Benefits

2021 Benefits Guide

Welcome

As part of your Total Rewards, UPMC offers a wide variety of comprehensive benefits for you and your eligible dependents. These benefits are designed to help you further your education, protect you financially, improve your health, and help you prepare for retirement. Our goal is to provide you with flexibility by offering choices so you can decide which options best meet your needs.

Whether you are a new hire or have changed status and are now eligible to make or change your benefit elections, this brochure contains detailed information about the benefits that are offered to you. Benefits are effective the first of the month following date of hire or change in status.

The UPMC employee internal website called Infonet, which is available at Infonet.UPMC.com is where you will go to learn more about your benefits and to gain access to HR Direct. This is your personal UPMC portal where you can manage employment-related functions such as enrolling in benefits, viewing your pay advice, and updating your address or phone number.

Meet with your manager to obtain and register your User Principal Name (UPN), establish a password, and set up two-step verification. This is how your will access Infonet and receive your UPMC email address.

An Enrollment Checklist is located on page 1. Use this list to confirm that you complete all required items by the deadlines.

For all of your benefits needs, action items, and more, search Infonet.

You can also call the UPMC Employee Service Center (ESC) — 1-800-994-2752, option 3 — with any questions.

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UPMC BENEFITS

Enrollment ChecklistUse the checklist below to complete your benefit selections within 30 days

Review your UPMC benefits information on Infonet prior to enrolling in your benefits. A high-level overview can be found in the Benefits Enrollment Toolkit which is also on Infonet. To assist with your medical selection, search “medical plan calculator” on Infonet to quickly estimate your out-of-pocket costs and payroll deductions with this easy to use tool.

Upload any required dependent documentation before you start your benefits enrollment (if possible). Select the Benefits icon on HR Direct, then click on Document Records to complete this step. If enrolling a domestic partner, search “domestic partner“ on Infonet to access the affidavit needed to upload proof. If you enroll a Spouse/DP, their coverage will be suspended until required documentation has been received and approved.

Enroll in your benefits - benefits enrollment instructions are located on page 35 of this guide. To begin, you will go to Infonet to access HR Direct, then choose the Benefits icon and click on the Make Benefit Elections button.

Print your benefits confirmation after you enroll. Review it for accuracy and keep it for your records. If changes are needed, make and submit those immediately, then print an updated confirmation.

Review and decide if you want to enroll in any UPMC Voluntary Benefits. Choose the Benefits icon in HR Direct, then click on the “Elect Voluntary Benefits” tile, or search “voluntary benefits” on Infonet to access the link to enroll.

Complete your MyHealth Questionnaire within 30 days to receive the $1,000 individual/$2,000 family deductible credit at MyHealth OnLine or by downloading the UPMC Health Plan mobile app. If you enrolled a spouse/domestic partner, they must also complete the questionnaire within 30 days for your family to earn the maximum $2,000 credit by logging in as a member at www.upmchealthplan.com.

Send Evidence of Insurability forms to CIGNA if you are electing life insurance above the guaranteed issue amounts for yourself, spouse, or domestic partner. Coverage will suspend and you will be sent an email to your email address on file from OnlineMedicalUnderwriting@CIGNA.com to complete required information.

Review the information about your UPMC Retirement benefits by searching “retirement” on Infonet or selecting “My Retirement” on HR Direct to access the UPMC Retirement Center website. You can enroll in or make changes to the UPMC Savings Plan at any time on HR Direct when you select “My Retirement”.

Review and complete any pending actions on HR Direct.

Review your payslip for your benefit deductions, which should begin during the pay period that contains the effective date of your coverage. If your elections are not submitted prior to the processing deadline for that pay date, deductions will be taken retroactively from subsequent pays. The 2021 Payroll calendar is on page 44.

Helpful Notes

For Infonet, HR Direct, UPMC email access, and log-on issues call the UPMC Help Desk at 412-647-HELP (4357).

Specific medical or dental treatment questions may be answered by calling 1-800-994-2752, option 2.

To elect your primary care physician (PCP), call UPMC Health Plan (1-800-994-2752, choose option 2). To search for providers, click on Find Care at www.upmchealthplan.com. After enrolling in medical, you may also select a provider on MyHealth OnLine in HR Direct. This is not required but strongly recommended to coordinate your care.

Medical ID cards will be mailed within 7-10 days after you have submitted your elections. You can print a temporary card when you access MyHealth OnLine in HR Direct, then under Your Insurance, select ID Cards. ID cards are also available on your phone after you download the UPMC Health Plan mobile app.

Questions about your benefits and enrollment should be directed to the Employee Service Center at 1-800-994-2752, option 3.

Benefits described may not be applicable to all staff. Some business units and job classifications have unique benefit programs that may affect eligibility. Actual plan provisions are contained in plan documents, agreements of insurance, and the Summary Plan Description. Physicians and collectively bargained staff should additionally reference contract terms. UPMC reserves the right to interpret, suspend, amend, or terminate the Plan at any time. Specific benefit related questions should be directed to the UPMC Employee Service Center at 1-800-994-2752, option 3.

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Table Of Contents:

Welcome ............................. Inside front cover

Enrollment Checklist .........................................1

Eligibility for Benefits .....................................3

Medical .................................................................5

MyHealth ...............................................................5

Medical Option Comparison .........................6

Health Savings Account .................................7

Prescription Drugs ............................................7

Vision ......................................................................8

Dental .....................................................................9

Flexible Spending Accounts .........................9

Life Insurance ....................................................10

Disability..............................................................10

Paid Time Off ...................................................10

Holidays ................................................................ 11

Employee Assistance Program ................. 11

Qualified Transportation Accounts ........... 11

Paid Parental Leave ......................................... 11

Other Benefits ................................................... 11

Retirement Program ...................................... 12

Tuition Assistance ........................................... 14

Voluntary Benefits .......................................... 14

2021 Bi-Weekly and Monthly Staff Contributions ......................................... 16

Your Benefits Rights ..................................... 18

HIPAA Special Enrollment Rights ........... 19

UPMC Welfare Benefits Plan ...................... 19

Premium Assistance Under Medicaid and the Children’s Health Insurance Program (CHIP) ........................24

Availability of Marketplace Notice .......... 25

Medicare (PART D) Prescription Drug Coverage ...................... 25

Women’s Health and Cancer Rights Act .........................................26

Newborns’ and Mothers’ Health Protection Act Notice ...................26

Patient Protection and Affordable Care Act ......................................26

General Notice of No Pre-Existing Condition Exclusion.......................................26

Notice Regarding Wellness Program .......................................... 27

General Notice Of COBRA Continuation Coverage Rights ................. 27

UPMC DirectLink ...........................................30

UPMC Education and Enrollment Services ....................................... 31

UPMC Savings Plan Quick Enrollment Form ............................... 33

Enrollment Instructions ............................... 35

2021 Payroll Calendar ...................................44

Notes ...................................................................45

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Eligibility for Benefits Benefits generally are effective the first of the month on or after your date of hire or employment status change. Staffing classification, such as full-time or part-time, and work location determine eligibility and availability of the programs in which you can participate.

You should complete your enrollment within 30 days of your hire/rehire/status change date to initiate coverage elections. If you do not enroll within 60 days after your hire/rehire/status change date, you decline the elective coverage options until the next open enrollment period.

Staffing classification Benefit eligibility(nonunion)

Full-time, flexible full-time, All benefits1 and job share

Regular part-time All benefits1 except disability coverage and holidays

Limited part-time UPMC Basic Bronze medical,2 PTO, Cash Balance, and Savings Plan only3

Casual UPMC Basic Bronze medical,2 Cash Balance and Savings Plan only3

Temporary Savings Plan only4

1 Some benefits are not available at all locations — check with your Human Resources representative for specific details. 2 Basic Bronze medical coverage is offered to limited part-time and casual employees working 30 or more hours per week on average during the measurement period. 3 If eligibility requirements for participation are met. 4 403(b) only, if working at a not-for-profit location.

You may enroll only eligible dependents in UPMC benefits programs. Eligible dependents include your spouse or domestic partner, and children/stepchildren up to age 26.

Infonet and HR DirectOnline access to your benefits information and more Infonet is UPMC’s internal website (intranet) that gives you access to a variety of tools, resources, and helpful information. You can use Infonet to reference systemwide news, policies, and search for information to learn more about your benefit options.

You will also gain entry to HR Direct, your personal portal for enrolling in benefits and single sign on access to the UPMC Retirement Center (My Retirement) and MyHealth OnLine websites.

Benefits EnrollmentYou must enroll within 30 days of hire, rehire, or qualified employment status change. Search “benefits enrollment” on Infonet to learn more, then access HR Direct, choose the Benefits icon, then click the “Make Benefit Elections” button to submit your benefit elections. Enrollment instructions are on page 35 of this guide.

Dependent proof is required when you enroll a spouse/domestic partner and/or children who are not your natural born children or stepchildren on to any benefits. Search “eligible dependents” on Infonet to determine acceptable documentation, such as a marriage certificate, adoption paperwork, etc. If enrolling a domestic partner, the Domestic Partner Affidavit must be completed and uploaded.

If possible, you should complete this step before enrolling in benefits. To upload your proof, select the Benefits icon on HR Direct, then choose Document Records. Be aware that dependent coverage requiring acceptable documentation will be pended until received and approved by the Employee Service Center, and should be completed within 30 days.

Open enrollment, held in the fall of each year, is your annual opportunity (outside of a qualifying event; see “Special enrollments during the year”) to make benefit changes that are effective Jan. 1.

Special enrollments during the yearNotify the Employee Service Center with any qualified changes to your or your dependents’ benefit status as soon as possible. Notification should be received within 30 days of the event.

If notification is received after 60 days, you must wait until the next annual open enrollment to make coverage changes. Search “report a life event” on Infonet to begin the process to make changes for birth, marriage, and domestic partnership.

For other events, such as a spouse’s, domestic partner’s, or dependent child’s gain or loss of group benefits (including loss or gain of eligibility of premium assistance for Medicaid or Children’s Health Insurance Program or divorce), or adoption, contact the Employee Service Center for assistance.

You are responsible for ensuring that all dependents included on your benefits are eligible for coverage.

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Summary of Benefits

Benefit coverage Paid by Payroll deduction

Medical/prescription Staff and UPMC Pretax

Dental Staff and UPMC Pretax

Vision Staff and UPMC Pretax

Flexible spending accounts Staff Pretax

Health savings account Staff and UPMC Pretax

Short-term disability (60%) UPMC Not applicable

Long-term disability (60%) UPMC Not applicable

Basic life and accidental death and dismemberment (AD&D) insurance UPMC Not applicable

Supplemental life insurance for employee Staff After tax

Supplemental AD&D insurance for employee Staff Pretax

Supplemental life insurance for employee’s spouse and children Staff After tax

Supp lemental AD&D insurance for employee’s spouse and children Staff After tax

Cash Balance Plan UPMC Not applicable

Savings Plan Staff and UPMC Pre- and after tax

Paid time off (PTO), paid parental leave, and holiday pay UPMC Not applicable

PTO buy program Staff Pretax

PTO sell program UPMC Not applicable

Voluntary products Staff Pre- and after tax

LifeSolutions (Employee Assistance Program) UPMC Not applicable

Tuition assistance UPMC Not applicable

Adoption assistance UPMC Not applicable

Qualified Transportation Accounts (QTA): commuter parking and commuter transit Staff Pretax

Note: If both you and your spouse/domestic partner work for UPMC, be aware that there may be limits or inability for both of you to cover dependents or each other under certain benefits. Also, if you are covered under a benefit as a staff member, you may not be covered under that same benefit as a dependent.

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Medical See chart outlining medical plan options on the next page.

Eligible staff and dependents may choose from three medical options through UPMC Health Plan. These options offer choices in benefit levels and employee contributions.

The three medical options are UPMC Advantage HSA, UPMC Advantage Silver, and UPMC Advantage Gold.

The UPMC Advantage Network (Level 1) includes all professional providers that participate with UPMC Health Plan plus all UPMC-owned facilities and any other facility designated as Level 1. You will receive the highest level of benefits when you seek care within this network. A lower level of benefit is paid if you receive care from a UPMC Health Plan Network (Level 2) contracted facility.

In addition to the Advantage options, employees living outside the Advantage Network area are offered Extended Network plans similar to the Advantage Silver, Gold, and HSA which include an expanded network. Eligible staff will see these Extended Network options available to select during enrollment.

Qualifying part-time, job share, and casual staff will be eligible for the UPMC Basic Bronze medical option. This option is mandated by the Affordable Care Act and has a schedule of benefits and features different from the other UPMC medical options. Information in this brochure is not applicable to the Basic Bronze option. If you are eligible, you will receive information in the mail. Search “Basic Bronze” on Infonet for details.

MyHealthAll staff members have the opportunity and are strongly encouraged to participate in UPMC’s well-being program. MyHealth, a partnership involving you, your physician, UPMC Health Plan, and UPMC, is designed to help staff improve their overall physical, emotional, and financial health with a set of programs centered around health promotion, disease management, and financial and emotional health management. You can manage your overall well-being and participate in special events and educational programs, engage a health coach to help you quit smoking, or make healthy lifestyle changes. Individual results and data from MyHealth are never provided to UPMC.

Important deductible credit note: All medical plan options include a deductible for services such as hospital stays and lab work. If you choose to participate in MyHealth and complete all the Take a Healthy Step (TAHS) requirements, you will receive the maximum $1,000 individual/$2,000 family deductible credit This amount will reduce your annual deductible; however you will still have a deductible remaining.

Upon initial enrollment, you will need to complete the MyHealth Questionnaire within 30 days of your coverage start date. If you enrolled a spouse/domestic partner in your medical coverage, they must also complete the questionnaire within 30 days for your family to earn the maximum medical plan deductible credit. See “Accessing MyHealth” below for instructions. TAHS requirements must be annually earned. Search “Take a Healthy Step” on Infonet for more information.

Wellness memberStaff members who do not receive medical benefits through UPMC are able to participate in a variety of wellness services provided through the MyHealth program at no cost. These wellness services do not include coverage for medical services and have no effect on your medical plan coverage.

Accessing MyHealthGo to HR Direct, then click on the MyHealth OnLine icon to complete the questionnaire. A spouse/domestic partner enrolled in your medical coverage must set up their own account, and must complete the MyHealth Questionnaire by logging in as a member at www.upmchealthplan.com. You may each download the UPMC Health Plan mobile app on your smart phone where you can complete the questionnaire, access ID cards, contact Member Services, view claims, and more.

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Medical Option Comparison

SILVERUPMC Advantage Silver

Deductible

Benefit Band Hourly Rate

Advantage Network

(ind./family)Health Plan Network

(ind./family)

A Below $17.58 $700/$1,400 $1,700/$3,400B $17.58 - $35.13 $800/$1,600 $1,800/$3,600C Above $35.13 $900/$1,800 $1,900/$3,800

Coinsurance

Advantage Network Health Plan Network

You Pay 20% 50%Plan Pays 80% 50%

Out-of-Pocket Maximum

Benefit Band Hourly Rate

Advantage Network

(ind./family)

Health Plan Network (ind./family)

A Below $17.58 $3,050/$6,100 $5,800/$11,600

B $17.58 - $35.13 $3,550/$7,100 $5,800/$11,600

C Above $35.13 $4,050/$8,100 $5,800/$11,600

Copay Services

Services Health Plan Network

PCP Sick Visits $30Specialist $60Urgent Care Visit $50Emergency Room Visit $250

Prescription

30-day supply 90-day supply

Generic $20 $40Preferred Brand $60 $120Non-Preferred Brand $120 $240Specialty $120 n/a

GOLDUPMC Advantage Gold

Deductible

Benefit Band Hourly Rate

Advantage Network

(ind./family)Health Plan Network

(ind./family)

A Below $17.58 $400/$800 $1,000/$2,000B $17.58 - $35.13 $500/$1,000 $1,100/$2,200C Above $35.13 $600/$1,200 $1,200/$2,400

Coinsurance

Advantage Network Health Plan Network

You Pay 10% 40%Plan Pays 90% 60%

Out-of-Pocket Maximum

Benefit Band Hourly Rate

Advantage Network

(ind./family)

Health Plan Network (ind./family)

A Below $17.58 $1,550/$3,100 $4,050/$8,100

B $17.58 - $35.13 $2,050/$4,100 $5,050/$10,100

C Above $35.13 $2,550/$5,100 $5,550/$11,100

Copay Services

Services Health Plan Network

PCP Sick Visits $20Specialist $50Urgent Care Visit $40Emergency Room Visit $200

Prescription

30-day supply 90-day supply

Generic $20 $40Preferred Brand $60 $120Non-Preferred Brand $120 $240Specialty $120 n/a

HSAUPMC Advantage Health Savings Account

Deductible

Advantage Network

(ind./family)Health Plan Network

(ind./family)

Individual $1,850 $4,250Family $3,700 $8,500

Coinsurance

Advantage Network Health Plan Network

You Pay 10% 40%Plan Pays 90% 60%

Out-of-Pocket Maximum

Advantage Network Health Plan Network

Individual $3,600 $5,750

Family $7,200 $11,500

PCP, Specialist, and ED Visits

After Deductible Advantage Network and Health Plan Network

You Pay 10%

Plan Pays 90%

Prescription Drug Costs

Until You Reach Your Deductible

UPMC Health Plan pharmacy

networkYou Pay 100%Plan Pays 0%After Deductible 30-day supply 90-day supplyGeneric $20 $40Preferred Brand $60 $120Non-Preferred Brand $120 $240Specialty $120 n/a

All charts assume the maximum TAHS requirements have been met, resulting in a deductible credit of $1,000 for individual and $2,000 for family coverage. For example, in the Advantage Gold option Benefit Band “B,” the deductible is $1,500 for an individual and $3,000 for family without completing the maximum TAHS requirements.

The Advantage HSA and Extended Network HSA options are high deductible consumer-directed health plans and are the only medical options that are accompanied by a tax-advantaged health savings account, also known as an HSA. All services (including physician office visits and prescription drugs) are subject to the deductible. Once you have met your deductible, all covered medical expenses are paid by the plan at 90% up to the out-of-pocket maximum with one exception: prescriptions are included in the deductible and then require copays after the deductible has been met.

UPMC will contribute into an HSA $1,000 for individual and $2,000 for employee plus dependent coverage in early January if you enroll in the HSA medical option. For newly hired employees, contributions will be prorated depending on your coverage effective date.

Refer to the HSA section on page 7 for information regarding the health savings account. Additional details can be reviewed by searching “HSA” on Infonet.

The Advantage and Extended Network Silver and Gold plans have annual deductible amounts and out-of-pocket maximums based on salary level (called Benefit Bands A, B, and C). Services such as hospital care, lab work, diagnostic imaging, and durable medical equipment are covered at the applicable coinsurance level after the annual deductible has been satisfied, up to the out-of-pocket maximum.

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These plans are not accompanied by a health savings account. However, you may elect a health care flexible spending account (see page 9 for details).

The Advantage Silver, Gold, and HSA are Exclusive Provider Organization (EPO) plans, which means you must use the UPMC Advantage (Level 1) or UPMC Health Plan (Level 2) networks. No coverage is available outside the networks, except for emergencies.

Health Savings AccountA health savings account (HSA) is an individually owned, tax-advantaged savings account designated for qualified medical expenses that is only available when you elect the Advantage or Extended Network HSA medical plan option. An HSA might be right for you whether you wish to pay for current medical expenses with pretax funds or to save for future qualified medical expenses on a tax-favored basis.

Health Savings Account Highlights: • You must be enrolled in the UPMC Advantage or Extended Network HSA medical plan and not have other coverage (e.g., another HMO or PPO type coverage, Medicare, or Tricare, or access to a health care FSA).

• UPMC will contribute to your HSA $1,000 for those enrolled in single HSA medical coverage and $2,000 for those enrolled in any level of family coverage effective Jan. 1 (prorated for enrollments beginning after Jan. 1).

• Additional contributions may be made by you via pretax payroll contributions or directly into your account (up to IRS limits from all contribution sources of $3,600 for individuals and $7,200 for any level of dependent coverage).

• Enjoy triple-tax advantages: contributions, investment earnings, and qualified distributions — all are exempt from federal income tax, FICA (Social Security and Medicare) tax, and state income tax (for most states).

• Deposited funds are held in a bank account, which is owned and managed by you. Access those funds using a debit card, electronic payment to providers or disbursement to yourself.

• Unused HSA dollars roll over from year to year. You own your HSA and can take it with you when you change medical plans, change jobs, or retire.

• Funds in excess of $1,000 in your account not needed for short-term expenses may be invested in money market accounts and mutual funds.

2021 HSA Contributions

Employee Only HSA Coverage

Family HSA Coverage

IRS Maximum Allowed Contribution* $3,600 $7,200

Upfront Account Seeding (enrollments after Jan. 1

are prorated)$1,000 $2,000

Remaining Amount Available for Your

Contributions (from all sources)*

$2,600 $5,200

* Additional catch-up contribution of $1,000 is available when age 55 or older.

Considerations:Only while enrolled in a qualified UPMC high-deductible consumer-directed health plan (CDHP) are you able to contribute to an HSA. The IRS maximum contribution is reduced when not enrolled for the entire calendar year.

Additionally, you cannot be enrolled in any other medical plan that is not a qualified high-deductible health plan.

Disqualifying coverage includes: • Medicare (Part A, B, C, and D)

• Tricare

• Utilization of VA benefits three months prior to enrollment

• Traditional, non-CDHP medical coverage (i.e. HMO or PPO) through a parent, spouse, or partner

• You or a spouse enrolled in general purpose health care FSA (limited purpose FSA is allowed)

Managing an HSA is your responsibility. To read more about the eligibility and information regarding the Health Savings Account, search “HSA” on Infonet.

Prescription DrugsPrescription coverage is included with the UPMC medical benefit options through a broad pharmacy network that includes the following pharmacies: Giant, Giant Eagle, CVS, Rite Aid, Sam’s Club, Walmart, Wegman’s, independent pharmacies, selected UPMC retail hospital pharmacies, and Express Scripts (a home-delivery pharmacy network).

You may use any network pharmacy to fill your prescriptions. The amount of your copayment is determined by the type of pharmacy you use (retail or mail order) and by your decision to choose generic, preferred brand, or nonpreferred brand medications. You may receive a 90-day supply through Express Scripts’ mail order or at a select UPMC hospital pharmacy for two copayments. Specialty medications are limited to a 30-day supply and are subject to the nonpreferred brand copay. Most specialty medications must be filled by Chartwell.

UPMC’s Your Choice pharmacy program offers three different levels of copayment to help you manage your prescription drug costs within a mandatory generic environment.

You are responsible for 100% of the prescription drug costs under the HSA medical options until you reach your deductible. After the annual deductible is met, prescription drugs revert to copayments until you reach your annual out-of-pocket maximum.

When your doctor prescribes a medication, you have the flexibility to choose from several medications in a drug class, depending on the level of copayment you are willing to pay. It is in your best financial interest to shop for the best price.

The medications in the first tier (generic) are available at the lowest copayment. If a generic equivalent medication is not available, you can select a medication from the second tier (preferred brand) at a higher copayment. If a generic equivalent is available and you choose the brand medication, then you will pay the higher copayment plus the difference in cost between the generic and the brand medication. You can also choose a medication from the third tier (nonpreferred brand) at the highest copayment. The decision on which drug will best treat your condition rests with you and your physician. Prior authorization is required for selected medications to ensure appropriate utilization. See the charts on page 6 for copay amounts.

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VisionVision coverage is offered through UPMC Vision Care. You may choose between the Basic Plus and Premier Plus Vision plan options. This coverage is administered through National Vision Administrators (NVA). You should choose from UPMC Vision Care’s extensive network of providers for the greatest benefit. An out-of-network benefit is also included.

Basic Plus Vision CoverageOne exam and frames with lenses or contacts are provided every 24 months for you and your adult dependents age 21 and older. Dependents under age 21 are eligible for an exam and lenses once every 12 months and frames once every 24 months.

UPMC Vision Care Basic Plus Option In-Network1 Out-of-Network2

Benefit

Copayment (applies to lenses) $15 N/A

Examination 100% $30

Lenses (for glasses) - Standard or Plastic. Out-of-Network amount reflects the total amount reimbursed for services.

Single 100% (after $15 copayment) $25

Bifocal 100% (after $15 copayment) $35

Trifocal 100% (after $15 copayment) $45

Polycarbonate (up to age 19) Included Not Covered

Scratch-Resistant Coating (Standard) 100% Not Covered

Blended Bifocal (Segment) 100% Not Covered

Frames

Frames $135 $50

Contact Lenses (in lieu of glasses)

Elective Contact Lens Fitting & Follow-Up3 100%

$20 Daily Wear$30 Extended Wear

$50 Specialty

Contact Lens Material4 $100 $30

Medically Necessary Contact Lenses UCR $200

1 In-Network Vision Providers may also include Participating Vision Providers who choose to use an out-of-network lab. 2 Out-of-network reimbursement is based on Usual, Customary, and Reasonable charges as determined by UPMC Vision Care. Nonparticipating Vision Provider may bill the Member the difference between the provider’s billed charges and the plan allowance. 3 For specialty contact lens evaluation, the provider may bill the 1member the difference between the provider’s billed charges and the plan/member allowance. Participating Vision Provider cannot balance bill for standard lens evaluation when received in-network. 4 Prior Authorization required from NVA.

Premier Plus Vision CoverageThis option provides an eye exam, glasses or contacts with an increased frame allowance once every 12 months. Certain additional lens options are covered at 100% when received from a participating provider.

UPMC Vision Care Premier Plus Option

In-Network1 Out-of-Network2

Benefit

Copayment (applies to lenses) $15 N/A

Examination 100% $40

Lenses (for glasses) - Standard or Plastic. Out-of-Network amount reflects the total amount reimbursed for services.

Single 100% $40

Bifocal 100% $50

Trifocal 100% $75

Polycarbonate (up to age 19) Included Not Covered

Tint 100% Not Covered

UV Coating 100% Not Covered

Scratch-Resistant Coating (Standard) 100% Not Covered

Standard Progressive (Tier 1) 100% Not Covered

Premium Progressive (Tier 2 or 3) 100% Not Covered

Standard A/R Coating (Tier 1) 100% Not Covered

Frames

Frames $150 $50

Contact Lenses (in lieu of glasses)

Elective Contact Lens Fitting & Follow-Up3 100%

$20 Daily Wear$30 Extended Wear

$50 Specialty

Contact Lens Material4 $150 $100

Medically Necessary Contact Lenses UCR $300

This is summary of services offered by the plan. Please refer to your plan documents for more details.

Both the Basic and Premier offer fixed pricing on additional lens options, discounts on balances above frame and contact allowance (may not apply to select proprietary frame brands), a discount benefit when coverage is exhausted, and a mail order contact lens program at www.contactfill.com. Some restrictions may apply.

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DentalDental coverage is offered through UPMC Dental Advantage. Eligible staff may choose between the Standard Dental PPO or the Premium Dental PPO options.

Participating dentists accept the UPMC Dental Advantage reimbursement as payment-in-full for covered services and collect only the applicable deductible and/or coinsurance from the member up to the maximum allowable charge. In addition, dentists file claims on the member’s behalf.

• Diagnostic and preventive services are covered at 100% when using in-network dentists and do not count against your calendar year maximum.

• No referral is necessary to see a specialist. Pre-authorization is encouraged for extensive work so you will know your out-of-pocket expense before incurring the services.

• Child orthodontia is covered. Adult orthodontia is not covered. Pre-authorization is strongly recommended.

• Participants can visit any licensed dentist they choose. However, higher reimbursement levels and greater savings are available when visiting in-network dentists.

• One additional cleaning during the course of pregnancy and additional diagnostic, preventive and periodontal services are offered. These enhancements are included in both the Standard and Premium PPO options.

Dental Option ComparisonCoinsurance percentages apply only after the annual deductible has been met.

Covered Services

Premium Dental PPO Standard Dental PPO

In- Network

Out-of- Network In-Network Out-of-

Network

Annual deductible $0

$50 Individual

$150 Family

$50 Individual*

$150 Family*

$100 Individual

$300 Family

Diagnostic/ preventive services**

100% 80% 100% 80%

Basic services 80% 60% 60% 40%

Major services 50% 40% 40% 20%

Calendar year maximum** $1,500 $1,500 $1,000 $500

Orthodontia (child only) 50% 50% 50% 50%

Lifetime orthodontia maximum

$1,500 $1,500 $1,000 $1,000

* Deductible waived for in-network preventive/diagnostic services.

** Cost of diagnostic and preventive services do not count toward calendar year maximums.

Note: When using out-of-network dentists, the percentages listed above represent the portion of the maximum allowable charge for which the plan will be responsible. The member will be responsible for the balance, including any difference between allowable charges and the fee charged by a non-network dentist.

Flexible Spending AccountsFlexible Spending Accounts (FSAs) are an excellent way to stretch your dollars to pay for out-of-pocket health and dependent care expenses. Both accounts are funded by you with pretax payroll deductions allowing you to save taxes on expenses paid out of the accounts. Estimate your anticipated expenses carefully before electing an FSA. Annual contributions do not carry over from one year to the next so you will forfeit any unused portion of your account at the end of the plan year. You must re-elect this benefit each year during Open Enrollment.

Health Care FSAYou may elect the health care FSA if you are enrolled in the UPMC Silver or Gold medical options, or if you have waived medical coverage. You may use it to pay for your and your tax-qualified dependents’ expenses. A debit card is provided to charge eligible expenses against your account balance, and the amount you pledge is added to the account on the effective date of coverage. Health care FSA balances not used by the end of the grace period following the plan year are forfeited in compliance with IRS rules. The IRS stipulates an annual contribution limit. Currently this limit is $2,750.

Eligible expenses include but are not limited to:

• Unreimbursed medical, dental, or vision expenses

• Copay and coinsurance expenses

• Unreimbursed orthodontia expenses

• Hearing aids and exams

• Laser eye surgery

Save your receipts. The IRS requires documentation of your expenses so you may be asked to submit a receipt after using the FSA debit card or need it to file a paper claim.

Dependent Care FSAYou may use the dependent care FSA to pay for day care (including in-home care) for dependents under age 13 or over age 13 if disabled and/or for elder care expenses while you or your spouse are at work or school. Unlike the health care FSA, you must have your payroll deductions posted in your account before you can file a claim and you must have a receipt showing that you have already paid for the expenses for which you are requesting a reimbursement. There is an annual limit of $5,000 per household.

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Life InsuranceTo help protect family financial security, UPMC provides eligible staff with basic term life and accidental death and dismemberment (AD&D) insurance. UPMC pays the premiums. In addition to the coverage provided by UPMC, staff may purchase additional protection for themselves and eligible family members.

Life coverage Coverage levels

Basic life and AD&D Base annual salary

Supplemental life One to five times base annual for staff salary up to $1 million

Supplemental life for In $10,000 increments spouse/domestic partner up to $100,000

Supplemental AD&D for staff $10,000 or $50,000, then in $50,000 increments to $500,000, then $100,000 increments up to $1 million

Supplemental AD&D for $25,000 or $50,000, then in spouse/domestic partner $50,000 increments up to $500,000

Supplemental life and AD&D $10,000 per child for children

Note: Proof of good health and insurance carrier approval (Evidence of Insurability) is required for initial elections over plan limits and some increases in coverage.

Eligible staff may purchase voluntary Manhattan (Humana) Whole Life for an additional benefit. For more information, call UPMC DirectLink at 1-800-994-2752, option 5.

DisabilityTo help protect your income in the event of an unforeseen illness or injury, UPMC provides eligible full-time, flexible full-time, and job-share staff working 20 hours per week or more with basic short-term disability (STD) and long-term disability (LTD) insurance.

STD LTD

Benefits begin 8th day* 181st day*

Duration Up to 26 weeks Up to age 65**

Basic coverage 60% 60% (UPMC pays)

Maximum No limit $15,000 per month

* Must be actively employed when the disability begins. ** May extend beyond age 65 if disability began at or after age 60.

Full-time, flexible full-time, job-share, and eligible part-time staff with 20 or more authorized hours can purchase voluntary supplemental STD coverage for a greater benefit. Contact a Voluntary Benefits representative at 1-800-994-2752, option 5, for more details.

Paid Time Off UPMC recognizes the need for staff to receive pay for vacation, sick, and personal time. The paid time off (PTO) program allows staff to earn PTO benefits that provide the flexibility to take care of the things they consider important.

PTO accrues based on staffing classification, years of service, and hours worked according to schedules for nonexempt staff, exempt staff, and executive staff.

Full-time, flexible full-time, and job-share maximum annual PTO accrual*

Years of Typically Typically Directors/ service nonexempt exempt Dept. Heads

0–5 17 days 22 days 27 days

5–15 22 days 27 days 27 days

15+ 27 days 27 days 27 days

Regular and limited part-time maximum annual PTO accrual, based on hours worked*

Years of Typically Typically Directors/ service nonexempt exempt Dept. Heads

0–5 14 days 19 days 24 days

5–15 19 days 24 days 24 days

15+ 24 days 24 days 24 days

You may accrue up to 1.5 times your maximum annual accrual amount. At that point, you stop accruing PTO until you start using your time.

PTO Buy ProgramEligible staff members may purchase an additional 8 to 40 hours of PTO per year in four-hour increments. Purchase must be made at initial hire and/or during open enrollment and is deducted from each paycheck. PTO Buy is just like earned PTO, with the exception that PTO is not accrued on PTO Buy. PTO available for Paid Parental Leave, Holiday Unused and your PTO Balance will be used prior to PTO Buy. Purchased PTO must be used before the final pay period of December. If not, the remaining balance of purchased PTO will be paid to you in the final paycheck of the year. In a year in which you buy PTO and then terminate before the end of the year, you will be required to pay back bought hours that were used if you are not vested**.

PTO Buy must be elected annually during Open Enrollment.

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PTO Sell ProgramEach year, those who are eligible*** may sell up to 40 hours of vested** PTO. Hours are sold in eight-hour increments. You must have a balance of at least 80 hours after you sell PTO. You may not buy and sell PTO in the same calendar year. PTO sold during the annual open enrollment period is paid out in full, less applicable taxes, in January, provided you have a balance of 80 hours remaining after the sell. Time sold during the year is paid out at 94% less applicable taxes of the value of PTO.

* PTO accruals are based on the number of eligible hours, up to a maximum of 80 eligible hours per pay period for staff members on the biweekly pay cycle and 173.33 eligible hours per pay period for staff members on the monthly pay cycle. Accrual schedules may not apply to all staff.

** You are vested after 3 years of service.

*** Vice President and above level are not permitted to sell or donate PTO.

HolidaysPaid holiday time is a valuable part of your benefits package.Contact your Human Resources representative to verify the holidays that are recognized by your location. UPMC generally recognizes these seven holidays:

• New Year’s Day

• Martin Luther King Jr. Day

• Memorial Day

• Independence Day

• Labor Day

• Thanksgiving

• Christmas

The maximum amount of holiday pay a staff member can receive on an annual basis is 56 hours of holiday time off per year. Full-time, flexible full-time and job share staff are eligible for paid holiday time. Full-time, flexible full-time, and job share staff who work less than 40 hours per week will receive a prorated portion of holiday pay, based upon the standard hours of the position. If you work a holiday, this time will be deposited into a “Holiday Unused” account and will be used on your next day off.

Employee Assistance Program LifeSolutions, an employee assistance program, is a free, confidential resource that offers assistance with personal or professional matters that may interfere with job performance or personal satisfaction. It’s LifeSolutions goal to help balance your work, life, and wellness. To learn more about services offered, contact LifeSolutions at 1-800-994-2752, option 6 or log in to the LifeSolutions website when you search “LifeSolutions” on Infonet.

Qualified Transportation AccountsQualified transportation accounts (QTAs) allow you to save money when you set aside pretax funds from your pay into dedicated accounts for eligible commuting expenses. UPMC offers both commuter transit and commuter parking accounts to help with these expenses. You may elect up to $270 per month per account. If you separately park and take transit, you may elect both accounts. (The IRS periodically reviews the maximum monthly amount, so it could change in the future.)

• Staff who park at a public or private lot near their work or transit for which a UPMC pretax payroll deduction is not available may elect a commuter parking account.

• Staff who commute to work by vanpool or mass transit may elect a commuter transit account.

You may enroll* or change your elections at any time (submissions made by the 15th of the month take effect for the following month). You remain enrolled in the account until you elect to stop contributions, your employment with UPMC ends, or you transfer into an ineligible job status (casual, limited part-time, or temporary).

After payroll deductions begin, you may use the UPMC Consumer Advantage Visa debit card mailed to your home address for your expenses. Alternatively, you may submit reimbursement claims** within 120 days of the date of service for reimbursement up to the amount of your account balance and IRS maximum of $265 each month per account.

* Search “voluntary benefits” on Infonet to access the link to enroll.

** Search “MyHealth OnLine” on Infonet then under Your Insurance, select Health Savings and Spending Accounts > Visit UPMC Consumer Advantage Portal > File a Claim.

Note: If you have a pretax parking lease deducted from your pay, you are not eligible to participate in a commuter parking account. The funds in each account cannot be transferred between accounts. Parking for family members, gas/mileage, or other transit expenses are not eligible. Staff whose job status is temporary, casual, or limited part-time are not eligible to participate in this program.

Paid Parental LeaveUPMC supports the importance of providing assistance to staff members who become new parents through the birth, adoption or foster care placement of a child by offering Paid Parental Leave to encourage and support baby bonding.

Full-time, flexible full-time, job-share and regular part-time employees are eligible for a Paid Parental Leave benefit on the first of the month following date of hire. This leave is paid at 100% of base salary up to a maximum of two weeks (10 days). Flexible full-time, job-share, and part-time staff members will receive a pro-rated amount of leave based on their full time equivalent value relative to a 40-hour work week.

This leave is available to both new mothers and new fathers. It may be used after Short-Term Disability (STD) benefits have ended (if applicable) or in lieu of a portion of STD, after the first 40 hours following the birth. The Paid Parental Leave must be used within 12 weeks following the date of birth, adoption or child care placement while on FMLA, Personal Leave or Parental Leave. If both parents work at UPMC, they will each be eligible for this paid benefit separately.

Search “Paid Parental Leave” on Infonet for additional details.

Other BenefitsUPMC offers several additional benefits including:

• adoption assistance

• carpooling

• credit union

• pretax payroll deductions for parking

• UPMC Perks — discounts offered to UPMC staff, physicians, and volunteers on merchandise, recreation and services. Search “perks” on Infonet to access national, regional, and local discounts.

• Tuition loan refinancing and consolidation. Search “student loan” on Infonet.

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Retirement ProgramFor most UPMC locations, the retirement program consists of two plans — the Cash Balance Plan and the Savings Plan — that work together to provide retirement income.

Savings Plan You can contribute to the Savings Plan on a pretax, Roth, and/or after-tax basis up to the annual IRS limits. Pretax and Roth contributions are subject to IRS 402g limits, which are available at https://irs.gov/retirement-plans/plan-participant-employee retirement-topics-contributions. You are immediately eligible to participate in this plan and you must take action to enroll*. You can make contributions to the plan by a percentage of pay or a flat dollar amount. Once eligible, UPMC matches a portion of your contributions. The amount of match you receive depends on the UPMC facility at which you are employed. You can save on taxes in several ways: on pre-tax contributions, tax-deferred growth, and tax-free income in retirement (Roth). You have the opportunity to choose among several investment options, including Target Retirement Funds, to invest your contributions and UPMC’s matching contributions. You may change your election or investment options at any time. Although you are always 100% vested in your contributions, you become fully vested in UPMC’s matching contributions after you complete three years of vesting service. You earn a year of vesting service for each year in which you are paid for at least 1,000 hours.

* Regular full-time and part-time staff at UPMC Centers for Rehab Services, UPMC Cole OPEIU Local 112, Mon Yough Community Services, Safe Harbor Behavioral Health of UPMC Hamot, and WCA Services (collectively bargained staff) are automatically enrolled with a 6% contribution.

Cash Balance PlanThis is an employer paid pension plan and participation is automatic; you do not have to enroll. Your participation begins on January 1 or July 1 after you attain age 21 and complete 1,000 hours of service. You receive a retirement credit based on your annual earnings, age, years of service determined at the end of the previous year, and the UPMC facility in which you are employed. Your retirement credits grow based on the 30-year Treasury security rate.

You will be 100% vested in your Cash Balance account after you complete three years of vesting service. You earn a year of vesting service for each year in which you are paid for at least 1,000 hours.

Note: Some staff members are not eligible to participate in the Cash Balance Plan due to staffing classification, hours worked, or company affiliation. Eligibility can be verified through Human Resources or when you search “retirement” on Infonet to access the link to the UPMC Retirement Center website.

How the Cash Balance Plan and Savings Plan work togetherIf you take full advantage of UPMC’s matching contributions under the Savings Plan, the Cash Balance and Savings Plan combine to provide you with annual benefits of 5.5 to 8% of your eligible pay, up to the annual IRS limits. To be eligible for the Cash Balance Plan and the matching contribution feature of the Savings Plan, you need to be at least age 21 and complete 1,000 hours of service with UPMC.

Although you can begin to contribute to the Savings Plan immediately after your date of hire, you receive matching contributions to the Savings Plan and begin participating in the Cash Balance Plan the Jan. 1 or July 1 after meeting the eligibility requirements. See the chart below for UPMC’s contributions to your retirement program. The contributions UPMC makes to your retirement program are in addition to any contributions you make to the Savings Plan.

Age & service* Total UPMC contribution**

Less than 36 5.5%

36–49 6.0%

50–69 7.0%

70 or more 8.0%

* Determined as of Dec. 31 of prior calendar year.

** Assuming you contribute enough eligible pay to the Savings Plan to receive the maximum matching contribution.

While the Cash Balance Plan grows with interest based on the prevailing 30-year U.S. Treasury bond rate, you have the opportunity to invest your Savings Plan account in a variety of investment options.

Review the information on the next page to determine your UPMC retirement benefit components.

Accessing your retirement information Search “retirement” on Infonet or select “My Retirement” on HR Direct to access the UPMC Retirement Center website.

You also can contact the UPMC Retirement Center through UPMC DirectLink at 1-800-994-2752; press option 1, then press option 1 again.

Retirement HelpUPMC partners with Alight Financial Advisors to offer education, guidance, and support that can make it easier to manage your UPMC Savings Plan investments. Online Advice, educational workshops, and one-on-one meetings with an on-site Financial Advisor are available at no cost to you. Professional Management, a fee-for-service managed account program that puts your portfolio in the hands of experts, is also available. An independent, unbiased investment advisor will provide personalized planning and account management for a quarterly fee based on the size of your UPMC Savings Plan account. Search “retirement” on Infonet to access the Retirement Center website, then select The Investment Help You Want,or call a Financial Advisor at the UPMC Retirement Center.

UPMC has partnered with Alight Financial Advisors, LLC (AFA) to provide investment advisory services to plan participants. AFA has hired Financial Engines Advisors L.L.C. (FEA) to provide sub-advisory services. AFA is a federally registered investment advisor and wholly owned subsidiary of Alight Solutions LLC. FEA is a federally registered investment advisor and wholly owned subsidiary of Financial Engines, Inc. Neither AFA nor FEA guarantee future results.

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Urban Plan Design

Age & Years of Service1

Annual Cash Balance Retirement Credit

Savings Plan Match2

Total Retirement Benefit Provided

< 36 2.5% of pay 3.0% of pay 5.5% of pay 36-49 3.0% of pay 3.0% of pay 6.0% of pay 50-69 4.0% of pay 3.0% of pay 7.0% of pay 70 + 5.0% of pay 3.0% of pay 8.0% of pay

1Age plus years of service (1,000 paid hours each year) as of previous Dec. 31. 2Assumes you contribute at least 6% to receive the maximum 3% match. Urban facilities include: Children's Hospital of Pittsburgh of UPMC, Corporate Services, Home Nursing Agency, UPMC Magee-Womens Hospital, UPMC Altoona, UPMC Cancer Centers, UPMC Cole, UPMC Community Provider Services, UPMC Chautauqua WCA, UPMC East, UPMC Hamot, UPMC Home Health, UPMC International and Commercial Services Division, UPMC Insurance Services Division, UPMC Jameson, UPMC/Jefferson Regional Home Health, UPMC Kane, UPMC Mercy, UPMC Northwest, UPMC Physician Services Division, UPMC Pinnacle, UPMC Presbyterian/Shadyside, UPMC Somerset*, UPMC Susquehanna, UPMC Western Maryland, and UPMC Western Psychiatric Hospital. *At the time of this publication, the Health Care PSEA contract was not finalized. Employees in that group should reference contract terms for retirement plan benefits upon ratification.

Community Plan Design

Age & Years of Service3

Annual Cash Balance Retirement Credit

Savings Plan Match4

Total Retirement Benefit Provided

< 36 3.5% of pay 2.0% of pay 5.5% of pay 36-49 4.0% of pay 2.0% of pay 6.0% of pay 50-69 5.0% of pay 2.0% of pay 7.0% of pay 70 + 6.0% of pay 2.0% of pay 8.0% of pay

3Age plus years of service (1,000 paid hours each year) as of previous Dec. 31. 4Assumes you contribute at least 4% to receive the maximum 2% match.

Community facilities include: UPMC Horizon, UPMC McKeesport, UPMC Passavant, UPMC Senior Communities, and UPMC St. Margaret. UPMC CENTERS FOR REHAB SERVICES, UPMC COLE OPEIU LOCAL 112, MON YOUGH COMMUNITY SERVICES, SAFE HARBOR BEHAVIORAL HEALTH OF UPMC HAMOT, AND W.C.A. SERVICES Upon hire, you are automatically enrolled in the UPMC Savings Plan at a 6% pretax contribution. You have the ability to make a change to your election or investment direction at any time. You are eligible to receive matching contributions on January 1 or July 1 after you attain age 21 and complete 1,000 hours of service. You will be matched 50 percent of your contributions up to 6 percent of pay (3 percent match). Your retirement benefit is limited to the Savings Plan based on comparative market conditions. Benefits described may not be applicable to all staff. Some business units and job classifications have unique benefit programs that may affect eligibility. Actual plan provisions are contained in plan documents, agreements of insurance, and the Summary Plan Description. Physicians and collectively bargained staff should additionally reference contract terms. UPMC reserves the right to interpret, suspend, amend, or terminate the Plan at any time. Specific benefit related questions should be directed to the UPMC Retirement Center at 1-800-994-2752, option 1.

UPMC Retirement Benefits

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Tuition AssistanceUPMC’s tuition assistance program provides financial assistance to eligible full-time, flexible full-time, job share, and regular part-time staff members, their dependent children, spouses, and domestic partners who wish to enhance their careers or further their education.

UPMC is committed to excellence in patient care, research, and education. Through this benefit, we are helping to educate tomorrow’s workforce and keep top talent in our region, enriching our staff, their families, and our communities.

Staff members:Eligible out-of-pocket tuition costs will be reimbursed 100% for any accredited institution. Studies must be relevant to a career within the health system.

For each academic calendar year, full-time and flexible full-time staff can receive up to $6,000, whereas regular part-time and job share staff will be eligible for $3,000. This benefit is subject to state, local, and federal taxes. The academic calendar year is August 1 through July 31.

Dependent child/spouse/domestic partner:Eligible staff members may receive a tuition assistance benefit for spouses, domestic partners, or dependent children pursuing up to their first baccalaureate degree at:

• University of Pittsburgh or a community college

• Health care related program at a technical school

• All other schools not eligible

• Eligibility begins after one year of service, provided the class start date begins on or after the eligibility date. Dependent children must attend on a full-time basis. Spouses or domestic partners may attend part-time or full-time. This benefit is subject to state, local, federal, and FICA tax.

Student Assistance Percentage*

Academic Year Maximum

Dependent child

50% for all eligible staff

$6,000 full-time and flexible full-time staff;

$3,000 job share and part-time staff

Spouse or domestic partner

$2,000 full-time and flexible full-time staff;

$1,000 job share and part-time staff

* Tuition only — books, fees, and other costs are not eligible. Must obtain a grade of “C” or higher to be eligible for tuition assistance.

** Academic year maximum is based on classes taken between August and July of the following year.

Repayment of tuition assistance is required for staff leaving UPMC or changing to a benefit ineligible employment status within 12 months of the course completion date. Search “tuition” on Infonet for forms, complete eligibility criteria, and additional details.

Voluntary BenefitsUPMC offers more options to help provide employees with additional financial security through 100% employee-paid voluntary programs at discounted group rates. These voluntary programs provide supplemental coverage in addition to the benefits provided by UPMC.

Premium payments are automatically withheld through payroll deductions. Voluntary programs are portable, allowing you to continue coverage through direct billing if you change to an ineligible job status or leave UPMC.

All voluntary products are available through payroll deduction and completely funded by the employee. Participation in the voluntary products is at the discretion of the employee. UPMC presents the programs to provide additional choices. The decision to enroll is exclusively up to the staff member based on his or her individual circumstances.

How to Enroll in Voluntary BenefitsYou may enroll in or make changes to the voluntary programs at any time, with the exception of the AFLAC Accident Advantage Plan (available when first eligible or during the annual Open Enrollment). If you enroll by the 15th of the month, the benefit is effective the 1st of the following month. Search “voluntary benefits” on Infonet to access the link to enroll.

Voluntary Program Paid by Payroll deduction

AFLAC Personal Staff After tax Short-Term Disability

AFLAC Accident Advantage Plan Staff Pretax

AFLAC Group Critical Illness Staff After tax

Cigna Hospital Care Staff After tax

Manhattan (Humana) Whole Life Staff After tax

MetLife (Hyatt) Legal Plans Staff After tax

LifeLock with Norton Staff After tax

To learn more and enroll in these plans, contact UPMC Education and Enrollment Services at 1- 800-994-2752, option 5 or appointment@brianpattenandassociates.com.

LifeLock with Norton • Provides a comprehensive set of features to protect your identity, personal information, and connected devices from the threats you may face in your digitally-connected home and workplace.

• LifeLock with Norton Benefit Essential includes identity theft protection and Norton device/online security which will cover up to 3 devices (6 for family), SafeCam, password manager, and a 10 GB cloud backup.

• LifeLock with Norton Benefit Premier includes additional services of three-bureau credit reports, Norton device/online security which will cover up to 5 devices (10 for family), SafeCam, password manager, and a 50 GB cloud backup.

Both plans offer additional features which are available when you search “LifeLock” on Infonet.

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AFLAC Personal Short-Term Disability Plan* • Provides you with a source of income if you become disabled due to sickness or off-the-job injury.

• Provides additional income replacement above the 60% provided by UPMC for full-time staff. No more than 72% of income replacement is guaranteed. The total benefit available for New York residents includes the New York State Disability Benefit.

• You must work at least 20 hours per week at UPMC. • Disabilities resulting from a pre-existing condition will not be covered for the first 12 months.

• Disability benefits for childbirth will be payable after the policy has been in force 10 months.

• Part-time employees working 20 hours per week or more and not eligible for the UPMC disability program can purchase up to a full disability benefit.

*This benefit does not apply to any physician, resident/fellow, or staff member with salary continuation.

AFLAC Accident Advantage Plan* • Helps cover expenses associated with accidental injury. • Family coverage is available.

• Benefits are paid directly to you unless otherwise specified.

• Benefits are paid regardless of any other insurance.

*New York residents are eligible for accident specific benefits.

AFLAC Group Critical Illness • Lump-sum benefit paid directly to the insured (unless otherwise assigned) for the treatment costs of covered critical illnesses, such as cancer, a heart attack, or a stroke.

• Designed to supplement your existing medical benefits. • Employees between ages 18 to 69 are eligible for benefit amounts from $5,000 to $50,000.

• Spouse/domestic partner coverage is also available in benefit amounts up to $50,000.

• Each dependent child up to age 26 is covered at 50% of the primary insured’s benefit amount at no additional charge.

• The plan has a 30-day waiting period. • Annual health screening benefit of $50 per calendar year. • Premiums do not increase with age; benefits do not reduce at age 70. • Initial coverage is available without answering health questions (up to $30,000) if you apply when you are first eligible.

MetLife (Hyatt) Legal Plans • Provides access to a national network of 12,000 attorneys, for a wide range of legal services.

• Provides face-to-face legal advice and consultation on a number of issues, including:

> General legal advice, document review and preparation

> Standard and living will preparation

> Family and personal > Home and real estate > Financial matters > Small claims assistance

• Legal services provided in an attorney’s office. You select a network attorney in your area. Attorney fees paid in full for most covered matters.

• Coverage includes access to self-help information and Law Firm E-panel.

• Staff must commit to remain in this plan through the calendar year.

Manhattan (Humana) Whole Life* • Part of your premium goes into a cash reserve that you can typically access at any time, for any purpose.

• Coverage amounts vary. When you are first eligible, you may choose from $2,500 to $125,000 up to age 50, and $70,000 for age 51+ without answering health questions.

• Premium rates are based on your age at the effective date of the policy. Rates will not increase unless you make policy changes.

• Spouse/domestic partner coverage is available even if you do not elect a policy. Coverage amount of $2,500 to $10,000 is guaranteed issue without answering health questions, with a $50,000 maximum.

• Accidental death, dismemberment and loss of sight (AD&D) is available for employee and/or spouse/domestic partner up to age 60.

• You may elect to age 65 for each eligible dependent child, up to age 24. Coverage amount of $2,500 to $10,000 is guaranteed issue with no medical questions, upon initial offering. Maximum available coverage is $25,000.

*New York residents are not eligible.

Cigna Hospital Care CoverageThis plan pays benefits for hospitalizations resulting from a covered injury or illness. Benefits are available for hospital admission, chronic condition admission, stay, intensive care unit stay, observation stay. You may elect coverage for yourself and dependents.

More information about each plan is available by searching the plan name on Infonet.

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Advantage HSA $50.77 $96.46 $110.77 $112.15 $119.08 $242.77 $302.77 $318.00

Advantage Silver $16.62 $37.85 $47.54 $54.92 $68.31 $144.92 $191.54 $207.23

Advantage Gold $50.77 $99.23 $135.69 $143.08 $142.15 $294.46 $394.62 $421.38

Extended Network HSA1 $58.62 $110.77 $127.38 $128.77 $156.92 $319.85 $400.15 $420.92

Extended Network Silver1 $18.92 $43.38 $54.46 $63.23 $90.92 $193.38 $255.69 $276.92

Extended Network Gold1 $58.62 $114.00 $156.00 $164.77 $177.23 $366.46 $491.08 $524.77

Basic Bronze2 9.83% of defined pay

EE only + $371.90

EE only + $626.59

EE only + $707.43

Extended Network Bronze1, 29.83% of

defined payEE only + $427.70

EE only + $720.59

EE only + $813.55

Employee Only

Employee & Children

Employee & Spouse

Employee & Family

Employee Only

Employee & Children

Employee & Spouse

Employee & Family

Basic Plus $0.46 $0.92 $1.15 $1.38 $0.46 $0.92 $1.15 $1.38

Premier Plus $2.95 $4.42 $5.26 $6.79 $2.95 $4.42 $5.26 $6.79

Employee Only

Employee & Children

Employee & Spouse

Employee & Family

Employee Only

Employee & Children

Employee & Spouse

Employee & Family

Standard $4.62 $16.38 $16.38 $16.38 $6.00 $17.54 $17.54 $17.54

Premium $10.15 $31.85 $31.85 $31.85 $11.54 $34.15 $34.15 $34.15

Cigna

Under age 30Age 30-39Age 40-44Age 45-49Age 50-54Age 55-59Age 60-64Age 65-69Age 70+

$0.602 $0.837

$0.056$0.047

$0.254$0.404 $0.564

**The Basic Bronze medical options are only offered to Job Share and Regular Part-Time employees; as well as Limited Casual and Limited Part-Time employees working an average of 30 or more hours per week. Bronze rates are monthly premiums.

Vision

$0.902 $1.260

Full-Time and Flexible Full-Time Job Share and Regular Part-Time

Dental

$0.094

UPMC Dental AdvantageFull-Time and Flexible Full-Time Job Share and Regular Part-Time

UPMC Vision Care

$0.132$0.141 $0.197

$.20 per $10,000 of coverage

Supplemental Life and Accidental Death & Dismemberment (Monthly Rate)Supplemental Employee

Life (Per $1,000 of coverage)

Supplemental life and spousal life rates are based on your and your spouse's age as of January 1. The supplemental life rate is also

based on your salary.

Supplemental Employee AD&D

Spouse/Domestic Partner AD&D

$1.918 $2.670

$0.357

Spouse/Domestic Partner Life

(Per $1,000 of coverage)

$.14 per $10,000 of coverage

$0.075

Dependent Child Life & AD&D $1.54 $10,000

$0.047

UPMC 2021 Bi-Weekly Staff Member Contributions

*Extended Network medical options are only available to those employees living in excess of 30 miles outside of the UPMC Advantage network. Please refer to your enrollment for eligibility.

Not Applicable

Medical

UPMC Health PlanJob Share and Regular Part-Time

Employee Only

Full-Time and Flexible Full-TimeEmployee

& ChildrenEmployee & Spouse

Employee & Family

Employee Only

Employee & Children

Employee & Spouse

Employee & Family

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Advantage HSA $110.00 $209.00 $240.00 $243.00 $258.00 $526.00 $656.00 $689.00

Advantage Silver $36.00 $82.00 $103.00 $119.00 $148.00 $314.00 $415.00 $449.00

Advantage Gold $110.00 $215.00 $294.00 $310.00 $308.00 $638.00 $855.00 $913.00

Extended Network HSA1 $127.00 $240.00 $276.00 $279.00 $340.00 $693.00 $867.00 $912.00

Extended Network Silver1 $41.00 $94.00 $118.00 $137.00 $197.00 $419.00 $554.00 $600.00

Extended Network Gold1 $127.00 $247.00 $338.00 $357.00 $384.00 $794.00 $1,064.00 $1,137.00

Basic Bronze2 9.83% of defined pay

EE only + $371.90

EE only + $626.59

EE only + $707.43

Extended Network Bronze1, 29.83% of

defined payEE only + $427.70

EE only + $720.59

EE only + $813.55

Employee Only

Employee & Children

Employee & Spouse

Employee & Family

Employee Only

Employee & Children

Employee & Spouse

Employee & Family

Basic Plus $1.00 $2.00 $2.50 $3.00 $1.00 $2.00 $2.50 $3.00

Premier Plus $6.40 $9.58 $11.40 $14.72 $6.40 $9.58 $11.40 $14.72

Employee Only

Employee & Children

Employee & Spouse

Employee & Family

Employee Only

Employee & Children

Employee & Spouse

Employee & Family

Standard $10.00 $35.50 $35.50 $35.50 $13.00 $38.00 $38.00 $38.00

Premium $22.00 $69.00 $69.00 $69.00 $25.00 $74.00 $74.00 $74.00

Cigna

Under age 30Age 30-39Age 40-44Age 45-49Age 50-54Age 55-59Age 60-64Age 65-69Age 70+

$0.602 $0.837

$0.141 $0.197

$0.404 $0.564$0.254 $0.357

Supplemental life and spousal life rates are based on your and your spouse's age as of January 1. The supplemental life rate is also

based on your salary.

$0.902 $1.260$1.918 $2.670

$0.075$0.094 $0.132

$.14 per $10,000 of coverage

Supplemental Life and Accidental Death & Dismemberment Supplemental Employee

Life (Per $1,000 of coverage)

Spouse/Domestic Partner Life

(Per $1,000 of coverage)

Supplemental Employee AD&D

$0.047 $0.056Spouse/Domestic Partner

AD&D$.20 per $10,000 of

coverage$0.047

Not Applicable

UPMC Dental AdvantageFull-Time and Flexible Full-Time Job Share and Regular Part-Time

Employee & Children

Employee & Spouse

Employee & Family

Vision

UPMC Vision CareFull-Time and Flexible Full-Time Job Share and Regular Part-Time

Dependent Child Life & AD&D $10,000 $1.54

UPMC 2021 Monthly Staff Member Contributions

1,2The Basic Bronze medical options are only offered to Job Share and Regular Part-Time employees; as well as Limited Casual and Limited Part-Time employees working an average of 30 or more hours per week.

1Extended Network medical options are only available to those employees living in excess of 30 miles outside of the UPMC Advantage network. Please refer to your enrollment for eligibility.

Dental

Medical

UPMC Health PlanFull-Time and Flexible Full-Time Job Share and Regular Part-Time

Employee Only

Employee & Children

Employee & Spouse

Employee & Family

Employee Only

18

Your Benefits Rights

Pages 19-29 provide you with information regarding government and state mandated notices that the UPMC Health and Welfare Benefits Plan complies with for your protection as a UPMC employee.

Further details and information can be found in the UPMC Health and Welfare Summary Plan Description (SPD), which is available by searching “SPD” on Infonet.

You may request a printed copy of the SPD via DirectLink at 1-800-994-2752, option 3, or by writing to:

UPMC Employee Service Center U.S. Steel Tower, Floor 56 600 Grant Street Pittsburgh, PA 15219

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HIPAA Special Enrollment Rights HIPAA provides for certain enrollment opportunities where in the future you may be able to enroll yourself and your dependents (including your spouse): 1) if you decline enrollment for yourself and/or yourdependents because you have other coverage and that coverage later ends due to a loss of eligibility (or if the employer stops contributing toward your or your dependents’ other coverage); 2) if you have a new dependent as a result of marriage, birth, adoption, or placement for adoption; or 3) if you or your dependents are notified of a loss or gain of eligibility for coverage or premium assistance under Medicaid or Children’s Health Insurance Program (CHIP) as explained below.

UPMC Welfare Benefits Plan

Notice of Privacy Practices for Protected Health Information

This notice is required by federal law. It describes how medical information about you may be used and disclosed and how you can get access to this information. Please review this documents carefully.

Further InformationThere is no need for you to respond to this notice. Federal law establishes privacy standards and requires that the UPMC Welfare Benefits Plan provide to you a summary of our Privacy Policy. For additional information, you may contact the Employee Service Center toll-free at 800-994-2752, option 3. You may also obtain a copy of this notice on Infonet.

Please note that a notice was originally issued effective Monday, April 14, 2003, and this revised notice is now issued to be effective Oct. 1, 2020.UPMC Office of Patient and Consumer Privacy US Steel Tower, Floor 58 600 Grant Street Pittsburgh, PA 15219 412-647-5757

Schedule A: List of ProvidersIf you want more information about your privacy rights, do not understand your privacy rights, are concerned that your privacy rights have been violated, or disagree with a decision that was made regarding access to your confidential information, you may contact the following applicable privacy offices.

UPMC and UPMC Welfare Benefits Plan AdministrationUPMC Welfare Benefits Plan Privacy OfficerUS Steel Tower, Floor 56 600 Grant Street Pittsburgh, PA 15219 412-647-5757

Employee Assistance Program LifeSolutions HIPAA and Privacy AdministrationUS Steel Tower, Floor 8 600 Grant Street Pittsburgh, PA 15219 1-800-647-3327

Medical, dental, vision, prescription drug coverage, and health care flexible spending accountUPMC Health Plan Privacy OfficerU.S. Steel Tower, Floor 55 600 Grant Street Pittsburgh, PA 15219 1-877-574-5517 (toll-free)

20

UPMC, as the plan administrator of the UPMC Welfare Benefits Plan, strongly believes in protecting the confidentiality and security of information that is collected regarding plan participants and their covered dependents in an effort to administer health and welfare benefits. We want to assure you that we will continue to uphold our obligation to protect this information. The following notice, which is based on federal law governing health privacy and on our own high standards of confidentiality, describes how information received regarding plan participants and their dependents covered through the UPMC Welfare Benefits Plan is handled. The UPMC Welfare Benefits Plan includes the following plan coverages that are subject to the Health Insurance Portability and Accountability Act (HIPAA):

Medical • Employee Assistance Program • Prescription Drug • Health Care Flexible Spending Account • Vision • Dental

(Each of these plans individually is referred to herein as the “Plan.”) Any other coverage offered under the UPMC Welfare Benefits Plan that is not listed above is not subject to HIPAA.

Protection of PHIProtected health information (PHI) means any nonpublic, individually identifiable health and other benefits-related information (including genetic information) transmitted or maintained by or on behalf of the Plan, without regard to what form (oral, written, or electronic) it may be. PHI may include information regarding your health status, including diagnosis, treatment and claims payment, or the fact that you are enrolled in or have participated in the Plan.

Security of EPHIThe Plan and third parties acting on behalf of the Plan (referred to as “business associates”) will implement administrative, physical and technical safeguards that reasonably and appropriately protect the confidentiality, integrity and availability of your electronic PHI (“EPHI”) that it creates, receives, maintains or transmits.

Collection and Use of PHIPHI that is collected will be used by UPMC personnel, representatives, and trusted third parties, such as insurance carriers and administrators, who are authorized to act on behalf of the Plan. In the event the Plan needs to verify or collect additional information, the Plan may obtain information from third parties such as adult family members, physicians, health system personnel, or other insurers with prior authorization from the individual in question. Individuals acting on behalf of the Plan are required to protect the confidentiality of any PHI. The Plan and its business associates are required to maintain physical, electronic, and procedural safeguards to ensure the protection of PHI and to ensure these safeguards comply with all applicable laws. The Plan will not disclose any PHI about you except as authorized by law, as described in this notice, or as otherwise communicated to you. The Plan will notify you within 60 days if the Plan makes any material changes to this notice.

Disclosure of PHIThe UPMC Welfare Benefits Plan is permitted by federal privacy laws to use and disclose your PHI for purposes of treatment, payment, and health care operations. The Plan does not disclose any PHI unless the Plan believes it is necessary for the administration of the Plan or where disclosure is required by law. There are some circumstances when

the Plan will disclose PHI related to medical underwriting or claims administration without authorization to third parties or affiliates assisting us with claims management, as permitted by law. Without exception, however, the Plan will never use your genetic information for underwriting purposes.

The Plan also will disclose PHI to third parties without authorization as required by law in such cases as subpoenas and mandated governmental disclosures.

The Plan may make these uses and disclosures without your written authorization or consent.

Example of use of your PHI for treatment purposes:During the course of your treatment, the physician determines that he or she will need to confirm information about your health benefits. The Plan will share the information with your physician.

Example of use of your PHI for payment purposes:Your physician submits requests for payment to the Plan or its business associate. The Plan or business associate requests and uses information from the physician regarding your medical care in order to make payment. The Plan will provide information to the physician about you or your Plan benefits.

Example of use of your PHI for health care operations:The Plan may obtain services from business associates such as our third-party administrators or legal advisors for plan administration and/or benefit claim adjudication. The Plan will share information about you with such business associates as necessary to obtain these services.

Personal RepresentativesYou may exercise your PHI rights through a personal representative. Your personal representative will be required to complete a written form provided by the Plan. This form will set forth his or her authority to act on your behalf and require him or her to produce evidence of this stated authority before that person will be given access to your PHI or allowed to act for you.

Except where state law provides otherwise, the Plan may disclose information about minors to their parents or other personal representative.

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The Plan retains discretion to deny access to your PHI to a personal representative to provide protection to those vulnerable people who depend on others to exercise their rights under these rules and who may be subject to abuse or neglect. This also applies to personal representatives of minors.

Minimum Necessary Except in those situations set forth below, when using, disclosing or requesting your PHI, the Plan will make reasonable efforts to limit the disclosure or use of PHI to the minimum necessary for the intended use, disclosure or request. The exceptions are:

• Disclosures to a health care provider for treatment;

• Disclosures to you about your PHI;

• Disclosures to the Secretary of Health and Human Services;

• Disclosures required by HIPAA Privacy Regulations;

• Disclosures which you authorize; or

• Disclosures required by law.

Effective February 17, 2010, to the extent practicable, this means that the Plan and its business associates will only disclose a limited data set. A limited data set is information where individually identifiable information about you is removed except that your age, address (city, State and zip code only) and dates (if reasonably necessary for the purpose of the disclosure) may be retained. The Plan must determine what is reasonably necessary based on the request that it receives.

Notice In The Event of a Breach of Unsecured PHIThe Plan goes to great efforts to prevent a breach of your PHI and EPHI. As such, the Plan does not anticipate any such breach. In the unlikely event that PHI or EPHI that has not been rendered unusable, unreadable or indecipherable by technology approved by Health and Human Services (referred to as “unsecured PHI”) is, or is reasonably believed to have been, accessed, acquired or disclosed as a result of a security breach, the Plan will notify you and, if required by law, the Secretary of Health and Human Services. If the breach affects more than 500 individuals within a designated state or jurisdiction, notice will be provided to prominent media outlets in that state or jurisdiction.

Your Rights and PHIYou have the following rights with respect to your PHI:

1. Right to Request, to Inspect, and to Copy: You have the right to request, to inspect, and to copy PHI held by the Plan.

To inspect and copy PHI that may be used to make decisions about you, you must submit your request in writing to the administrator as listed in Schedule A. You can call the administrator to receive instructions about how to submit such a request. If you request a copy of your PHI, there may be associated costs of copying, mailing, or other supplies related to your request. A fee related to the actual inspection and review of the PHI also may be incurred.

In certain very limited circumstances, your request to inspect and copy may be denied. If you are denied access to your PHI, you may request a review of the denial. Procedures pertaining to the Plan participant’s request to review will be determined by the administrator. The Plan will comply with the outcome of the review.

2. Right to Receive Notice of a Breach from the Plan: You have the right to be notified upon a breach of any of your unsecured PHI.

3. Right to Request an Amendment: If you feel that the PHI the Plan has about you is incorrect or incomplete, you may request that the PHI be amended (corrected). You have the right to request an amendment for as long as the PHI is retained by the administrator. You must make your request in writing and submit it to the administrator. You also must provide a reason that supports your request.

Your request for an amendment may be denied if it is not in writing or does not include a reason to support your request. Your request may be denied if you ask us to amend PHI that:

• was not created by the administrator, unless the person or institution that created the PHI is no longer available to make the amendment

• is not part of the PHI retained by the administrator

• is not part of the PHI you are permitted to inspect and copy

• is accurate and complete

4. Right to Request an Accounting of Disclosures: You have the right to request what is called an accounting of disclosures. This is a list of the disclosures of PHI about you that have been made available to those persons or entities outside of the Plan. This accounting does not include disclosures for treatment, payment, or health care operations or where you have provided the Plan with authorization to do so.

To request this list of disclosures, you must submit your request in writing to the administrator. You can call the administrator to receive instructions about how to submit such a request. Your request must state the time period for which you want disclosures listed. It may not be longer than six years and may not include dates before April 14, 2003.

5. Right to Request Restrictions: You have the right to request that the PHI used or disclosed about you for treatment, payment, or health care operations is restricted (limited). You also have the right to request a limit on the PHI disclosed about you to someone who is involved in your care or payment for your care, such as a family member or friend. You can ask that PHI about a surgery you had is not used or shared.

The Plan is not required to agree to your request. If the Plan does agree, the Plan will comply with your request unless the PHI is needed to give you emergency treatment. To request that the Plan limit the PHI the Plan releases, you must make your request in writing to the administrator. You can call the administrator to receive instructions about how to submit such a request. In your request, you must tell us:

(1) What PHI you want to limit; (2) Whether you want to limit our use, disclosure, or both; and (3) the person or institution the limits apply to (for example, your spouse).

6. Right to Request Confidential Communications: You have the right to request that communication with you about medical matters be conducted in a certain way or at a certain location. You can ask that you only be contacted at work or by mail. To request confidential communications, you must make your request in writing to the administrator.

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The Plan will not ask you the reason for your request. The Plan will comply with all reasonable requests. Your request must state how or where you wish to be contacted.

7. Right to Request a Paper Copy of This Notice: You have the right to a paper copy of this notice. You may ask us to give you a copy of this notice at any time. Even if you have agreed to receive this notice electronically, you still have the right to a paper copy of this notice. You may contact the Employee Service Center toll-free at 1-800-994-2752, option 3, to obtain a paper copy.

You have the right to review this notice before signing the authorization for use and disclosure of your PHI for reasons other than treatment, payment, and health care operations purposes.

Any revised version of this notice will be distributed within 60 days of the effective date of any material change to the uses or disclosures, the individual’s rights, the duties of the Plan or other privacy practices stated in this notice.

To Request PHI or File a ComplaintIf you believe your privacy rights have been violated, you may file a written complaint directly with the Privacy Officer. You can do this by calling the UPMC Compliance Help Line (877-983-8442 toll-free) or by contacting UPMC HIPAA Program Office listed at the beginning of this notice. You will be provided with assistance on the steps to take to exercise your rights.

You also may file a complaint with the Secretary of the U.S. Department of Health and Human Services. To file a complaint with the Secretary of Health and Human Services, you must:

• name the Plan that is the subject of the complaint and describe the violation

• file the complaint within 180 days of when you knew or should have known that the violation occurred

The Plan cannot, and will not, require you to waive the right to file a complaint with the Secretary of Health and Human Services as a condition of receiving treatment.

You will not be penalized or retaliated against for filing a complaint.

Responsibilities of the PlanThe Plan is required to:

• maintain the privacy of your PHI as required by law

• provide you with a notice as to our duties and privacy practices regarding the PHI the Plan collect and maintain about you

• abide by the terms of this notice

• notify you if the Plan cannot accommodate a requested restriction or request

• accommodate your reasonable requests regarding methods to communicate PHI with you

The Plan reserves the right to amend, change, or eliminate provisions in our privacy practices and to enact new provisions regarding the PHI the Plan maintains. If our information practices change, the Plan will amend our notice, and UPMC will issue a revised notice by first-class U.S. mail at your last known address. You are entitled to receive a revised copy of the notice by calling the UPMC Employee Service Center at 1-800-994-2752 option 3 and requesting a copy.

Other Uses and Disclosures Allowed By The Privacy Rule

Plan SponsorThe UPMC Welfare Benefits Plan may, without your permission, provide your PHI to the Plan Sponsor, UPMC, as necessary to operate the Plan where UPMC, as it has done or will do, amends its Plan documents to protect your PHI consistent with federal law.

At no time, however, will the Plan disclose information to UPMC for employment-related actions or decisions unless otherwise authorized by you.

For example, your PHI may be disclosed to UPMC, or third parties retained or hired by UPMC, for quality improvement, business planning and cost management purposes. This information may identify you, your diagnosis and treatment, and supplies used in the course of treatment.

In addition, the Plan may disclose “summary health information” to UPMC for obtaining premium bids or for modifying, amending or terminating the Plan. Summary health information is information that summarizes the claims history, claims expenses or type of claims experienced by individuals for whom UPMC has provided health benefits under a health, medical, or similar plan; and from which identifying information has been deleted. This material will be provided in a manner that is consistent with federal law.

Finally, the Plan may disclose to UPMC information on whether you are participating in the Plan.

Public Health Activities

Controlling DiseaseAs required by law, the Plan may disclose your PHI to public health or legal authorities charged with preventing or controlling disease, injury, or disability.

Child Abuse and Neglect The Plan may disclose PHI to public authorities as allowed by law to report child abuse or neglect.

Food and Drug Administration (FDA) The Plan may disclose to the FDA your PHI relating to adverse events with respect to food, supplements, products and product defects, or post-marketing surveillance information to enable product recalls, repairs, or replacements.

Victims of Abuse, Neglect, or Domestic ViolenceThe Plan can disclose PHI to governmental authorities to the extent the disclosure is authorized by statute or regulation and, in the exercise of professional judgment; the Plan believes the disclosure is necessary to prevent serious harm to the individual or other potential victim.

Oversight AgenciesFederal law allows us to release your PHI to appropriate health oversight agencies or for health oversight activities to include audits; civil, administrative, or criminal investigations; inspections; licensures or disciplinary actions; and for similar reasons related to the administration of health care.

23

Judicial/Administrative ProceedingsThe Plan may disclose your PHI in the course of any judicial or administrative proceeding as allowed or required by law, with your consent, or as directed by a proper court order or administrative tribunal, provided that the only PHI released is expressly authorized by such order or in response to a subpoena, discovery request, or other lawful process.

Law EnforcementThe Plan may disclose your PHI for law enforcement purposes as required by law, such as when required by court order, including laws that require reporting of certain types of wounds or other physical injury.

Coroners, Medical Examiners, and Funeral DirectorsThe Plan may disclose your PHI to funeral directors or coroners consistent with applicable law to allow them to carry out their duties.

Organ Procurement OrganizationsConsistent with applicable law, the Plan may disclose your PHI to organ procurement organizations or other entities engaged in the procurement, banking, or transplantation of organs, eyes, or tissue for the purpose of donation and transplant.

Threat to Health and SafetyTo avert a serious threat to health or safety, the Plan may disclose your PHI consistent with applicable law to prevent or lessen a serious, imminent threat to the health or safety of a person or the public.

For Specialized Governmental FunctionsThe Plan may disclose your PHI for specialized government functions as authorized by law such as to U.S. military personnel, for national security purposes, or to public assistance program personnel.

Correctional InstitutionIf you are an inmate of a correctional institution, the Plan may disclose to the institution or its agents the PHI necessary for your health and the health and safety of other individuals.

Workers’ CompensationIf you are seeking workers’ compensation, the Plan may disclose your PHI to the extent necessary to comply with laws relating to workers’ compensation.

Other Uses and Disclosures - When Your Written Authorization is RequiredOther uses and disclosures of PHI not covered by this Notice or the laws that apply to the Plan besides those identified in this notice will be made only as otherwise authorized by law or with your written authorization. For instance, the Plan has not ever sold your PHI or used your PHI for marketing purposes but if it ever wanted to do so it would need to get your authorization first.

If you do give the Plan an authorization, you may revoke it at any time by submitting a written revocation to our Privacy Officer and the Plan will no longer disclose PHI under the authorization. However, disclosures that the Plan made in reliance on your authorization before you revoked it will not be affected by the revocation.

24

ALABAMAMedicaid

Website: http://www.myalhipp.com/ Phone: 1-855-692-5447

ALASKAMedicaid

The AK Health Insurance Premium Payment Program Website: http://myakhipp.com/ Phone: 1-866-251-4861 Email: CustomerService@MyAKHIPP.com Medicaid Eligibility: http://dhss.alaska.gov/dpa/Pages/medicaid/default.aspx

ARKANSASMedicaid

Website: http://myarhipp.com Phone: -855-MyARHIPP (855-692-7447)

CALIFORNIA Medicaid

Website: https://www.dhcs.ca.gov/services/Pages/TPLRD_CAU_cont.aspxPhone: 916-440-5767

COLORADOHealth First Colorado (Colorado’s Medicaid Program) & Child Health Plan Plus (CHP+)

Health First Colorado Website: https://www.healthfirstcolo-rado.com/ Health First Colorado Member Contact Center: 1-800-221-3943/ State Relay 711 Health Insurance Buy-In Program (HIBI): https://www.colo-rado.gov/pacific/hcpf/health-insurance-buy-programHIBI Customer Service: 1-855-692-6442 CHP+: https://www.colorado.gov/pacific/hcpf/ child-health-plan-plus CHP+ Customer Service: 1-800-359-1991/ State Relay 711

FLORIDAMedicaid

Website: https://www.flmedicaidtplrecovery.com/flmedic-aidtplrecovery.com/hipp/index.html Phone: 1-877-357-3268

GEORGIAMedicaid

Website: https://medicaid.georgia.gov/health-insurance-premium-payment-program-hipp Phone: 678-564-1162 ext. 2131

INDIANAMedicaid

Healthy Indiana Plan for low-income adults 19-64 Website: http://www.in.gov/fssa/hip/ Phone: 1-877-438-4479 All other Medicaid Website: https://www.in.gov/medicaid/ Phone: 1-800-457-4584

IOWAMedicaid

Medicaid Website: https://dhs.iowa.gov/ime/membersPhone: 1-800-338-8366Website: http://dhs.iowa.gov/Hawki Phone: 1-800-257-8563

KANSASMedicaid

Website: https://www.kdheks.gov/hcf/default.htm Phone: 1-800-792-4884

KENTUCKYMedicaid

Kentucky Integrated Health Ins. Prem. Payment Program (KI-HIPP) Website: https://chfs.ky.gov/agencies/dms/ member/Pages/kihipp.aspxPhone: 1-855-459-6328KHIP Website: https://kidshealth.ky.gov/Pages/index.aspxPhone: 1-877-524-4718Medicaid Website: https://chfs.ky.gov/Pages/index.aspx

LOUISIANAMedicaid

Website: https://ldh.la.gov/index.cfm/subhome/1/n/331 Phone: 1-888-342-6207 or 1-855-618-5488

MAINEMedicaid

Website: https://www.maine.gov/dhhs/ofi/applications-forms Phone: 1-800-442-6003 TTY: Maine relay 711

MASSACHUSETTSMedicaid and CHIP

Website: http://www.mass.gov/eohhs/gov/departments/masshealth/ Phone: 1-800-862-4840

MINNESOTAMedicaid

Website: https://mn.gov/dhs/people-we-serve/children-and-families/health-care/health-care-programs/programs-and-services/other-insurance.jsp Phone: 1- 800-657-3739

MISSOURIMedicaid

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

MONTANAMedicaid

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

NEBRASKAMedicaid

Website: http://www.ACCESSNebraska.ne.gov Phone: (855) 632-7633 Lincoln: (402) 473-7000 Omaha: (402) 595-1178

NEVADAMedicaid

Medicaid Website: https://dhcfp.nv.gov Medicaid Phone: 1-800-992-0900

NEW HAMPSHIREMedicaid

Website: https://www.dhhs.nh.gov/oii/hipp.htm Phone: 603-271-5218 Toll free: 1-800-852-3345, ext 5218

NEW JERSEYMedicaid and CHIP

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

NEW YORKMedicaid

Website: https://www.health.ny.gov/health_care/medicaid/ Phone: 1-800-541-2831

NORTH CAROLINAMedicaid

Website: https://medicaid.ncdhhs.gov/ Phone: 919-855-4100

NORTH DAKOTAMedicaid

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

OKLAHOMAMedicaid and CHIP

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

OREGONMedicaid

Website: http://healthcare.oregon.gov/Pages/index.aspx http://www.oregonhealthcare.gov/index-es.html Phone: 1-800-699-9075

PENNSYLVANIAMedicaid

Website: https://www.dhs.pa.gov/providers/Providers/Pages/Medical/HIPP-Program.aspx Phone: 1-800-692-7462

RHODE ISLANDMedicaid and CHIP

Website: http://www.eohhs.ri.gov/ Phone: 855-697-4347, or 401-462-0311 (Direct RIte Share Line)

SOUTH CAROLINAMedicaid

Website: https://www.scdhhs.gov Phone: 1-888-549-0820

SOUTH DAKOTAMedicaid

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

TEXASMedicaid

Website: http://gethipptexas.com Phone: 1-800-440-0493

UTAHMedicaid and CHIP

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

VERMONTMedicaid

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

VIRGINIAMedicaid and CHIP

Website: https://www.coverva.org/hipp/ Medicaid Phone: 1-800-432-5924 CHIP Phone: 1-855-242-8282

WASHINGTONMedicaid

Website: https://www.hca.wa.gov/ Phone: 1-800-562-3022

WEST VIRGINIAMedicaid

Website: http://mywvhipp.com/ Toll-free Phone: 1-855-MyWVHIPP (1-855-699-8447)

WISCONSINMedicaid and CHIP

Website: https://www.dhs.wisconsin.gov/badgercareplus/p-10095.htm Phone: 1-800-362-3002

WYOMINGMedicaid

Website: health.wyo.gov/healthcarefin/medicaid/programs-and-eligibility/Phone: 1-800-251-1269

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 July 31, 2020. Contact your State for more information on eligibility.

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 toll-free 1-866-444-EBSA (3272).

To see if any other states have added a premium assistance program since July 31, 2020, or for more information on special enrollment rights, contact either:U.S. Department of Labor Employee Benefits Security Administration www.dol.gov/agencies/ebsa 1-866-444-EBSA (3272)

U.S. Department of Health and Human Services Centers for Medicare & Medicaid Services www.cms.hhs.gov 1-877-267-2323, Menu Option 4, Ext. 61565

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Availability of Marketplace Notice

September 2020This notice is for informational purposes only as required by the Affordable Care Act.

As a valued UPMC employee, we would like to inform you of the Marketplace (or “Exchange”) in your state. This Marketplace Notice will inform you of important information pertaining to the existence, contact information for, and services provided to you by the Marketplace. In addition, this notice will provide direction to important information regarding your UPMC sponsored medical plan.

Under the Affordable Care Act, each state was required to create and maintain a health insurance Marketplace by January 1, 2014. These Marketplaces will serve individuals and small businesses to assist in the purchase of medical insurance. For Pennsylvania residents, the commonwealth chose to participate in the federally sponsored marketplace versus establishing their own – details can be found at www.healthcare.gov. For non-Pennsylvania residents, please check www.healthcare.gov to see how the marketplace in your state is established and maintained.

What is the Marketplace?The Marketplace is designed to provide alternative medical insurance coverage. Open enrollment for medical insurance coverage through the Marketplace begins in November for coverage starting as early as January 1 of the following year. The Marketplace can help you evaluate coverage options, including eligibility and cost.

Can I Save Money?You may be eligible for a federal tax credit to assist in paying a monthly premium on medical insurance coverage purchased through the Marketplace. During 2021, the amount of the tax credit to assist you in paying a monthly premium for coverage from the Marketplace will depend on your household income. As of January 1, 2021, the availability of a federal tax credit to assist you in paying a monthly premium will also depend on whether UPMC offers you coverage, and whether the coverage offered meets certain standards (for example, whether UPMC’s share of the total allowed costs of benefits provided under the plan is less than 60%).

The medical plans offered by UPMC are affordable and exceed government minimum value standards. Because UPMC offers competitive and valuable medical coverage that is affordable for all eligible UPMC employees, this limits your eligibility for a federal tax credit if you are eligible for UPMC coverage (even if you are not actually enrolled). See the online tool in the “How to get More Information” section in the next column to determine if you are eligible for UPMC health coverage.

Loss of UPMC Contribution to Your Medical CareIt is important to understand that if you purchase a medical insurance plan through the Marketplace instead of accepting medical coverage offered by UPMC, you will lose the UPMC contribution toward the medical coverage offered by UPMC. Depending on your employment status, this contribution by UPMC is substantial. For example, UPMC’s contribution toward family coverage under the 2021 UPMC Advantage Gold is follows:

Total Premium Per Year $21,801.24 Less: Amount Paid by EE $3,720.00 Amount Contributed by UPMC $18,081.24

Enrolling in a plan offered by one of the Marketplace offerings means you would be losing this type of subsidy, which generally equals 85% or more of the total premium in 2021 for most coverage options. Both the UPMC contribution and your premium contribution are excluded from income for Federal income tax purposes under the UPMC sponsored plan, while your premium payments to the Marketplace are not. Your payments for coverage through the Marketplace are made on an after-tax basis.

How to get More InformationShould you choose to complete a Marketplace application for medical insurance, UPMC employer and plan information will be needed. Call the Employee Service Center at 1-800-994-2752, option 3 to obtain your UPMC medical benefit information needed to complete the Marketplace application. You can visit www.healthcare.gov for more information on the Marketplace for Pennsylvania and the state in which you reside, including an online application. For more information about medical benefit coverage offered by UPMC, please check your Summary Plan Description, and the Benefits section on Infonet.

Medicare (PART D) Prescription Drug CoverageIf you or your dependents have Medicare or will become eligible for Medicare in the next 12 months, a federal law gives you choices about your prescription drug coverage. Please see the information below for details and keep this for your records. If you or your dependents are not now or will not become eligible for Medicare in the next 12 months, please disregard this notice.

Important Notice from UPMC About Your Prescription Drug Coverage and MedicarePlease read this notice carefully and keep it where you can find it. This notice has information about your current prescription drug coverage with UPMC 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. UPMC has determined that the prescription drug coverage offered by the UPMC Health Plan is, on average for all plan participants, expected to pay out as much as standard Medicare prescription drug coverage will pay 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.

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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 Oct. 15 through Dec. 7. 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 Current Coverage If You Decide to Join a Medicare Drug Plan?If you decide to join a Medicare drug plan, your current UPMC Health Plan coverage will not be affected. Your current coverage pays for other health expenses in addition to prescription drugs. If you enroll in a Medicare prescription drug plan, you and your eligible dependents will still be eligible to receive all of your current health and prescription drug benefits. If you do decide to join a Medicare drug plan and drop your current UPMC Health Plan prescription drug 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 coverage with UPMC Health Plan 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 UPMC Employee Service Center at 1-800-994-2752, option 3, for further information.

NOTE: You will get this notice each year and if coverage through UPMC changes. You also may request a copy 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 prescription 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 or your dependents have Medicare or will become eligible for Medicare in the next 12 months. 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 whether or not you are required to pay a higher premium (a penalty).

Women’s Health and Cancer Rights Act UPMC medical options, as required by Women’s Health and Cancer Rights Act, provide coverage for mastectomy-related services including 1) all stages of reconstruction on the breast on which the mastectomy has been performed, 2) surgery and reconstruction of the other breast to produce a symmetrical appearance, and 3) prostheses and physical complications of mastectomy, including lymphedemas, in the manner determined in consultation with the attending physician and the patient. Benefit coverage is subject to annual deductibles and coinsurance provisions as may be deemed appropriate and are consistent with those established for other medical and surgical benefits under the coverage option in which you are enrolled. Notice of the availability of such coverage is provided upon enrollment and annually. For more information, contact UPMC Health Plan via UPMC DirectLink: 1-800-994-2752, option 2, to obtain a detailed description of the mastectomy-related benefits under the plan.

Newborns’ and Mothers’ Health Protection Act Notice Hospital services and surgical/medical services rendered by a hospital or other professional medical provider are covered for maternity care and nursery care of the newborn child (this includes pre-and post-natal care, complications of pregnancy, and childbirth) for at least 48 hours following a normal vaginal delivery and for at least 96 hours following a cesarean section. For full details, see the Newborns’ and Mothers’ Health Protection Act Notice in the UPMC Summary Plan Description (SPD) in the benefits section of UPMC Infonet.

Patient Protection and Affordable Care ActUPMC group health plan includes all consumer protections of the Patient Protection and Affordable Care Act (PPACA). For more information, see the UPMC SPD in the benefits section of UPMC Infonet. As required by PPACA, Summaries of Benefits and Coverage (SBC) are available in the Benefits section of Infonet. You may request a printed copy by calling the Employee Service Center at 1-800-994-2752, option 3.

General Notice of No Pre-Existing Condition ExclusionThe UPMC medical group health plans do not impose a pre-existing condition exclusion. The Health Insurance Portability and Accountability Act (HIPAA) places limitations on a group health plan’s ability to impose pre-existing condition exclusions, provides special enrollment rights for certain individuals, and prohibits discrimination in group health plans based on health status. UPMC does not deny individuals enrollment in the medical plans (or delay the effective date of an individual’s coverage) based on an individual’s health status, medical condition (including both

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physical and mental illnesses), claims experience, receipt of health care, medical history, genetic information, evidence of insurability (including conditions arising out of acts of domestic violence), or disability. Please refer to the Health and Welfare SPD for further details.

Notice Regarding Wellness ProgramMyHealth is a voluntary wellness program available to all employees. The program is administered according to federal rules permitting employer-sponsored wellness programs that seek to improve employee health or prevent disease, including the Americans with Disabilities Act of 1990, the Genetic Information Nondiscrimination Act of 2008, and the Health Insurance Portability and Accountability Act, as applicable, among others. If you choose to participate in the UPMC wellness program you will be asked to complete a voluntary health risk assessment (HRA) called the MyHealth Questionnaire, that asks a series of questions about your health-related activities and behaviors and whether you have or had certain medical conditions (e.g., cancer, diabetes, or heart disease). You will also be asked to complete a biometric screening, which will include a blood test for LDL, total cholesterol and glucose levels, along with an exam for blood pressure and body mass index (BMI). You are not required to complete the HRA or to participate in the blood test or other medical examinations.

However, employees and their covered spouse/domestic partner who choose to participate in the wellness program will receive an incentive of a medical plan deductible credit of $500 for an individual, $1,500 for employee plus child(ren), and $1,000 for family by completing the necessary steps by the announced annual deadline. Although you and your spouse/domestic partner are not required to complete the HRA or participate in the biometric screening, only employees and their spouse/domestic partner who do so will receive a medical plan deductible credit. If your medical plan coverage begins mid-year, fewer requirements will apply to obtain the credit for the first year.

Additional incentives of up to $500 for an individual or employee plus child(ren), and $1,000 for a family may be available for employees and their spouse/domestic partner who participate in certain health-related activities such as a physical or vision exam, health coaching or personal health review. If you are unable to participate in any of the health-related activities required to earn an incentive, you may be entitled to a reasonable accommodation or an alternative standard. You may request a reasonable accommodation or an alternative standard by contacting us at 1-855-395-8762. We will work with you (and, if you wish, with your doctor) to find a wellness program with the same reward that is right for you in light of your health status.

The information from your HRA and the results from your biometric screening will be used to provide you with information to help you understand your current health and potential risks, and may also be used to offer you services through the wellness program, such as an online smoking cessation course or an activity tracking program. You also are encouraged to share your results or concerns with your own doctor.

Protections from Disclosure of Medical InformationWe are required by law to maintain the privacy and security of your personally identifiable health information. Although the wellness program and UPMC may use aggregate information it collects to design a program based on identified health risks in the workplace, MyHealth will never disclose any of your personal information

either publicly or to the employer, except as necessary to respond to a request from you for a reasonable accommodation needed to participate in the wellness program, or as expressly permitted by law. Medical information that personally identifies you that is provided in connection with the wellness program will not be provided to your supervisors or managers and may never be used to make decisions regarding your employment.

Your health information will not be sold, exchanged, transferred, or otherwise disclosed except to the extent permitted by law to carry out specific activities related to the wellness program, and you will not be asked or required to waive the confidentiality of your health information as a condition of participating in the wellness program or receiving an incentive. Anyone who receives your information for purposes of providing you services as part of the wellness program will abide by the same confidentiality requirements. The only individual(s) who will receive your personally identifiable health information are your designated health care professional and UPMC Health Plan staff in order to provide you with services under the wellness program and for purposes of its clinical and quality improvement programs and initiatives.

In addition, all medical information obtained through the wellness program will be maintained separate from your personnel records, information stored electronically will be encrypted, and no information you provide as part of the wellness program will be used in making any employment decision. Appropriate precautions will be taken to avoid any data breach, and in the event a data breach occurs involving information you provide in connection with the wellness program, we will notify you immediately.

You may not be discriminated against in employment because of the medical information you provide as part of participating in the wellness program, nor may you be subjected to retaliation if you choose not to participate.

If you have questions or concerns regarding this notice, or about protections against discrimination and retaliation, please contact 1-855-395-8762.

General Notice Of COBRA Continuation Coverage Rights** Continuation Coverage Rights Under COBRA**

IntroductionYou’re getting this notice because you recently gained coverage under a group health plan (the Plan). This notice has important information about your right to COBRA continuation coverage, which is a temporary extension of coverage under the Plan. This notice explains COBRA continuation coverage, when it may become available to you and your family, and what you need to do to protect your right to get it. When you become eligible for COBRA, you may also become eligible for other coverage options that may cost less than COBRA continuation coverage.

The right to COBRA continuation coverage was created by a federal law, the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA). COBRA continuation coverage can become available to you and other members of your family when group health coverage would otherwise end. For more information about your rights and obligations under the Plan and under federal law, you should review the Plan’s Summary Plan Description or contact the Plan Administrator.

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You may have other options available to you when you lose group health coverage. For example, you may be eligible to buy an individual plan through the Health Insurance Marketplace. By enrolling in coverage through the Marketplace, you may qualify for lower costs on your monthly premiums and lower out-of-pocket costs.

Additionally, you may qualify for a 30-day special enrollment period for another group health plan for which you are eligible (such as a spouse’s plan), even if that plan generally doesn’t accept late enrollees.

What is COBRA continuation coverage?COBRA continuation coverage is a continuation of Plan coverage when it would otherwise end because of a life event. This is also called a “qualifying event.” Specific qualifying events are listed later in this notice. After a qualifying event, COBRA continuation coverage must be offered to each person who is a “qualified beneficiary.” You, your spouse, and your dependent children could become qualified beneficiaries if coverage under the Plan is lost because of the qualifying event. Under the Plan, qualified beneficiaries who elect COBRA continuation coverage must pay for COBRA continuation coverage.

If you’re an employee, you’ll become a qualified beneficiary if you lose your coverage under the Plan because of the following qualifying events:

• Your hours of employment are reduced, or

• Your employment ends for any reason other than your gross misconduct

• If you’re the spouse of an employee, you’ll become a qualified beneficiary if you lose your coverage under the Plan because of the following qualifying events:

• Your spouse dies;

• Your spouse’s hours of employment are reduced;

• Your spouse’s employment ends for any reason other than his or her gross misconduct;

• Your spouse becomes entitled to Medicare benefits (under Part A, Part B, or both); or

• You become divorced or legally separated from your spouse.

• Your dependent children will become qualified beneficiaries if they lose coverage under the Plan because of the following qualifying events:

• The parent-employee dies;

• The parent-employee’s hours of employment are reduced;

• The parent-employee’s employment ends for any reason other than his or her gross misconduct;

• The parent-employee becomes entitled to Medicare benefits (Part A, Part B, or both);

• The parents become divorced or legally separated; or

• The child stops being eligible for coverage under the Plan as a “dependent child.”

When is COBRA continuation coverage available?The Plan will offer COBRA continuation coverage to qualified beneficiaries only after the Plan Administrator has been notified that a qualifying event has occurred. The employer must notify the Plan Administrator of the following qualifying events:

• The end of employment or reduction of hours of employment;

• Death of the employee; or

• The employee’s becoming entitled to Medicare benefits (under Part A, Part B, or both).

For all other qualifying events (divorce or legal separation of the employee and spouse or a dependent child’s losing eligibility for coverage as a dependent child), you must notify the Plan Administrator within 60 days after the qualifying event occurs. You must provide this notice to the Plan Administrator at: COBRA Administrator, UPMC Employee Service Center, U.S. Steel Tower, Floor 56, 600 Grant Street, Pittsburgh, PA 15219 or by phone at 1-800-994-2752. You should keep a copy, for your records, of any notices you send to the Plan Administrator.

How is COBRA continuation coverage provided?Once the Plan Administrator receives notice that a qualifying event has occurred, COBRA continuation coverage will be offered to each of the qualified beneficiaries. Each qualified beneficiary will have an independent right to elect COBRA continuation coverage. Covered employees may elect COBRA continuation coverage on behalf of their spouses, and parents may elect COBRA continuation coverage on behalf of their children.

COBRA continuation coverage is a temporary continuation of coverage that generally lasts for 18 months due to employment termination or reduction of hours of work. Certain qualifying events, or a second qualifying event during the initial period of coverage, may permit a beneficiary to receive a maximum of 36 months of coverage.

There are also ways in which this 18-month period of COBRA continuation coverage can be extended:

Disability extension of 18-month period of COBRA continuation coverageIf you or anyone in your family covered under the Plan is determined by Social Security to be disabled and you notify the Plan Administrator in a timely fashion, you and your entire family may be entitled to get up to an additional 11 months of COBRA continuation coverage, for a maximum of 29 months. The disability would have to have started at some time before the 60th day of COBRA continuation coverage and must last at least until the end of the 18-month period of COBRA continuation coverage. In the case of a newborn or adopted child added to a covered employee’s COBRA coverage, then the first 60 days of continuation coverage for the new born or adopted child is measured from the date of the birth or adoption. The employee, spouse or dependent has 30 days to notify the Plan Administrator from the date of a final determination that he or she is no longer disabled.

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Second qualifying event extension of 18-month period of continuation coverageIf your family experiences another qualifying event during the 18 months of COBRA continuation coverage, the spouse and dependent children in your family can get up to 18 additional months of COBRA continuation coverage, for a maximum of 36 months, if the Plan is properly notified about the second qualifying event. This extension may be available to the spouse and any dependent children getting COBRA continuation coverage if the employee or former employee dies; becomes entitled to Medicare benefits (under Part A, Part B, or both); gets divorced or legally separated; or if the dependent child stops being eligible under the Plan as a dependent child. This extension is only available if the second qualifying event would have caused the spouse or dependent child to lose coverage under the Plan had the first qualifying event not occurred.

Are there other coverage options besides COBRA Continuation Coverage?Yes. Instead of enrolling in COBRA continuation coverage, there may be other coverage options for you and your family through the Health Insurance Marketplace, Medicaid, or other group health plan coverage options (such as a spouse’s plan) through what is called a “special enrollment period.” Some of these options may cost less than COBRA continuation coverage. You can learn more about many of these options at www.healthcare.gov.

If you have questionsQuestions concerning your Plan or your COBRA continuation coverage rights should be addressed to the contact or contacts identified below. For more information about your rights under the Employee Retirement Income Security Act (ERISA), including COBRA, the Patient Protection and Affordable Care Act, and other laws affecting group health plans, contact the nearest Regional or District Office of the U.S. Department of Labor’s Employee Benefits Security Administration (EBSA) in your area or visit www.dol.gov/ebsa. (Addresses and phone numbers of Regional and District EBSA Offices are available through EBSA’s website.) For more information about the Marketplace, visit www.HealthCare.gov.

Keep your Plan informed of address changesTo protect your family’s rights, let the Plan Administrator know about any changes in the addresses of family members. You should also keep a copy, for your records, of any notices you send to the Plan Administrator

Plan contact informationIf you have any questions about the law or your obligations or you need to provide notice to the Plan Administrator, contact the Plan Administrator at: COBRA Administrator, UPMC Benefit Management Services, 339 Sixth Avenue, Heinz 57 Center, 9th Floor HFS010901, Pittsburgh PA 15222 or by phone at 1-877-851-5578. You should keep a copy, for your records, ofany notices you send to the Plan Administrator.

COBRA Address Notification If you have a dependent who is covered by our group health plan (medical, dental, flexible spending) and whose legal residence is not yours (dependent child covered by court order, living with an ex-spouse, etc.), you are required to provide us with their address so initial and subsequent COBRA notices can be sent to them. This does not include a dependent child whose legal residence is still yours but who is away at school.

Please provide the following information to the UPMC Employee Service Center upon commencement of coverage under the group health plan as well as any changes:

• Your name and social security number

• Covered dependent’s name and address

If you have any questions, please call the Employee Service Center at 1-800-994-2752, option 3.

For all of your benefits needs, action items, and more, search Infonet.

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UPMC DirectLink — 1-800-994-2752DirectLink is your one-stop phone number to reach many benefits-related contacts.

Welcome to UPMC DirectLink

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1 MetLife2 Fidelity

3 TIAA4 Vanguard5 Valic

To return to the main menu

1

Retirement plans

2Medical, dental, FSA, HSA, vision, disability claims, leave of absence, QTA, or COBRA

5Voluntary Benefits

6 LifeSolutions (Employee Assistance Program)

4Payroll questions

3 Employee Service Center (general benefits questions and tuition assistance)

Dail 1-800-994-2752 toll-free from your telephone. Follow the recorded instructions to reach representatives.

Provides access to the following representatives

Retirement 8:30 a.m. to 5 p.m., Monday through Friday

UPMC Health Plan 7 a.m. to 7 p.m., Medical, dental, vision, Monday through Friday flexible spending, 8 a.m. to 3 p.m.health savings account, on Saturday and qualified transportation accounts

UPMC Work Partners (disability, leaves) ............... 8 a.m. to 5 p.m.,During non-business hours, Monday through Friday callers will be connected to an answering service seven days a week, including holidays.

Employee Service Center .............................................8 a.m. to 5 p.m., Monday through Friday

Payroll 8 a.m. to 5 p.m., Monday through Friday

LifeSolutions ....................................................................8 a.m. to 5 p.m., 24-hour emergency service Monday through Friday(Evening hours by appointment)

Optional Voluntary BenefitsAFLAC voluntary programs ....................................... 8 a.m. to 6 p.m., Monday through Friday

Boston Mutual Life Insurance Co. .......................8:30 a.m. to 5 p.m., Monday through Friday

Cigna Hospital Care ...................................................... 8 a.m to 8 p.m., Monday through Friday

Manhattan (Humana) Whole Life ......................8:30 a.m. to 6 p.m., Monday through Friday

MetLife (Hyatt) Legal Plans ........................................8 a.m. to 7 p.m., Monday through Friday

Unum Interest-Sensitive Whole Life .......................8 a.m. to 8 p.m., (for inforce policies) Monday through Friday

ING (Voya) Premier Universal Life ....................... 9 a.m. to 6:30 p.m.,(for inforce policies) Monday through Friday

LifeLock with Norton ......................................Calls are answered 24/7

Assurity Life ..................................................................... 8 a.m. to 6 p.m.,

Monday through Friday

1 Savings Plan and Pension account information for current employees, former staff, and retirees, or to report a death

2 MetLife, Fidelity, TIAA, Vanguard, or Valic balances

3 Retirees or former staff requiring forms signed for distribution with TIAA, Vanguard, VALIC, Fidelity, or MetLife

1 Medical, Dental, Vision, Health and Dependent Care FSA, HSA, and QTA

2 Disability, Leave Request

3 COBRA

1 AFLAC voluntary programs, Manhattan (Humana) Whole Life, Assurity Life, or ING (Voya) Premier Universal Life

2 MetLife (Hyatt) Legal Plans

3 LifeLock with Norton

4 Unum Interest-Sensitive Whole Life

5 Cigna Hospital Care6 Boston Mutual Life

Insurance Co.

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UPMC Savings Plan Quick Enrollment Form

Step 1: Check the box

Yes, I want to begin contributing to the UPMC Savings Plan! • Enroll me in the UPMC Savings Plan at a 4 percent pretax contribution rate (with

contributions occurring every pay date).

• Invest my contributions in the age-appropriate Vanguard® Institutional Target Retirement Fund (based on the year I’ll turn 65).

• Use Automatic Contribution Increases to increase my pretax contributions 1 percent each year (until I reach a 6 percent contribution rate).

I can change my contribution rate and investment fund elections at any time through Infonet.UPMC.com. Click on HR Direct, then select the “My Retirement” icon, or at digital.alight.com/upmc. You will need to set up a separate user ID and password if you use the digital web address.

Step 2: Sign and print clearly

Signature Date

Name Person ID #

Work Location

Step 3: Return this form

Return to:

UPMC Retirement Department U.S. Steel Tower 600 Grant Street, Floor 56 Pittsburgh, PA 15219

This form will be processed as soon as administratively possible. More About Vanguard® Institutional Target Retirement Funds

Birth Year* Investment Birth Year* Investment 1947 and earlier Vanguard Target Retirement Income 1973-1977 Vanguard Target Retirement 2040 1948-1952 Vanguard Target Retirement 2015 1978-1982 Vanguard Target Retirement 2045 1953-1957 Vanguard Target Retirement 2020 1983-1987 Vanguard Target Retirement 2050 1958-1962 Vanguard Target Retirement 2025 1988-1992 Vanguard Target Retirement 2055 1963-1967 Vanguard Target Retirement 2030 1993-1997 Vanguard Target Retirement 2060 1968-1972 Vanguard Target Retirement 2035 1998 and later Vanguard Target Retirement 2065

*The Birth Year default investments noted above are general in nature and are not intended to reflect your actual retirement date or any participant's specific risk tolerance or investment needs. UPMC Savings Plan participants are encouraged to review their investment fund elections (whether default or specifically chosen) on a regular basis to ensure that they are on track to meet their investment objectives.

More About Automatic Contribution Increases

If you enroll in the UPMC Savings Plan... Your 4 percent contribution rate will increase to 5 percent... ...between Jan. 1 and Aug. 31 ...in the Jan. immediately following your initial enrollment ...between Sept. 1 and Dec. 31 ...two Januarys following your initial enrollment

Some business units and job classifications have unique benefit programs that may affect eligibility. Physicians and members of collective bargaining units should refer to the terms of their contracts for information regarding their eligibility. Vanguard is a trademark of The Vanguard Group, Inc.

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Benefits Enrollment Through HR Direct Step 1: It is recommended that you use a modern browser, such as Chrome, Edge, Firefox, or Safari. Internet Explorer is not recommended. Ideally, your view should be set at 100%, however if that is not possible, make sure you scroll to the left and right, or up and down as needed to ensure that you review all details. If you are newly joining UPMC, your manager will provide you with your User Principal Name (UPN). You will then need to register and establish a password, for you to log into Infonet to access HR Direct.

Infonet: https://upmchs.sharepoint.com/sites/infonet/Pages/default.aspx

Step 2: Click on the HR Direct link, which is located on the left side of the page.

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Benefits Enrollment Through HR Direct Step 1: It is recommended that you use a modern browser, such as Chrome, Edge, Firefox, or Safari. Internet Explorer is not recommended. Ideally, your view should be set at 100%, however if that is not possible, make sure you scroll to the left and right, or up and down as needed to ensure that you review all details. If you are newly joining UPMC, your manager will provide you with your User Principal Name (UPN). You will then need to register and establish a password, for you to log into Infonet to access HR Direct.

Infonet: https://upmchs.sharepoint.com/sites/infonet/Pages/default.aspx

Step 2: Click on the HR Direct link, which is located on the left side of the page.

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After clicking the link to access HR Direct, you will see the page below. Your name should be at the top of the page.

Your Name

Setting Up Emergency Contacts The first thing you want to do in HR Direct is set up your emergency contacts. If you skip over this part, you will have difficulty

enrolling in benefits.

Step 1: Click the Personal Information icon.

Step 2: Click the Family and Emergency Contacts tile.

*When setting up emergency contacts you will need the social security number and date of birth of your contact. This information will then be available for you when you make your benefit elections and choose your life insurance beneficiaries.

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Step 2: Click the Family and Emergency Contacts tile.

*When setting up emergency contacts you will need the social security number and date of birth of your contact. This information will then be available for you when you make your benefit elections and choose your life insurance beneficiaries.

Step 3: On the “My Contacts” page you will click the Add button. This will trigger a drop-down box to open. Click to add a new contact.

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Step 4: Provide all the information with an asterisk before you submit. Please note, you will be prompted for a relationship start date. You must use a date that is as of your date of hire or earlier. Otherwise, the dependent will not show in your enrollment options. Once you complete the information, click the Submit button.

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Step 2: Click the Document Records tile.

Uploading Document Records Step 1: You will want to upload required documents before you begin your benefits enrollment. On the HR Direct home screen, click the Benefits icon.

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Step 3: Click the Add button in the top, right-hand corner.

Step 4: Upload required documentation. If enrolling a domestic partner, search “domestic partner“ on Infonet to access the affidavit, and upload documents as instructed. Your domestic partner coverage will be suspended until required documentation has been received and approved. If enrolling your spouse, upload required documentation (marriage certificate) before enrolling to prevent coverage from suspending.

Dependent documentation (such as a marriage certificate, adoption paperwork, domestic partner affidavit) needs to be uploaded within 30 days if you want to enroll a spouse, domestic partner and/or a child who is not your natural born child(ren) or stepchild(ren) to any benefit. It is your responsibility to confirm your documentation is submitted.

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Electing Benefits If you need assistance enrolling in benefits, you can schedule a meeting with UPMC Education and Enrollment Services, also known as Brian Patten and Associates. They will assist you while you complete the benefits enrollment process. To set up an appointment, send an email to appointment@brianpattenandassoicates.com.

Step 1: To elect your benefits, click the Benefits icon.

Step 2: Under you name, click the Make Benefit Elections button.

You are eligible for benefits the first of the month following your date of hire. If your date of hire is the first of the month, benefits are effective that day.

Example: You are hired on August 16. You are eligible for benefits on September 1, provided you complete and submit your online enrollment through HR Direct by September 16.

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Step 3: Before making your benefit elections, you need to add eligible dependents that you want to enroll in your benefits. This step must be completed before enrolling in benefits. You will see the names you already added as contacts. Follow the instructions used for adding emergency contacts on page 6. This page # needs to be changed once loaded into the Guide. If you need to correct any data for your dependents (such as date of birth, spelling of name, etc.), please contact the Employee Service Center at 1-800-994-2752, option 3, for assistance. Do not add the dependent a second time as that will cause enrollment issues. Once you have added the eligible dependents you wish to cover, click the Continue button.

*Remember, coverage suspends until required documentation is submitted and approved. You have 30 days to submit this documentation.

Step 4: Click Accept on the Start Enrollment Authorization page. Then, the UPMC Benefits page will load, and you can begin making your benefit selections. To enroll in each benefit, select the Edit button for that benefit. If you don’t want that benefit, it is already marked as “waive.” If you choose to waive that benefit, just proceed to the next benefit you want to elect and click Edit to enroll.

Step 5: Once you have elected or waived each benefit, you will see you your total cost per pay period. You must click Submit to complete the enrollment process.

Step 6: After you finalize your enrollment, make sure to print a benefit confirmation statement. This is the only proof you will have that indicates you submitted your elections.

Step 3: Before making your benefit election, you need to add eligible dependents that you want to enroll in your benefits. This step must be completed before enrolling in benefits. You will see the names you already added as contacts. Follow the instructions used for adding emergency contacts on page 37. If you need to correct any data for your dependents (such as date of birth, spelling of name, etc.), please contact the Employee Service Center at 1-800-994-2752, option 3, for assistance. Do not add the dependent a second time as that will cause enrollment issues. Once you have added the eligible dependents you wish to cover, click the Continue button.

*Remember, coverage suspends until required documentation is submitted and approved. You have 30 days to submit this documentation.

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After you click the Edit button, your available levels of coverage will be listed based on whether you added eligible dependents to your record. Be aware that you must choose the appropriate level of coverage to add the dependent(s). Your eligible dependents will appear. Click the box next to their name to add them to your coverage. Unless you click the box, the dependent will not be included on your coverage. Don't forget to also provide the necessary dependent proof within 30 days. That dependent's coverage will be suspended until you submit acceptable proof. Note: the rates shown will be different based on the coverage you are selecting and the current plan rates.

Step 5: Once you have elected or waived each benefit, you will see you your total cost per pay period. You must click Submit to complete the enrollment process.

Step 6: After you finalize your enrollment, make sure to print a benefit confirmation statement. This is the only proof you will have that indicates you submitted your elections.

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JANUARY FEBRUARY MARCH S M T W T F S

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APRIL MAY JUNE

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JULY AUGUST SEPTEMBER S M T W T F S

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OCTOBER NOVEMBER DECEMBER

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2021

Payroll Calendar

Paid Holidays Observed Friday, Jan. 1 - New Year's Day Monday, Jan. 18 - Martin Luther King Jr. Day Monday, May 31 - Memorial Day (recognized) Monday, July 5 - Independence Day (recognized)

Monday, Sept. 6 - Labor Day Thursday, Nov. 25 - Thanksgiving Day Friday, Dec. 24 - Christmas Day (recognized) Friday, Dec. 31 - New Years Day (recognized)

Paid Holiday

Biweekly Payday

Monthly Payday

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Notes

UPMC policy prohibits discrimination or harassment on the basis of race, color, religion, ancestry, national origin, age, sex, genetics, sexual orientation, gender identity, marital status, familial status, disability, veteran status, or any other legally protected group status. Further, UPMC will continue to support and promote equal employment opportunity, human dignity, and racial, ethnic, and cultural diversity. This policy applies to admissions, employment, and access to and treatment in UPMC programs and activities. This commitment is made by UPMC in accordance with federal, state, and/or local laws and regulations.

BEN518553 IB/EH 1/21 Form No. UPMC-2216 © 2021 UPMC