billed as diagnostic medicine and result in some
out-of-pocket costs. Read over your benefit summary to see what specific preventive services are provided to you.

16
 WHERE TO GO FOR CARE
You think you may be sick, but your primary care physician is booked through the end of the month. Instead of immediately
choosing an expensive trip to the emergency room or relying on questionable information from the internet, take a look below at
various care centers and resources and the types of care they provide.

PRIMARY CARE TELADOC

CENTER

When would I use this? When would I use this?

You need routine care or treatment for a current health issue. You need care for minor illnesses and ailments, but would prefer
Your primary doctor knows you and your health history, can not to leave home. These services are available by phone and
access your medical records, provide routine care, and manage online (via webcam).
your medications.
What type of care would they provide?*
What type of care would they provide?* » Cold & flu symptoms » Urinary tract infection
» Routine checkups » Preventive services » Allergies » Sinus problems
» Immunizations » M
 anage your general » Bronchitis » Mental Health
health
What are the costs and time considerations?**
What are the costs and time considerations?** » There is usually a first-time consultation fee and a flat fee
» Often requires a copay and/or coinsurance or copay for any visit thereafter.
» Normally requires an appointment » Access to care is usually immediate.
» Usually little wait time with scheduled appointment » S
 ome states may not allow for prescriptions through
telemedicine or virtual visits.

URGENT CARE
CENTER
When would I use this?
You need care quickly, but it is
not a true emergency. Urgent
care centers offer treatment for
non‑life‑threatening injuries or
illnesses.
DO YOUR
HOMEWORK
What may seem like an EMERGENCY
urgent care center could
actually be a standalone ROOM
ER. These newer facilities
come with a higher price
tag, so ask for clarification
if the word "emergency"
appears in the company When would I use this?
name.
You need immediate treatment
for a serious life‑threatening
condition. If a situation seems life
What are the costs and What are the costs and threatening, call 911 or your local
time considerations?** time considerations?** emergency number right away.

What type of care would » Often requires a copay » O

 ften requires a much
higher copay and/or What type of care would
they provide?* and/or coinsurance that
is usually higher than an coinsurance. they provide?*
» Strains, sprains office visit. » O
 pen 24/7, but waiting » Heavy bleeding
» M
 inor broken bones » W
 alk‑in patients periods may be longer » Chest pain
(e.g., finger) welcome, but waiting because patients
periods may be longer with life‑threatening » Major burns
» Minor infections
as patients with more emergencies will be » Spinal injuries
» Minor burns urgent needs will be treated first.
treated first. » Severe head injury
» X‑rays
» Broken bones

*This is a sample list of services and may not be all‑inclusive. **Costs and time information represent averages only and are not tied to a specific condition or treatment.

17
 VIRTUAL MEDICINE - TELADOC
When you’re sick, the last thing you want to do is leave the cozy comfort of your home.
Or sometimes you’re just too on the go to pop in for a visit. Virtual medicine is a
convenient and easy way to talk to a doctor fast.

Teladoc
We provide a telemedicine benefit through Teladoc to
you and your dependents. Teladoc offers on-demand
access to board-certified doctors through online video,
telephone or secure email. You and your family can be
treated for general health issues at home at no charge*.
Telemedicine is useful for after-hours non-emergency
care, when your primary care doctor is unavailable, if
you need prescriptions or refills or if you’re traveling.
Please note that some states do not allow physicians
to prescribe medications via telemedicine. For more
information, visit www.teladoc.com.

Virtual Visits
A virtual visit with Teladoc lets you see and talk to a
doctor from your phone, tablet or computer without an
appointment. Most visits take about 10-15 minutes, and
doctors can write a prescription (in participating states). Access Virtual Visits
Try a virtual visit when your doctor is not available or
Visit www.teladoc.com to request a virtual visit. Once
you’re traveling.
you register and request a consult, you will pay your
Doctors can diagnose and treat a wide range to non- portion of the service costs according to your medical
emergency medication conditions through a virtual visits. plan, and then enter a virtual waiting room. During your
The most common conditions treated during a virtual visit you can talk to a doctor about your health concerns,
visit include: symptoms and treatment options. Virtual visits aren’t
» B
ladder infection/ » Cold/flu good for conditions requiring an exam or test, complex
urinary tract infection or chronic problems, or emergencies, including sprains or
» Sore throat
broken bones.
» Respiratory infection » Pink eye
» Bronchitis Consultations are $50. Those enrolled in the Bronze or
» Stomachache
Silver HDHP Plans will pay $50 per consultation until they
» Sinus problems » Rash have reached their deductible. Those enrolled in the Gold
or Platinum PPO Plans will pay $0 per consultation.

18
 TELADOC BEHAVIORAL HEALTH
Behavioral Health Visits
Employees will have access to behavioral health
practitioners by telephone or video conference in the
BH Program’s service area. The BH Program offers
employees ongoing access to behavioral diagnostic
services, talk therapy, and prescription medication
management, when appropriate. Employees and their
dependents age 18 or older will have access to the
following types of
BH practitioners:
» Psychiatrists » Therapists (Marriage
(MD/DO) and Family) (Masters)
» Clinical Social Workers » Counselors
(Masters) (Masters)
» Psychologists » Substance Abuse
(PhD) Counselors
Things to note:
» Teladoc will provide employees with information
identifying each BH Practitioner’s licensure,
specialties, gender and language.
» BH Practitioners are not accessible 24 hours/
day, 365 days/year. Employees must schedule an
appointment with the practitioner based on
their availability.
» Employee or dependents age 18 or older will be
required to complete a comprehensive Medical
History Disclosure and an assessment that is
specific to the BH Program prior to scheduling
an appointment.
» Initial consultation is expected to be 45 minutes
in length, on average followed by subsequent
psychiatric visit that will be shorter in length.
The cost for a telephonic or video visit will be the same
regardless of which medical plan you are enrolled in.
The first consultation with a psychiatrist is $220, with all
subsequent visits for $100 per visit. A BH consultation
with a therapist other than a psychiatrist will be $90.

19
 401(K)/RETIREMENT BENEFITS

Whether you’re just starting out in your career or you’ve been in the workforce for years,
it’s always a good time to plan for retirement.

Market-leading 401(k) Plan the eligibility requirements; you are immediately vested in
these company contributions.
At USACS, we don’t just invest in your present. We
also invest in your future. We offer an industry-leading For new hires, 500 hours must be worked within
401(k) contribution of up to 10%, regardless of their anniversary year to become eligible to
your contribution. The USACS contribution is receive 3% of the USACS contribution. The company
immediately vested. contributions will begin on the date the eligibility
requirement is met. New hires who work 1,000
What is a 401(k)? hours within the calendar year will receive an
additional 7% contribution starting on the date
This employer-sponsored retirement account can
that the 1,000 hours requirement is met. The 7%
help build and create choices for your future self by
contribution will be retroactive to the date that
saving money — tax free — from your paycheck. Due
the 500 hour requirement is met or January 1,
to the value of compounding interest, the sooner you
whichever is later.
participate in a 401(k), the better.
Current clinicians/non-clinicians who are already receiving
Eligible employees can invest for retirement while
USACS contributions will continue to receive a 3% pre-tax
receiving certain tax advantages. Administrative and
contribution from USACS regardless of how many hours
record-keeping services for this plan are provided by
are worked in the year. However, in order to qualify for
Fidelity. You may start making pre-tax contributions into
the additional 7% USACS contribution, clinicians/non-
the plan as of date of hire.
clinicians must work 1,000 hours within the calendar year.
Contributing to a 401(k) account now can help keep you
This additional contribution will begin following the
financially secure later in life. The US Acute Care Solutions
date at which the hours requirement is met and will
401(k) plan provides you with the tools and flexibility you
be retroactive to January 1st or the date at which
need to prepare.
the clinician/non-clinician became eligible for USACS
PLAN AT A GLANCE contributions, whichever date is later.
US Acute Care Solutions
PLAN NAME 401(k) Plan
RECORDKEEPER Fidelity Contribution Increases
WEBSITE www.netbenefits.com If you contribute less than 8% to your 401k, your
ELIGIBILITY As of date of hire percentage will be automatically increased by 1% (not to
USACS provides up to a 10% exceed the maximum individual contribution allowable
company contribution to
clinicians/non-clinicians based
by the IRS). Once you reach 8%, the automatic increases
COMPANY MATCH on a set criteria defined below. will stop. This is an automatic way to invest more into
You are immediately vested in
the Company contributions. your 401(k) plan without having to take action. You may
change the amount of your contributions at any time. All
Eligibility changes are effective as soon as administratively feasible
and remain in effect until you modify them. You may also
As a clinician/non-clinician, you are eligible to participate
discontinue your contributions and start them again at
in the 401(k) by making either pre-tax or Roth/post-tax
any time.
contributions effective upon date of hire. USACS offers
a 10% contribution to clinicians/non-clinicians who meet You can elect to opt out of the automatic increase by
logging into your account at www.netbenefits.com.

20
 How Much Should I Be Saving?
Industry standards suggest saving, at a minimum, 12% to
15% of your income, inclusive of US Acute Care Solutions’
generous contribution. USACS provides a 10% company
contribution to employees after meeting their eligibility
requirements outlined on the previous page. Employees
are 100% vested in their 401(k) balance.

Consolidating Your Retirement

Savings
If you have an existing qualified retirement plan (pre-tax)
with a previous employer, you may transfer that account
into the plan any time. Contact Fidelity at 800-835-5095
for details.

Regardless of which retirement account you choose or

how much you contribute, it’s important to think of it as
a long-term strategy. Dipping into the account early will
jeopardize the quality of your retirement and rack up
penalties from the IRS.

Investing in the Plan

It’s up to you how to invest the assets in your account.
Pre-tax vs. Roth 401(k): What’s The US Acute Care Solutions 401(k) plan offers a selection
the difference? of investment options for you to choose from. You may
If you contribute to your 401(k) pre-tax, your change your investment choices any time. For more
contributions will be taken out before taxes each pay details, refer to your 401(k) Enrollment Guide or visit
period. However, you’ll have to pay taxes on the funds www.netbenefits.com.
when you withdraw them during retirement. If you
choose the available Roth 401(k), contributions will be Financial Wellness
deducted from your paycheck after taxes — so you
Fidelity offers a Financial Wellness Checkup that will
won’t pay taxes when you withdraw during retirement.
allow you to see where you stand, financially, and if there
Once you retire, you might be in a higher tax bracket, so
is room to do better when it comes to planning for
contributing after taxes now could save you money in the
your retirement.
long run.
In this checkup, you will answer a few questions related
to budgeting, debt management, savings, and protection.
Contributing to the Plan
Once you answer all the questions, you will get a
The contribution limit set annually by the IRS
summary of your financial strengths, and suggestions
is $20,500.
for next steps to help improve your overall financial
If you are age 50 or older this calendar year and you well-being.
already contribute the maximum allowed to your 401(k)
account, you may also make a “catch-up contribution.”
This additional deposit accelerates your progress
toward your retirement goals. The maximum catch-
up contribution is $6,500 — for a combined total
contribution allowance of $27,000. See your plan
administrator for details.

21
 DENTAL BENEFITS
Brushing your teeth and flossing are great, but don’t forget to visit the dentist too!
US Acute Care Solutions offers affordable plan options for routine care and beyond.
Coverage is available from Delta Dental of Ohio.

Network Dentists Dental Premiums

If you use a dentist who doesn’t participate in your plan’s Premium contributions for dental are deducted from
network, your out-of-pocket costs will be higher, and you your paycheck on a pre-tax basis. Your tier of coverage
are subject to any charges beyond the Reasonable and determines your monthly premium.
Customary (R&C). To find a network dentist, visit Delta
Dental of Ohio at www.deltadentaloh.com. Dental Plan Summary
This chart summarizes the 2022 dental coverage
provided by Delta Dental of Ohio.

BASIC PLAN BUY-UP PLAN

MONTHLY CONTRIBUTIONS
EMPLOYEE ONLY $4.00 $12.00

EMPLOYEE + SPOUSE $9.00 $26.00

EMPLOYEE + CHILD(REN) $7.00 $22.00

EMPLOYEE + FAMILY $13.00 $38.00

BASIC PLAN BASIC PLAN BUY-UP PLAN BUY-UP PLAN

NETWORK NON-NETWORK NETWORK NON-NETWORK

CALENDAR YEAR DEDUCTIBLE

INDIVIDUAL $50 $50 $25 $25
$50 per $50 per $25 per $25 per
FAMILY individual individual individual individual

CALENDAR YEAR MAXIMUM

PER PERSON $1,000 $1,000 $2,000 $2,000

COVERED SERVICES
PREVENTIVE SERVICES
Oral Exams, Routine Cleanings, Bitewing X-rays, Fluoride Applications, 100% 100% 100% 100%
Sealants, Space Maintainers, Panoramic X-rays
BASIC SERVICES
80% 80% 90% 90%
Full Mouth X-rays, Fillings, Oral Surgery, Simple Extractions
MAJOR SERVICES
Oral Surgery, Complex Extractions, Denture Adjustments and Repairs, Root 50%* 50%* 60%* 60%*
Canal Therapy, Periodontics, Crowns, Dentures, Bridges
ORTHODONTICS
50%* 50%*
Dependent Child(ren) Only
ORTHODONTIC LIFETIME MAXIMUM $1,000 $1,500
Plan pays after deductible

Thoughts & Tips: Only 60% of adults ages 20 to 64 have been to the dentist in
the past year. Take advantage of your dental coverage to keep your smile healthy.

22
 VISION BENEFITS
Don’t wear glasses? Even you shouldn’t skip an annual eye exam! US Acute Care Solutions
provides you and your family access to quality vision care with a comprehensive vision
benefit through VSP.

Vision Premiums Vision Plan Summary

Premium contributions for vision are deducted from This chart summarizes the 2022 vision coverage provided
your paycheck on a pre-tax basis. Your tier of coverage by VSP.
determines your monthly premium.

VISION PLAN
MONTHLY CONTRIBUTIONS
EMPLOYEE ONLY $6.08

EMPLOYEE + SPOUSE $12.14

EMPLOYEE + CHILD(REN) $13.00

EMPLOYEE + FAMILY $20.76

NETWORK NON-NETWORK FREQUENCY

EXAMS
COPAY $10 copay $45 allowance Every 12 months

LENSES
SINGLE VISION $10 copay $30 allowance

BIFOCAL $10 copay $50 allowance Every 12 months

TRIFOCAL $10 copay $65 allowance

CONTACTS (IN LIEU OF LENSES AND FRAMES)

FITTING AND EVALUATION Up to $50 copay N/A

ELECTIVE $150 allowance $105 allowance Every 12 months

MEDICALLY NECESSARY $10 copay $210 allowance

FRAMES
ALLOWANCE $150 allowance $70 allowance Every 24 months

Thoughts & Tips: More than 150 million Americans use corrective eyewear to
compensate for refractive errors.

23
 FLEXIBLE SPENDING ACCOUNTS
Flex your spending power! A Flexible Spending Account (FSA) is a special tax-free account
you put money into to pay for certain out-of-pocket expenses.
Healthcare Flexible
Spending Account
You can contribute up to $2,850 annually for qualified
medical expenses (deductibles, copays and coinsurance)
with pre-tax dollars, reducing your taxable income and
increasing your take-home pay. You can even pay for
eligible expenses with an FSA debit card at the same time
you receive them without waiting for reimbursement.
Please note: Over-the-counter (OTC) drugs are not eligible
for reimbursement through an FSA unless you have a
prescription for them.
Limited Purpose Flexible
Spending Account
A Limited Purpose Flexible Spending Account (LPFSA)
works alongside a Health Savings Account (HSA) and
allows for reimbursement of eligible dental and vision
expenses. You must decide how much to set aside for
this account. You may contribute up to $2,850.
Thoughts & Tips: Your FSA
money can cover the cost of going to a
chiropractor or acupuncturist, if your
insurance doesn’t already cover it.
24
Dependent Care Flexible
Spending Account
In addition to the Healthcare FSA, you may opt to
participate in the Dependent Care FSA — whether or not
you elect any other benefits. You can set aside pre-tax
funds into a Dependent Care FSA for expenses associated
with caring for elderly or child dependents. Unlike the
Healthcare FSA, reimbursement from your Dependent
Care FSA is limited to the total amount that is deposited
in your account at that time.
» With the Dependent Care FSA, you can set aside up
to $5,000 to pay for child or elder care expenses on
a pre-tax basis.
» Eligible dependents include children under 13 and
a spouse or other individual who is physically or
mentally incapable of self-care and has the principal
place of residence as the employee for more than
half the year may be a qualifying individual.
» Expenses are reimbursable if the provider is not
your dependent.
» You must provide the tax identification number or
Social Security number of the party providing care
to be reimbursed.
This account covers dependent day care expenses that
are necessary for you and your spouse to work or attend
school full time. Examples of eligible dependent care
expenses include:
» In-Home Baby-Sitting Services (not provided by a tax
dependent)
» Care of a Preschool Child by a Licensed Nursery or
Day Care Provider
» Before- and After-School Care
» Day Camp
» In-House Dependent Day Care
Due to federal regulations, expenses for your domestic
partner and your domestic partner’s children may not be
reimbursed under the FSA programs. Check with your tax
advisor to determine if any exceptions apply.
How to Use the Account
You can use your FSA debit card at doctor and dentist
offices, pharmacies and vision service providers. It cannot
be used at locations that do not offer services under
the plan, unless the provider has also complied with IRS
regulations. The transaction will be denied if you attempt
to use the card at an ineligible location.

Once you incur an eligible expense, submit a claim form

along with the required documentation. Contact Contigo
Health with reimbursement questions. If you need to
submit a receipt, you will be notified by Contigo Health.
Always retain a receipt for your records.

While FSA debit cards allow you to pay for services at

point of sale, they do not remove the IRS regulations for
substantiation. Always keep receipts and Explanation of
Benefits (EOBs) for any debit card charges. Without proof
that an expense was valid, your card could be turned off
and your expense deemed taxable.

General Rules and Restrictions

The IRS has the following rules and restrictions for
Healthcare and Dependent Care FSAs:
» Expenses must be incurred during the 2022
plan year.
» Dollars cannot be transferred between FSAs.
» You cannot participate in a Dependent Care FSA
and claim a dependent care tax deduction at the
same time.
» You must “use it or lose it” — any unused funds
will be forfeited.
» You cannot change your FSA election in the middle
of the plan year unless you experience a qualifying
life event.
» Those considered highly compensated employees
(family gross earnings were $130,000 or more last
year) may have different FSA contribution limits. Visit
irs.gov for more information.

25
 HSA VS. FSA

Flexible Spending Accounts (FSAs) and Health Savings Accounts (HSAs) are both ways to
save pre-tax money to pay for your eligible healthcare costs. Which one is right for you?

HSA FSA
You own your HSA. It is a savings account in your name Your employer owns your FSA. If you leave your
OWNERSHIP and you always have access to the funds, even if you employer, you lose access to the account unless you
change jobs. have a COBRA right.

1. You must be enrolled in a Qualified High Deductible Health

Plan to be eligible to contribute money to your HSA. You
cannot be covered by a spouse’s non-High Deductible plan
ELIGIBILITY & or eligible for a spouse’s FSA or enrolled in Medicare or
ENROLLMENT TRICARE.
2. Y ou can change your contribution at any time during the
Plan Year.
You’re eligible for an FSA if it’s offered by your employer. You
can elect a Healthcare FSA even if you waive other coverage.
You cannot make changes to your contribution during the Plan
Year without a Qualifying Life Event. You cannot be enrolled in
both a Healthcare FSA and an HSA.

For Federal tax purposes, the money in the account is “triple

tax free,” meaning:
Contributions are tax free via payroll deduction. However, the
TAXATION 1. Contributions are tax free.
funds spent are not tax free.
2. The account grows tax free.
3. Funds are spent tax free (if used for qualified expenses).

Both you and your employer can contribute to the account

according to IRS limits. The contribution limit for 2022 is $3,650 Both you and your employer can contribute to the account
CONTRIBUTIONS for individuals and $7,300 for families. This amount includes the according to IRS limits. The contribution limit for the Health FSA
employer contribution. If you are 55 or older, you may make a for 2022 is $2,850.
“catch-up” contribution of $1,000 per year.

Many HSAs include a debit card, ATM withdrawal or

checkbook to pay for qualified expenses directly. You can
also use online bill payment services from the HSA financial Some plans include an FSA debit card to pay for eligible
PAYMENT bank. You decide when to use the money in your HSA to pay expenses. If not, you pay up front and submit your receipts
for qualified expenses, or if you want to use another account for reimbursement.
to pay for services and save the money in your HSA for future
expenses or retirement.

You must use the money in the account by end of Plan

The money in the account rolls over from year to year.
ROLL OVER OR Year; a Health FSA or Dependent Care FSA may include a
Funds are always yours and may be used for future qualified
GRACE PERIOD expenses — even in retirement years.
2.5-month grace period after the end of the Plan Year for any
extra expenses to be incurred and reimbursed.

Physician services, hospital services, prescriptions, dental

Physician services, hospital services, prescriptions, dental
QUALIFIED care, vision care, Medicare Part D plans, COBRA premiums
care and vision care. A full listing of eligible expenses is
EXPENSES and long-term care premiums. A full listing of eligible
available at www.irs.gov.
expenses is available at www.irs.gov.

Other types of FSAs include:

• Dependent Care FSA - Allows you to set aside pre-tax dollars
for elder or child dependent care and covers expenses such
as day care and before- and after-school care.
OTHER TYPES There is only one type of HSA. • Limited Purpose FSA (LPFSA) - Some employers offer a
LPFSA that only covers eligible dental and vision expenses.
LPFSAs are typically offered in conjunction with an HSA as
the IRS does not allow someone to have a Health FSA and
an HSA.

Please refer to your Summary Plan Description or plan certificate for your plan’s specific FSA or HSA benefits.

26
 LIFE AND AD&D INSURANCE
It is important to have a plan in place in case something happens to you. USACS’ Life &
AD&D coverage can help prepare for the unexpected. Survivor benefits provide financial
protection and security.

Company-paid Life and Accidental

Death and Dismemberment
(AD&D) Insurance
US Acute Care Solutions provides employees with
Company-paid Life and AD&D insurance as part of your
coverage through Prudential, which guarantees that loved
ones, such as a spouse or other designated survivor(s),
continue to receive part of an employee’s benefits
after death.

Your Company-paid Life and AD&D insurance

benefit is $100,000 or higher, depending on role. If
you are a full-time employee, you automatically receive
Life and AD&D insurance even if you elect to waive
other coverage.

Terminal Illness Payout

If you are terminally ill, you can get a partial payment of
your group life insurance benefit that can be used as you
see fit. The payment to your beneficiary will be reduced
by the amount you receive. Refer to the plan booklet for
additional details.
What’s a beneficiary? Your beneficiary is the person
you designate to receive your Life insurance benefits
in the event of your death. This includes any benefits
payable under Company-paid Life offered by US Acute
Care Solutions. In the event of a dependent’s death,
you would receive the benefit payment under
Prudential insurance.

Thoughts & Tips: Did you know that
the beneficiary that you select for your
life insurance does not carry over to your
retirement plan? Be sure to select your
beneficiaries for both.
Name a primary and contingent beneficiary to make your
intentions clear. Make sure to indicate their full name,
address, Social Security number, relationship, date of
birth and distribution percentage. Please note that in
most states, benefit payments cannot be made to a
minor. If you elect to designate a minor as beneficiary, all
proceeds may be held under the beneficiary’s name and
will earn interest until the minor reaches majority age of
18. If you need assistance, contact the Human Resources
Team or your own legal counsel.

27
 Voluntary Life and AD&D Insurance
Life and AD&D benefits are an important part of your family’s financial security. USACS provides a generous company-paid
Life and AD&D insurance benefit to cover expenses in a time of need. Additional coverage is also available to protect you
and your family. Eligible employees may purchase additional Voluntary Life and AD&D insurance. Premiums are paid through
payroll deductions.

COMPANY-PAID EMPLOYEE LIFE/AD&D

COVERAGE AMOUNT $100,000

WHO PAYS US Acute Care Solutions

MAXIMUM BENEFIT $100,000 or higher, depending on role

EVIDENCE OF INSURABILITY (EOI) REQUIRED No

VOLUNTARY EMPLOYEE LIFE

COVERAGE AMOUNT $10,000 increments, up to $500,000

WHO PAYS Employee

MAXIMUM BENEFIT $500,000

VOLUNTARY SPOUSE LIFE

COVERAGE AMOUNT $10,000 increments, up to $250,000

WHO PAYS Employee

MAXIMUM BENEFIT $250,000, up to 100% of the employee’s amount

EVIDENCE OF INSURABILITY (EOI) REQUIRED $50,000

VOLUNTARY CHILD LIFE

COVERAGE AMOUNT $10,000

WHO PAYS Employee

MAXIMUM BENEFIT $10,000

EVIDENCE OF INSURABILITY (EOI) REQUIRED No

VOLUNTARY EMPLOYEE AD&D

COVERAGE AMOUNT $10,000 increments, up to $500,000

WHO PAYS Employee

MAXIMUM BENEFIT $500,000

28
VOLUNTARY INSURANCE RATES

VOLUNTARY LIFE INSURANCE

RATES/$1,000 (MONTHLY)

AGE AGE
EMPLOYEE SPOUSE
(AS OF JANUARY 1, 2022) (AS OF JANUARY 1, 2022)

<25 $0.053 <25 $0.074

25-29 $0.061 25-29 $0.085
30-34 $0.080 30-34 $0.105
35-39 $0.103 35-39 $0.149
40-44 $0.146 40-44 $0.211
45-49 $0.233 45-49 $0.331
50-54 $0.372 50-54 $0.518
55-59 $0.575 55-59 $0.798
60-64 $0.905 60-64 $1.377
65-69 $1.580 65-69 $2.371
70-74 $2.820 70-74 $4.228
75+ $5.484 75+ $8.375
Benefits Subject to Age Reduction Schedule beginning at age 65

VOLUNTARY AD&D INSURANCE

PREMIUM RATES / $1,000 (MONTHLY)

Employee $0.019
Spouse $0.022

VOLUNTARY CHILD LIFE & AD&D

INSURANCE
PREMIUM RATES / $1,000 (MONTHLY)

Child(ren) $0.072

TO CALCULATE HOW MUCH YOUR VOLUNTARY LIFE COVERAGE WILL COST:

$ ÷ 1,000 = $ x Age Based Rate = $

Benefit Elected Monthly Premium

29
 SHORT AND LONG TERM DISABILITY
US Acute Care Solutions provides a market-leading, company-paid short and long term
disability benefit. This coverage protects you financially in the event you cannot work as a
result of a debilitating injury.

Short Term Disability Long Term Disability

(STD) Insurance
Short Term Disability (STD) benefits are provided by
USACS at no cost. STD insurance replaces a percentage
of your income if you become partially or totally disabled
for a short time. Certain exclusions, along with pre-
existing condition limitations, may apply. See your plan
documents or the Human Resources Team for details.
(LTD) Insurance
Long Term Disability (LTD) benefits are provided by
USACS at no cost. LTD insurance replaces 60% of your
income if you become partially or totally disabled for
an extended time. Certain exclusions, along with pre-
existing condition limitations, may apply. See your plan
documents or the Human Resources Team for details.

Weeks 1-6: 100% of MONTHLY MAXIMUM

WEEKLY MAXIMUM BENEFIT
ELIMINATION PERIOD
MAXIMUM BENEFIT PERIOD
$10,000
your Weekly Earnings BENEFIT
Weeks 7-13: 60% of ELIMINATION PERIOD 3 months
your Weekly Earnings
Payments will last
8 days for as long as you
13 weeks are disabled or until
MAXIMUM BENEFIT PERIOD you reach your Social
Security Normal
Retirement Age,
whichever is sooner.

Thoughts & Tips: Nearly 6% of

working Americans will experience a short
term disability due to illness, injury or
pregnancy on average every year.

30
 PAID PARENTAL LEAVE
US Acute Care Solutions provides an industry-leading parental leave benefit that covers up to 12 weeks of paid leave
for birth mothers and 2 weeks of paid leave, at 100% of base wages, for all new parents. This paid leave includes birth
mothers as well as fathers, partners, spouses, adoptive, or surrogate parents. We take care of you like family so you can
take care of yours.

FATHER, PARTNER OR SPOUSE (Non-Primary Parent):

2 weeks Parental Leave paid at 100%

ADOPTIVE OR SURROGATE PARENT (Primary Parent):

2 weeks Parental Leave paid at 100% + 4 weeks Primary Care Giver Leave paid at 50%*

BIRTH MOTHER:
8 weeks Leave paid at 100%* +4 weeks Primary Care
(2 weeks Parental Leave + 6 weeks short-term disability) Giver Leave paid at 50%*

*Based on 12 months average salary.

PLUS flexible clinical scheduling for 3 months post leave, when available.

31
 WELLBEING/MENTAL HEALTH
You visit your doctor when you’re feeling sick, and you exercise and eat healthy to keep
your body strong. But your mental health is just as important. What do you do to stay
healthy mentally? Do you know where you can go when you need help? Whether you need
assistance with work-life balance or anxiety, there are resources available to help you out.

Employee Assistance Program Mental Health and Your

We know life is complicated, and sometimes we all just
need a little help. Our Employee Assistance Program
(EAP), Guidance Resources, helps manage your and your
family’s total health, including mental, emotional and
physical. And it comes at no cost to you — whether you’re
enrolled in a company-sponsored medical plan or not.
Through this program, you have access to mental
health assistance and legal and financial help from
a number of professionals. You have 24-hour access
to helpful resources by phone, and the EAP benefit
includes three face-to-face visits per issue with a licensed
professional. All services provided are confidential and
will not be shared with US Acute Care Solutions. You may
access information, benefits, educational materials and
more either by phone at 800-311-4327 or online at
www.guidanceresources.com.
Medical Plan
When your covered EAP services run out, the medical plan
covers behavioral and mental health services at 80% per
visit. Coverage includes virtual therapy from Teladoc (see
pages 18-19 for additional details). Via video or telephone,
you can receive confidential 1-on-1 counseling from the
privacy and convenience of your home. Your licensed
virtual therapist may provide a diagnosis, treatment, and
medication if needed. You can see the same therapist with
each appointment and establish an ongoing relationship.
See plan documents for specifics on coverage for
inpatient and outpatient services. Call 800-835-2362 or
visit www.teladoc.com for more information.

The Program provides referrals to help with:

» Emotional Health and Well-Being
» Alcohol or Drug Dependency
» Marriage or Family Relationship Problems
» Job Pressures
» Stress, Anxiety, Depression
» Grief and Loss
Note: According to the American Psychological
Association, 61% of adults say they could have used
» Financial or Legal Advice more emotional support in 2020.

Other Mental Health Resources

No matter your problem, whether you’re a manager or entry-level employee, don’t be afraid to ask for help. There are
resources available 24/7.

National Suicide Prevention Lifeline Call 800-273-TALK (8255); En Español 888-628-9454

The Lifeline is a free, confidential crisis hotline that connects callers to the nearest crisis center in
the Lifeline national network. These centers provide crisis counseling and mental health referrals.

32
 Crisis Text Line Text “HELLO” to 741741 Send a text 24/7 to the Crisis Text Line to speak with a
crisis counselor who can provide support and information. Standard text messaging rates may apply.

Veterans Crisis Line Call 800-273-TALK (8255) and press 1 or text to 838255 The Veterans
Crisis Line can be used by phone or text to connect veterans with a trained responder 24/7.
The service is available to all veterans, even if they are not registered with the VA or enrolled
in VA healthcare.

Call 911 if you or someone you know is in immediate danger or go to the nearest emergency room.

An important aspect of your overall wellbeing is emotional wellness – the ability to successfully adapt to changes and
challenges as they arrive and handle life’s stresses. These five actions have been shown to improve emotional wellness.

The Big Five of Emotional Wellness

Practice mindfulness.
Practice deep breathing, enjoy a stroll,
and stay present in each moment.

Strengthen social connections.

Improve your outlook.
Reach out to a friend or family
Treat people with kindness,
member daily — even if it’s just
including yourself.
a video call or text.

Get quality sleep.

Deal with
Keep a consistent sleep your stress.
schedule and limit Think positively, exercise
electronic use before bed. regularly, and set
priorities.

33
 SUPPLEMENTAL HEALTH BENEFITS
US Acute Care Solutions offers several ways for you to supplement your medical plan
coverage. This additional insurance can help cover unexpected expenses, regardless of
any benefit you may receive from your medical plan. Coverage is available for yourself
and your dependents and is offered at discounted group rates.

Critical Illness Coverage » Pre-Existing Conditions: This plan does NOT have a
pre-existing condition exclusion; however, your date
Critical Illness coverage through Unum pays a lump-sum
of diagnosis must be on or after the effective date of
benefit if you are diagnosed with a covered disease or
your policy for benefits to be paid.
condition. You can use this money however you like;
» Wellness Benefit: A wellness benefit is payable
for example: to help pay for expenses not covered by
for each covered member for completing certain
your medical plan, lost wages, child care, travel, home
wellness screenings such as a pap test, cholesterol
healthcare costs or any of your regular household
test, mammogram, colonoscopy or stress test.
expenses.
» Rates are based on your age and benefit amount
Covered Benefits and will be calculated for you when you go online
for enrollment. Rates for this plan are grouped in
(paid at 100% of your elected benefit amount unless
five-year increments and are subject to increase
otherwise noted):
each time you enter a new age-band. Refer to
» Heart Attack » Major Organ Failure www.unum.com for additional information.
» Stroke » Coma
» Coronary Artery » Complete Blindness
CRITICAL ILLNESS MONTHLY RATE
Bypass (25%) » Occupational HIV PER $1,000 OF COVERAGE
» Cancer » Cerebral Palsy ISSUE AGE
EMPLOYEE AND
SPOUSE
DEPENDENT CHILDREN
» Carcinoma in Situ » Cleft Lip or Palate Less than
$0.336 $0.502
(25%) age 25
» Cystic Fibrosis 25 - 29 $0.416 $0.582
» Benign Brain Tumor
» Down Syndrome 30 - 34 $0.516 $0.682
» End Stage Renal
Failure » Spina Bifida 35 - 39 $0.676 $0.842
40 - 44 $0.896 $1.062
45 - 49 $1.206 $1.372
LEVEL OF COVERAGE WELLNESS BENEFIT PAYABLE
50 - 54 $1.696 $1.862
$10,000 $50
55 - 59 $2.346 $2.512
$20,000 $75
60 - 64 $3.346 $3.512
$30,000 $100
65 - 69 $4.906 $5.072
70 - 74 $7.426 $7.592
Plan Highlights 75 - 79 $7.906 $8.072
» Employees can elect $10,000, $20,000, or $30,000
80 - 84 $11.086 $11.252
of coverage
85 or
$17.546 $17.712
» Guaranteed Issue Coverage (no medical questions) over

– Employee: $30,000
– Spouse: $15,000
– Child(ren): 50% of Employee coverage amount

34
Accident Coverage Accident Coverage

Accidents happen. You can’t always prevent them, SUMMARY OF BENEFITS*

but you can take steps to reduce the financial impact. FRACTURES $75-$7,500

Accident Coverage, available through Unum, provides DISLOCATIONS $150-$6,000

benefits for you and your covered family members if you EMERGENCY CARE $150

have expenses related to an accidental injury. Health NON-EMERGENCY INITIAL CARE $75

insurance helps with medical expenses, but this coverage MEDICAL TESTING BENEFIT
(X-RAY, MR/MRI, ULTRASOUND, $200
is an additional layer of protection that can help you NCV, CT/CAT, EEG)
pay deductibles, copays and even typical day-to-day PHYSICIAN FOLLOW-UP VISIT $75
expenses such as a mortgage or car payment. Benefits
THERAPY SERVICES $25
under this plan are payable to you to use as you wish.
HOSPITAL OR ICU BENEFIT $200-$1,500
The Accident insurance plan pays cash benefits to help BURNS (2ND AND 3RD DEGREE) $1,000-$10,000
with costs associated with out-of-pocket expenses and CONCUSSION $150
bills in the event of a covered accident: COMA $10,000

» Emergency treatment - $150 RUPTURED DISC $800

» Hospital Admission - $1,000 TORN CARTILAGE IN KNEE $750

LACERATION $25-$600
» Intensive care unit - $400/day
TENDON/LIGAMENT/ROTATOR
» Ambulance transportation - $400 $800
CUFF REPAIR (WITH SURGERY)
» Injuries - varies (for a schedule of payments for Ground - $400
AMBULANCE
fractures, dislocations, lacerations, burns, etc., Air - $1,500
please visit www.unum.com PROSTHETIC DEVICE $750

MEDICAL APPLIANCE $100

BLOOD BENEFIT $400

OUTPATIENT SURGERY $300

ANNUAL WELLNESS BENEFIT $50

*This list is a summary. Refer to plan documents for a comprehensive

list of covered benefits.

ACCIDENT PLAN MONTHLY RATE

EMPLOYEE ONLY $11.48

EMPLOYEE + SPOUSE $20.32

EMPLOYEE + CHILDREN $25.80

EMPLOYEE + FAMILY $34.64

35
 ADDITIONAL BENEFITS
US Acute Care Solutions cares about you and wants you to succeed in all aspects of life,
so we offer a variety of additional benefits to help make your day-to-day easier.
Identity Theft
Identity theft protection is available on a voluntary
basis. In today’s online world, there is a new identity fraud
victim every two seconds. Protect yourself with IDNotify.
IDNotify monitors millions of transactions every second,
alerting you to suspicious activity by text, phone or email.
This protection is different than free credit monitoring and
offers a full set of features to help protect you and your
covered family members against identity theft. IDNotify
membership features:
IDNotify Identity Alert System
» Deeper credit knowledge with 3 Bureau Credit
Monitoring, Positive Activity Alerts, and Experian
Credit Snapshot
» Real-time identity monitoring alerts
» Extended protection to children and
family members
» Lost wallet protection
» Internet surveillance
» Identity theft insurance
» Full-service identity restoration
» Credit monitoring
This plan is yours to keep if you retire or leave US Acute
Care Solutions.
36
Pet Insurance
Available through Nationwide Pet Insurance, you receive
preferred pricing on coverage for your household pets. You
work hard to provide your family with everything they need.
So, whether your family includes kids with two feet or kids
with four paws, you know what responsibility looks like.
My Pet Protection® from Nationwide® helps you provide
your pets with the best care possible. Plans cover accidents,
illnesses and hereditary conditions.
Easy Enrollment
There are three simple ways for employees to sign up for
their new pet insurance voluntary benefit:
1. Go directly to the dedicated URL:
http://www.petinsurance.com/usacs
2. Visit PetsNationwide.com and enter the company name.
3. Call 877-738-7874 and mention that you are an
employee of US Acute Care Solutions to receive
preferred pricing.
Employee Discount Program
With PerkSpot, you can get dozens of exclusive discounts
on your favorite brands. You can browse deals, search
by brand or category, and enjoy savings on a variety of
products and services. Access these exclusive discounts by
going to usacs.perkspot.com.
TutorMe
The USACS TutorMe benefit allows employees and their
dependents to receive free online tutoring. You or your
dependents can connect with a live tutor in under 30
seconds for over 300 subjects, 24 hours a day. They have a
network of over 10,000 verified tutors who are ready to help
with any question, no matter how big or small. The limit is
3 hours per week; per household.
Receive one-on-one tutoring for:
» Career support services including resume/cover
letter writing and interview techniques
» K-12 students
» College or grad school students who need support
for specialized programs (nursing, engineering, etc.)
» Standardized exam prep including ACT, GRE, LSAT,
MBA and more
How it Works:
» Connect with a Live Tutor
OR
» Upload a paper on our Writing Lab to receive
feedback
How to Access TutorMe:
» Be on the lookout for an email from TutorMe
containing login info
» Log in with the email address associated with the
inbox in which the TutorMe email was received using
the temporary password provided
» Change your password
» Start tutoring!
Rocket Lawyer
Legal Benefits are available through Rocket Lawyer. Whether
you are starting a family, buying a home, working through
a landlord dispute, or planning your estate, Rocket Lawyer
Legal Benefits can help.
To take advantage of these benefits, follow the steps below:
» Go to go.rocketlawyer.com/usacs (this link will
become active on 7/1/2022)
» Enter your work email address
» You will receive an email from Rocket Lawyer; click
the “Activate Account” button
» Fill out the form, and you are set!
With Rocket Lawyer, you will have access to:
» Legal Documents Library: Create and sign hundreds
of legal documents such as wills, leases, and
childcare authorization forms
» Attorney Q&A: Submit a question and get reliable
legal advice within one business day
» Attorney Phone Consultations: Schedule a free,
30-minute phone call with a Rocket Lawyer attorney
specializing in your issue
» Attorney Discounts: Save 40% on lawyers in your area
RocketLawyer can help you with:
» Getting married
» Landlord/Tenant issues
» Estate planning
» Speeding tickets
» Family/Elder care
» Immigration issues
» Buying a home
» Starting a family
Need Help? Email benefitssupport@rocketlawyer.com.
37
 Loan Refinancing
USACS is pleased to offer qualifying employees, their friends and family a student loan consolidation and refinancing
service. Administered by SoFi, the program reduces your loan repayments by consolidating and refinancing your federal
and private loans into one loan at a lower interest rate.

As an employee, you and your friends and family members will receive a 0.25% rate discount (1) when you refinance your
student loans through sofi.com/USACS. Employees can also refinance an existing Parent PLUS loan, or co-sign for their
children’s student loans. SoFi saves their borrowers (2) when they refinance loans. Terms range from 5-20 years with low
variable & fixed rate options, no application fees, no origination fees, no prepayment penalties.

How to Apply
Visit sofi.com/USACS (this link will become active on 7/1/2022) and follow the steps. You must start your application through
this link to receive the 0.25% rate discount available to Practice employees and their friends and family (1) . SoFi takes several
factors into consideration when evaluating your application, including your education, employment history, income and
credit rating.

(1)
Payment will be issued electronically once you become a SoFi borrower; and you have submitted a completed application with documents and
your loan has been disbursed. Offer good for new customers only.
(2)
See sofi.com/disclaimer

38
 Student Loan Refinancing

Refinance to a lower interest rate today – as low as 2.99%!

Save tens of thousands of dollars on your student loans!
USACS partnered with our preferred bank to offer its best-in-class student

ATTENTION loan refinancing. For the first time ever, physicians can secure lower interest
rates on their entire student loan portfolio…as soon as they sign with USACS!

PHYSICIANS Regardless of how much is refinanced, you have the option to pay as little
as $100/month for the remainder of residency and for 6 months after.

INTEREST RATES BY JOINING USACS ADDITIONAL FEATURES

• Free to apply
LOAN TYPE RATE • No origination fees or prepayment penalties
• Option to pay as little as $100/month during
5-year fixed 2.99% residency and for 6 months after
• Up to 12 months of Economic Hardship
10-year fixed 3.99%
Forbearance is available
20-year fixed 4.99% • Fully dischargeable in case of death or
permanent disability

CONTACT US
ELIGIBILITY
(800) 828-0898 • BORROWERS: Must be a U.S. Citizen or
permanent resident with a valid I-1551 card
@ dgrella@usacs.com

www.usacs.com
• ELIGIBLE LOANS: Up to 100% of outstanding private
and federal student loans from both undergrad and
Go to USACS.com/refinance and calculate medical school (min $5,000; no maximum)
your student loan savings!

GRADUATES FROM THESE SCHOOLS HAVE ALREADY REFINANCED THEIR LOANS WITH OUR PREFERRED BANK
Harvard Medical School • Johns Hopkins School of Medicine • Pritzker School of Medicine • Indiana University School of
Medicine • University of Pennsylvania School of Medicine • Duke University School of Medicine • The School of Medicine
at the University of California • University of Texas Health and Science • Ross University School of Medicine

Our preferred bank can write loans in all 50 states

9/9/16

39
 GLOSSARY
Balance Billing – When you are billed by a provider for Healthcare Cost Transparency – Also known as market
the difference between the provider’s charge and the transparency or medical transparency. Online cost
allowed amount. For example, if the provider’s charge is transparency tools, available through health insurance
$100 and the allowed amount is $60, you may be billed by carriers, allow you to search an extensive national
the provider for the remaining $40. database to compare varying costs for services.
Coinsurance – Your share of the cost of a covered Health Reimbursement Account (HRA) – A personal
healthcare service, calculated as a percent of the allowed healthcare account funded by your employer that you
amount for the service, typically after you meet your could use to pay for qualified medical expenses.
deductible.
Health Savings Account (HSA) – A personal healthcare
Copay – The fixed amount, as determined by your bank account funded by your or your employer’s tax-free
insurance plan, you pay for healthcare services received. dollars to pay for qualified medical expenses. You must
be enrolled in a HDHP to open an HSA. Funds contributed
Deductible – The amount you owe for healthcare
to an HSA roll over from year to year and the account is
services before your health insurance begins to pay its
portable, so if you change jobs your account goes with
portion. For example, if your deductible is $1,000, your
you.
plan does not pay anything until you’ve paid $1,000 for
covered services. This deductible may not apply to all
services, including preventive care.
Explanation of Benefits (EOB) – A statement from
your insurance carrier that explains which services were
provided, their cost, what portion of the claim was paid
by the plan, and what portion is your liability, in addition
to how you can appeal the insurer’s decision.
Flexible Spending Accounts (FSAs) – A special tax-
free account you put money into that you use to pay for
certain out-of-pocket healthcare costs. You’ll save an
amount equal to the taxes you would have paid on the
money you set aside. FSAs are “use it or lose it,” meaning
that funds not used by the end of the plan year will be
lost. Some Healthcare FSAs do allow for a grace period or
a roll over into the next plan year.
» Healthcare FSA – A pre-tax benefit account used
to pay for eligible medical, dental, and vision care
expenses that aren’t covered by your insurance
plan. All expenses must be qualified as defined in
Section 213(d) of the Internal Revenue Code.
» Limited Purpose FSA – Designed to complement
a Health Savings Account, a Limited Purpose FSA
allows for reimbursement of eligible dental and
vision expenses.
» Dependent Care FSA – A pre-tax benefit account
used to pay for dependent care services. For
additional information on eligible expenses, refer to
Publication 503 on the IRS website.

40
High Deductible Health Plan (HDHP) – A plan option
that provides choice, flexibility and control when it comes
to healthcare spending. Most preventive care is covered
at 100% with in-network providers, there are no copays
and all qualified employee-paid medical expenses count
toward your deductible and your out-of-pocket maximum.
Network – A group of physicians, hospitals and other
healthcare providers that have agreed to provide
medical services to a health insurance plan’s members at
discounted costs.
» In-Network – Providers that contract with your
insurance company to provide healthcare services
at the negotiated carrier discounted rates.
» Out-of-Network – Providers that are not contracted
with your insurance company. If you choose an out-
of-network provider, services will not be covered at
the in-network negotiated carrier discounted rates.
» Non-Participating – Providers that have declined
entering into a contract with your insurance
provider. They may not accept any insurance and
you could pay for all costs out of pocket.
Open Enrollment – The period set by the employer
during which employees and dependents may enroll for
coverage, make changes or decline coverage.
Out-of-Pocket Maximum – The most you pay during
a policy period (usually a 12-month period) before your
health insurance begins to pay 100% of the allowed
amount. This does not include your premium, charges
beyond the Reasonable & Customary, or healthcare your
plan doesn’t cover. Check with your carrier to confirm
what applies to the maximum.
Over-the-Counter (OTC) Medications – Medications
available without a prescription.
Prescription Medications – Medications prescribed
by a doctor. Cost of these medications is determined by
their assigned tier: generic, preferred, non-preferred or
specialty.
» Generic Drugs – Drugs approved by the U.S. Food
and Drug Administration (FDA) to be chemically
identical to corresponding preferred or non-
preferred versions. Usually the most cost-effective
version of any medication.
» Preferred Drugs – Brand-name drugs on your
provider’s approved list (available online).
» Non-Preferred Drugs – Brand-name drugs not on
your provider’s list of approved drugs. These drugs
are typically newer and have higher copayments.
» Specialty Drugs – Prescription medications used to
treat complex, chronic and often costly conditions.
Because of the high cost, many insurers require that
specific criteria be met before a drug is covered.
» Prior Authorization – A requirement that your
physician obtain approval from your health
insurance plan to prescribe a specific medication for
you.
» Step Therapy – The goal of a Step Therapy Program
is to steer employees to less expensive, yet equally
effective, medications while keeping member and
physician disruption to a minimum. You must
typically try a generic or preferred-brand medication
before “stepping up” to a non-preferred brand.
Reasonable and Customary Allowance (R&C) – Also
known as the UCR (Usual, Customary, and Reasonable)
amount. The amount paid for a medical service in a
geographic area based on what providers in the area
usually charge for the same or similar medical service.
The R&C amount is sometimes used to determine the
allowed amount.
Summary of Benefits and Coverage (SBC) – Mandated
by healthcare reform, your insurance carrier provides you
with a summary of your benefits and plan coverage.
Summary Plan Description (SPD) - The document(s)
that outline the rights, obligations, and material
provisions of the plan(s) to all participants and their
beneficiaries.
41
 Required Notices
Important Notice from US Acute Care Solutions About
Your Prescription Drug Coverage and Medicare under
the Health Design Plus (HDP) with Anthem BCBS PPO
Network plan(s) Plan(s)
Please read this notice carefully and keep it where you can find it. This
notice has information about your current prescription drug coverage with
US Acute Care Solutions 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. US Acute Care Solutions has determined that
the prescription drug coverage offered by the
Health Design Plus (HDP) with Anthem BCBS PPO Network plan(s)
plan(s) 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
during a seven-month initial enrollment period. That period begins three
months prior to your 65th birthday, includes the month you turn 65, and
continues for the ensuing three months. You may also enroll each year from
October 15th through 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
US Acute Care Solutions coverage will not be affected. For most persons
covered under the Plan, the Plan will pay prescription drug benefits first, and
Medicare will determine its payments second. For more information about
this issue of what program pays first and what program pays second, see the
Plan’s summary plan description or contact Medicare at the telephone number
or web address listed herein.
If you do decide to join a Medicare drug plan and drop your current
US Acute Care Solutions coverage, be aware that you and your dependents
will not be able to get this coverage back.
42
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
US Acute Care Solutions 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 person listed at the end of these notices for further information.
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
US Acute Care Solutions 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 Medicare Part D 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).
Date: January 1, 2022
Name of Entity/Sender: US Acute Care Solutions
Contact—Position/Office: Human Resources
Address: 4535 Dressler Rd NW,
Canton, OH 44718
Phone Number: 833-447-8326
Women’s Health and Cancer Rights Act under this plan within 60 days after the date Medicaid or CHIP determine that
you or the dependent(s) qualify for the subsidy.
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 In addition, if you have a new dependent as a result of marriage, birth,
(WHCRA). For individuals receiving mastectomy-related benefits, coverage adoption, or placement for adoption, you may be able to enroll yourself and
will be provided in a manner determined in consultation with the attending your dependents. However, you must request enrollment within 30 days after
physician and the patient, for: the marriage, birth, adoption, or placement for adoption.
» All stages of reconstruction of the breast on which the mastectomy
was performed; To request special enrollment or obtain more information, contact
» Surgery and reconstruction of the other breast to produce a Human Resources at 833-447-8326.
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. For deductibles and coinsurance information applicable to the plan
in which you enroll, please refer to the summary plan description. If you would
like more information on WHCRA benefits, please contact Human Resources at
833-447-8326.

HIPAA Privacy and Security

The Health Insurance Portability and Accountability Act of 1996 deals with how
an employer can enforce eligibility and enrollment for health care benefits, as
well as ensuring that protected health information which identifies you is kept
private. You have the right to inspect and copy protected health information
that is maintained by and for the plan for enrollment, payment, claims and
case management. If you feel that protected health information about you is
incorrect or incomplete, you may ask your benefits administrator to amend
the information. For a full copy of the Notice of Privacy Practices, describing
how protected health information about you may be used and disclosed and
how you can get access to the information, contact Human Resources at
833-447-8326.

HIPAA 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 later 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).

Loss of eligibility includes but is not limited to:

» Loss of eligibility for coverage as a result of ceasing to meet the plan’s
eligibility requirements (i.e. legal separation, divorce, cessation of
dependent status, death of an employee, termination of employment,
reduction in the number of hours of employment);
» Loss of HMO coverage because the person no longer resides or works
in the HMO service area and no other coverage option is available
through the HMO plan sponsor;
» Elimination of the coverage option a person was enrolled in, and
another option is not offered in its place;
» Failing to return from an FMLA leave of absence; and
» Loss of coverage under Medicaid or the Children’s Health Insurance
Program (CHIP).
Unless the event giving rise to your special enrollment right is a loss of
coverage under Medicaid or CHIP, you must request enrollment within 30 days
after your or your dependent’s(s’) other coverage ends (or after the employer
that sponsors that coverage stops contributing toward the coverage).

If the event giving rise to your special enrollment right is a loss of coverage
under Medicaid or the CHIP, you may request enrollment under this plan
within 60 days of the date you or your dependent(s) lose such coverage under
Medicaid or CHIP. Similarly, if you or your dependent(s) become eligible for a
state-granted premium subsidy towards this plan, you may request enrollment

43
 IMPORTANT CONTACTS

MEDICAL FLEXIBLE SPENDING PET INSURANCE

Contigo Health ACCOUNTS Nationwide Pet
(Medical claim questions) Contigo Health 877-738-7874
844-207-8124 844-207-8124 http://www.petinsurance.com/usacs
www.contigohealth.com https://hdpmember.lh1ondemand.com
CSUSACS@ContigoHealth.com FREE ONLINE TUTORING
Anthem BCBS PPO Network TutorMe
(Provider search) LIFE AND AD&D www.tutorme.com
www.anthem.com Prudential
800-524-0542 LEGAL BENEFITS
PRESCRIPTION www.prudential.com Rocket Lawyer
DRUG COVERAGE Policy #: 53373 benefitsupport@rocketlawyer.com
Optum Rx go.rocketlawyer.com/usacs
844-785-1599 DISABILITY (link active on 7/1/2022)
optumrx.com Prudential
877-367-7781 LOAN REFINANCING
SUPPLEMENTAL HEALTH www.prudential.com/mybenefits SoFi
(ACCIDENT, CRITICAL Policy #: 53373 855-456-7634
ILLNESS) sofi.com/USACS
Unum RETIREMENT (link active on 7/1/2022)
800-635-5597 Fidelity
www.unum.com 800-835-5095 US ACUTE CARE
www.netbenefits.com SOLUTIONS
TELEMEDICINE/ HUMAN RESOURCES
VIRTUAL VISITS IDENTITY THEFT 4535 Dressler Rd. NW
Teladoc IDNotify Canton, OH 44718
800-835-2362 NetBenefits.com/IDProtectionHelp AskHR@usacs.com
www.teladoc.com 833-447-8326
EMPLOYMENT
TOBACCO CESSATION VERIFICATION EMPLOYEE DISCOUNT
UBreathe The Work Number PROGRAM
800-882-2109 TheWorkNumber.com PerkSpot
coaching@mywellportal.com 866-604-6572 https://usacs.perkspot.com/

DENTAL SAGEVIEW ADVISORY

Delta Dental of Ohio GROUP
800-524-0149 sage411.sageviewadvisory.com
www.deltadentaloh.com 833-SAGE-411

VISION EMPLOYEE ASSISTANCE

VSP PROGRAM
800-877-7195 Guidance Resources
www.vsp.com 800-311-4327
Policy #: 30072173 www.guidanceresources.com
Web ID: MGR311
HEALTH SAVINGS TDD line: 800-697-0353
ACCOUNT
HSA Bank
855-731-5213
www.hsabank.com

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